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were treated in 1922-24. Novarsenobillon injectionshad been used in the beginning, and two injections,intravenous or intramuscular, usually abolish alloutward signs of the disease, though it cannot yet bedecided if they produce permanent cure. Early in1923 treatment by intramuscular injection of sodium-potassium-bismuth-tartrate was introduced, and thisdrug has proved very effective. It is made in theColony, and the cost of materials used in its prepara-tion works out at 10 doses a penny. The doses are-1 to 3 gr. dissolved in the proportion of 1 gr. to1 c.cm. The salt contains 54’5 per cent. bismuth, anddosage is regulated according to age and susceptibility ;children up to 2 years old receiving t to 1 gr. of thesalt ; those from 2 to 18 years old, 1 to 2 gr. ;adults, 2 to 3 gr. ; and aged persons, 1 to 2 gr.Children, it was found, tolerated relatively larger dosesthan adults, while old persons were very susceptibleto the poisonous properties of the drug. Bothpotassium and bismuth are depressants of muscle,heart, and nerve tissues, and doses of 5 gr. of thesalt given to adults caused severe stomatitis, withoedema of cheeks, lips, eyelids, scalp, and sometimesof the neck as well ; in one case there were tonic andclonic spasms of limbs, unconsciousness, and lowmuttering delirium. Bismuth produces a stomatitismore readily and more severe in type than doesmercury. Usually two injections of the salt sufficedto procure rapid healing of the lesions, but here alsotime alone can show if that is really enough forpermanent cure. Intravenous injection of tartare"’1.etic had no influence on the disease ; and when,later, Castellani’s mixture by the mouth was tried,the patients rejected it, for by that time they had nofaith in any treatment that did not involve injectionby needle. As a result of treatment, not a tithe of thedisease existing in 1921 could be found in the localitiesto-day ; indeed, the vast majority of patients now comevoluntarily from districts outside the area of this yawscampaign.Yaws is definitely neither hereditary nor congenital,

and a breach of skin surface is probably necessary forthe entry of the virus. It is significant that by farthe most of primary yaws lesions seen in Kenya werefound on the anterior surface of the leg-the part ofthe body most liable to injury, as, for instance, fromthorn and grasses along the narrow single-file nativepaths. The disease is spread by direct contact, orby the feet of non-biting flies, while the bite of anarthropod may be a ready place for the virus carriedby some other agency, as, for example, by the scratch-ing or rubbing of infected fingers. Cases occurredfrequently at 5000 ft. altitude and over, but weremostly found in the warmer parts of the district. Theinsanitary conditions of native village life are idealfor the spread of the disease ; the people live in small,verminous, ill-lighted, unventilated huts strewnaround with garbage. There are swarms of flies, andmicturition and defaecation are promiscuous in andabout the villages. Though the average accommoda-is 2’4 persons per hut, cattle, goats, sheep, and fowl areherded every night into them besides the humanoccupants. There is no isolation of the sick ; they live ein intimate contact with the fit, and eat from thecommon dish with the pus from their ulcers soilingthe floor and the clothing of others. Clothing,blankets, and bedding are commonly exchanged. Thepractice of depilation of face and body provides ameans of entry and a mode of conveyance of the yawsvirus ; sometimes the primary yaw appears at the siteof mutilation resulting from the drastic uncleanmethods used in circumcision of the youths andexcision of labium minus in the maidens. Yet, in spiteof all this, merely treatment of those with surfacelesions, in breaking repeatedly the chain of contagion,has sufficed to bring about this enormous reduction inthe disease. No evidence was found in support of thosewho deny existence of the primary yaw. The infectioncannot be a venereal one, for the only patients present-ing genital primary yaws were children. The granulo-matous secondary skin eruption had a very definitepreiilection for moist surfaces, such as muco-cutaneous

junctions of mouth, alae nasi, vulva, and anus. It wasfrequently accompanied by inflammation of jointswith or without pyrexia. In all cases, after thesecondary eruption had completely healed, tertiarylesions appeared as irregular ulcerations followingbreaking down of gumma-like nodules. Periostitis anddactylitis occurred, but iritis was not observed.Scarring after healing of ulcerations led to contrac-tures, muscle wasting and shortening, a common

consequence being great deformity. Dr. Callanan isconvinced from his observations that the terribledestruction of palate and nasal bones and skin of face,known as gangosd, was directly due to untreated yaws.Many of the yaw cases showed splenic enlargement,but no internal organ other than the spleen was seento be affected. No nervous conditions that could beattributed to yaws were discovered—an interestingobservation in view of the persistent reports fromFiji of general paresis and tabes dorsalis attributedthere to yaws. Dr. Callanan deserves congratulationon this record of his careful observations on a greatnumber of individual cases, and the organisation andconduct of the campaign. It is a valuable contributionto the literature of yaws, whilst the campaign itselfreflects credit on the medical administration of theColony, and provides an instructive and encouragingexample for other countries where yaws is a scourge-even for some others under the British flag and theaegis of the Colonial Office.

