an anomalous disease

823DEMOBILISATION AND VENEREAL DISEASES.

It is to be hoped that the chemistry of these iaccessory factors will soon be cleared up anda method found for their isolation in the purestate. Biologists have done well in developingthis new scientific aspect of dietetics, and so

far chemists have not kept pace with them.We may appropriately, in connexion with thewhole subject, congratulate Professor FREDERICKGOWLAND HOPKINS, University Reader in ChemicalPhysiology and Praelector in Bio-chemistry in

Cambridge University, on having been awarded atthe last annual meeting of the Royal Society, heldon St. Andrew’s Day (Nov. 30th), the Royal Medal ofthe society. As stated on the occasion of the presen-tation of the medal, Professor HOPKINS was amongthe very earliest, if not actually the earliest, torecognise and announce that minute quantities Ofcertain bodies, the nutritive value of which hadhitherto been unsuspected, exert an enormous

influence upon growth and upon normal adultnutrition. He showed that without these accessoryfactors a diet otherwise full and seemingly completeis incapable of allowing growth and even of main-taining body-weight or life. Subsequent events haveabundantly proved what a valuable observation indietetic research was thus made.

Demobilisation and VenerealDiseases.

THE Local Government Board is’alive to the verypressing danger of the mobilisation of venerealdiseases on demobilisation of the Armies to which wemade extended reference last week. The Board hasissued a circular (V.D. 19) to county and boroughcouncils, asking them to secure at once a consider-able extension of facilities for the free treatment ofvenereal diseases. In the first instance arrange-ments are suggested for more frequent clinics,including evening sessions at existing treatmentcentres, and in the second for the provision ofadditional centres. The Board suggests that in

many cases it will not be practicable to provide sufficient centres by arrangement with the voluntaryhospitals, and that it will therefore be necessaryfor the borough councils to make arrangements ontheir own premises, possibly utilising a tuberculosisdispensary or isolation hospital. For the treatmentof gonorrhoea, in the intervals between the clinics

. treatment by a trained nurse or attendant (subjectto medical supervision) is suggested, the treatmentto be given either at the hospital where the treatmentcentres are or at new auxiliary centres. The latter

should also serve the requirements, between thedates of attendance of the doctors at the regularclinics, of persons who are apprehensive that theymay have contracted disease, although no medicaldiagnosis has yet been made. Borough councils ofthe larger areas are urged to consider at once thedesirability of appointing whole-time venerealdisease officers. Negotiations are proceeding withthe naval and military. authorities for the earlyrelease of doctors specially experienced in thetreatment of venereal diseases, of whom a list willshortly be available.

Annotations.A NATIONAL TRIBUTE TO VOLUNTARY

AMBULANCE WORKERS.

A LETTER from Lord Ranfurly in another columncalls attention to the admirable work, extendingover 40 years, which has been done by the Ambu-lance Department of the St. John AmbulanceAssociation. And in our correspondence columnslast week Sir Rickman Godlee and Sir James Cantlie,respectively President and Principal of the Collegeof Ambulance, Vere-street, W., entered a plea forfunds in order that the College may have an assuredincome, and be enabled to carry out in peacetime the useful-the immeasurably useful-workwhich it has done during the war. Everyoneshould recognise the important part which first-aidteaching has played in the saving of life duringthe war, while the Home Office regulations withregard to emergency treatment in factories is a

proof of the value of prompt surgical aid in the

civil direction. First-aid is, indeed, an essentialadjunct to medicine and surgery; immediateattention after injury, wherever it may take placeand by whatever means, often saving lives, andalways assisting treatment. It should be realised

that men, women, and children of these islandsalso leave the homeland to reside under unusualclimates and in thinly populated districts, as theneed of the workers dictates, and these localities aresurrounded by many dangers to health which arenew to them, and which present themselves incircumstances where the threatened persons arebound to depend on their own ingenuity. A partof the work of the College of Ambulance is to

guard against these dangers. At any time thehealthy individual life is an asset to the nation,but at the present moment such a life has anartificial value when war has left its hideousmark on the population. The College ofAmbulance was founded in September, 1914, whenSir James Boyton gave the magnificent buildings,3, Vere-street, London, as a home for the Collegefree of rent for a year, the expenses of the work beingpaid in part by the fees of the pupils, and Sir JamesCantlie giving his services as teacher free. In

September of the present year the incorporation ofthe College took place, and now, if the institution is toform a sufficiently noble memorial to the thousandsof voluntary workers who have given their servicesto the country in time of need and adequately playits part in the reconstruction work that is beforeus, it is necessary that substantial financial aidshould be forthcoming. The very nature of thework prevents it from being self-supporting, forlarge teaching fees cannot be asked from those whofreely give their services to the country withoutpay. The sum required to establish the associationon a permanent basis as a national memorial is1:100,000, and Lord Mount Stephen has started thelist of subscriptions with £500. We hope the appealwill receive the whole-hearted support of both thepublic and the medical profession. Subscriptionsshould be sent to the Honorary Treasurer, 3, Vere-street, London, W. 1.

____

AN ANOMALOUS DISEASE.

