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the 1922 cases, as were also prostration, anaemia andwasting. Haemorrhage under the nails, noted by Sheldonin the present epidemic, was not observed in 1922. In1922 the sausage was proved to be the criminal and it islikely to be convicted again this time. In pigs themuscles chiefly invaded by the parasite are the diaphragm,intercostals and neck muscles, all of which are com-

monly used to make sausages. In Wolverhampton busywomen eat sausage meat raw ; in Milford Haven 19 yearsago thirteen infected people ate sausages obtained froma particular butcher. His pork was raised and slaugh-tered locally, but the farmer who had supplied the

unlucky pig was not identified. At Harpenden the sourceof the infected pork is still uncertain. This week caseshave been reported in two districts of Cumberland.One of the chief features of this disease is muscular

pain and stiffness, and patients may therefore beseeking treatment for "rheumatism" and may on thataccount be misdiagnosed unless a blood count is done.Eosinophilia is hkely to occur towards the end of the firstweek and to persist for about six weeks, and recent casesin this outbreak have shown 20-70% of eosinophils.THE CONSTITUTIONAL FACTOR IN BEHAVIOUR

DISTURBANCE

IN assessing the relative importance of environmentand constitution in the causation of such abnormalities ofbehaviour as are seen in the psychoneuroses, in subjectswith psychopathic personalities, and even in thepsychoses, psychologists have been hampered byinadequate criteria of constitutional defect. It is truethat gross somatic signs of degeneration are often present,particularly in the shape of the face and head, and thata detailed family history often gives a clue to causation,but even so the question of the hen and the egg arises.In most instances environment has played a precipitatingpart, and some people remain normal only through thestability of their surroundings and the sympathetic skillwith which their lives are controlled by others. The

electroencephalogram has brought to hand a new indexof abnormality. Cerebral dysfunction-whether causedby gross damage, by such agents,as intracranial tumours,abscesses or the toxaemias, or by more subtle states, suchas the changes underlying epilepsy or the geneticaberration in the members of an unstable stock-isassociated with abnormally slow alterations in cerebralelectrical potential which can be readily. recorded andmeasured. Lindsley and Cuttsl have produced furtherconvincing evidence of the important part played byconstitutional defects in the causation of even the milder

grades of behaviour disorders. They have taken groupsof normal children and intelligent healthy adults and havecontrasted their electroencephalograms with those of agroup of 50 behaviour problem children, and of 30children whom they considered to be constitutionallyinferior. The behaviour problems were sufficientlydefinite for the children to be admitted to a specialhospital, and included such things as irritability, restless-ness, temper tantrams, lying, stealing and obscenityleading to unmanageability in the home and delinquencyin the community. The 30 constitutionally inferiorchildren were wards of the state who were found to beunplaceable in foster homes, and who had a poor biologicaland social heritage. By studying the characteristics ofdifferent groups of abnormal waves in the electro-

encephalogram, Lindsley and Cutts found a greatpreponderance of abnormality both in children withknown behaviour disturbance and in those who wereconstitutionally inferior. For example, while only 3%of the normal adults and 30% of normal children showedmore than 5-8 waves a second, 80-90% of the abnormalchildren gave readings above this level. Thus abnormalelectroencephalograms were three times as common inchildren with abnormal behaviour as in normal children.

1. Lindsley, D. B., Cutts, K. K. Arch. Neurol. Psychiat. 1940, 44, 1199.

This suggests a disturbance of cerebral function whichmay be important in preventing the abnormal groupsfrom adjusting themselves to their environment,particularly if conditions are adverse. Similarly, wemight expect that the so-called normal children whoshowed evidences of abnormality in the electroence-

phalogram would be relatively poorer risks in the face ofpersistent environmental difficulties.

MECHANISM OF THE CARPUSTHE mechanical anatomy of the carpus has lately been

worked out by MacConaill.1 The capitate and hamatemove together, as do the lunate and triquetral, while thescaphoid moves sometimes with one row and sometimeswith the other. The other bones can be excluded fromthe discussion. He regards the capitate as the fixed bonein all movements. In dorsal flexion the lunate slidesround the capitate, and the radius slides round the lunatein even greater degree. In the movement from full volarflexion to full dorsal flexion the scaphoid moves on thecapitate until the hand is straight, but after this positionhas been passed these two bones remain fixed while thelunate moves on them both. This locking together ofthe scaphoid and capitate is of supreme importance.MacConaill says that the proximal articular surfaces ofthe hamate and capitate form a screw surface so that indorsal flexion the scaphoid and lunate are also broughtmore closely together. In fact the bones of the carpusare welded together in dorsiflexion and more looselypacked in volar flexion. These observations becomeof practical value in relation to dislocation of the lunate.The methods of reduction that have been advised in the

past, apart from operative reduction, are either simpletraction or dorsiflexion followed by volar flexion. IfMacConaill’s concept is correct, reduction should be moreeasily achieved by volar flexion followed by dorsiflexion,and this is the method he recommends. The movementof volar flexion draws the carpus over the dislocatedlunate bone. Slight traction on the hand helps this,but only the very gentlest pressure on the lunate is

required. One minute only is needed for recent disloca-tions. The movement of dorsiflexion then retains thebone in its reduced position, and this is the position ofthe subsequent plaster. Late cases will require operativetreatment, for in them the space that the lunate shouldoccupy has been partly filled with fibrous tissue. ’ Ninecases, six of which had an associated fracture of thescaphoid or triquetral, have been treated by this methodwith excellent results.

REACTIONS TO T.A.B. VACCINE

THE case for active immunisation of the civil popula-tion against enteric fever has been much discussed inrecent months, and despite an official caveat that therewere no strong grounds for widespread immunisationmany local and hospital authorities have undertakenthe inoculation of certain classes of the community a ainstboth enteric fever and tetanus. One of the objectionsraised to T.A.B. vaccine is that the local and constitu-tional reactions which follow the injection result in con-siderable loss of working time-perhaps more thanvaccination would save by preventing enteric fever

among an industrial population. T.A.B. vaccines mayvary in their toxicity, and clinical comparisons of theimmunising properties (as measured by agglutinin-formation) and toxicity of different commercial pre-parations are needed. There is no reliable evidence thatthe use of detoxicated or oral vaccines to avoid reactions

gives the same degree of protection as a crude vaccineof the whole organism, but care should be taken to usea mouse-virulent strain of Bacterium typhosum. Bact.

paratyphosum C is added to certain vaccines, thoughinfections with A and C are extremely rare in thiscountry, and this T.A.B.C. vaccine should not be

1. MacConaill, M. A. J. Anat. January, 1941, p. 166.