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blood leaving the lungs had an inadequate amountof oxygen; moreover, the respiratory quotientand oxygen-consumption altered when the patientbreathed oxygen instead of air. The authorsconclude that in these neurotics there is an actual

oxygen deficiency of pulmonary origin, whichaccounts for their fatigue. It would have beenuseful if they had combined with their lactic-acidestimations an investigation of the glutathionecontent. The well-known difficulties in the wayof interpreting lactic-acid variations, to which theyseem to have given too little attention, make itinstructive to compare their findings with those ofearlier workers such as LooNEY and CHMDS p3 whomthey do not mention.

In a communication from the fatigue laboratoryof Harvard University THOMPSON, CORWIN, andASTE-SALAZAR 4 report that the differences in

schizophrenic subjects between the gaseous contentof arterial blood and that drawn from the internal

jugular vein are remarkably consistent-more sothan in a normal control group-and that theyfound no single physiological anomaly tested bythem to be characteristic of the schizophrenics,inasmuch as occasionally they found also inmembers of the normal group high arterial carbondioxide and low oxygen saturation, large differencesin the gaseous content of the venous and arterial

blood, and other variations. Fixity of the physio-logical processes which would, somewhat para-doxically, make physiological equilibrium difficult,was all that they could establish as peculiar to theschizophrenics, and they regard it as probably aconstitutional phenomenon which precedes theactual illness.Hard upon the heels of these reports comes an

informative review by HOSKINS 5 of the workdone during the past decade at Worcester, Mass., onoxygen metabolism in schizophrenia to which wehave already alluded. The chief findings werethe abnormally low range of the rate of oxygen-consumption (Benedict-Roth) and of blood volume,when this is referred to the surface area ; the

circulatory rate, measured by the cyanide arm-to-carotid method, was only 80 per cent. of the normal;the glutathione and lactic-acid levels in the bloodwere unduly closely related ; and the patientswere less responsive than normal persons to meta-bolic stimulants such as thyroid and dinitrophenol.HOSKINS thinks that the next step should be thestudy of the oxidative tissue reactions of materialobtained at biopsy ; one might object to this thatthere are not yet adequate normal data for com-parison. He says, more dubiously, that thedefective oxidation in schizophrenia may be dueto abnormal metabolites in the internal milieu,which serve as anticatalysts at some stage in theoxidation sequence, and that it may be possibleto detect these, using normal living tissue as thereactive system. Any work of this sort done onschizophrenia would require very critical scrutiny.

3 Looney, J. M., and Childs, H. M., J. clin. Invest. 1934, 13,963.

4 Thompson, J. W:, Corwin, W., and Aste-Salazar, J. H.,Nature, Dec. 18th, 1937, p. 1062.

5 Hoskins, R. G., Arch. Neurol. Psychiat., Chicago, December,1937, p. 1261.

INFANTICIDE

WRITING on her experience as a magistrate incases of puerperal insanity, Mrs. R. H. CROWLEYcomments 1 on the unfortunate emphasis at presentlaid on the criminal element. A mother sufferingfrom puerperal insanity kills her baby and perhapsattempts suicide. These are two indictable offences.The police are brought in. When well enough tobe charged, she is taken to the police-stationwhere the charge is read over and explained to her.She is then brought before the local magistratesand, in the London area, is probably committed toHolloway pending trial at the Central CriminalCourt. The result may be a sentence of detentionat a criminal lunatic asylum " during His Majesty’spleasure," or, if her family can afford to pay forit, release on condition that she enters a mentalhospital for treatment. Mrs. CROWLEY’s experi-ence as a magistrate leads her to think that themedical aspect is too little considered. Inci-

dentally she mentions seeing a few years ago inone of our provincial prisons an obviously distraughtyoung woman in a cell with one side consisting ofupright iron bars, caged like some savage animal.Inquiry of the prison governor elicited the informa-tion that this was a young mother awaiting trialfor infanticide apparently committed under theinfluence of puerperal insanity. These were theconditions in which the community detained herfor observation and presumably for treatment.

Puerperal insanity is said to occur approximatelyonce in every 700 labours, usually within six weeksof confinement. Lactational insanity comes laterand is less severe. The law still treats as murderthe case where a mother deliberately kills her baby.These cases seem to be rare. The latest availablecriminal statistics show that only eleven personswere prosecuted in the year for murder of a childunder one year of age. Out of this total (which wasnot restricted to mothers) nobody was found guiltyof the major offence of murder. If a verdict ofmurder is returned, the judge must pass sentenceof death, though the capital sentence is not goingto be inflicted. In 1922 the Infanticide Act madeit possible to pass a non-capital sentence, as formanslaughter, where the victim was a newly bornchild and where the mother, at the time of thewilful act or omission which caused its death" had not fully recovered from the effect of givingbirth to such child and by reason thereof thebalance of her mind was then disturbed." Unfor-

tunately this effort of humanity, enacted mainlyat the instance of judges who detested the duty ofthe death’sentence, was largely negatived by adecision of the Court of Criminal Appeal. InR. v. O’Donoghue the trial judge was held to havebeen correct in deciding that, where a baby wasborn on August 19th and the mother took its lifeon Sept. 21st, there was no evidence fit to be leftto the jury on which they could be asked to holdthat the baby was " newly born" within the

meaning of the Act. Lord DAwsorr’s InfanticideBill, which appeared in print just before Christmas,

