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made long and adventurous voyages, pushing East,step by step, from island to island, while there ismuch evidence that the Polynesians had ways andmeans of reaching America which were employedsome centuries before the discovery made by Columbus.What is the absurdity of this theory that should temptthose who disagree with it to be rude about it ?We recommend this book to all who, while valuing

the lessons of ethnology, are not aware of the extremepains necessary to comprehend the ancient messages.Prof. Elliot Smith produces a mass of evidence insupport of the view that the influences of Asia mightbe found in the remains of the pre-Columbian civilisa-tions of America, and Mr. Gerrard and Mr. Leigh-Pemberton have cooperated in a series of remarkablewoodcuts. The testimony cannot be pushed asideas supporting " an extravagant hypothesis, long sincerelegated to the rubbish pile of scientific discords."Such an attitude towards scientific opponents is notto be commended.

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ACTION OF TESTICLE ON OVARIAN GRAFTS.

Drs. A. Lipschütz and H. E. Voss have carried outsome interesting experiments, described in the Comptesrendus de la Soc. de Biologie, in order to throwlight on the mechanism of the inhibitory actionexercised by the testicle on experimental glandularhermaphroditism. It has previously been shownthat if ovarian grafts are made in an intact maleguinea-pig no enlargement of the breasts occurs, theeffect of the grafts being inhibited by the action ofthe testes. Lipschutz and Voss have, however, nowfound that if previous to the grafting the lower poleof the epididymis be removed so as to convert thetesticles into fragments having no connexion withtheir excretory ducts, the inhibiting action of thetesticles is prevented, with the result that the ovariantransplantation produces a- marked development ofthe breasts. This at first sight would suggest thatthe inhibiting action exerted by the testicles on theovarian grafts depends on spermatogenesis ratherthan on the interstitial cells. The experiments,therefore, as far as they go, are in harmony with theview that is held by many investigators, that thehormonal function of the testes is not entirely centredin the interstitial cells. The epididymectomy carriedout by Lipschutz and Voss is similar in its effect onspermatogenesis to ligature of the vas. It must,however, always be borne in mind that regression inthe tubules does not occur immediately after ligatureor epididymectomy, but only after an interval hasoccurred. Intact tubules, as Mr. Kenneth Walkerpointed out in an article published in THE LANCETof Feb. 2nd, are found in the human subject as longas three months after vasotomy. Care must, there-fore, be exercised in interpreting Lipschutz’s experi-ments as a proof that the inhibitory action exercisedby the testicle on an ovarian graft is entirely depen- Ident on the existence of spermatogenesis.

SCHISTOSOMIASIS.

THE scattered literature on the subject of theschistosomiasis of the Far East, the disease producedby the trematode, Schistosoma japonicunz, has beencollected and coordinated by Drs. E. C. Faust and H. E.Meleney in the Monographic Series of the AmericanJournal of Hygiene (No. 3, March, 1924), where theyhave supplemented and embellished our knowledge ofthe fascinating subject with a considerable amount of original work. This monograph consists of some 339pages with a comprehensive index, and is abundantly illustrated with drawings and microphotographs.There is included an appreciation of the historical aspect of the schistosomiasis problems which was badly needed, and in this survey the fine work of theearlier Japanese investigators is given due credit.Other sections deal with the morphology, biology, andlife-history of S. japonicum, its development with themolluscan host, the cercaria stage of the fluke, itsdevelopment within the definite host-all the stages

being well depicted by means of accurate comparativeoutline drawings and photographs. The migration ofthe fluke in the human body, the pathological anatomyof the disease, the clinical and therapeutical aspectsare all passed under review, while the portions deal-ing with the biology of the intermediate hosts,the geographical distribution of the disease, and thequestion of its efficient prophylaxis are all welcome.The monograph contains two important appendices.The first, a zoological study of the molluscan hosts ofS. japonicum, is from the pen of the late Dr. NelsonAnnandale, F.R.S. elect, and must have been com-pleted shortly before his death. Emanating from sucha source, and from the zoological survey of India andthe Indian Museum, Calcutta, this contribution isquite authoritative. The accurate description of thesnails is illustrated with some fine illustrations oftheir morphology, and from this it appears that thecorrect nomenclature of the intermediate hosts isOncomelania, Gredler (1881), of which there are three.species-nosophora, formosana, and hupensis-which.act as intermediaries in various parts of the Far East.The genus Blanfordia is now known to be quite-distinct. The other appendix contains a fullbibliography historically arranged.

GOITRE IN BRITISH COLUMBIA.

