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imported from China. It was alleged by the Japanesethat the hair used for the brushes had been disinfected,but bacteriological evidence in our own countryshowed that many samples examined containedvirulent anthrax spores notwithstanding the fact thatthe brush was wrapped up in a Japanese certificatestating that it was free from infection. As soon as itwas found that these brushes were causing anthraxendeavour was made to stop their sale. Of one

consignment of 40,000 brushes 30,000 were recoveredand many others were destroyed by their owners.Their importation into this country was forbiddenearly in 1920, and after this the outbreak subsided.It is of interest to mention that the Canadian Govern-ment purchased 200,000 shaving brushes for theirtroops from a New York firm, and that some casesof anthrax were traced to the use of these Americanbrushes. In the training camps of the troops of theUnited States a series of anthrax cases numberingbetween 40 and 50 were reported during 1918, andtheir origin was attributed to the use of new shavingbrushes, samples of which when submitted to a

bacteriological examination proved to contain -virulentanthrax spores. The Americans and the British werethe chief sufferers, being the two nations where shavingis almost universal.

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SUTURE OF ARTERIES.

PROBABLY few surgeons are familiar with the tech-nique of the anastomosis of blood-vessels. This is duenot to neglect, but rather, as is shown in an articleby J. )1. Neff,l to lack of opportunities. This writerclaims that any good surgeon should be able to suturean artery as readily as he would a stomach or intestine,and then seems to render the claim nugatory by makingit clear that conditions suitable for the anastomosis ofblood-vessels are hardly ever found. The techniqueof doing an end-to-end anastomosis between arteryand vein was of evident importance when direct bloodtransfusions were still being performed, but thisoperation is not even mentioned by Neff and certainlyis seldom used at the present time. Injury to a blood-vessel, as in gunshot or stab wounds, might be a morefrequent indication, were not the presence of anybacterial infection an almost certain cause of failure.End-to-end suture might sometimes be made necessaryby the removal of a growth involving a large blood-vessel, but here another cause of failure-namely,tension-is likely to be introduced. Arterio-venousanastomosis done for embolism, thrombosis, senilegangrene, or Raynaud’s disease, almost always fails.The few occasions, in fact, in which arterial suturewill be called for are almost.limited to closed fracturescomplicated by injury to a large vessel and to accidentalinjuries inflicted during the course of surgical opera-tions. Even here the example given by Neff is perhapsunfortunate, for a surgeon who injures the femoralartery during an operation for hernia is unlikely toperform successfully the delicate operation of arterialsuture. Nevertheless the claim made by Neff thatsuture of blood-vessels should be readily performed byany good surgeon is not invalidated by this restrictionof its field of usefulness. The value of the article liesin its demonstration of the principle, so often found tohold good in surgery, that the best method is thesimplest. The technique associated with the name ofCarrel should be adopted to the exclusion of allothers. Some form of arterial clamp is necessary ;beyond this no instruments are needed more specialthan fine scissors, dissecting forceps, and sewingneedles. Thin silk impregnated with paraffin is thebest suturing material. Redundant adventitia is cutaway from the vessels so that clean ends are obtained.Three equidistant sutures are then inserted and tied,and these are used as " guy-ropes," with the help ofwhich a continuous suture is put all round the circum-ference of the cut ends, so that accurate appositionis obtained. Delicacy of manipulation and asepsisshould make this technique sure of success in the handsof any reasonably skilful surgeon.

1 Surgery, Gynecology, and Obstetrics, December, 1921.

THE DROUGHT.

A HEAVY snow-fall soaking gently into the groundmay help to replenish the ultimate springs of waterin six months’ time or more. The article whichappears on page 148 draws attention to the presentshortage of water in England and Wales, which isinconvenient and disquieting, if not actually seriousat the moment. The public supply of water in sucha city as Bristol is turned off from 4 P.M. to 7 A.Il:. ;

Boston, Lincolnshire, is in dire straits ; Wetherby hasfound it necessary to arrange for a supply from Leeds ;and in various parts of Yorkshire where water isusually plentiful it is now being sold at ld. a bucket.It is natural for the rainy West and the Pennines notto take a serious view of the water shortage, andDevon is actually considering a project to harnessthe water power of Dartmoor to supply electricitythroughout the county; while in the Nid Valley thenew Scarhouse reservoir for Bradford city is to bebuilt by means of turbines actuated by waterpower from higher up the valley. Our specialcorrespondent touches on the obvious duties of thecitizen in regard to economy in the use of his publicsupply of water. It is encouraging to note thatthe shortage is not a world shortage, for in thereport of the New South Wales Metropolitan Boardof Water Supply, which has just reached us, theyearly rainfall for 1920-21 at each of the 11 obser-vation stations was so abundant as to exceed theaverage for past years by 30 per cent. or more.

GASTRIC ULCER AND TABES.

1K a paper read before the Section on Gastro-Enterology and Proctology at the last meeting of theAmerican Medical Association, Dr. Burrill B. Crohn,lof New York, calls attention to the fact that a fully-developed gastric or duodenal ulcer may be presentin tabes, although the discovery of such characteristicsigns of tabes as the Argyll-Robertson pupil or theabsence of deep reflexes may lead the practitioner toignore the possibility of a coexistent abdominallesion. The percentage of cases of tabes accom-

panied by gastric ulcer would be difficult to estimate,and in a general hospital in New York neurologicalcases as such are not treated in medical wards.While admitting that the presence of a gastric orduodenal ulcer in tabes may be a pure coincidencewithout any causal connexion between the twoconditions, Dr. Crohn ofters the following explanationof the association. Cerebro-spinal syphilis is accom-panied in a large proportion of cases by gastric hyper-secretion. Organic lesions of the spinal cord or brainoften cause delayed gastric motility and probablygastric peristalsis, these two conditions presumablypredisposing to gastric or duodenal ulcer. Syphiliticaortitis may also play a r6le. Dr. Crohn has beenunable to find any reference to syphilitic ulcer orgumma of the stomach or duodenum in a tabeticsubject suffering from gastric crises, and expressesthe opinion that the ulcers found in tabes are prob-ably simple peptic and not syphilitic ulcers, or

syphilis of the stomach. Three illustrative cases arerecorded in the quoted . paper. The first was

one of violent tabetic crises, with symptoms verysuggestive of gastric ulcer, the existence of which,however, could not be established. The secondwas a case of tabes, with predominant gastricsymptoms, and an apparent duodenal ulcer. Inthe third case advanced tabes was associated withvomiting, h8ematemesis. and melaena due to an

active bleeding duodenal ulcer.

A’r the social evening to be held on Jan. 25th atthe Royal Society of Medicine Prof. Elliot-Smith willdeliver a short address at 9 P.M. on the RhodesianSkull.

1 Journal of the American Medical Association, Dec. 2!th,1921.