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virus and bacteria have indicated that the severityof the viral process is unaffected by superimposedbacterial pneumonia.l Conversely, sulphonamides exerttheir antibacterial action even in the presence of a

rapidly multiplying influenza virus and of extensive

pulmonary exudate. This is probably because thevirus, though destroying the ciliated cells of respiratoryepithelium and so probably lowering resistance tobacterial invaders, does not interfere with the activityof the phagocytic cells which are important in chemo-therapy. There is thus good reason for continuing totreat specifically the bacterial pneumonic complicationsof influenza. We may hope thereby to lower the riskof death, provided that the viral infection itself is nottoo severe. The white-cell count in conjunction with theclinical picture is sometimes a useful guide to the patientsmost likely to benefit from chemotherapy : leucopeniasuggests that the infection is predominantly viral and notsusceptible to this treatment, whereas a leucocytosisfavours the chance of a good response.

JOURNALS OF THE BRITISH MEDICAL

ASSOCIATION

WE learn with regret that Dr. Gerald Horner is toretire at the end of this year from the editorial chairof the British Medical Journal which he has occupiedwith so much distinction since 1928. He will be suc-ceeded by Dr. Hugh Clegg, the deputy editor. Mean-while the staff of the journal has been brought up topeace-time strength by the return from the R.A.M.C.of Dr. Harvey Flack, assistant editor, and by theappointment of two new subeditors, Dr. E. G. Murphyand Dr. D. Swinscow. The responsibilities of theeditor will be increased in January by the publication,under his general direction, of two important newjournals, entitled Abstracts of World Medicine andAbstracts of World Surgery, Obstetrics, and Gynœcology.Brigadier G. W. M. Findlay, of the Wellcome ResearchInstitution, will edit them, with the assistance ofDr. S. S. B. Gilder, who as prisoner-of-war in Germanyacquired varied surgical experience and a knowledgeof various languages.Of the association’s specialist journals the Archives

of Disease in Childhood (which now incorporates theBritish Journal of Children’s Diseases) is edited byDr. Richard Ellis, newly elected professor of childhealth in the University of Edinburgh ; the Journal ofNeurology, Neurosurgery, and Psychiatry by Dr. E. A.Carmichael ; and the British Heart Journal by Dr.Maurice Campbell and Dr. Evan Bedford-the last

being published with the Cardiac Society. The BritishJournal of Industrial l6Tedicine, with Dr. Donald Hunteras editor, is produced in conjunction with the Associa-tion of Industrial Medical Officers, and the Annals ofRheumatic Diseases, in charge of Dr. C. W. Buckley, withthe Empire Rheumatism Council. The latest additionsto the list are the British Journal of Pharmacology andChemotherapy, with Prof. J. H. Gaddum, F.R.S., as

chairman of the editorial committee, published quarterlywith the British Pharmacological Society, and Thorax,edited by Mr. N. R. Barrett and Dr. J. G. Scadding,published with the Association for Study of Diseasesof the Chest. The British Journal of Social Medicine,under the editorship of Prof. F. A. E. Crew, F.R.S.,and Prof. Lancelot Hogben, F.R.s., is to come out inthe New Year.

In the secretariat of the B.M.A. Dr. Charles Hill hasDr. A. Macrae and Dr. L. S. Potter as his assistants.To these have now been added Dr. E. Claxton, ofSutton Coldfield, and Lieut.-Colonel D. P. Stevenson,R.A.M.C., while Dr. Agnes Kelynack, a temporary1. Harford, C. G., Smith, M. R., Wood, W. B. J, exp. Med. 1946,

83, 505.

assistant secretary since 1944, has joined the permanentstaff. Dr. E. R. C. Walker has lately been appointedScottish secretary in succession to Dr. R. W. Craig,and Mr. John Pringle, deputy editor of the Listener,has become press officer to the association.

TUBERCULOSIS IN THE COLONIES

TUBERCULOSIS is now widespread among many peoplesto whom it was formerly almost unknown-notably theAfricans and American negroes, the West Indians, theMalayans, and the Indians. A vivid impression of itsravages is obtained from a summary compiled by Prof.S. Lyle Cummins,1 a pioneer and life-long student of thesubject. Much of the monograph is devoted to an

account of work by many different investigators inAfrica, but there are references to Cyprus, India, Burma,the United States, and the West Indies.The picture which emerges is gloomy. Africans are