GoiTRE affecting animals in British Columbia has:a seasonal incidence, being more prevalent in latewinter and early spring when the fresh green food ofsummer is not available. An article by Dr. W. DKeith, of Vancouver, in the April issue of the CanadianMedical Association Journal, draws this and otherinteresting conclusions from his own personal observa-tions. The incidence of goitre in the valley which hestudied has disappeared entirely following on the useof iodine. Sanitation appears to play little part, for’in the Indian Reserve, where conditions seem mostfavourable for spread of contagion, no goitre wasfound either among live-stock or human beings. Butgoitre was endemic in the Pemberton Meadows,inhabited only by white men during the last 30 or40 years on a virgin soil with remarkably purewater-supply. Certainly, the iodine-deficiency theoryof goitre is strongly supported by the evidence whichDr. Keith brings forward. There may be otherfactors. In a recent British Medical Associationlecture 1 Dr. R. McCarrison still lays special stress onone of these-namely, the continued infection of thebowel by way of polluted water. But wherever goitrearises in the absence of bowel hygiene, ColonelMcCarrison would now assume insufficiency of intakeof iodine in food and water. The method of preventionof goitre by iodine, he states, is at once simple,.rational, cheap, and devoid of ill consequences.

THE ULTIMATE RESULTS OF RADICALOPERATIONS FOR MIDDLE-EAR

DISEASE.

IT is a disappointing feature of radical operations.for middle-ear disease that they so often leave aserous or purulent discharge which, though it maynot be a serious danger, is, at any rate, a blemish anda social hindrance. The causes of this sequel are-

various ; it may be that the operation has not beenradical enough, some of the diseased bone having-been left behind, or, as happens frequently, theoperator has not succeeded in providing the cavumtympani with an epithelial lining suited to its modifiedfunctions. Yet another important cause of a persistentdischarge is neglect of after-care, of that periodic-supervision which patients should enjoy for at least a"year after a radical operation. It is this lesson inparticular that Dr. P. Henius and Dr. H. I. Schousboeemphasise in the last number of Acta Oto-Laryngo-logica (1924, vi., fasc. 1 and 2). In the autumn of 1922they investigated the fate of the 301 patients on whom

1 Brit. Med. Jour., June 7th, p. 989.

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a radical operation for middle-ear disease had beenperformed in the period 1901-20 in a Danish hospital.In 19 of these cases the operation was performed onboth sides, and in 65 cases cholesteatomata were found.Of the 13 patients who died in hospital, as many as12 showed intracranial complications before theoperation. Among the 288 patients who left hospitalalive, there were 234 about whom information wasobtained in 1922. Eleven were found to have died,but in no case was the cause of death connected withthe operation. Of the 135 patients who submittedto a re-examination in hospital, 15 had been operatedon for middle-ear disease on both sides. There werethus 150 operation results to check, and only in 67,or 45 per cent., was the operation wound found to havehealed completely. Among the remaining 83 cases

of imperfect healing, a mucous discharge from theEustachian tube or from the imperfectly healedcavum tympani was the most common defect. Inother cases there was a comparatively profuse and oftenpurulent discharge from the cavum tympani or otherparts of the field of operation where granulation tissueand, at a few points, denuded bone were found.Some of the worst cases, from the point of view ofhealing, were also the worst cases from the point ofview of elementary cleanliness on the part of patientswhose indifference and inertia were mainly responsiblefor the accumulation of wax and epithelial debris.In many cases a short course of after-treatmenteffected complete healing of the operation wound,and the authors insist that it would be well if everypatient undergoing a radical operation for middle-eardisease were to be instructed to report periodically,say once or twice a year, for supervision, and, ifnecessary, a short course of after-treatment.

A JOURNAL OF INFECTIOUS DISEASES.