THE ELEMENTS OF LONGEVITY.THE duration of human life has various aspects;

the physician at the bedside, the medical man examin-ing a candidate for life assurance, the referee at theheadquarters of the assurance company, all workwith a different set of data with somewhat differentends in view. The philosophic yet precise considerationof the biology of death constitutes the greater part ofthe work of the last named ; he has a tough pro-position to deal with. To help him there is theinductive method of clinical medicine, the analogy ofanimal’ experiment especially used by Pearl, thesomewhat unworked field of life-assurance statistics,the science of heredity, and sundry other possibilitiesinto which Dr. Hans Ullmann, of Berlin, goes atsome length in one of the recent instalments1 ofBrugsch and Le,vy’s

" Biologie der Person." Dr.Ullmann cites Rubiier’s view that the duration oflife of a species depends upon the potential energyacquired from its food, WTeismann’s theory of potentialimmortality, the effect of the extent of surface, ofinternal secretions, of the physico-chemical chagnes,intoxication with products of metabolism, and thehypotheses of the gradual death of increasing propor-tion of the cells (Kassowitz) and of the gradual lossof power of function in the cells (Ribbert). Obviouslythe individual duration of life is influenced by sex,by different environments and diseases, by socialstatus and race, by the effect of different dietaries,by heredity and pigmentations. But Dr. Ullmannis impressed by the preponderance of familial influencein consequence of which the individual reacts in acertain way to his environment. Belief in the occur-rence of familial longevity and short-livedness is nowspreading, as may be seen in the work of Mary Beetonand Karl Pearson, L. Cuenot, D. Westergaard, andA. Ploetz. W. Scheidt, working over A.von Lindheim’sAustrian material, ascertained that out of 281 eighty-year-olds 102 came from parents of whom one wasover 80, and 64 from parents both of whom wereover 80. Among the old people in the Jewish alms-houses in Vienna in 1908, 41 per cent. came fromparents both of whom were over 70 years old. In all95 per cent. of the old people dealt with by Lindheimwere from parents of whom at least one was over70 years old. The author gives the unfavourableexperience of 34 American life assurance companies

1 Die Biologie der Person : ein Handbuch der Allgemeinenund Speziellen Konstitutionslehre. Edited by Prof. Th. Brugschand Prof. F. H. Lewy. Third instalment comprising pp. 749—1051 of vol. i. which it completes. Berlin and Vienna : Urbanand Schwarzenberg. 1926. Mk.15.

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in regard to the lives of those in whom the circumferenceof the abdomen exceeds that of the chest. But evenhare a hereditary tendency to longevity is the rulingfactor, for corpulent descendants of longer-livedparents have a normal expectation of life. Assuredpersons who are under weight and whose parents diedfron lung disease under 70 years of age are more liableto die during the age-period 15-28, their excess ofmortality being 30 per cent. On the average the risksof the underweight class are not increased ; those whohave had no lung disease in their family show adiminished mortality. Short-livedness is frequentlydue to arterio-sclerosis or tuberculosis. Mollwos andFlorschutz, working with material derived from theLübeck Life and Gotha Assurance Societies respec-tively, are thought by Dr. Ullmann to have establishedhow great a r6le heredity and a feebler constitutionplay in the aetiology of tuberculosis. The tuberculouswho have a family history of tuberculosis do not doso well as those whose parents died of other diseases.Florschutz suggests that when this untoward resultdoes not occur it is because special care has been taken-of the patient on account of his unsatisfactory familyhistory. Comparison of the family history of tuber-culous persons possessing tuberculous heredity witha number of controls clearly brings out their less- satisfactory constitution.

THE HERITABILITY OF INTELLIGENCE.

