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and the symptoms disappeared in a few days.In a third case an infant, aged 9 months, hadbeen fed on a milk prepared with peptogenicmilk powder, upon which it had thriven. Fromthe beginning of the eighth month it had ceasedto gain weight, becoming fretful, with loss of

appetite and sleep. These symptoms were attributedto teething, although no teeth were present. Theonly suggestive sign was some oedema of thelower limbs and perhaps slight pain on deep pres-sure over the spines of the tibise. Orange juice andfresh milk were given and the powder discarded. Ina week all symptoms had disappeared. In a fourthcase a child of 10 months was fed on a proprietarydextro-maltose preparation and pasteurised milk,on which it did well up to 8-2L months. From thistime it ceased to gain weight, or gained only slightly.Anorexia then ensued, only half the amount offood being taken. For two or three weeks there hadbeen slight fever (100’5°F. at night), with fretful-ness and sleeplessness. As usual, the symptomswere attributed to teething, and two upper incisorswere erupting. Careful examination revealed only-slight exaggeration of the knee-jerks. On stoppingthe malt food and giving fresh milk and orangejuice the infant’s condition quickly became normal.Not one of these infants showed the classicalpicture of scurvy. Indeed, two of them wouldhave been impossible to class as such butfor the therapeutic test. This form of scurvyhas been described also by an American writer,Alfred F. Hess, as " latent scurvy," characterisedby stationary weight, pallor, anorexia, and generalwant of well-being, quickly disappearing underantiscorbutic treatment. No doubt, as Dr. Millerremarks, it is not uncommon, although not gene-rally recognised. It then either ends in spon-taneous recovery or progresses to a well-definedform. Hess has shown that it can be produced bypasteurisation of milk. Bi-pasteurisation seems tohave been a factor in some of the above cases.Dr. Miller appears to have given a satisfactoryexplanation of some of the cases labelled " denti-tion " for want of a better diagnosis.

CAMPHOR IN CARDIO-VASCULAR DISEASES.

THERAPEUTIC observations by Professor Marfori,1 Iof the University of Naples, with regard to theaction of camphor on the cardio-vascular system,have brought to light certain properties whichdeserve attention. Hitherto this drug has beenlooked upon as the last resource to prolong the lifeof a diseased and exhausted heart, and injections ofcamphorated oil have been almost exclusively re-served for counteracting cardiac collapse in acuteinfective disorders or the threatened paralysis of thelast stages of heart disease. Professor Marfori andhis assistant, Dr. G. Leone, found that the isolatedmammalian heart, when poisoned by chloral so as torender the pulsations barely perceptible, could berapidly restored to action by camphor, and further-more, that its action on the circulation was verycharacteristic, as it could be proved that small dosesinvariably caused a diminution of arterial pressureand at the same time increased the volume of thecardiac pulsations. Only toxic doses of camphorgive rise to increased arterial pressure, accompaniedby convulsive phenomena which seem to be inde-pendent of the vaso-motor centres, as they areobserved even during profound narcosis when thesecentres are randered inexcitable. Hence during thecourse of chronic myocarditis with simple cardiac

1 Il Policlinico, Practical Section, June 17th, 1917.

insufficiency, changes in rhythm and auricularfibrillation, Professor Marfori considers no other

drug can compete with camphor in sustaining theactivity of the heart and steadying the pulse. Henoticed that the beneficial effects obtained werecontinued after the drug was suspended, butrecommends systematic treatment for a longperiod by giving one, or two, daily hypodermicinjections of 0’10 gramme in oily solution.These doses may also be given by mouth as

they are well borne. In valvular lesions, when dis-turbance of the pulmonary circulation and hyper-tension in the right ventricle predominate, camphoris the most rational and efficacious remedy. Thedrug is also quite useful in the pulmonary sclerosisof tuberculosis and in arterial hypertension withhypertrophied heart, vascular spasm of climactericorigin, and arterio-sclerosis ; it is capable of in-ducing beneficial changes in disordered functionof the myocardium and especially of the rightventricle. In conclusion, Professor Marfori saysthat camphor must no longer be considered merelyas a remedy in the hour of death, but rather as adrug which, when intelligently administered, iscapable of producing beneficial results throughoutthe entire course of various cardiac and vasculardiseases owing to its special properties, which aredistinct from those of other heart drugs.

