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by patients in his series were morphia, cocaine,hashish, heroin, chloral, sal volatile, dial, and medinal.In discussing the treatment of these cases he remindsus of Wolff’s dictum that " somatic detoxication is

by no means a cure, but merely lays the basis forpsychological treatment." The patient must beawakened to the causes which underlie his addictionand helped to face the situation with renewed willpower. To make one drug difficult of access, hethinks, is only to bring another into favour ; attentionought to be focused on the addict, not on the drug,and it is unreasonable to try to solve problems ofaddiction by making the temperate man sufferbecause of another person’s " -ism." The last

argument, though true of many drugs, scarcely appliesto paraldehyde, a beverage from which most peopleprefer to be total abstainers.

SUPPLEMENTARY GRANTS FOR RESEARCH

THE trustees of the Ella Sachs Plotz foundationare anxious to make known the resources of theirfund for the advancement of scientific investigation.The foundation seldom or never offers stipends toinvestigators nor does it provide apparatus andmaterials which are ordinarily part of laboratoryequipment. Its special purpose is to give grants forthe purchase of apparatus and supplies needed forspecial investigations and for the payment of unusualexpenses, including technical assistance. At presentresearch is favoured which bears on medicine or

surgery, but grants will be given in the sciences

closely related to medicine and will not be restrictedto work dealing with similar or allied problems. Inthe ten years of its existence the foundation has made200 grants-including one last year to the AcademicAssistance Council-and investigators have beenaided in 23 countries. A third of the money appro-priated for use in 1934 is being reserved to helpscientists who are at the present time without positions.Applications for assistance should arrive before

May 1st, including statements about the nature of theresearch, the amount of money wanted, and the wayin which it will be spent. The secretary of theexecutive is Dr. Joseph C. Aub, and he should beaddressed at Collis P. Huntington Memorial Hospital,695, Huntington-avenue, Boston, Mass., U.S.A.

MUCOCELE OF THE VERMIFORM APPENDIX

MUCOCELF of the appendix is so rare that thepublication of two cases at about the same time isalmost a coincidence. The exact cause of the cysticdilatation is obscure. Elbe, in 1909, laid down thefollowing conditions as essential to its development :a slowly progressive stenosis at one or more pointsof the lumen of the appendix, absence of grossinfection, and the presence of an actively secretingmucosa (or at least more rapid secretion than

absorption). Both E. R. Easton and (on p. 395of our present issue) Dr. Brennan Cran add anothercondition-namely, the transformation of mucininto pseudomucin, which constitutes the contentsof the cyst. Easton suggests that this is the actualdetermining factor, pointing out the difference betweenthe incidence of mucocele (0’2 per cent. of a largeseries of post-mortems) and obliteration of the lumenof the appendix (25 per cent. of all adults, accordingto Gray’s Anatomy).

Clinically, acute inflammatory attacks are a

recognised complication of mucocele of the appendix,and may lead to rupture. In Easton’s case therewas macroscopic and microscopic evidence of acuteinflammation in the wall of the cyst, which was

1 New Eng. Jour. Med., Dec. 20th, 1933, p. 463.

removed at operation for supposed acute appendicitis.The patient was a man aged 47, who gave a historyof occasional slight dragging sensations in the rightiliac fossa. The abdomen was fat and rigid, and thecyst had not been felt before operation. It measured11 cm. long and 22 cm. at its largest circumference.It was removed entire, and Easton emphasises theimportance of this, since accidental rupture mayresult in subsequent pseudomyxoma peritonei. LikeCran, he comments on the absence in these cases ofany trace of a mucosal lining to the cyst. Probably,as Cran says, pressure of the retained secretionultimately leads to atrophy of the mucosa, which inits turn may put an end to any further increase inthe size of the cyst. It seems probable that only inthe very rare intermittent form, in which X rayexamination is occasionally diagnostic, is an appendi-cular mucocele likely to be recognised before operation.ADHESIONS IN ARTIFICIAL PNEUMOTHORAX

THOUGH many years have passed since Jacobaeusfirst converted a partial into a complete artificial

pneumothorax by the cauterisation of fibrous bands,there seems still to be an impression that this operationis a curiosity, which does little more than demonstraterare dexterity. A paper by A. Tuxen 1 is designedto correct this impression by showing how the prog-nosis of many a case of partial artificial pneumothoraxmay be bettered by pneumolysis undertaken bya sanatorium physician who has mastered the notvery complicated technique of the operation. Hecalculates that adhesions between the visceral andparietal pleura are encountered in more than three-quarters of all pneumothorax cases. His materialconsists of 115 patients on whom 122 thoracoscopieswere undertaken, the average interval between theinduction of a pneumothorax and thoracoscopy beingfive months. In 17 cases the thoracoscopic findingscontra-indicated cauterisation. In the remaining98 cases, 103 cauterisations were undertaken. Theadhesions were single in 25 cases, multiple in theremainder. In as many as 50 what Jacobaeus hascalled "lung stalks " were found-extensions of lungtissue into the adhesions. The 103 cauterisationswere followed by collapse of the lung in 32 instancesand considerable detachment in 53. Eighteen wereunsuccessful. From the beginning of 1931, whencauterisation of pleura! adhesions was begun, to theend of June, 1933, a total of 264 patients were treatedwith artificial pneumothorax by Tuxen at hissanatorium. This figure was reduced to 165 so as toinclude only sputum-positive patients, and to excludethose in which the pneumothorax was not long main-tained. These patients were classified according asthey were or were not subjected to endopleuralcauterisation, and it was found that 67 per cent. ofthe total were sputum-negative on discharge, whereasthis percentage was only 45 for the patients nottreated by cauterisation. Tuxen describes as theworst complication the development of a spontaneouspneumothorax which followed cauterisation in 5 cases.

PERITONSILLAR ABSCESS

Prof. Canuyt and Dr. Daull, of Strasbourg, havewritten a full and valuable description 2 of quinsy,which they regard as a suppurative cellulitis, or

phlegmon, rather than an abscess. Canuyt hastaken much trouble to investigate the exact siteof this affection-by autopsy in two fatal cases,

1 Norsk. Mag. f. Laegevidensk., February, 1934.2 Les phlegmons de la loge amygdalienne. By G. Canuyt,

Professor de Clinique; and P. Daull, Chef de Clinique Oto-Rhino-Laryngologique, à la Faculté de Médecine de Strasbourg. Paris :Masson et Cie. 1934. Pp. 138. Fr.16.