1472

pericarditis and, probably, pneumonia. Those whothink harshly of James I. will do well to bear in mindthat he had Bright’s disease, enlarged tonsils, renalcalculi, jaundice, haemorrhoids, dental caries and

pyorrhoea, and arthritis-surely enough to sour anyman,

THE WORLD REQUIREMENTS OF NARCOTICDRUGS

THE Supervisory Body acting under the 1931 Conven-tion for Limitation of Manufacture of Narcotic Drugshas completed its estimate of the world requirementsof morphine and its derivatives, and of cocaine, for1936. The estimates for morphine, heroin, andcocaine " for use as such" are respectively 9799 kg.,930 kg., and 4503 kg. Compared with the estimatesfor the two previous years these figures representa substantial reduction of heroin, some decrease ofcocaine, and a slight increase of morphine. No lessthan 34,279 kg. of morphine were however requiredfor " conversion," chiefly for the manufacture ofcodeine, of which 25,710 kg. are estimated as theworld requirement for 1936. The increasing demandfor morphine for " conversion " has attracted theattention of the Supervisory Body and is beingcarefully investigated. For 59 countries and 89 terri-tories the estimates were furnished bv the Govern-ments concerned ; in 11 countries and 9 territoriesthe Supervisory Board, in default of such returns,had itself to frame them. In tables appended tothe report are set out for each narcotic drug theestimated requirements of each country and territoryfor the year 1936. The compilation of this elaboratereturn (C. 429. M. 220. 1935. XI.) reflects greatcredit on the Supervisory Body and the secretariatof the League.

THE COMPOSITION OF "WHITE BILE "

A GROUP of workers engaged on a study of gall-bladder function have been fortunate in obtaining15 examples of " hydrops " of the gall-bladder frompatients in whom the cystic duct was obstructed.In their opinion the sequence of events in thesecases is : damage to the biliary system ; obstructionof the entrance of bile into the damaged gall-bladder ;dilution of the gall-bladder contents ; and finallydecoloration of the bile by absorption or destructionof the pigment. Whether acute infection plays apart they have not decided. The colourless contentsof the gall-bladder are secreted by its damagedmucosal cells, bile salts and bile-pigment beingabsent. In this white bile chlorides and calcium arefound at approximately serum level though some-times (in 5 of the 15 cases) the calcium content is

considerably higher. The amount of cholesterolvaries : in 9 cases it was either absent or present inproportions under 9 mg. per 100 c.cm., while in theother 6 the figures ranged from 15 to 143 mg. per100 c.cm., the higher cholesterol figures being usuallyassociated with a higher calcium content. Thereis as yet no obvious explanation for these facts. In2 cases in which the gall-bladder was drained, dailyobservations were made of the composition of thefluid obtained. Bile salts did not reappear withinthe period of study, presumably because the cysticduct remained blocked. The chlorides remainedat the usual level of 90-120 milli-equivalents per litre.The calcium figures were very constant ; in one

case they showed a slight gradual decrease, butthey were always approximately at serum level.

1 Riegel, C., Ravdin, T. S., Johnston, C. G., and Morrison,P. J. : Amer. Jour. Med. Sci., November, 1935, p. 655.

The cholesterol content was much higher inone case than in the other. It is hoped by theseinvestigations of the isolated gall-bladder andducts to get information about the functions ofthese structures. Unfortunately, in the humansubject their isolation is often due to a preliminaryinflammatory process which somewhat vitiates the

experiment.THE MARCH OF MEDICINE

THE turn of the year is the traditional time forreviewing the year’s events and achievements. Thefew days that come after the festivities of Christmasand before the New Year’s invitation to good resolu-tions, should be made to yield an hour or two fordetached retrospection, not sentimental, but rathera little critical. Those who have, or aspire to have,a hand in the advancement of medicine, whether bymaking discoveries, by proclaiming them to the

world, or by applying them for the benefit of thesick, may well take the Year Book of General Medi-cine as the basis for their retrospective meditation.The 1935 volume actually deals with work publishedbetween mid-1934 and mid-1935, and can thereforebe in our hands before Christmas. It is edited bysix physicians of great eminence, who have chosenfor abstraction the most valuable papers in theirseveral fields, and have often added for the reader’sgreat benefit their own brief comments. In the

period they cover there has been no single discoveryof startling importance, but the march of medicineon many fronts has been steady and progressive.The impetus given to h2ematology by Minot andCastle has not spent itself, but is spreading ratherto adjacent subjects ; in their section of the book

they call special attention to a report of the pro-duction in pigs, through a vitamin-deficient diet, ofchanges in the oral and gastric mucous membranes,achlorhydria, diarrhoea, muscular weakness, and

macrocytic anaemia-a picture so like that of per-nicious anaemia that it may be a clue to the causationof that disease and perhaps also of some of the chronic"

gastritic" conditions towards which a great dealof interest has lately been directed. In the gastro-intestinal section there are several important paperson chronic gastritis, which is now satisfactorilydefined in terms of structural changes in the gastricmucosa, although its relation to functional changesand to symptoms, as well as its pathogenesis, remainobscure. Meulengracht’s localisation of the sourceof the intrinsic (gastric) factor of the anti-perniciousanaemia principle is another notable advance in thisfield ; medicine is undoubtedly marching, in Napo-leonic fashion, on its stomach.

Three other sections, on cardiovascular disease,on lung disease, and on infections, complete thebook, for " General Medicine " is defined by exclusion,and endocrinology, neurology, psychiatry, and thera-peutics find their places in others of the Year Bookseries. In cardiology, many writers seem to be

re-working old ground, often with greater care andmore precision than heretofore ; the bold attemptto ameliorate cardiac failure and severe angina bytotal thyroidectomy is being continued, and " thisrather radical procedure still seems definitely indi-cated in a number of carefully selected cases." Amongthe infectious diseases, the virus investigators are

working quietly ahead. In the chest section, the

1 The 1935 Year Book of General Medicine. Edited byGeorge F. Dick, M.D., Lawrason Brown, M.D., George R.Minot, M.D. S.D., F.R.C.P. (Hon.) Edin., William B. Castle,M.D., A.M., William D. Stroud, M.D., and George B. Eusterman,M.D. Chicago : The Year Book Publishers, Inc. Pp. 848.12s. 6d.