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Milk fat will be deficient in A-vitamin if the animalbe not fed upon food containing it, such as green leaf,which is its ultimate source. The antiscorbutic valueof milk depends upon the animal’s food. The twobest foods are milk and green leaves. Milk suppliesgood protein and mineral matter, and vitamins iffrom properly fed animals. Green leaves are said tocontain good protein, and they are certainly rich invitamins. An ill-balanced diet will therefore be made

adequate by the inclusion of milk and green vegetables.

THE SOLDIER’S LOAD.

WHAT weight can a soldier carry and yet march andfight well ? Major N. V. Lothian deals with thisimportant question in the opening paper of theJournal of the Royal Army Medical Corps for October.The diseases ascribed to overloading have beenpulmonary emphysema, so-called soldier’s heart, and, Itentatively, trench nephritis. Some burden thesoldier must have : arms, armour, spade, clothing,food, to which he adds souvenirs ; together thesecannot weigh less than 40 lb., and men have carried 88.The problem has faced soldiers of all times. TheAthenian hoplite in battle carried 80 lb., but eachhad an attendant to carry his equipment to the field.Thus heavily weighted they were little mobile,consequently no sooner were they, as we may put it,standardised, than light infantry in considerablenumbers were added to all armies, and it was thesewho gave Philip of Macedon much of his success. Ifa soldier is well trained he can carry greater weightsmore easily, so the Romans specially trained theirrecruits to carry a load of 45 lb., while the legionarieseach month did three 20-mile route marches in heavymarching order, carrying about 50 lb. His pack hecarried on a forked stick, introduced into the serviceby Marius, and called after him, " Marius’s mule,"but much of his burden was, on service, borne for himby a servant (calo) or in carts, as may be seen on thecolumn of Trajan and elsewhere. Major Lothian’spaper is a valuable contribution to military science,worthy of the Army School of Hygiene from whichit comes, though it is defaced by careless printing ofLatin words.

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IRRADIATION OF LYMPHOID TISSUE.

As a result of clinical and experimental investiga-tions into the action of radium and X rays uponnormal and diseased lymphoid tissue carried out inthe Department of Cancer Research of the MontefioreHospital, New York, Dr. Isaac Levin1 concludes thatthe lymphocytes in the blood stream and lymphoidtissue generally throughout the body are extremelysensitive to these radiations. Dr. Levin is not alonein this opinion reports issued from various centres ofradium-therapy will generally be found to includedata showing the remarkable susceptibility of diseasedlymphoid tissue to radium. Lympho-sarcomata figureamong the tumours giving the highest percentage offavourable clinical results. Dr. Levin’s paper consistsfor the most part of short descriptions of clinicalcases illustrating his conclusions. Apart from theimmediate clinical results, his observations are

valuable as factors which must be taken into accountwhen any sort of generalisation is attempted on thissubject. More recent studies have shown that the ,,physiological response of the organism must in no casebe ignored when generalised exposures to radiationare given. Levin states that the rays do not actmerely as a local agent, but produce a generalisedeffect on the lymphoid system of the whole organism.The evidence for this statement is based upon obser-vations such as the following. In a case of lympho-sarcoma, examination showed a large diffuse massoccupying the whole of the right axilla and invadingthe pectoral muscles. In the left axilla was an enlargedfreely movable gland, the size of a hen’s egg. Theradium applications were made only at the rightaxilla, with complete disappearance of the mass there,

1 Journal of the American Medical Association, Sept. 17th.

as well as that in the other axilla ; this and othercases cited by the author are probably paralleled bythe experiences of radiologists elsewhere. Dr. Levincomments upon the hypothesis that specific enzymesare freed from the disintegrating lymphocytes, butoffers the timely reminder that hardly any workhas yet been done to clear up the problem. As thefield of utility of these radiations widens in medicine,the necessity for investigations becomes increasinglyurgent, for the feeling of insecurity of any practicebased upon empiricism increases with the dimensionsof the superstructure. ____

THE EFFECTS OF PROLONGED DEPRIVATIONOF SLEEP.