1 Policewoman’s Review, December, 1937, p. 72.

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proposes to eliminate the word "newly born,"and to substitute for the words in the 1922 Act

already cited the words " had not fully recoveredfrom the effect of giving birth to such child,including the effect of lactation following uponsuch birth, and by reason thereof the balance ofher mind was then disturbed." The Bill alsocontains a proviso to make clear that its provisionsmay apply up to the time when the child is twelvemonths old. This is a most desirable reform, butit still does not wholly cover Mrs. CROWLEY’s

point-namely, that the accused mother is a fittersubject for observation and treatment in a mentalhospital than in a prison cell. It seems indeed

unjustifiable that such cases should be remitted toany place associated with the custody of criminals.The effect of prison must be deplorable; even

worse perhaps is the prospect and the ordeal oftrial in the Central Criminal Court. There seemsno reason why the administration of justice shouldnot find a better way ; recourse to statutoryamendment of the law may not be essential.Suicide is no longer dealt with under the rigidroutine of criminal justice. Parliament has notaltered the law, but the police and the magistrateshave quietly reformed it. In the introduction tothe Criminal Statistics for 1930 we were told thatin recent years it has not been the practice toprosecute for attempted suicide unless specialreason exists. The special reason is usually inter-

preted as meaning the need to place the patient incustody for his own protection. The acceptedmodern practice in respect of attempted suicides ishospital first, and criminal prosecution eitherafterwards or, far more commonly, not at all.Infanticide, to use the word in a general andnon-statutory sense, might well be dealt with inthe same spirit. Like all other proposals forreform, the problem may prove less simple thanthe reformers suppose. The authorities concernedwith the administration of criminal justice cannotbe expected to overlook the occasional instances ofthe wilful murder of the unwanted child. Thefather of the child may resent the suggestion ofthe certification of his wife, or her commitment toa mental hospital in respect of what may prove abrief period of delirium, quite as much as publicopinion resents the present arrangement of com-mitment to prison. The shorter the period, thegreater perhaps would be the difficulty. The

provision of suitable accommodation in an appro-priate hospital may be the main crux. The prisonmedical service is enlightened and humane ; itcommands the confidence of the courts and of the

public. The prison infirmary, however, is scarcelythe ideal place for patients suffering from puerperalpsychosis. These difficulties must be faced. The

community cannot be satisfied with a system whichsees in the distraught mother just another criminallunatic.

ANNOTATIONS

POSTHUMOUS HONOURS

IT has been suggested that admission to the

Dictionary of National Biography carries with it apassport to Heaven ; if this is going too far, at leastany " Worthy " (the dignined term applied in theindex to those whose names are included) achieves.an enviable measure of temporal immortality. The

supplement now issued covers the toll of less than adecade (1922-1930). Doctors may find just causefor pride in the number of their colleagues portrayedin this distinguished gallery. The first we meet isJohn George Adami, who did much to forge the linkbetween pathology and clinical medicine; other

pathologists honoured by a place include SamuelGeorge Shattock, one of the first to give whole-timeservice to his subject, and Adrian Stokes who diedat 40 of yellow fever whilst investigating that diseaseat Lagos. Physiology is represented by John NewportLangley, Noel Paton, William Bayliss, and ErnestStarling, names familiar to every medical student.A pharmacologist, Arthur Cushny, and a bacterio-logist, William Leishman, complete a formidablelist of laboratory workers. Louisa Aldrich-Blake,the first woman to become master in surgery in the

University of London, was best known as the dean ofthe London (R.F.H.) School of Medicine for Womenin its years of great development during the war.Among the physicians, Clifford Allbutt will beremembered for many reasons, not the least, perhaps,for his " scholarly care in the use of words." Next,in alphabetical order, come William Selby Churchand Dyce Duckworth-two wise and whole-heartedphysicians-and David Ferrier whose work on

1 Edited by J. R. H. Weaver. London: Humphrey Milford,Oxford University Press. 1937. Pp.962. 28s.

the localisation of cerebral functions made modernneuro-surgery a practical possibility. Here also areJames Mackenzie, the general practitioner turnedcardiologist ; Patrick Manson, the father of tropicalmedicine ; Frederick Mott, neuro-pathologist;Richard Douglas Powell, physician-in-ordinary to

Queen Victoria ; and John Thomson, the pmdiatri-cian. Among the surgeons we find the names of

Anthony Bowlby, Rickman Godlee, William Macewen,Thomas Teale, and, lastly, Frederick Treves, whowrested " perityphlitis " from the medical wardsand cured it by surgery. Here also will be found

Mary Ann Scharlieb, one of the first women gynaeco-logical surgeons and, no less fittingly, Francis Champ-neys, one of the last of the obstetric physicians.Oto-laryngology is represented by Arthur Cheatle andWilliam Milligan. But there remains a small groupconsisting of those who, having qualified in medicine,subsequently played truant and excelled in otherspheres of activity. Such were Stephen Paget, whocombined surgery with biography and the writing ofessays, and Hugh Kerr Anderson, who started as aphysiologist and came to wield, as Master of Gonvilleand Caius College, an influence which was the greaterfor his sensitive and modest bearing. John Kirkforsook medicine for natural history; AlexanderWollaston for exploration ; Thomas William Smarttfor politics ; and Arthur Conan Doyle and RobertBridges for letters. Edward Granville Browneturned his medical knowledge to good account in hisoriental researches.

’

Doubtless, in a brave new world, it would bedecreed that books of reference should be dull, lest,as with this one, the earnest student might be dis-tracted from the matter in hand by the fascinationof the text adjacent, but not relevant, to his parti-