THERE was a curious epidemic at Taranto in Mayand June of this year, attacking the civil populationand the crews of the men-of-war. Ships might

11 Ne quid nimis."

824

have three or four hundred cases on board in a very i

few days. Luckily the cases only lasted two daysusually. The very young and the very old werenot attacked. The disease was clinically differ-entiated from dengue, influenza, and pappataci fever, and a Micrococcus tetragenus was found inthe blood and pleural exudate; a streptococcus was sometimes present. The disease was characterisedby pharyngitis, headache, pain in the back, pyrexia(104° even), and in severe cases pneumonia,pleurisy, albuminuria, enlargement of spleen.Endocarditis is mentioned in the post-mortemreport of ten fatal cases. Gargling the throat ismentioned as a prophylactic, and in treatmentaspirin is forbidden, as weakening of the heart isspecially feared. Relapses did not occur, so someimmunity is probably set up. We quote from thereport of Lieutenant-Colonel Saccone in theAnnali de Medicina Navale.

WAR NEPHRITIS OR TRENCH NEPHRITIS.

AMONG the many controversial questions raised by the conditions of medicine and surgery whichseem to be directly dependent upon war the problemof war nephritis or trench nephritis occupies aprominent place. There seems to be little doubtthat its incidence is determined entirely by warconditions. It affects almost exclusively troops inthe front line, civilians having in great proportion escaped. Few cases occur amongst officers or inunits that are well housed. Numerous theories ]have been evolved, most of them speculative incharacter and based upon little evidence, though there seems to be an increasing consensus of opinionin favour of an infective agent in the causation. We published in a recent issue of THE LANCETan admirable summary of the clinical featuresof this disease by Professor H. B. Day,i Professor ofClinical Medicine, Egyptian School of Medicine,based upon a careful personal study of 50 casesin the early stages and a critical examinationof the records of other observers. Professor Dayexcludes the cases of recurrent nephritis andof infective nephritis with more or less obviousprimary focal disease, and bases his observationson what may be regarded as war nephritis or

trench nephritis proper. This he divides into twomain groups-the common form characterised bybreathlessness, oedema, and the urinary signs of

acute nephritis, and a smaller group distinguishedby hæmaturia and involvement of the lower urinarytract, which he follows Dr. R. G. Abercrombie incalling "lower tract cases." 2 Professor Day finds, inagreement with Dr. Abercrombie, that the onset ofwar nephritis is almost invariably associated withfever which may be of very short duration, so thatthe general course of the disease is in the mainafebrile. He points out that pains in the limbs andback occur, often severe enough to keep the patientawake, and also observes that the spleen wasenlarged in all of his cases, and that it became

actually palpable in 50 per cent. of them. Professor

Day was early impressed with the periodicity ofsome of the manifestations of the disease. He foundthat the daily output of urine increased at regularintervals or that it might show periodical fallswith a temporary increase of the albumin-uria or a visible return of hæmaturia. Suchslight recurrences or relapses were often asso-

ciated with a distinct febrile reaction lasting1 THE LANCET, 1918, ii., 660.

2 Journal of Royal Army Medical Corps, August, 1916.

three days, with a change in the pulse-rate and afall of blood pressure. Professor Day has observedin cases of trench fever a periodic variation in theenlargement of the spleen which occurs in that ,

disease. He found that the spleen showed alternateadvances and recessions in size at regular intervalsof five or six days. In war nephritis he notedan exactly similar condition, the spleen varyingin size with a periodic variation of identicalcharacter. The illustrative details of some of hiscases were accompanied in the contribution toour columns with charts showing the variationsin temperature, quantity of urine, and splenic en-largement, and his observations were summarisedby claiming that the course of war nephritisis marked by more or less evident changes at

regular intervals of five or six days-a featurewhich it shares with trench fever-and he askswhether war nephritis is a complication of trenchfever. He admits that the actual proof or disproofof this hypothesis can only be settled by experi-mental and laboratory work. His reflections areof such interest that they should attract theattention of other observers to this question.

THE MEDICAL PARLIAMENTARY COMMITTEE.

MEETINGS of the Executive Committee of theMedical Parliamentary Committee have taken placesince our last issue, at which the work ahead wasdiscussed. Coming into existence at so short aperiod before the General Election the Committeecould not expect to play any prominent part in theelection; but its offer to supply medical speakersto medical candidates has been welcomed inseveral directions. The fact that the Committeetakes no cognisance of party distinctions will thusbe made apparent on several platforms, and in thisway the public will see that the Committee is

standing for the principle that the medical pro-fession should receive a full share of responsibilityin the inception and administration of nationalhealth legislation, because the foundation of nationalprogress is national health.

A NEW SIGN OF FOREIGN BODY IN THETRACHEA OR BRONCHI.

IN the American Journal of the Medical Sciencesfor November Professor Chevalier Jackson hascalled attention to a new sign of foreign body inthe trachea or bronchi which he terms the" asthmatoid wheeze." Further help in the

diagnosis of such a body is desirable, for theusual methods-auscultation, percussion, and theX rays-though valuable when positive, do notallow the conclusion to be drawn that a foreign.body is absent when they are negative. The newsign is called the " asthmatoid wheeze " because itis similar to the wheezing heard when the ear is

placed close to the mouth of an asthmatic. Thechief difference is that with the latter rales are

more or less associated. In the case of the foreignbody the sound is drier when typical, though it

may be associated with the bubbling sounds arisingfrom secretion. In a typical case the wheeze ismuch more marked after coughing out of allsecretion than before. This is probably becausesecretion more or less occludes the spacesby which air escapes between the wall of thebronchus and the irregularly shaped foreignbody. When cleared out more air passes and thewheezing is louder. Numerous cases of foreignbody in the air passages are reported in which