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heart of an apparently lifeless newborn baby after anintramuscular injection of 0-5 c.cm. had produced noresponse. It subsequently struck me that this dose ofcardiazol should really be enough to produce convulsions’in an infant, and I was interested to learn a few weeksago from a fellow practitioner that a second injection of0.5 c.cm. of cardiazol-ephedrine, given to an infant 15days old in a state of collapse after a first 0-5 c.cm. hadproved ineffective, had been followed immediately byconvulsions which continued till death supervened twohours later. Thus it seems quite possible that babiesthat do not breathe may require some exaltation of cere-bral sensitivity bordering on the convulsive to sensitisethem sufficiently to their cutaneous stimulation to startrespiration. When the brain has started functioningactively after birth such a dose may actually causeconvulsions. This is hypothetical but it fits in withSir Joseph Barcroft’s experimental work and has realpractical importance. I am interested to note (Practi-tioner, July, 1941, p. 429) that strychnine hydrochlorideis still recommended for asphyxia neonatorum. Thedose suggested (gr. 1/300) seems ample for a baby, butin view of the above reasoning it might be justifiable totry an even larger dose if that failed. I may perhapsalso refer in this connexion to my letter on- drowning(Brit. med. J. 1940. 1. 1035).Winsford, Cheshire. W. N. LEAK.

SANDFLY FEVER

SIR,—Your leading article of Aug. 2 recalled a studyI made in Baghdad on the blood-picture in sandfly fever(Trans. R. Soc. trop. Med. Hyg. 1937, 30,309). A series of130 cases were investigated. They showed a neutropeniaand monocytosis, and the eosinophils reduced to lessthan half the normal figure. A striking characteristicof the white cells was the large proportion which showeddegenerative changes. Smear and basket cells werecommon ; the granulation of many neutrophils wasdeficient and even absent, and numbers of monocyteswere vacuolated or had pale, diffuse cytoplasm and lightlystaining nuclei, and the chromatin network had a

washed-out appearance. Even more striking was theextremely low polynuclear index-i.e., the Arneth countas modified bv Cooke and Ponder. The deviation was themost " left-handed " of any blood-picture met with inIraq. This proved a useful point in the differentiation

’

between sandfly fever and malaria. Numbers of meta-myelocytes and other " abnormal " leucocytes were found.In the original paper by Walker and Dods on whichyou comment, it is stated that mental depression was adistinct feature of convalesence in some cases, and thatno patients looked well for at least a week after an attackof average severity. Full health was usually regainedquite quickly once this phase had passed. In myexperience (which includes many more cases than theseries mentioned above) an aftermath of depression,both mental and physical, occurred in almost all cases,and often lasted for months. In none of my own casesdid the depression go as far as suicide, but this hashappened in the experience of some of my colleagues.The treatment generally adopted in Baghdad is full doses of tincture of opium and an aperient.

London. WALTER P. KENNEDY.

SUTURE OF CAUDA EQUINA SIR,—I should be glad to know of any successful case c

of suture of the cauda equina. In the official history of 9the last war it is stated that not a single example was metwith, yet most textbooks comment on its feasibility. Ifyou can put me in touch with anyone who has sutured -one or more elements of the cauda equina with success 0

I shall be obliged. LAMBERT ROGERS. c/o Medical Department, Admiralty, London, S.W.1.

POSTGRADUATE COURSE IN TUBERCULOSIS.—The Joint . Tuberculosis Council has arranged to hold a postgraduate w

course in tuberculosis and allied conditions at the Middlesex slcounty sanatorium, Harefield, from Sept. 1 to 5. Special leave hito attend the course will be granted to members of the E.M.S. fcFurther information may be had from Dr. Frederick Heaf, 0]

County Hall, Westminster, S.F.I. T

ObituaryDUNCAN FORBES

M.B.E., M.D., B.SC. (PUBL. HLTH.) EDIN., D.P,11.Dr. Duncan Forbes, for thirty years Brighton’s chief

health officer, died on July 25 in University CollegeHospital, London, after an operation. He was in his68th year and leaves a widow, a son recently qualifiedin medicine, and three daughters of whom one wascalled to the bar in 1935. Forbes was an Aberaonianwho qualified at Edinburgh in 1898, became Crichtonscholar in pathology, and spent three years in intensivestudy of hygiene and acquiring higher degrees, beforeentering the public health service at Leith, passing on toManchester and Cambridge, and in 1908 succeedingSir Arthur Newsholme as medical officer of health forBrighton. Between them they covered half a centuryand now, looking back on the intervening years, News-holme writes of the integrity and originality whichfitted Forbes to be the medical adviser of a communitywhich in process of urbanisation remained one of thehealthiest places of residence in the world. Integrityshown in his indifference to popularity when he clearedthe Carlton Hill slums and insisted on rehousing some ofthe dispossessed tenants on the site. Originality whenhe discarded the outworn shibboleths of fumigation infavour of soft soap and elbow grease. Forbes, theScot, with native dourness and pawky humour, embracedthe ideas and life of Southern England but lived a littleapart from the ordinary social activities of the town,descending now and again into the arena to bring forwardsome quasi-Shavian solution of a current problem, aswhen a few weeks ago he propounded to the local healthplanning committee an embargo on meat and tobacco,the consumption of greenstuff raw, doubling the rationof potatoes, destruction of useless animals (especiallydogs), and the emigration to Canada of people over 65not engaged in essential work. But behind the occa-sional pyrotechnic was a life of duty quietly and con-sistently lived ; it was, for instance, told of Forbes thatup to the day of his retirement in 1938 no case wasdischarged from the fever hospital without his personalinspection. There will be many to miss the well-knownfigure, always in the same garb and never in an overcoat,striding over the Downs or to his office in Castle Square.

LEONARD MORTIS WEBBER

M.R.C.S., D.P.M.

Dr. Webber, who died on July 25 following an opera-tion, spent his life in the service of the Surrey countymental hospital at Netherne of which he had beensuperintendent since 1934. He was educated atWellingborough and qualified from Charing CrossHospital, where he won thegovernors’ clinical gold medal, in 1909, becoming resident obste-trical officer there. After a term aat Lewisham Infirmary, as it wasthen called, he was appointed second assistant to Netherne, ayear after it was opened, remain-ing there except for a break in ‘

the R.A.M.C. from Nov.,1915, to ;March, 1918. He was a soundpsychiatrist, not quick to ac-custom himself to changes butgiving full trial to establishedtreatments and every encourage- iment to his staff to pursue them. iHis main interest lay in the careof his patients and he would ’inever spare himself in makingthem comfortable and happy.He never missed their dancesor entertainments. He wasgreatly interested in occupational therapy and thedepartments grew through his efforts. At first hewas a little difficult to know and would hide his ownshyness with a rather short manner, but his integrity,his genuine character and his real kindness were thefoundation of solid friendships which grew as time wenton. He was a great reader, never at a loss to quoteThackeray or Dickens ; he loved his garden and was very