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with air in an attempt to improve the collapse andform a pad against the bleeding area. Later theblood can be removed by repeated aspirations, andRanson 1 suggests that not more than 1000 c.cm. shouldbe removed at a time. Air-replacement will preventthe intrapleural pressure from falling too low, whichmight lead to the reopening of torn blood-vessels.But after three or four days clot in the wound will prob-ably have become sufficiently organised to withstanda pressure in the neighbourhood of 0-4 cm. of water.The maintenance of a full pneumothorax should notbe encouraged after the bleeding has finally ceased.As long as infection does not supervene our effortsshould then aim more at re-expansion of the lung,which may be hindered by fibrosis resulting fromclot and damaged tissue actually in the lung substance.

NITROUS OXIDE WITHOUT ASPHYXIA

BEFORE nitrous oxide came to be used as an ants-thetic for long operations there was a clearer realisa-tion of the part played in its administration by oxygendeprivation than there is today among anaesthetistswho have grown up in the service of machines whichgive full scope for the delivery of oxygen along withthe anaesthetic. Frederic Hewitt was perhaps fore-most in pointing out that certain symptoms often seenduring nitrous-oxide inhalation were nothing to dowith that gas but were purely anoxaemic phenomenadue to the curtailment of air or oxygen. Jactitation,violent stertor and the like were, he rightly held,to be regarded as warnings to remove the gas or toadd air or oxygen in sufficient quantity to relieve theanoxaemia. It seems odd that it should be necessaryat this late date to insist as does Murphy 2 on theundesirability of permitting anoxaemia with nitrous-oxide anaesthesia, and it is interesting that much hasbeen written of late to show the evil, even the fataleffects, of permitting oxygen insufficiency during shortand still more during long operations. We have com-mented 3 on the cerebral lesions that have been demon-strated post mortem when anoxaemia has been per-mitted and on the evidence adduced to show thatthese lesions are due not to any toxic action of nitrousoxide but purely to deprivation of the brain cells ofsufficient oxygen. Recent investigations of maternaland fcetal blood at delivery appear to show that thereis some evidence of shortage of oxygen in the fcetalcirculation when nitrous oxide has been administeredto the mother. The evidence however is slight and theshortage slighter and there does not appear to be anygood reason on this account to decry the use of gasand oxygen in obstetrics.

ALBERT CALMETTE

THE friends and pupils of Calmette have honouredtheir chief in a book which tells the story of theman who applied the principles of Pasteur’s workto the various problems of disease in men and animalsin the tropics, and who sought to apply them to theconquest of tuberculosis in man. Calmette served asa medical " aide " in the French Navy in the East,in Africa, and on the French islands off the New-foundland coast. Here he taught himself the methodsof bacteriological research and on his return to Francepresented himself at the Pasteur Institute and enrolledhimself as a worker under the Master. Within a few

1. Ranson, J. thorac. Surg. April, 1940, p. 278.2. Murphy, F. J. Surg. Gynec. Obstet. April, 1940, p. 741.3. Lancet, 1939, 2, 1180.4. Smith, C. A. Surg. Gynec. Obstet. April, 1940, p. 787.5. Albert Calmette. Sa vie, son œuvre scientifique. By Noel

Bernard and Léopold Nègre. Paris : Masson et Cie.Pp. 272. $1.15.

months he was selected by Pasteur to establish inCochin China the first Pasteur laboratory outsideFrance. There in addition to his administrative workhe began his study of snake venoms. On his returnto Paris six years later its importance was quicklyrecognised, and the various anti-venom institutesthroughout the world are all the offspring of his work.He was barely thirty when he returned to Paris andin a few months he was appointed to organise aninstitute in Lille. At Lille he lived and worked forthe next twenty-five years, including the four yearsof the German occupation. Under his energeticguidance the institute there soon became famous,especially among those interested in the scientificproblems of industrial occupations and in sanitaryreforms. Calmette gathered round him a body ofdevoted workers and friends, and while still an activedirector of the scientific work of the institute hebecame more and more wrapped up in his studies oftuberculosis, and on the methods by which immunisa-tion could be established. At the end of the war hereturned to the Pasteur Institute at Paris, and in col-laboration with Guerin he elaborated the B.C.G.immunisation of infants. In England the tendencyhas been to regard this method as not sufficiently safeto be adopted, and the Ministry of Health has pre-ferred to encourage other methods of prevention, butin France and other countries it has been extensivelyemployed. No-one can read the account of hislaborious studies and careful experimental work with-out realising the high standard of Calmette’s scien-tific attainments. Whatever may be the final judgmentas to its efficacy it is clear, now that the dust of con-flict has subsided, that it represents a logical develop-ment of Pasteur’s principles, that it is an advanceon any previous work, and that it must be the founda-tion for all future work in this special sphere.

SENDING REPRINTS ABROAD

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typescript publication, or cuttings or portions fromany of the above" may be sent by post to countrieson the reserved list without special permission fromthe Deputy Chief Censor. There is no restriction,other than ordinary postal censorship, on posting toplaces within the British Empire, in allied countries,or in the United States or South America, and tradecirculars and catalogues and some other " commercialpapers" can be sent without restriction. The postalservices to Denmark, Estonia, Finland, Greenland,Latvia, Lithuania, Norway and Sweden are tempor-arily suspended. The main countries on the reservedlist are: Belgium, Bulgaria, China, Greece, Holland,Hungary, Italy, Japan, Portugal, Rumania, Russia,Spain, Switzerland, Turkey and Jugoslavia. Doubtsthat the local Post-Office officials cannot resolve shouldbe referred to the Deputy Chief Censor (PermitBranch), Aintree, Liverpool, 9.

We regret to announce the death of Sir GILBERTBARLING, emeritus professor of surgery in the Univer-sity of Birmingham, on April 27, three days beforehis 85th birthday.

THE LANCET is shortly to state the case for FamilyAllowances from the doctor’s point of view in a

32-page broadside, which will be on sale at all book-sellers, price 3d.