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enforced. It is, of course, a form of by-law whichhad been in existence in many other towns before thePublic Health (Smoke Abatement) Act, 1926, wasplaced on the Statute book, but I believe that morerecent by-laws have been approved only with threeminutes emission per half-hour substituted for twominutes. The epithet " black " is also always insistedupon, although Section 2 of the Act would appearto allow some latitude as regards the density ofsmoke for by-law purposes.

It appears to be true, however, that no localauthority has so far been allowed to exercise its

power to make by-laws for requiring new buildings,other than private dwelling-houses, to have such

arrangements for heating or cooking as are calculatedto prevent atmospheric pollution, a power conferredupon them by Section 5 of the Act.

I am, Sir, yours faithfully,Cardiff, Nov. 28th. RALPH M. F. PICKEN.

DETECTION OF THYROTOXICOSIS

To the Editor of THE LANCETSIR,-Several interesting points are raised by

Dr. Brazier in your last issue. Experience hasshown that the clinical value of any test for thyro-toxicosis may be gauged by its specificity in border-line cases. There can be no difficulty in diagnosingclinically, by inspection, the typical case of Graves’sdisease, in which the basal metabolic rate and

impedance-angle values are both altered. On theother hand, in obscure cases where the basal metabolicrate and impedance angles are within normal limits,our experience in diagnosis agrees with that of Mr.Joll who remarked in your columns a fortnight agothat "the method of checking -B.M.R. estimationsbefore and after saturation’ of the patient withiodine will ... prove in the long run to be infinitelymore exact than ... any other test at presentavailable." Impedance-angle determinations, as wehave reported, do not alter with iodine therapy.This fact unfortunately precludes the use of impedance-angle measurements in an investigation of this kind.Although little use is made of them in this country,

satisfactory techniques are available for the determina-tion of the basal metabolic rate on out-patients.

We are, Sir, vours faithfully,J. D. ROBERTSON,A. T. WILSON.

Courtauld Institute of Biochemistry, MiddlesexHospital Medical School, W., Dec. 1st.

PROTEIN SHOCK THERAPY IN TYPHOID

To the Editor of THE LANCET

SIR,-May I, through you, ask Dr. C. E. Price tobe good enough to give us further information aboutthe results of this treatment in typhoid. I draw theconclusion, rightly or wrongly, that the fatality oftyphoid cases treated in this way by him and Dr.Stejskal has been zero or nearly zero. Is that correct ? °?I should like to see reports of a series of cases insufficient numbers and of the same clinical character,treated by protein shock and not so treated ; thetyphoids should be distinguished from the para-typhoids. At the present time, fortunately for us,enteric fever is not frequent enough in this countryfor it to be possible to obtain here the informationI ask for. Some years ago I treated a few cases bywhat would now be recognised as protein shock.I found that the effect in any given case could notbe foretold. In some cases it appeared to be good,in others it was indifferent but rfot harmful (see" A Text-Book of Infectious Diseases," p. 658). I thinkthat, according to Dr. Price’s experience, I did not

give the protein in large enough doses nor by thebest, that is the intravenous, method assumingthat the intravenous injection does produce theresults claimed for it.-I am, Sir, yours faithfully,Hampstead, Dec. 3rd. E. W. GOODALL.

INTRAVENOUS ALCOHOL AS AN ANALGESICIN LABOUR

To the Editor of THE LANCETSIR,-May I suggest a possible method of shortening

and rendering painless the second stage of labour 1It is to inject at the onset of this stage alcohol intothe median basilic vein of the arm in sufficientquantity to cause definite intoxication with possibly’a subsequent light coma. By using this route insteadof the oral one only a small proportion of the alcoholgiven would pass through the liver which may besensitive to any form of toxins during pregnancy.The advantages would be :-

(1) Efficient analgesia for a sufficient period of time tocomplete labour in an uncomplicated case. The efficiencyof alcohol as an analgesic is amply demonstrated in theout-patient department of a general hospital where thebroken leg of an intoxicated patient may be placed inplaster-of-Paris without complaint.

(2) A shortening of the second stage of labour throughthe temporary depression of the higher psychical centresassociated with fear and nervousness, enabling the expulsivemechanism to act more efficiently.

(3) A post-partum partial amnesia of the second stage.The possible disadvantage of an increased excita-

bility and restlessness in a certain type of patientwould be outweighed by the advantages. The

quantity, dilution, and technique of injection wouldrequire preliminary research.

I am. Sir. vours faithfullv.Woodlands-road, S.W., Nov. 29th. S. C. S. COOKE.

SERUM PROPHYLAXIS AND PUERPERALSEPSIS

To the Editor of THE LANCETSIR,-The persistent high mortality from puerperal

sepsis has made even the most complacent advocateof normalcy in parturition dubious. Is it too muchto hope that it may do more ; that it may inducethe medical man to view pregnancy in the civilisedwoman as a morbid state ? For that, to the immuno-logist, is what it is. Pregnancy lowers a woman’sresistance to all infections ; it prepares her for thestreptococcus.The outset of the last general war found medical

opinion prepared to accept tetanus complicatingwar wounds as inevitable, for not until 1915 wasantitetanic serum used prophylactically in all cases,and the case-mortality reduced from 53 to 22 per cent.To-day any lacerated street wound is treated withantitetanic serum, and frequently anti-gas gangreneserum, although the risk of these complications is

slight. But the lacerated wounds of parturition,with their high menace of streptococcal sepsis,find the doctor in a state analogous with that of thewar surgeon of 1914 ; and streptococcal antitoxicserum, universally administered to the moribundinfected, is withheld from the potential victim ata stage when it would certainly do good. There is a

story of Pasteur, facing a meeting of obstetricians,then as now discussing puerperal sepsis. " But I doknow what causes it " he said, and showed them astreptococcus. The bacteriologist is still showingthem streptococci, and has indeed found many newtypes. But he has also produced antitoxic serum.Antitoxic serum administered to a rabbit is a

complete protection against streptococcal toxin and