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when Mr. Devadhar explained his proposals toan audience which included many friends to thecause of Indian progress. We understand that theSt. Thomas’s Hospital authorities have promisedtheir help in carrying out the scheme, and any

friends desirous of lending pecuniary assistancecan do so by communicating with the secretaries ofthe association at 26-27, Hatton-garden, Holborn, E.C.

THE RETAINED PLACENTA.

IN the Oor1’esponden.<:blatt fiir Schweizer Aerzteof April 19th Dr. Eugen Frey-Bolli of Aarau,describes the manual removal of the placenta as oneof the most risky obstetric operations practised atthe present time, being followed, he alleges, in ’,60 per cent. of cases by febrile reaction in the

puerperium and (quoting Alletse) having an actualpercentage mortality approaching 8. In the Uni-versity Women’s Clinic at Frankfort-on-Main, underthe direction of Professor M. Walthard, where Dr.Frey-Bolli worked as assistant, an average ofnine digital removals in every 1000 births has beennecessary of late years. In order to avoid thisnecessity Dr. Frey-Bolli has revived a method forremoval of the retained placenta without the intro-duction of the hand or of any instrument, originallyproposed by a Frenchman, Dr. B. Mojon, emeritusprofessor in the University of Genoa, and describedin the Zeitschrift fiir Geburtskunde of the year1827. Dr. Mojon injected cold water slightlyacidulated with vinegar with some force into theumbilical artery through the cut end of the cord,and found that the sudden impulse and the dis-placement of the placenta so caused, as well asperhaps the effect of the cold shock and of theactual increase in weight of the placenta, resultedin after-pains which emptied the uterus withoutfurther ado. His communication, in admirablybrief form, received an editorial note by Dr. Nagelewarmly recommending the procedure. A certain Dr.Astrubali, of Rome, later contested the priority of themethod, stating that he had taught his pupils to useit in the year 1814. Dr. Frey-Bolli employed warmnormal saline in place of cold water, injecting300 to 600 c.cm. into the severed umbilical veinuntil the cord attained a certain degree of tension,indicating sufficient filling of the placenta withoutrisk of bursting the smaller vessels. During theyears 1916 to 1919, out of 3201 births occurring atthe Frankfort Clinic 53 cases arose of placentalretention associated with bleeding. After adoptingthe method of " turgescing " the placenta the neces-sity of digital removal of the placenta disappeared,and in 1918 no single such interference was neces-sary. Of the 53 cases mentioned, in 25 the turgidplacenta was expelled spontaneously, in 22 aftergentle abdominal expression, in 4 others employingthe Crede method under anaesthesia. The resultsof turgescence were the more favourable in pro-portion to the earliness at which it was carriedout; out-patients brought into the clinic after muchmanipulation outside reacted relativels badly. Onthe ground of his three years’ experience atFrankfort Dr. Frey-Bolli recommends the procedurefor general adoption.There can be no doubt that the manual removal

of the placenta is one of the most dangerous of themanipulations of midwifery practice. Fortunately,the number of cases in which it is necessary isrelatively very small, and quite possibly in thepractice of some obstetricians io is resorted to toofrequently. There are very few cases in which, iif the patient is left a sufficient length of time and ,

) in which the ordinary methods are employed, theplacenta cannot be expressed or is not expelled spontaneously without the necessity of introducingl the hand into the uterus. Dr. Frey-Bolli’s methodr is certainly ingenious, but would appear not to befree from the danger of washing away clots, andE would seem only applicable in cases where theplacenta is still completely attached to the uterus,

since if any separation has occurred the risk ofbursting the vessels would be very great, and thenecessary turgescence would not be obtained. We

hardly think the method is one suitable for general

, adoption, nor, indeed, do we think that it would

, often be required. --

RABIES.

! THE appearance of rabies in Great Britain hasfollowed a period of rapidly increasing prevalenceon the continent. That the number of cases in

, these islands is increasing ominously is confirmedby reports this week, but the public should bythis time be well guarded by knowledge andofficial measures. We must still preserve a

rigorous exclusion of dogs from abroad, and

perhaps, of other animals. In all probability theinfection has reached us from France where thepresent serious situation has been the subject ofseveral resolutions of the Acad&eacute;mie de Medecineurging the authorities to take steps for the captureof all stray dogs and appealing to the public to assistin precautionary measures. We have receivedfrom a correspondent the following interestingparticulars :-" During my recent leave in Paris I became aware that

