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pensions in arrear. The subcommittee recommendthat, in order to raise the status of hospital service,every year of work should command a vestedright to pension, so that the benefits of any existingpolicy would follow the officer either on withdrawalgenerally or on migration.This is the general recommendation of the sub-

committee, but in a dissentient memorandum SirWILLIAM COLLINS finds himself unable to concur inthe conclusion that a scheme based on a recourseto insurance companies is the only possiblesolution of the problem, for he considers thatthe conference of hospital representatives, whichshould follow upon the report, should have beforeit not -only the plan based upon the methodsof insurance companies, but the various alterna-tives presented in the report, such as theCivil Service and other State service patterns,the pattern adopted by the police and theasylums officers, and the schemes of greatrailway companies, where, for the most part,the amount of the pension depends upon theofficer’s future salary. The whole report is a mostvaluable document, because it brings within thecovers of a readable book the causes and details ofmuch financial disorder and much injustice knownto exist in the management of great charities, andknown, moreover, to exist there to the extremedissatisfaction of all the authorities concerned.Everyone is aware that hospital officers deservepensions ; the result of this close investigation ofthe circumstances should be prompt reform.

Annotations.11 No quid nimis."

THE LYMPHOID TISSUES, TUBERCULOSIS, ANDSUNLIGHT.

THE greater part of the January number of theJournaZ of ExperimentaZ Medicine is taken up byrecords of very suggestive experimental work uponthe activity of the lymphoid tissues in the body.Their study has in the past been difficult on accountof the lack of methods of approaching the subject.The wide distribution of the lymphoid tissue

throughout the body has prevented observationscomparable to those adopted in investigating thefunctions of the internal secretions. Owing to

rapid hyperplasia of the lymphoid tissues, com-pensation for loss, such as can be induced bysplenectomy for example, so readily occurs thatlessened function cannot be detected. Dr. J. B.

Murphy and his co-workers have found, how-ever, that practically the entire lymphoid tissuesof the body can be destroyed without any

noticeable effect upon the health of the animal bymeans of small repeated doses of X rays. Thereresult important changes: there is a lessening ofthe mechanism of resistance to implant of foreigntissue, to inoculated cancer, to grafts, tuberculosis,and to poliomyelitis in various animals; and it issuggested that the lymphocyte is an active agentin these processes. The present experiments havebeen directed to the study of the converse condi-tions-namely, those by which the activity of the.Iymphoid tissues can be increased. It is foundthat one of the most effective means of inducingsuch increase is by dry heat. Animals subjected to Idry heat (55-65° C. for mice, 60Q for rats andguinea-pigs) for short periods showed, after a

sharp preliminary fall, a subsequent gradualincrease of both the polymorphonuclear leucocytesand the lymphocytes. Increase in the latter oftenamounts to 200 to 300 per cent. above the normalcount (J. B. Murphy and E. Sturm). This pro-nounced lymphocytosis is held to be due to theenhanced proliferative activity of germinal centresin the spleen and lymph glands (W. Nakahara). As

might be expected, the effects of the lymphocytosisthus induced are the reverse of those above notedas following X ray applications. There is a markedincrease in resistance to transplanted cancer inmice, to the rate of growth of spontaneous tumoursin these animals, and especially to experimentallyinduced tuberculosis in mice. The resistance ishere increased two- to three-fold (Murphy andSturm). The beneficial effect of sunlight uponclinical tuberculosis is known, and some obser-vations are recorded upon the effect of sunlightupon the lymphocyte count in healthy indi-viduals (J. B. Taylor). Thirty-eight subjects wereexamined. In 25 of the cases in which chronic solardermatitis was produced there was an appreciableincrease, percentage and absolute, in the number ofcirculating lymphocytes. In 8 there was a definitedecrease and in 5 there was no appreciable change.Of the 13 cases with no lymphocytosis, 6 failedto tan and 5 had an extremely high lymphocyteto begin with. There was clearly a definiteparallelism between the tanning and the bloodchanges. Similar blood changes follow exposureto small doses of X rays (Taylor and others),so that it is suggested that the sunlight effects are’due to the ultra-violet rays of the spectrum.Rollier and others have emphasised the fact thattanning is necessary to obtain beneficial results intuberculosis with heliotherapy. The relationshipof this observation to the possible associated bloodchanges and the manner of their production is

interesting and suggestive.

TRANSIENT HEMIANOPIA.

As a symptom of ocular migraine momentaryhemianopia is well known. As a phenomenonlasting for days or weeks and then ceasing it is

very rare. A case is recorded by Tyson of leftsuperior quadrantic hemianopia occurring after analcoholic debauch in a heavy smoker, lasting for afew days, and recurring nine months later after arenewal of excess in alcohol. On this occasionthe visual defect lasted much longer, but after aboutthree weeks the form fields had widened to within10 degrees of normal, while the colour fields remainedcontracted in the left superior quadrants to aboutfixation point. The case is interesting as bearingupon the pathology of migraine on which subjectvarious theories have been put forward. Perhapsthe theory most generally held is that it is due to anerve storm of the cerebral cortex akin to epilepsy,but there is another that it is the result of spasm ina cerebral artery. This case is brought forward insupport of the latter theory, but although the patientgave a history of occasional attacks of migraine fromthe age of 8 to the age of 23, these had ceased fiveyears before the hemianopic attacks began, and theconnexion may have been fortuitous. That thecause of the latter was temporary occlusion of theposterior calcarine artery is supported by a caserecorded by Beevor and Collier (not Beevor andCollins, as stated in the article) in 1904,2 in which a

1 American Journal of Ophthalmology, December, 1918.2 Brain, vol. xx.

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permanent left superior quadrantic hemianopia wasproved by an autopsy to be due to a softening ofthe whole lower half of the right visual cortex,caused by an occlusion of this vessel. It may beadded that cases of transient hemianopia resultingfrom severe concussion of the cerebral cortexfollowing upon wounds of the occipital region haverecently been noted by Captain M. L. Hinein whichmore or less complete recovery took place, therecovery for colour vision always lagging behindthat for form vision. In cases of quadrantic hemi-anopia from war wounds it is usually the lowerquadrant that is affected, the reason for this beingthat cases which recover are almost always due towounds affecting the upper part of the visualcortex; not that the upper part is any more liableto be wounded than the lower, but whereaswith occlusion of the calcarine artery the resultsare limited to the area of the cortex supplied bythat vessel, wounds of the same region generallyinvolve the medulla and cerebellum as well, so

that the patient rarely survives.

