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to be desired not only for sanitary but also for economicreasons. Unfortunately, the extermination of the rat is afar more difficult problem than that of the domestic fly.Though each householder, shopkeeper, and shipowner canperform his own share of the necessary work, united actionby local and central authorities is also essential if the

numbers of the malignant rat are to be perceptibly reduced,total extermination being apparently impossible under

present conditions. The rendering of dwellings, stores, andwharves reasonably rat-proof is likewise indispensable. If,therefore, the public authorities are not impelled to move inthis direction on medical grounds alone, there is a verystrong incentive to immediate action strictly upon economicconsiderations, which, perhaps, are more likely to appeal tothe sympathies of the public all the world over.

MAN AND HIS FORERUNNERS.

IT was one of the most heartfelt pleadings uttered by thelate Professor Dwight, of Harvard, that we should stop fromtime to time in the march of science; pause for howeverbrief a spell, just to look back to see where our ideas hadcome from, and to look ahead to see where they were leadingus. He made this charge against the men who were labour-ing at the problems of evolution, that once the idea hadstarted making progress not one of them paused to make areasoned survey of the premises, or considered the logicaloutcome of pushing those ideas to a conclusion and present-ing the final product to the world. There is no study inwhich this stock-taking process is more necessary than thatwhich concerns itself with the geological story of man. Everyfresh find, whether of actual bones or objects of culture,dictates a pause ; it is not enough to attempt to fit the newmaterial into some gap in a preconceived scheme ; for thematerial must be judged on its own merits and the scheme, ifnecessary, be recast for its reception. Within the last two

years our knowledge of the early remains of man has beenadmirably summarised in three separate publications, eachmarked with its own distinctive individuality, by Keith,Sollas, and Duckworth. These excellent réS1tmés of the

story of ancient man were all issued before the discovery ofthe remains of the individual, now famous as ’’ the Piltdownskull," was made known to the public ; but recently there hasappeared an English translation of the work of Professor

H. v. Buttel-Reepen, which incorporates this Sussex find

among the forerunners of modern man.x We have thereforean entirely up-to-date review of the position to which thestudy of the early human forms has attained-a position fromwhich it is possible to take some survey of the past and of thefuture. It is curious to look back only 50 years in the story ofthe study of the history of man. It is less than 50 yearsago that Huxley was seriously concerned in a vigorous andweighty reply to Professor Mayer, of Bonn, and it is almoststartling to-day to think that this fighting effort was made inorder to refute Professor Mayer’s assertion that the celebratedNeandertal skull had belonged to no one more interestingthan I I a rickety Mongolian Cossack belonging to one of thehordes driven by Russia, through Germany, into France in1814." " The exactly similar debate that was waged aroundthe Trinil find of Dubois is a more familiar subject, and inEngland Cunningham and Keith took up the cudgels indefence of the antiquity and primitive characters ofthe Java man. Each fresh discovery has had pitchedbattle waged around it ; and from some the smokeof battle has not yet cleared away. It is healthyand proper that this atmosphere of doubt and debateshould be the one into which such ancient relics are

1 Man and His Forerunners. By H. v. Buttel-Reepen. AuthorisedTranslation by A. G. Thacker, A.R.C.S Lond. With a frontispiece,70 figures in the text, and three tables. London: Longmans, Green,and Co. 1913. Pp.96. Price 2s. 6d. net.

born, for from the conflict of the views of the extremiststhe mean, which probably lies nearest to the truth, is apt tobe chosen and accepted as currency in the end. So manydebates, have been won and lost that it will probably strikethe attentive reader of more recent work that there may, inthe near future, be danger of a lack of healthy opposition tothe acceptance of new finds. From the controversies of the

past Neandertal man and Pithecanthropus have emerged asorthodox and accepted axioms, and now is added Eoanthropusdawsoni. Eoanthropus dawsoni has not had his baptism offire. It must be remembered that while Huxley was attackingMayer, of Bonn, he was equally engaged in refuting the viewsof Professor King, for if the Cossack idea of the one struckHuxley as being too homely, the assertion of the other that theskull was not only specifically but generically distinct fromman was far too revolutionary for him. May not history repeatitself ? 1 Professor Buttel-Reepen says of the Piltdown skullthat it I has been placed by Woodward not only in a newspecies, but-an extreme step-in a new genus, and has beengiven the name Eoanthropus dawsoni." The Piltdownindividual has had a peculiarly fortunate genesis, for he hasbeen ushered into the world under a geological segis so dis-

tinguished that he takes rank at once as a representativeof late Pliocene or early Pleistocene times. But it seems.

