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’viscera. In the scaffolding of fibrin leucocytes canmove ; they can reach the infecting organisms whichthey alone are able to attack. So important is thiscellular defence against infection that the use of any.agent which directly limits or interferes with fibrin- tformation in the infected peritoneum is strongly to bedeprecated. Drainage for diffuse peritonitis is always 8-necessary, but the surgeon in instituting it hopes Ethereby to bring about localisation of the process. NHe is not likely to do this by interfering with the 1

production of fibrin. The problem of peritonealadhesions is not the prevention of their formation 1curing an acute infective process, but the elucidation of 1the cause of their formation, and especially the failureof their resolution in some abdominal affections which:have never been acute, and, at any rate at theirinception, may not even have been infections at all. i

A PORTABLE BASAL METABOLISM APPARATUS.Y

ESTIMATIONS of basal metabolism may prove ofvalue in determining the relative vital activities ofgroups of individuals of different races. It has Erecently been shown that the metabolism of healthy iJapanese, Chinese, and American women students tliving under the same conditions in the same college fshowed a racial difference, the metabolism of the 1Japanese and Chinese being perceptibly lower than Ethat of the Americans. Confirmation of this fact L

has led anthropologists during the past year to idevelop a project for studying the metabolism of tvarious races in different parts of the world. A istumbling block to such a project, however, is the (complicated nature of the apparatus for estimating (basal metabolism and its unsuitability for use in iregions remote from laboratories. In a recent paper1 I

Dr F. G. Benedict describes his modification of the<’.j student respiration apparatus, designed by Bcnodiet 1Bmd&mdash;Be’!Ted’Mt in 1923, to meet these fresh require- i’&mdash;*TT Tnents. The principle of what he calls a "field 1

respiration apparatus " is the introduction of a 4measured amount of pure oxygen into a closed circuitand the estimation of the time taken for its absorption. ,This method does away with gas analysis and the need 1for a gasometer, while it gives an accurate record

. of the oxygen consumed. The technique is brieflythis : the subject breathes through a rubber mouth-piece into a circuit containing oxygen-rich air. Thisclosed circuit consists of a metal can, partly filled withsoda lime, to absorb the carbon dioxide given out,and covered with a light rubber bathing cap for theexpansion and contraction of air during respiration.The oxygen consumed is replaced from a rubber bagby oxygen saturated with water vapour and deliveredin measured quantities into the circuit by a pump ofknown and constant volume. The experiment beginsand ends with the bathing cap at a definite degree ofdistension, indicated by an index button on the tip ofthe cap in contact with a fixed point, the oxygenintroduced during the experiment being thus equal inamount to the oxygen consumed by the subject. Theonly major measurement needed for the calculationof the basal metabolism with this apparatus is thetime required for the absorption of six pumpfuls ofoxygen, normally about ten minutes. Dr. Benedict

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describes the various parts of the apparatus and thetechnique of an experiment in detail, and sets outpossible sources of error and the means of obviatingthem. The apparatus, he says, is already being usedin Hong-Kong, Jamaica, Peru, Mexico, New Guinea,and South Australia. Those who have used a

simple apparatus of this type for estimating basalmetabolism cannot fail to be impressed by the easeand simplicity of the process compared with thecomplicated type in which the analysis of a sampleof expired air, followed by calculation, is a preludeto the measurement of the oxygen absorbed.

1 A field respiration apparatus for a medical and physio-logical survey of racial metabolism, Boston Medical andSurgical Journal, Dec. 22nd, 1927.

A TUBERCULOSIS SURVEY AMONG SCHOOL-

CHILDREN.

IN the Journal of the Norwegian National Associa-tion against Tuberculosis for December, 1927, isan account by Prof. Th. Froelich of a tuberculosissurvey of school-children started by him in 1912. Hewanted to know how many children were alreadyinfected by tuberculosis in Oslo at the age of 7,when school begins. To work with as uniform amaterial as possible he selected the children who hadbeen born between September, 1904, and September,1905, examining clinically and with the Pirquet test2900, or 66 per cent., of all the children in Oslo aged7 years. With the help of the public health authoritieshis findings were correlated with the notifications oftuberculosis in the town, so that fairly accurateinformation was available as to the degree of exposureto infection to which each child was subjected. Thevisiting tuberculosis nurses of the public health servicemade inquiries at the homes of all the children, andwere thus able to follow up the careers till the age of20 of all except those who left the town before thisage. Much of the j.QfRrm41n obtained in this wayis of considerable interest and should help to stimulatethe organisation of similar surveys elsewhere. It wasfound that 84 per cent. of the children were alreadyPirquet-positive, and that between 4 and 5 per cent.already showed clinical signs of tuberculosis. In4-8 per cent. there were infectious cases of tuberculosisin the homes. At the end of 1925 75 per cent. of allthe children were traced, and of the 1830 childrenfound in 1912 to be Pirquet-positive, as many as 223(or 12-2 per cent.) had subsequently developed tuber-culosis, and 79 had died of it. The deaths fromtuberculosis were twice as frequent among the girlsas among the boys ; for every 1000 boys who werePirquet-positive at the age of 7 20 died of tuberculosisbefore the age of 20, whereas for every 1000 girls inthe same category there were 39 deaths. The fate ofthe 332 children who were Pirquet-negative at the ageof 7 depended largely on their sex. When the boysand girls were taken together the subsequent incidenceof tuberculosis among them was somewhat lower thanthat among the boys and girls who had been Pirquet-positive at the age of 7. But when the originallyPirquet-negative children were classified according tosex it was found that the subsequent death-rate fromtuberculosis among the girls was as high as 5-4 percent., whereas it was only 0-6 per cent. among theboys. The tuberculosis death-rate among the girlswho had been Pirquet-positive at the age of 7 was3-9 per cent. As was to be expected the tuberculosisincidence was considerably higher among the childrenin whose homes there were open cases of tuberculosisthan in homes free from tuberculosis.

CANCER OF THE UTERUS.

A RECENT report by the Ministry of Health’s Depart-mental Committee on Carmer 1 analysed some 80,000cases of cancer of the uterus reported from all overthe world. Most of them were foreign, and owing tothe apparent disinclination of English surgeons ingeneral to publish their results it has been difficult todecide whether the conclusions were applicable topractice in this country. In order to settle thisquestion the Committee has taken advantage of aninvestigation which Mr. W. McK. H. McCullagh wasmaking at the Samaritan Free Hospital, where high-grade treatment has been given by a number ofdifferent surgeons over a suitable period. The factselicited are described in a further report,2 and it issatisfactory to find that in nearly 900 cases treatedbetween 1901 and 1920 the results were as good as, orbetter than, the average deduced from reported casesat home and abroad. The percentage of patients whose

1 Ministry of Health Report on Public Health and MedicalSubjects, No. 40.

2 Ibid., No. 47. H.M. Stationery Office. 9d.