hypersensitive to the tubercle bacillus, with so littlecontrol of infection that manual work in the gold-minesbreaks down their unstable defences, and with so littleresistance to overt pulmonary tuberculosis that recovery,even in the restricted sense applied in Britain, is rare.At one end of the scale of susceptibility are the Senegalesesoldiers in France during the war of 1914-18, carefullyobserved by Borrel,2 who were taken to an infectiveenvironment from their own country, in which tuber-culosis was almost absent, and who died in great numbersof a disease they could not defeat ; the form was theacute generalised tuberculosis found characteristically inEuropean infants and susceptible laboratory animals.Those who survived were probably rather more resistantthan those who died, and natural selection would there-fore operate towards the breeding of a race with ratherhigher resistance. At the other end of the scale are the

negroes of the United States, whose death-rate, thoughstill higher than that of whites, is decreasing with thegeneral fall. In these negroes natural selection is furtheradvanced, and the race is relatively resistant. Betweenthe Senegalese and the American negroes lie the massof indigenous Africans, more susceptible than the

Europeans and increasingly subject to infection. Thatthe majority of Africans control primary infection is

proved by the observation that most surviving adultsare positive to tuberculin but are not diseased ; but itis equally true that a far greater proportion of Africansthan of Europeans fail to control primary infection,become diseased, and die.The gravity of the position, especially in urban com-

munities, has been recognised by the government of

Tanganyika Territory, who have lately decided to extendthe tuberculosis organisation directed for the past twentyyears by Dr. H. N. Davies at Kibongoto.3 It was alsorecognised by the medical services in the late war, asCullinan 4 has indicated. The incidence of the diseaseis not, of course, determined solely by susceptibility ofthe community ; on this basis the high rates constantlyfound in the Royal Navy 5 would be inexplicable.Environment, especially opportunity for close contact(as in the Navy), malnutrition (as at Belsen), andunfavourable conditions of work (as in African gold-mines), is the other obvious factor.More knowledge is needed ; but in the meantime

tuberculosis is a pressing human and social problem,and the question is always, what is to be done ? Inactionmight in time provide a partial solution, by breedingout the susceptibles ; but to accept such a measure ofdespair would be indefensible. Extensive social measures

1. Cummins, S. L. Empire and Colonial Tuberculosis : a GeneralSurvey of the Problem. London : National Association forthe Prevention of Tuberculosis. Pp. 59. 5s.

2. Borrel, A. Ann. Inst. Pasteur, 1920, 34, 105.3. Tanganyika Standard, June 15, 1946.4. Cullinan, E. R. Trans. R. Soc. trop. Med. Hyg. 1946, 39, 353.5. R. Nav. med. Bull. 1945, no. 20, p. 1.

279

are required if the disease is to be checked. Opportunityfor infection must be reduced by social, educational, andeconomic means; malnutrition by agricultural reform andimproved distribution; and conditions of work by legis-lation and enlightenment. Of the more direct methods,immunisation by B.C.G. or other vaccines needs earlytrial; the memorandum recently prepared by Prof.W. H. Tytler for the National Association for thePrevention of Tuberculosis 6 encourages the hope thatB.C.G. could be used effectively in the tropics ; and the

discovery by Russian workers that the vaccine may bekept for long periods in the dry frozen state may removethe major administrative disabilities of present schemesfor its use.

In treatment, the standard procedures have sometimesproved disappointing in the tropics, because primitivepeoples do not yet understand the importance of long-continued care. But this should not discourage theirapplication, under the best conditions possible.

STYPTIC FROM SEAWEED

WHEN seaweed is broken in the sea the injury ishealed by contact of the plant juices with the calciumions of the water. The substance responsible is alginicacid, which is a polymer of d-mannuronic acid andresembles cellulose in chemical structure. Alginic acidsalts are used in industry as thickening and bindingagents, and fine filaments and foams can be produced ;the usual source is an extract of the seaweed Laminaria

digitata, and sodium and calcium salts are the importantforms. Sodium alginate solution can be sterilised byautoclaving. When applied to raw tissue surfaces, itreacts immediately with the ionised calcium, to form aclot or layer of calcium alginate ; this material acts asa styptic, and has the advantages that it is absorbable,has no deleterious action on the surrounding tissues, and,so far as is known, does not interfere with the action ofdrugs like penicillin ; moreover, dilution with plasmadoes not interfere with the formation of calcium alginate.Another method is to prepare calcium alginate by addingto sodium alginate solution a soluble calcium salt to

produce thin films in situ ; or a foam or plastic sheetcan be prepared. Calcium alginate filaments can beprepared as an absorbable haemostatic gauze for applica-tion to oozing surfaces. Blaine, Dollar, and Sorsby 8have described the use of calcium alginate in scleralwounds, but consider that in this site it comparesunfavourably with fibrinogen. Smith 9 has reportedgood results with powdered alginic acid as a styptic,after ’tooth-extraction and other minor surgical pro-cedures in the mouth. It is evident that these alginateproducts will be a useful alternative to the other absorb-able haemostatics or fixatives that have been developedduring the war.Fibrinogen is used to form fibrin films for the arrest