not impossible that the geological distinction of his rebirthmay be in danger of permitting him to pass to his placewithout running the gauntlet of battle waged around theearlier finds. He has come to his place in the lay mind, hehas found his way into printed books and into tables andschemes; his relationship with other early types is guessedat, presumed, or asserted ; and yet, anthropologicallyspeaking, his battle is unfought. As a geological relic hehas taken permanent and proper place, but as an anthro-pological type he remains unchastened by criticism. He is

late Pliocene or early Pleistocene, but is he Eoanthropus-a genus distinct from Homo ? 1 It is for questions such as.

these that the pause and the stock-taking are required.

HERPES ZOSTER SIMULATING DISEASE WITHINTHE ABDOMEN.

THE eruption of herpes zoster may be preceded for somedays by pain, and then a wrong diagnosis may easilybe made. In the Journal of the American Medical Associationof May 31st Dr. L. Litchfield has reported two cases inwhich intra-abdominal disease was suggested. In the first,a widow, aged 45 years, suffered from severe pains over thecourse of the left ureter, with exacerbations at night whichkept her awake. The pain was not influenced by meals,defalcation, or micturition. On deep pressure tendernesswas elicited over the left ureter and nowhere else. Owingto the apparent urgency of the case radiograms were at

once taken. On the next day the eruption of herpes zosterappeared in the site of the pain. In the second case Dr.Litchfield’s opinion as to the advisability of immediate

operation was sought by colleagues. On Oct. 2nd, 1912, hesaw a woman aged 70 years. She was taken ill on

Sept. 25th with severe pain across the upper abdomen whichkept her awake most of the night. On the following daythe pain was less, but at night it again became severe.On Sept. 26th and 27th the pain was accompanied by abdo-minal distension and she vomited. On the 29th she was

somnolent; she could be aroused, but immediately went tosleep again. The bowels were kept open from the beginningby calomel and other means. On Oct. lst gall-stones werediagnosed and immediate operation was recommended by asurgeon. On the 2nd the abdomen was much distended.

The pain had not been severe since Sept. 28th. There was

a well-marked eruption of herpes zoster in the right hypo-chondriac and subscapular regions. At first the rash was

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:attributed to mustard plasters and turpentine stupes whichhad been used. Only when characteristic vesicles were dis-covered in the same segment posteriorly was the nature of ’,the case recognised. Close inspection of the anterior I

,patches showed the characteristic grouped vesicles of

herpes zoster. Marinacci has reported a case of herpes zosterin which intense pain across the lower abdomen with markedtenderness in the hypogastrium and both iliac fossae, fever,small frequent pulse, persistent vomiting, hiccough, anddrawn face suggested peritonitis. Dr. Henry Head hasmentioned the fact that cases of herpes zoster in the pre-eruptive stage have been admitted to London hospitals asexamples of pleurisy and pneumonia.

ACUTE UNILATERAL NEPHRITIS.

AN interesting account of the condition of acute unilateralnephritis with the report of a case is published in the

Archives of Internal Medioine of June 15th, by Dr. DavidRiesman and Dr. George P. Muller, of Philadelphia. The

patient was a woman, aged 22 years, who was seized in theearly morning with sudden pain in the left loin after vomit.ing. The temperature rose to 1020 F. and the pulse to 120.There was rigidity of the lumbar muscles, with tendernessin the costo-vertebral angle. The leucocytes were 7000

,per cubic millimetre on the first day, but two days later hadrisen to 13,000. The urine was highly coloured, contained.albumin, and on microscopical examination showed hyalineand granular casts, but no pus cells. The pain and fevergradually subsided, but the rigidity persisted. About

a week after the onset of the attack the patient insistedon getting out of bed, after which her symptoms re-