A FREAK OF NATURE ?

To the philosopher the capacity for error whichhe observes in his fellows, and particularly in hisfellow philosophers, is a perennial source of sur-

prises, and there is one branch of study-that ofman’s earliest history-which, on account of themystery surrounding it and of the zeal which itsfascination inspires, is especially productive of

questionable conclusions. Dickens illuminated thesubject with some satiric flashes in his story of theantiquarian discovery made at Cobham, and lesseminent students of nature than the immortalPickwick have also been misled by appearances.One has accepted as evidence of the artisticdevelopment of cave man the daubs on the wall ofa boat-builder’s former paint store; another hasfound neolithic

"

pot-boilers "

on the site of aJubilee bonfire. From time to time there are un-earthed prodigies which may deceive the very elect.The fossil shell from the red crag described a fewyears ago by Dr. Marie C. Stopes, to the PrehistoricSociety of East Anglia, is perhaps a case in point.It bore upon its surface a face of the kind whichvery youthful artists draw in these days, butwhich, possibly, in the childhood of the race repre-sented the highest flights of the limner’s art. Manygeologists regarded it as a genuine product of

primeval culture. More recently we have had, alsofrom East Anglia, a similar

"

freak." It is a massof chalk, about 4 inches long and between 2 and3 inches in its other dimensions, which bears afantastic resemblance to a mammoth, an animalwith which the present generation has not even anodding acquaintance, though enough is knownabout its appearance to justify us in calling itElephas primigenius. The model, or as he prefersto call it, statue, was described and figured in theanthropological review, Man, for February last byMr. Reid Moir, who is well known among geologistson account of his enthusiasm in the search for flintimplements, and to the general public as beingresponsible for the recent appearance in theagony" column of the Tivies of one of the oddestcontributions ever made even to that quaint gallery-we mean the advertisement for the Foxhallmandible. Mr. Reid Moir regards the shaping ofthe piece of chalk discovered at Saxmundham as

3 Brit. Journal of Ophthalmology, January, 1918.

due to human agency, and from the circumstancesattending its discovery it would, if taken at hisvaluation, be of great importance for the solutionof the problem of the antiquity of mankind. ButDr. Charles W. Andrews, of the Natural HistoryMuseum, in a letter to Nature of March 13th, saysthat " the object is nothing more than a somewhatimperfect natural cast of a chamber of the shell ofan Ammonite," and as Mr. Reid Moir, so far as wehave seen, has not responded to the impliedchallenge the hopes raised by him may be doomedto disappointment. ---

LEFT SCAPULAR PAIN AND HYPERALGESIA INHEART DISEASE.

THE significance of symptoms in the diagnosis ofdisease and in the estimation of its degree isreceiving exact study in many departments ofmedicine. In pulmonary tuberculosis it is prac-tically impossible to express an opinion as to thenature and stage of the disease without carefulcorrelation of the symptoms with the physicalsigns observed. In heart disease the symptomsafford a valuable measure of the degree ofthe derangement of function caused by thelesion indicated by the physical signs andof the necessity for treatment. That variouscardiac conditions are associated with some degreeof praecordial pain and tenderness has long beenfamiliar, but the extent, character, and radiationsof these pains have perhaps not received the atten-tion they deserve except in the case of anginapectoris. We publish in this week’s issue ofTHE LANCET an interesting and suggestive noteby Dr. John Parkinson upon a little-recognised formof cardiac pain and tenderness-namely, thatoccurring in the left scapular region. He hasmade a careful study of 50 cases in which theseconditions were observed. The scapular painis usually referred to a spot just below or

internal to the lower angle of the left scapula,though it is sometimes felt along the vertebralborder of the lower half of the scapula.It is apparently always accompanied by sub-

mammary pain, which is more generally recognisedas of cardiac origin. The scapular pain is usuallya later manifestation, though in a few patients itappeared to originate at the same time as the sub-mammary. The hyperalgesia was less frequentlypresent than the pain, and its extent was variable,as shown in the record of 10 cases given by Dr.Parkinson. The conditions in which left sub-

mammary and scapular pain was observed includedvalvular and myocardial disease, arterio-sclerosisand renal disease with cardiac embarrassment,especially when associated with high bloodpressure; also "functional" " heart disease andconditions of general ill-health with inefficientaction of the heart. As might be expected, Dr.Parkinson finds the explanation of these symptomsin the well-recognised principle of referred pain invisceral disease, so ably elucidated by Dr. HenryHead and Sir James Mackenzie. He finds that thesixth thoracic segment alone or in combinationwith the fifth supplies the submammary andscapular regions to which the pain is usually referred.The hyperalgesia corresponds to the same segments,though it may extend to a larger area. He regardsthe development of hypersesthesia in cases ofchronic heart disease or disorder, especially whenit persists or recurs, as indicating a new and moreobstinate stage. In his opinion the hypersestheaiainduces and supplements the pain since it may be