of haemorrhage, and it can be employed as a fixativein plastic surgery ; it is, however, expensive and cannotbe heat-sterilised. Oxidised cellulose gauze swells andbecomes sticky when blood-soaked, and it does not

depend for its action on the clotting of blood within themeshes; it is absorbable and is not invaded by fibro-blasts, so that scarring is minimal.10 Here, too, heatcannot be used for sterilisation, which is usually effectedby immersion in formalin. Alginates, on the other hand,are relatively cheap, and can be sterilised by heat ;gauzes of various absorption rates can be manufactured,and the starting material-sodium alginate-is stable.There is evidence that clots of calcium alginate are

invaded by fibroblasts, but its action on scar tissue hasnot yet been described. When supplies become more6. See Lancet, July 27, p. 138.7. Leschinskaya, E. N. Amer. Rev. Soviet Med. 1946, 3, 210. Cited

by Tytler, W. H. Lancet, August 3, p. 180.8. Blaine, G., Dollar, M., Sorsby, A. Trans. Ophthal. Soc. U.K.

1944, 64, 187.9. Smith, C. A. H. Science, 1946, 103, 634.10. Frantz, V. K., Clarke, H. T. Ann. Surg. 1944, 120, 181.

plentiful, it will be interesting to see whether it can beused in haemorrhagic diseases, such as haemophilia,and to control oral haemorrhage after tooth-extraction,especially since snake venoms have proved on the wholedisappointing.

H. G. WELLS

A LATTER-DAY prophet, Wells increased our per-ception of the past, the present, and the future. Manyof his ideas are now part of our mental daily life, whilethe central theme of his teaching has begun to sound likea platitude. He believed in education as the only hopeof giving men control over themselves and hence oftheir own inventions. " The conviction grew continuallystronger with him that man must order himself as

a political animal or perish," and " every effort ofhis multifarious writing became consolidated uponemphasising the necessity that nations should sacrificesome part of their sovereign rights in the creation of aworld State." 1 His first book was a manual of biology,and from the imaginative tales which opened so manypeoples’ minds to the possibilities of science he turnedto novels which became more and more frankly socio-logical. His supreme effort in direct education wasmade after the first world war, when with collaborators heproduced the trilogy, The Outline of History, The Scienceof Life, and The Work, Wealth, and Happiness of Mankind.His Shape of Things to Come was another arresting work,and was translated to millions through the cinema.As he grew old his propaganda became less effective,partly because it was more explicit; but what is moreastonishing is that his spirit remained so ardent inflesh so frail. His last work, Mind at the End of ItsTether, refers to a familial fatty degeneration of theheart which ended the lives of his forebears and was oneof the complications

" of his own " never very soundbody " ; he was also, one gathers, a diabetic; and inearly years it was tuberculosis that diverted him fromteaching to writing. The life lived apparently by a manof outstanding physical vigour and tireless energy,and extending to 79 years, was thus handicapped by atleast two serious ailments.To judge the place of Wells in the life of his time

it is necessary, as the Times says, to retrace the yearsand to recall the responses of successive generationsto the intellectual challenges he hurled at them. Beyondall question he gave stimulus after stimulus to thought.The flushing torrent of his ideas left ... few tranquilpools for the reflective reader. Yet as an urgent andgenuine seeker after truth he must have persuadedmultitudes to join him in his quest." 2 The interpreterof evolution was in fact a great leader of men, and hismessage was as important as he supposed.

Dr. OTTO MAY, chairman of the British Social HygieneCouncil, and until his retirement principal medical officerof the Prudential Assurance Company, died on August15 at the age of 67.

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1. Manchester Guardian, August 14, p. 4.2. Times, August 14, p. 5.

TRAFFIC IN DANGEROUS DRUGS.-The Advisory Com.mittee on Traffic in Opium and other Dangerous Drugshas resumed the issue of summaries of illicit trans-actions and seizures of narcotics, which has been delayedduring the war years. The summaries for the years1942-45 deal with seizures of raw opium, prepared opium,morphine, heroin, cocaine, and indian hemp, and cover Europe,Asia, Africa, America, and Australia. The report bears testi-mony to vigilance on behalf of world-wide administrationsin tracking out centres of illicit manufacture and exposingclandestine traffic in habit-forming drugs. It is interestingto note that indian hemp, in the form of hashish, was seizedin considerable quantities in Egypt, and in the form ofmarihuana cigarettes in North and South America, while

’Palestine also was not immune from illicit traffic. In 19424689 kg. of hashish in all were seized in addition to marihuana,as such, and in cigars and cigarettes.