curred, and pus appeared in the urine. The pain wasin the left loin and left hypochondrium, radiating at timesdown to the groin, at others to the back. There wastenderness to pressure at the costo-vertebral angle extendingforwards to the crest of the ilium. There was rigidity of themuscles in the loin, with some fulness on palpation, but notumour could be felt. At this time examination of theurine showed erythrocytes and pus cells in addition to thealbumin and casts. Unilateral infection of the kidney wasdiagnosed. Hot fomentations were applied to the kidneyregion, and urotropine, abundant water to drink, liquid diet,and purgation were prescribed. For about ten days thepatient varied, sometimes improving, but eventually relapsing.Her temperature continued at about 102°, and her generalappearance indicated increasing sepsis, so that an operationwas deemed advisable. The symptoms were throughoutunilateral and localised in the region of the left kidney. Atthe operation the perinephric fat was found to be infiltrated-and inflamed, and on further exploration an abscess wasopened containing 3 or 4 ounces of thick pus. On exposingthe kidney it was found to be the seat of a diffuse suppurativeprocess. Nephrectomy was performed and the patient slowlyrecovered. She was discharged 44 days after admission to the.hospital with a small sinus which closed shortly afterwards.About six weeks later a swelling of the right submaxillarysalivary gland developed and pus was found to exude fromWharton’s duct. Examination by X rays showed the

presence of a calculus. The gland was removed under- ether ansesthesia. Subsequently the patient became

pregnant and miscarriage occurred. About 10 monthsafter the original attack she was passing an average of f40 ounces of urine in 24 hours, the urine being normal incharacter. Examination of the pus in the kidney at thetime of operation and later of the discharge from the’wound showed the presence of micrococcus pyogenes aureus.Dr. Riesman and Dr. Muller, in discussing the origin of’unilateral nephritis, maintain that although infection may

occur by an ascending invasion from the bladder or bylymphatic infection from the intestinal tract or fromthe lower urinary organs, the common origin is byhmmatogenous infection. They believe that most cases

of pyelonephritis are probably unilateral in the be-

ginning. They also state that the great majority of

cases of unilateral nephritis have occurred in women,and the explanation they offer is that it is due to the

frequency of displacement of the right kidney and thegreater tendency to intestinal stasis in that sex. FollowingBrewer, they describe three types of unilateral nephritis, asevere one in which the local symptoms are obscured by anintense toxaemia, and an intermediate type with severe

initial symptoms but without grave toxasmia, going on, how-ever, to renal abscess, perinephritic abscess, pyelonephritisor pyonephrosis unless recognised and treated ; the thirdform is of mild character, with tenderness over the costo-

vertebral angle as the only symptom, frequently mistaken forsubacute appendicitis or cholecystitis. To this they add afourth type in which the chief and perhaps the only symptomis hasmaturia. The treatment recommended is that theacute form should be operated upon as soon as the diagnosiscan be made, nephrectomy or nephrotomy being performed.In mild cases rest in bed, milk diet, urinary antiseptics,purgatives, and abundance of water usually suffice to bringabout recovery.

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THE ENDOWMENT OF MEDICAL RESEARCH.

WE are not without examples in this country of

magnificent generosity for philanthropic purposes, thoughso far they have mainly been of one pattern. The benefitsderived from increasing knowledge of pathology are con-

stantly placed at the disposal of our sick poor by charitablerich. This is the side of philanthropic endeavour that mostinsistently thrusts itself upon the practical man. We mayrefer, for example, to the munificence of the late Mr. GeorgeHerring, who, besides large donations during life to hospitalsand the Hospital Sunday Fund, to the Salvation Army’sphilanthropic work, and to the establishment and endow-ment of various charitable institutions, bequeathed at

his death in 1906 the residue of his vast estate to the Metro-

politan Hospital Sunday Fund. But before philanthropicendeavour can effectively be applied to the relief of sufferingknowledge must first be gained, and the work of those whodevote themselves to seeking that knowledge and estab-

lishing therefrom the principles of action whereby suchknowledge can effectively be applied must be adequatelysupported. The endowment of research, therefore, serves

humanity, as it were, in geometrical progression, for as

achievement is added to achievement in knowledge methodsof application become multiplied many fold. Suppose thatan absolute preventive of and cure for cancer were discoveredto-morrow, can we doubt that money in abundance would be

forthcoming to help to distribute its benefits as widely aspossible ‘! Everyone could see the practical utility of that.But it is a far harder matter to get money to search for sucha cure. The reason, doubtless, is because the cure once found,its application is speedily fruitful of obvious results-thereis a sure return for the money expended-while moneylaid out in research offers merely a possibility of definiteresults being derived therefrom in the uncertain future.Public spirited men in America are more alive to the

pregnant possibilities of research from the practical pointof view, and are more ready to devote money to its prosecu-tion, secure in the conviction that sooner or later it will

fructify to the good of suffering humanity. Recentlythe American Ambassador, Dr. Hines Page, startled his

English hearers at the dinner of the Anglo-Saxon Clubby the announcement that the sum of 100 million dollars