1037

is made the subject of a general discussion. For those whoseek a wider mathematical training Prof. Pearson’s Instituteoffers a rich choice of lectures and practical classes. Neitherthe National Institute of Medical Research now, nor theSchool of Hygiene in the future, will claim to be able toproduce by this method professional statisticians. Aforeigner who wishes to master the general theory of mathe-matical statistics must betake himself to Prof. Pearson’sInstitute or to Mr. Udny Yule, at Cambridge. I and mycolleagues are only competent to help those who wish toemplov the statistical method as a useful tool in epidemio-logical and public health investigations. In a word, weare not epidemiological statisticians but statistical epidemio-logists."No doubt this method will be continued by Prof.

I

Greenwood when he formally assumes the professorialfunctions, and it appears to be suited to the require-ments of most medical post-graduates.

DANGERS OF THE BARBITURIC HYPNOTICS.

SINCE 1902, when the barbituric acid group of

drugs was first introduced, there has been a steadilyincreasing stream of hypnotic preparations of thisclass. The number of proprietary remedies nowon the market indicates the rapidity of their rise topopularity and the extensive use which is being made ofthem by practitioners throughout the world. Veronal,medinal, dial, and the like have a certain and speedynarcotic action which is eminently satisfactory, andafter their use the patient wakes without objectionablesequelæ. Yet prolonged use of these drugs has attimes produced symptoms almost identical withthose of disease of the central nervous system, andSir William Willcox, speaking at a meeting- of theSection of Therapeutics and Pharmacology of theRoyal Society of Medicine on May 10th, was able torecall two cases, one of allonal and one of veronalpoisoning, which had been sent to him by a neurolo-gist as undoubted cases of organic nervous disease.Ocular palsies, nystagmus, paralyses of the facialnerve or of a limb, polyneuritis, ataxia, remarkablehypotonia of the muscular system, scanning speech,faults of memory and marked emotional instabilityhave all been recorded again and again in chroniccases of poisoning. The literature on the subjectis indeed enormous, as Dr. Helen Young found whencollaborating with Sir William Willcox and Dr. F. A.Pickworth in the preparation of the paper presentedat this meeting. Most regrettable of all is the pre-dominance of mental symptoms, and especially ofdepression, leading to frequent suicides. The first caseof directly fatal poisoning occurred in 1905. and thenumbers rapidly increased until 1913, when the groupwas put on Part II. of the Poisons Schedule ; in 1918it was transferred to Part I., and this resulted in adistinct drop, but in 1925 the numbers rose again to22, as the public began to find out the possibility ofusing medical prescriptions. Sir William Willcoxsaid that he regards these statistics as incomplete,for additional fatalities from these drugs may behidden in the class of " narcotic poisoning " or inthat of " broncho-pneumonia," since the comatosecondition so lowers the resistance of the lungs that atrue terminal broncho-pneumonia almost always soccurs. Most practitioners consider these drugsalmost harmless and prescribe them freely, butcertain investigators have always had their suspicions,and Sir William Willcox has already sounded a noteof warning. Never before, however, has he been soitncompromisingly backed by the weight of solidlaboratory evidence. Dr. Pickworth reported theexperiments carried out, under rigid control conditions,in Sir Frederick Mott’s laboratories at 13irirnin-haiyi.and showed that continued administration of these- drugs produces pathological changes in the centralnervous system which, although they usually dis-appear when the dose is discontinued, may neverthe-less become permanent. The chief phenomenon isthe deposition of a homogeneous mucinoid substancein the white matter of the central nervous system,This is believed to be a product of neural meta-

bolism, so that it must have an inhibitory effect onthe life of the cells. Moreover, it is present inconsiderable quantity, and probably causes pressureand affects the intracranial circulation. Conductionalong the nerve-fibres is interfered with, and a largepart of the narcotic effect is due to the damping downof visceral afferent impulses. When administrationof the drugs is still further continued, the cerebralcells shrink, lose their processes and stain poorly,and the Nissl substance is found to be reduced or evenabsent. It has been shown that these lipoid-solubledrugs render the lipoid envelope of the cell lesspermeable, so that tissue-respiration is embarrassedthroughout the body. There is a capillary dilatation,an increase in the flow of blood. and a slowing of thepulse. The resemblance between the comatosecondition induced by them and the condition of normalsleep is only superficial, and Dr. Pickworth found thatunder the influence of these drugs the margin betweensleep and fatal coma in cats was a very narrow one.The peripheral parts of the nervous system are mosteasily affected, and the centre more slowly. There wasdefinite evidence of a cumulative action, and of theexistence of addiction Sir William Willcox had nodoubt whatever. Nor, he maintained, is tolerance everestablished. He felt strongly that the danger of thesedrugs was not properly recognised. They should beordered only on a prescription marked " not to berepeated " and covering only six doses. The patientshould be warned against daily doses, and preferablyonly one should be given each week. He desired towarn practitioners most solemnly against advertise-ments, which urged the value and ignored the dangersof preparations of the barbituric acid group. Thepoisonous constituent was often concealed under afancy name, and a note in very small print. Heregarded the continued introduction of new prepara-tions, and the glowing advertisements accompanyingthem, as seriously misleading to the profession and agrave danger to the public.

E 107.

THE new anaesthetic, E 107 or avertin, to whichwe alluded in a recent annotation (THE LANCET,April 2nd, p. 718) is further described in the DeutscheMedizinische Wochenschrift of April 22nd, and we areinformed of its chemical nature, hitherto not divulged.The substance is tribromethylalcohol (CBr3CH2OH).It. decomposes on long exposure to light or in alcoholicsolution. From experiments with rabbits it appearsthat avertin is rapidly eliminated by the kidneys.50 per cent. of the amount administered being passedout into the urine in combination with glycuronicacid. The narcotic action of the anaesthetic is veryrapid, and, when it is injected intravenously, is almostinstantaneous. With excessive doses the respiratorycentre is rapidly paralysed. Further clinical evidenceis wanted before the drug can be tried with confidencefor operations.

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SOCIETY FOR RELIEF OF WIDOWS AND

ORPHANS OF MEDICAL MEN.

THE annual general meeting of this Society washeld at 11, Chandos-street, London, W. 1, on

May llth, when the report for the year 1926was presented. The Society has scored in its longwrangle with the Inland Revenue Authorities forrefund of income-tax as a charity under theFinance Act. In 1925 the Commissioners of InlandRevenue dissented from the decision of the SpecialCommissioners to grant rebate, and requested themto state a case for hearing in the High Court. Withincome-tax at 4s. in the pound the annual tax wouldamount to some £940, and the directors of the Societywere compelled to reduce the Christmas present inDecember, 1925, and the grants from the BrickwellFund in January, 1926. In June, 1926, however, whenthe case came up for hearing before Mr. JusticeRowlatt in the High Court, the Society obtained