it is considered by the authorities there that there is atpresent, not merely in Paris alone but throughout Francegenerally, a serious and relatively enormous outbreak ofrabies, which is especially frequent among stray dogs,such as tend to be adopted for longer or shorter periods bysoldiers. Everywhere there are notices posted up at theinstance of the Prefecture warning the public of thedanger, and forbidding dogs to be allowed out of doorsunless muzzled and held on the leash. With very few excep-tions, all the dogs I saw out of doors were so muzzled andrestrained. (See Prefectorial notice dated Jan. 15th, 1919.)I understand that in 1913 there were only 3 cases of canine

rabies observed in Paris, in 1914 there were 4 cases, and in1915 5 cases. In 1916, however, there were 62 cases, in 1917there were 56, and last year no fewer than 411. In the first24 days of the present year 41 cases were found (and 63during the whole of January), about three and a half timesas many as in the entire three-year period, 1913 to 1915inclusive, or three-quarters the entire number for the wholeof the year 1917. This seems to indicate that this very seriousstate of affairs may become even worse in the near future.It is held that the food difficulties and fears of extra taxa-tion (such as a more costly dog licence), instead of mendingmatters by reducing the canine population, have greatlyincreased the amount of rabies, as the result of peopleabandoning their dogs. These have wandered at large bothin Paris and in the suburbs, where they have been bittenby mad dogs, and so have become infected and spread thedisease.In rural areas the same state of affairs holds good. In

the provinces in 1913 there were from 120 to a maximum of 150mad dogs in France (excluding Paris) per month ; in 1915 from240 to 280 were discovered every month (also excluding Paris).The figures given for the first six months of each of the threeconsecutive years 1916 to 1918 for canine rabies in France aresaid to be 1746, 1632, and 1778, in comparison with 864 duringthe first half of 1914-when the country was in its normalstate previous to the outbreak of war. Finally, I am givento understand that the Institut Pasteur in Paris had 350persor _nder treatment in 1918, against only 92 in 1914, anincrease of no less than 380 per cent."

From another source we learn that the number ofstray dogs captured by the Paris police has risenfrom 3773 in 1917 to 10,677 in 1918. In the UnitedStates 87 cases of canine rabies were reportedbetween Dec. lst, 1918, and March lst, 1919, andthree people have died from hydrophobia in thesame period. During 1918 414 persons received

I anti-rabic treatment in New York City without a

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single death. Of these, 255 had been bitten by dogsafterwards proved to be rabid. In 1916 only154 persons were treated for bites by rabid dogs,and in 1917 the corresponding number was 278.It appears that rabies is far from uncommon inthe rural districts of India among jackals, andthis incidence seems to be increasing. Among the5206 patients treated at the Kasauli Institute in1917 no fewer than 869 had received their bites from

jackals, which, like those ofwolves, are usually ofa serious kind. Investigations are therefore beingmade in India to ascertain whether the saliva ofthe jackal is more virulent than that of dogs andother animals, or whether this special virulencedepends more on the multiplicity of the bites, theirdepth, and their situation.

THE SIGNIFICANCE OF THE WASSERMANNREACTION.

IF anyone had been able to devise a less intricatetest for the diagnosis of active syphilis in all itsstages the Wassermann reaction would never havesurvived to the present day. In default of such adiscovery, and having constantly in mind theimportance of an accurate diagnosis of syphilis,many workers have devoted their time and talentsto the improvement of Wassermann’s technique.The margin of experimental error has beensteadily decreased; indeed, from the latest reportof the Medical Research Committee it wouldappear almost to have been eliminated. SurgeonLieutenant-Commanders P. Fildes and R. J. G.Parnell here compare the clinical and patho-logical records of over 1400 unselected men. Theirevidence is clearly tabulated and summarised,and bas led them to two conclusions : (a) thatclinical evidence confirms the positive results-i.e., that " a positive reaction actually indicatessyphilis"; and (b) that " if a test is reported nega-tive ...... it will be more or less improbable thatthe case is one of syphilis." These conclusions arevery nearly justified. Out of 1177 cases which

gave a positive reaction, only 65 were foundwithout clinical evidence of the disease; and ofthese it could be said that "their condition wasnot inconsistent with the diagnosis of syphilis." Itis unfortunate that amongst the unselected casesthere were not more of whom the oppositemight be true. The investigation would havebeen more convincing, also, by the inclusion of somecases suffering from other spirochaetal diseases.With regard to the significance of the negativeresult it is to be noted that, although there wasno instance of a negative reaction in an acute

secondary syphilitic with a rash, amongst the 268cases who had been infected 18 months or morebefore their blood was tested two did give negativeresults, one being a " manifest tertiary and theother a cerebro-spinal case; and these are thecases in which the general practitioner will mostneed the pathologist’s help. The technique isnot yet perfect. Two papers which are publishedin this number of THE LANCET lay stress on thevariable absorbability of different complements.The standardising of a complement may change apositive reading into a negative one. When manytests are being carried out at once there is roomeven for clerical mistakes as well as for errors oftechnique. The clinician, therefore, must not yetassume that with the pathologist’s report the lastword has been said in the diagnosis of syphilis.