Prof. G. W. Crile, in his recent studies on exhaustion,has extended his observations on this subject, andhas determined the effects in rabbits of prolongeddeprivation of sleep-96-118 hours. Marked changesare thereby produced in the cells of Purkinje in thecerebellum ; in the first stage there is an increase ofthe chromatin material-both in its diffuse and par-ticulate form, in the plasma and size of the nucleus ; gthe cells contain an average amount of chromatin,but changes manifest themselves in the dendrites.Then the chromatin diminishes, and its remainscollect around the periphery of the cell and nucleus.In the next stage the chromatin completely disappears,the cytoplasm showing disintegrative changes, andvacuolisation ; somewhat similar changes affect thenucleus, and in extreme cases there seems to bedeath and complete disintegration of the cells. It issuggested that neither man nor animal can survive theloss of 15 per cent. of the brain cells. In eight experi-ments, six animals showed more or less pronouncedchanges in the liver, especially at the periphery ofthe lobules. The nuclei lay excentrically and weredeformed, the granules diminished or absent, vacuoleswere present and the cell as a whole materiallychanged, including the disappearance of its glycogen.In five cases out of six the medulla of the adrenalglands was not affected, while the cortex in six outof eight cases showed changes and disintegration afterloss of the nuclei. No marked changes were noted inthe thyroid, pancreas, kidneys, spleen, stomach, orintestines. By inducing sleep at the end of a sleeplessperiod, and by the action of different agents, the authorendeavoured to mitigate the effects and restore theactivities of the injured cells. Sleep and nitrousoxide have a marked recuperative effect, except incases where the disintegration of the brain cells hasproceeded too far. As experimental poisoning byacids produces similar changes in the cells of thebrain, liver and kidney, the pH of the blood wasdetermined, but it was found that sleeplessness pro-duced no marked change, the pH being nearly thesame during the sleeping as in the waking condition.

THE PREVENTION OF DIPHTHERIA.

LAST winter the incidence of diphtheria was high,the mortality correspondingly high, and the numberof cases notified so far this.autumn points to a severewinter epidemic. In America the mortality fromdiphtheria is apparently heavier than it is in England,and the public health authorities there are institutinga campaign to stamp out, the disease on the principlethat since its prevention and cure are known, the diseaseshould be eradicable. The method of the campaignis to confer active immunity on all children betweenthe ages of 6 months and 6 years by the injectionof three doses of toxin-antitoxin, thereby renderingthe children insusceptible of infection for several yearsor maybe for life. This is especially applicable toyoung children, as the mortality from diphtheria aswell as the incidence of the disease is vastly greaterin the younger age periods. Children at birth arefound by means of the Schick reaction to have anatural immunity to diphtheria, which fades away

1 Archives of Surgery, vol. ii., 1921.

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gradually after the sixth month, leaving the child moresusceptible during the first six years than at any otherperiod of its life. The practical value of such a campaign,of course, depends upon two assumptions—viz :1. That the Schick reaction is a reliable indicator ofsusceptibility to diphtheria. 2. That the injectionof toxin-antitoxin actually confers active and lastingimmunity. We pointed out some time ago that the ’,crucial test of the value of the reaction had not beencarried out, as no cases giving a negative reaction had ’,been purposely infected with diphtheria. Whether itoxin-antitoxin confers lasting immunity has yet tobe demonstrated. So great, however, is the confidence ’,in America that the methods proposed will stamp out ’,diphtheria that public health authorities are beginning I,to hold parents responsible if their children contractthe disease. This standpoint is strikingly illustrated ’,by a letter sent by the sanitary authority in North ’,Carolina to every home in which diphtheria occurredlast year :-

" Dear Friend,-We regret that you had a case of diphtheria I-in your home last year. We appreciate the care you took Ito keep this disease from spreading to others in your homeor community. In the future you will be responsible if youhave a case of diphtheria, as the North Carolina State Boardof Health is preparing to furnish the doctors and the healthofficers toxin-antitoxin. When three doses of this are given,the person is protected against diphtheria for several years,possibly for life."The importance of the issue is great and is worthy

of earnest consideration and investigation on the partof those responsible for the maintenance of publichealth in this country. ____

GENERAL PARALYSIS IN OLD AGE.