LEAD POISONING IN CHIL DREN

LEAD poisoning in children is a condition whichhas received little or no attention in this country.Many cases have, however, been observed in Australia,and articles which have appeared in the medicaljournals there from time to time during the last 25years constitute the important literature of the sub-j ect. As the symptoms differ somewhat from those inadults, on which all text-book descriptions are based,lead poisoning in children is probably often over-looked. One way in which Australian children havebeen poisoned is by contaminating their hands withthe dried paint of railings and walls and then suckingtheir fingers or biting their nails. In the AmericanJournab of the Medical Sciences Dr. K. D. Blackfan,of Baltimore, has published an important paperon lead poisoning in children and reported fourcases. In early cases a change in disposition isoften the first symptom noticed. The child growsfretful, peevish, and often very restless at night.The appetite declines, the breath is foul, and fre-quently haemorrhages from the gums occur. Thechild may complain of pain in the epigastrium andlegs. In cases of longer duration the pains in theabdomen become continuous and more severe.

Constipation is the rule and vomiting is rare. Themuscles are often so painful as not to permit of theweight of the bedclothes. The gait is described ascharacteristic. It is waddling; the patients walkon the outside of the feet, the toes are dragged,and with each step the legs are swung sidewaysbefore the feet are put to the ground. The atten-tion of the parents maybe attracted by one or more ofthese symptoms, but frequently nothing is observeduntil cerebral manifestations, such as convulsions,occur. Very few of the cases show the charac-teristic wrist-drop of adults. Paralysis of cranialnerves is usual, the facial and motor oculi, entirelyor partly, being most frequently affected. Opticneuritis is also common. As a rule the tempera-ture is normal, but it may be irregularly elevated.In fatal cases, especially in those with cerebraldisturbances, it may rise as high as 105° or 106° F.before death. In early cases the symptoms may beonly suggestive. Then other evidence, such as the

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blue line on the gums and stippling of the redcorpuscles, may be found. Direct evidence oflead poisoning may be obtained by finding themetal in the urine or faeces. The following aretwo of the cases reported by Dr. Blackfan. A boy,aged 2½ years, on March 8th, 1915, had a convulsionfrom which he recovered. On the 12th he wasbrought to hospital in convulsions which continuedfor 24 hours. They involved the eyes, the left sideof the face, and the left arm. There were a leuco-

eytosis of 19,000, stippling of the red corpuscles, alead line on the gums, and an enlarged spleen. Thefundi were normal and lead was not found in theurine. On March 26th convulsions involving theface and left arm recurred. They continued for 24hours; the temperature rose to 107’5°, and he died.His father stated that he would gnaw any paintedarticle and that he and his brother had ruined a setof parlour furniture by eating the paint off it. Inanother case a boy, aged 3 years, became drowsyon July 30th, 1915, refused food, and vomited.At night he was delirious. On August lst hebecame comatose and had several convulsions.On the next day he was admitted to hospital. Therewas a lead line about several of the upper teeth,and a few of the red corpuscles were stippled. He

lay in a condition of stupor for two or three days.There was a tache eiribrale and the neck was

rigid. On the 5th he was much better, sat up inbed, and could walk, but there was incompleteparalysis of the right facial nerve. By the 12thhe had quite recovered. The source of the

poisoning was not known.

THE PROTECTIVE FUNCTIONS OF THE SKIN.