1 An Analysis of the Results of Wassermann Reactions in 1435 Cases ofSyphilis or Suspected Syphilis. Special Report of the Medical ResearchCommittee, No. 23,1919, price 2s. net.

THE JOURNAL OF GENERAL PHYSIOLOGY.l

WAR may have somewhat circumscribed theactivities of the great band of workers of theRockefeller Institute for Medical Research-aninstitute almost unique in medical annals-but ithas not affected the broad policy of its energeticdirectors. We give a cordial welcome to a newventure, the Journal of General Physiology, whichis to be devoted to the explanation of life pheno-mena on the basis of the physical and chemicalconstitution of living matter. Perhaps we mayremind our readers that this is another importantaddition to the many-sided activities of the insti-tute, for besides "Studies" published from timeto time on important medical subjects, itissues in addition the Journal of ExperimentalMedicine and the Journal of Biological Chemistry,so that in this new departure another phaseof unexplored vital territory will be investigated.The combination of an experimental botanist, Pro-fessor Osterhout, with a comparative physiologist,Professor Jacques Loeb, is a sure earnest of aharvest. The journal will be issued bi-monthly,one volume of about 600 pages appearing in a year.There is no want of variety in the subjects includedin No. 1. They range from "the Dynamics of Photo-synthesis" to "Lutear Cells and Hen-feathering."We can refer only briefly to some results of generalinterest.Professor Osterhout finds that minute amounts of photo-

synthesis in marine plants can be accurately measuredby adding a little phenol-phthalein to the sea-waterand observing the colour in the indicator. Ulva keptin the dark begins photo-synthesis as soon as it isexposed to sunlight and the rate steadily increasesuntil a constant speed is attained.-E. Uhlenhut givessome interesting observations on the antagonism betweenthyroid and parathyroid glands and on the existenceof a specific tetany-producing substance in the thymusgland. It is well known that extirpation of the parathyroidsin mammals is followed by tetanic convulsions. This led tothe assumption that certain tetany-producing toxins areformed in the body, which in normal animals must be eitherremoved or turned into non-toxic substances by the para-thyroids. The experiments seem to indicate that thesetetany-producing substances are contained in and producedby the thymus gland. On feeding larvse of certain speciesof salamanders with the thymus gland of mammals theydevelop tetany. As long as their own thymus glandsare not developed they are able to counter-balance thetetanic action of the thymus substance introduced in theirfood. When their own thymus becomes active and itssecretion is added to the thymus food material, themechanism of preventing tetany becomes inadequate, andtetany ensues. It is probable that the parathyroidsantagonise these results. Anural amphibians, whichdevelop their parathyroids soon after hatching, never showtetany if they are fed on thymus, but in certain species ofsalamanders, whose parathyroids develop only during meta-morphosis, the larvse invariably have tetanic convulsionsupon thymus feeding, while the metamorphosed animalsnever showed tetany. If the thymus is the organ by whoseaction tetany is produced we can understand why tetany inhuman beings occurs far more frequently in childrenthan in adults, since in the latter the thymus gland isreplaced, at least to a great extent, by connective tissue,and experiments are given to show that the effect of thethymus gland in producing tetany is due to a specific tetanytoxin produced by, and contained in, the thymus, so that thethymus must be classed amongst the endocrine glands.-Loeb has an elaborate paper on "Amphoteric Colloids."-S. C. Brooks explains "a theory of the mechanism of dis-infection, hsemolysis, and similar processes."-Loeb, inanother contribution, arrives at "the law controlling thequantity of regeneration in the stem of Bryophyllum caly-ct?vuiii.11 It was found that in a piece of the stem withone basal leaf attached the mass of shoots regenerated at theapex of such a piece of stem increases under equal conditionsand in equal time with the mass of the leaf, and is approxi-mately proportional to the mass of the leaf ; such influence ofleaf-mass on shoot-mass is only intelligible on the assumption

1 The Journal of General Physiology. Editors : Jacques Loeb andW. J. V. Osterhout. Published bi-monthly, Rockefeller Institute forMedical Research. Vol. I., No. 1, September, 1918. Pp. 1-131. $5 pervolume.