Dr. Heinrich Herschmann, I assistant at the

Psychiatric Department of the Vienna GeneralHospital, has made a clinical study of 84 cases ofgeneral paralysis which developed after the age of 60.Eighty of the patients were between 60 and 70 atthe onset of the disease, and only four were over 70,the oldest being 75. Fifty-eight were males and 26,or about a third of the total, females. The relativelyhigh proportion of women among aged general para-lytics, a circumstance which had been previouslyobserved by Kraepelin, Junius, and Arndt, is all themore remarkable as syphilitic infection after 50 ismuch rarer in women than in men. It is probable,therefore, that the interval between infection and theonset of general paralysis is longer in women than inmen. The greater frequency of alcoholism in themale sex and the more intense strain on the nervoussystem caused by the struggle for existence probablyaccount for the shortening of the incubation period.Of the 84 cases in the present series, 66 were keptunder observation until their death, while the restwere sent home. The average duration of the illnessof the 66 cases, reckoning from the time of theiradmission to the clinic, was 263 days, so that senilegeneral paralysis does not assume a particularlyrapid course. In only 22 of the 66 cases was deathdue to cachexia alone, the causes of death in theother cases being convulsive attacks, pneumonia,myocarditis, atheroma, or enteritis. The numberof cases of tabo-paralysis was high, no less than 21,or exactly one quarter of all the cases, showingtabetic symptoms. In the 20 cases in which the dateof syphilitic infection could be determined the lengthof the interval between it and the onset of generalparalysis was remarkable ; in six cases infection hadoccurred more than 40 years previously, in six morethan 30 years, in seven more than 20 years, and inone 12 years before the onset of the psychosis.According to Dr. Herschmann, the special features ofsenile general paralysis are the rapid development ofdementia, the loss of the power of orientation, noc-turnal delirium, and, most of all, the frequency ofthe paranoid form. He suggests that this peculiarsymptomatology is due to the histopathology ofsenile general paralysis, which will form the subject ofa future communication.

1 Medizinische Klinik, Oct. 9th, 1921.

RADIOLOGY AND PHYSIOTHERAPY.

IT was announced at the recent annual meeting ofthe British Association for the Advancement ofRadiology and Physiotherapy that a certificate ofincorporation had just been secured. Dr. RobertKnox, from the presidential chair, reviewed the workaccomplished by the Association during the four yearssince its foundation, referring to the share taken inthe institution of the Cambridge diploma in medicalradiology and electrology. In conjunction with theInstitution of Electrical Engineers, the Associationhad been successful in founding the Society of

Radiographers, the Council of which was appointedin equal ratio by the B.A.R.P., the Institution, andthe general body of its own members. The con-

stitution of the Society of Radiographers had beenapproved by the General Medical Council, inasmuchas its diploma of membership (M.S.R.) was obtain-able by examination only, all its members under-taking not to accept any patients for diagnosis or

treatment except under the direction of a qualifiedmedical man. In addition to its educational activities,Dr. Knox mentioned the policy recently initiated bythe B.A.R.P. of issuing authoritative statements onmedical subjects to the daily papers. The issue ofmanifestos approved by the Council but otherwiseunsigned appeared to him to fulfil the joint require-ment of being authoritative and at the same timefree from any suggestion of personal bias. Dr. Knoxexpressed a hope to see in London some day a worthyinstitute of radiology, having its own museum andlibrary, and perhaps its own clinic, and giving everypossible facility for teaching and research.

THE UNSOLVED MYSTERIES OF ARTERITIS.

WHEN a pathologist with an international reputa-tion publishes a series of cases closely observed byskilled clinicians during life, and searchingly investi-gated after death ; and when his detailed summing-upends in a frank avowal of ignorance, of inability tofix a truthfully descriptive label to the case, we arereminded that the sense of complete and nicelyrounded-off knowledge is, most fortunately, withheldfrom every explorer. A few years ago our knowledgeof the causes of arteritis was hardly even elementary,and when the relation of endarteritis to syphilis andof arteritis to tuberculosis had been noted, there waslittle more to be said-of importance, at any rate.Recent research has, indeed, added greatly to ourappreciation of the part played by arteritis in suchwidely different diseases as CO poisoning, influenza,typhus and cerebro-spinal fever. That curiousdisease, periarteritis nodosa, is also better, thoughstill imperfectly, understood. These recent advancesshould not, however, obscure the fact that we arestill groping about the fringe of the problem, and thisis the lesson on which Prof. F. Harbitz conscientiouslyinsists when, in N orsk M agazin for Laegevidenskabenfor September, 1921, he records one case after anotherof obscure arteritis observed at the Pathological-Anatomical Institute in Christiania. One of his caseswas that of a man of 22 who was subject to idiopathicrenal haemorrhage. After it had continued off andon for about a year decapsulation was performed,and a piece of kidney excised for microscopic examina-tion. This showed nothing abnormal, but as thehaemorrhage continued the whole kidney wasremoved. Its macroscopic appearance was normal,but the microscopic examination showed necrotic fociwithin which the arterioles were diseased ; their wallswere swollen, and the lumen of each vessel was reduced,in some places to the point of obliteration. Theswelling of the walls was partly due to proliferation ofthe intima, partly to hyaline degeneration of theconnective and elastic tissues. There was no signof inflammation, syphilis, or arterio-sclerosis, and ifthe case was one of periarteritis nodosa, then thisdisease does occasionally develop as a strictly localisedphenomenon. Arousing without satisfying curiosity,this case shows that the term idiopathic renal hxmor-