Sir Francis Galton’s demonstration of the tendencyfor exceptional ability to run in families has becomeclassic, and to it the modern eugenic movementowes its rise. Other investigators have confirmedhis results, but their methods have varied. Galtonaccepted as a criterion of exceptional capacity orgenius the attainment of some position of eminencein the world. In the latest of these investigationsthat has come to our notice, described in a Bulletinof the Eugenics Record Office, published by theCarnegie Institute of Washington, the cases selectedfor study are children--19 in all-whose exceptionalability is inferred from the very high scores obtainedby them on the Stanford-Binet scale of intelligencetests. The investigation was carried out by MissGrace Allen, and her results may be briefly sum-marised. Of the fathers of the gifted children 70 percent. occupied positions of responsibility and power,many professional, and 25 per cent. were engagedin semi-intellectual work. Among brothers 52and 44 per cent. were the corresponding figures.Brothers and sisters tested by the Stanford scale,with only one exception, scored over 100, and onlyone cousin out of 21 tested scored below 120. Homeswere rated according to the scale of the WhittierState School, and in practically all cases and in allrespects neatness, size, necessities, parental control,scored high. Fecundity in the families concernedwas low, the fathers were above average age, grand-parents were long-lived. The children were theoffspring of normal gestations and were physicallyabove the average, partly attributable no doubt tothe fact that 70 per cent. were Jewish. Miss Allendoes not make any inferences from the statisticalfacts, but the writer of the preface, Prof. C. B.Davenport, does not hesitate to interpret the resultsas further evidence of the heredity of high intelli-gence. It is somewhat doubtful if such an inferenceis justified, when one considers the small numberof cases studied and the admittedly incompletestudy of the families they came from. Putting thisobjection aside, however, there is the further questionwhether one is entitled to assume, as most of theseinvestigators do assume, that any scale of intelli-gence, such as the Stanford-Binet, really adequatelygauges native intelligence. Its value in assessingparticularly the higher grades of intelligence has beenfrequently disputed, and the work of Dr. Cyril Burtand Mr. Hugh Gordon has shown that the results arevery considerably influenced by general environmentand school training. Is it not the fact that eventhe development of the intelligence itself is much

modified by the nature of the environment ? Thegeneral fact that a high grade of ability does frequentlyrun in families can scarcely be disputed, but there isstill no completely satisfactory evidence to show howmuch is due to heredity and how much to the excep-tional opportunity afforded in a prosperous and acultured home. The ardent eugenist is too ready toassume that the latter is not essential. It may bequite true to say, as Prof. Davenport does say, that" the children do not have high intelligence merelybecause they come from prosperous households," butsurely the prosperous households make some contri-bution to the growth of the intelligence. Naturemust be nurtured. ____

CHOLECYSTOGRAPHY.THE discovery bv Prof. E. A. Graham and his

co-workers that certain phthalein compounds duringexcretion by the biliary tract were capable of castingopaque shadows has led to extensive application ofthis phenomenon as a means of taking X ray photo-graphs of the gall-bladder. It has stimulated effortsto improve the technique of radiographic methodsapplied to the gall-bladder, which are reflected incontributions to medical journals of all countriesand in keen discussions at medical societies, notablyat the Section of Medicine of the B.M.A. at Notting-ham. The opaque substances chiefly employed forthe purpose have been tetra-halogen compounds ofphenolphthalein, and both the oral and intravenouschannels of administration have been used. Althoughat the B.M.A. meeting, reported in our issue ofJuly 31st, it was stated that there had been no deathrecorded following the intravenous employment ofthese dyes, since that date a fatal case has beenbrought to our notice, and it appears expedient todirect attention once more to certain difficulties andrisks which face those who are using the method.In the first place it must be recalled that severalsubstances are on the market. Both tetra,-iodo andtetra-bromophenolphthalein are in use ; further, insome preparations the halogen atoms are linked tothe phenol portion of the molecule and in others tothe phthalein. As these compounds differ from oneanother in toxicity, both towards the general organismand the local tissues, the problem of selection is notan easy one in the absence of precise guidance. ,

Moreover, the fact that they are all extremely unstablemakes it difficult to obtain reliable solutions for intra-venous use without the assistance of a skilled chemist.

In a recent article in THE LANCET1 T. Izod Bennett,Alan Moncrieff, and F. G. Nicholas strongly advocatedthe employment of the oral route of administration ;they stated that toxic effects had never given themanxiety. and their results appear to have been excel-lent. On the other hand, they, in common withothers using this route, had had considerable difficultyin finding a capsule to hold the dye which wouldneither allow it to be liberated in the stomach norto pass unchanged into the caecum. If liberated abovethe pylorus an insoluble substance is formed with thegastric hydrochloric acid and violent vomiting mayoccur ; if, on the other hand, the dye passes into thecsecum there will be no absorption, and hence nogall-bladder shadow can be seen. If, however, a

capsule or covering is secured which is digested onlyin the small intestine the oral route does appear togive results which are quite satisfactory and are

obtained without risk. There is, on the other hand,little doubt that in general the cholecystogramstaken after intravenous injection are clearer, andhere there can be no doubt in the observer’s mindas to whether proper absorption has taken place.Since a negative cholecystogram implies disease ofthe biliary apparatus, it is often of supreme importancefor the observer to know that the dye has been fullyabsorbed into the blood stream. Intravenous injec-tion alone can g-uarantee this. If, however, suchintravenous injections are going to lead to the pro-duction of local thrombo-phlebitis owing to inexpertuse, or if the fatality mentioned above, which was

1 THE LANCET, July 3rd, p. 19.