THE function of the skin as a mechanical pro-tection to the organs which lie within it is soobvious that it may have led to the overlooking ofother equally important protective functions. The skin as a whole may, of course, be regarded as anorgan with a common and complete function of itsown, to which view testimony is borne by the com-plete way in which it suffers in certain infectiousdiseases, such as scarlatina and variola; and itshould be noted that it is precisely these infectionsin which the skin plays a large part where per-manent or nearly lifelong immunity results. Pro-fessor B. Bloch, head of the dermatological clinic inZiirich, discusses some of these immunity problemsin relation to the skin in a novel and suggestive wayin the Correspondenz-Blatt für Schweizer Aerztefor August 4th. He notes how seldom generalparalysis or tabes is associated with a cutaneous

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gumma in the same patient and how rare it is tosee these late parasyphilides at all in countrieswhere in consequence of defective treatment severetertiary lesions are common in the skin. He quotesthe statistics of Mattauschek and Pilcz to confirmthe relative infrequency of tabes in patients withearly abundant cutaneous involvement. Takentogether these and similar observations lead Dr.Bloch to lay great stress on the allergic functionof the skin, its reaction to an unwelcome intrusionof which it has once had experience. The classicalresearches of Richet, v. Pirquet, and Romer haveshown how the cutaneous manifestations oftubercle are influenced by this function of allergywhich regulates their clinical course as wellas the anatomical structure of the tuberculousnodule itself. Cutaneous tuberculides are nothingelse but the reaction of the forewarned skinof the chronic consumptive to any isolatedbacilli brought by the blood stream. Historically

it has been from studies of the skin-beginningwith Jenner’s vaccination and Koch’s funda-mental experiment of tubercle inoculation in theguinea-pig-that most light has been thrownon problems of immunity. Due in part to thefact that the skin is so favourably situated forexact observation, the fact probably remains thatit is to the external covering of the body which wemust look for the most important workshop of theimmunisation. The struggle against attackingmicrobes from without has slowly adapted theskin and given it the ability to react against theparasites themselves as well as their toxins withthe process which we now know as allergic inflam-mation. This function has been gradually acquiredin the history of the race and of the individual,since neither the skin of the lower animal nor ofthe new-born child reacts in at all the same

way as that of the human adult. In this qualityDr. Bloch sees one of the most important relationsbetween dermatology and general medicine.

THE inaugural address at the London (RoyalFree Hospital) School of Medicine for Women,

, Hunter-street, W.C., for the session 1917-18 will bedelivered by Dr. Louisa Garrett Anderson, C.B.E.,

, on Monday, Oct. lst, at 3.30 P.M., the subject being" Ambition."

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WAR SERVICE AND THE MEDICAL MAN :

PENSIONS, GRANTS, AND ALLOWANCES.

WE have put together in concise form the various meansthrough which the medical man, who has entered eitherthe Navy or Army, is compensated for invalidism or loss ofprofessional income, while the case of his -death on service isconsidered in respect of pensions to widows and children.The new Royal Warrant is placed first, as it is not merely themost important organisation, but is part of the ordinaryterms of agreement between employer and employed.Various agencies follow applicable in greater or lesser degreein different circumstances, and the source of further informa-tion if required is given in each case. The War EmergencyFund of the Royal Medical Benevolent Fund is placed last butone, as its intention is avowedly to supplement and fill inthe gaps of the other agencies ; the Medical Patriotic Fundof the British Medical Association last of all, as the fundis only to be instituted if others fail to cooperate or

amalgamate.MINISTRY OF PENSIONS: THE ROYAL WARRANT (July, 1917).Object.-The draft Warrant issued by the Minister of

Pensions in July deals with the retired pay of disabledofficers (naval or military) and with the pensions of thefamilies and relatives of deceased officers, with effect fromApril lst, 1917, and the option of further retrospective effectif more favourable to the officer than his present retired pay.The actual schedules are given as follows :-

(1) Retired Pay to Disabled Officers.