Prof. R. Kraus, of Vienna, is editing a new journal,with the title of Seuchenbekämpfung,1 which has as itsobject to keep the general practitioner and veterinarysurgeon in contact with recent developments ofexperimental medicine, especially in its application toinfectious diseases, such as vaccine therapy, chemo-therapy, protein therapy, and new methods ofprophylaxis. The literature on this subject is so vast,so difficult to appreciate critically by the non-expert,frequently so contradictory, that the general prac-titioner may well be excused if he lets his innateconservatism get the better of him. The aim is topresent positive achievements which are ripe forapplication in general practice in the form of briefand clearly written articles by authorities of standing.The first number opens with an article of ten pagesby Dr. J. Gerstmann, on the Malarial Treatment ofGeneral Paralysis. Details of the treatment are givenand the conclusion is reached that " the dogma of theincurability of this disease has been overthrown."This is followed by a paper from Prof. Pirquet’s clinic,on the present state of diphtheria prophylaxis.Prof. Przibram has a paper on the diagnosis andastiological treatment of bacillary dysentery. Prof.Kraus writes in favour of the curative and prophylacticvalue of anti-tetanus serum. Other papers in thisnumber deal with the technique of the production ofantitoxic sera, the technique of collecting specimensfor bacteriological and serological examination,the experimental production of cancer by tar, theanimal epidemics in Jugoslavia, and the methodsemployed in fighting them. The last paper is a shortnote by Prof. Kraus dealing with certain ill-effectsencountered in immunising sheep against anthrax.The papers are clearly written, and if the standard setby this first number can be maintained the journalwill certainly be a useful addition to current medicalliterature. It was apparently conceived by Prof.Richard Paltauf, whose death, recently recorded byour Vienna correspondent, removes one of the lastsurviving pioneers of bacteriology and serology. His

1 Verlagsbuchhandlung M. Perles, Wien I., Seilergasse 9A double number two-monthly. Subs. 4 Swiss francs a year.

labours, which were devoted particularly to the appli-cation of bacteriological discoveries and methods topractical medicine, have gained for him a distinguishedplace in one of the most remarkable periods in thehistory of medicine. ____

AN OVERCROWDED MENTAL HOSPITAL.

THE impression that certifiable mental disorder inIreland is increasing is confirmed by the annual report(for 1922) of the Ballinasloe Mental Hospital, which hasjust reached us. Here the number of patients increasedin the course of the year by 49 to a total of nearly1500, although the medical staff consists of threemembers only. The inspector’s report opens with thesentence,

" This mental hospital is greatly over-

crowded." Apparently the dormitories being full ofbeds, corridors are also being used as sleeping apart-ments. This report contains other serious criticisms ;food and clothing were of bad quality, the groundswere not well kept; " the attendants’ rooms werenot in a proper state of order and cleanliness " ; thewomen’s exercise grounds were entirely inadequate ;more patients could have been usefully employed,some of those who were working had been hired outto farmers, " a practice objectionable on more thanone ground." Two suicides and two fatal and manynon-fatal accidents are recorded ; various infectiousdiseases, including typhoid, have been prevalent;the deaths from tuberculosis numbered 14. Nomention is made of therapeutics. It is to be fearedthat the bad conditions reflected in this report areonly too common in Irish asylums, and are duedirectly or indirectly to financial difficulties. Theefforts of the staff might be expected to producecertain improvements, but initiative may well bediscouraged by the impoverished aspect of theinadequate buildings in which they work.

RAT-BITE FEVER.

Dr. Paul A. O’Leary,I associate in the Section onDermatology and Syphilology of the Mayo Clinic, statesthat since rat-bite fever was first described by Jlillot-Carpentier in 1884 about 140 cases have been recorded.The disease has occurred in all parts of the world, butis naturally most prevalent in those countries whererats are numerous, such as Japan, England, France,and the United States. In 1915 Futaki described,under the name of Spirochœta morsus muris, an

organism which he had recovered from rats and frompatients suffering from rat-bite fever, and thereforeregarded as the cause of the disease. Hitherto,however, only Japanese observers have succeeded inisolating this organism in cases of rat-bite fever inman, and other organisms have been regarded as ofaetiological importance, such as a streptothrix, byTileston, Schottmiiller and Blake, a sporozoon byOgata, and a diplococcus by Douglas, Colebrook, andFleming. 2 Dr. O’Leary, who records two illustrativecases, pays special attention to the dermatologicalmanifestations of the disease, which he classifies underthe headings of roseola, indurated erythematousplaques, lesions of the mucous membranes, andalopecia. The roseola consists of large reddish-blue orpurple macules scattered diffusely over the lowerextremities, neck, and face, in contrast with theroseola of syphilis which is more pronounced on thetrunk. The macular lesions usually appear with thefirst attack of fever and rapidly undergo involution,leaving brown pigmented patches which may remainfor several weeks, but do not usually persist throughoutthe disease. The most characteristic lesion of rat-bite fever is the indurated bluish-red or livid plaquewith a lighter coloured concentric zone just within themargin. The lesions are widely disseminated and varyin size. The larger plaques are, as a rule, definitelyindurated, and may be surrounded by smaller non-indurated macules. With each exacerbation of feverthe older or fading lesions become more distinct, and

1 Archives of Dermatology and Syphilology, 1924, ix., 293.2 THE LANCET, 1918, i., 253.