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malignant process. Others again, particularly thosein which gross oedema of the limb is present, are

secondary to perivenous lymphatic obstruction.

Clinically, therefore, the process may manifest itselfas a phlegmasia alba dolens or as a silent or occultpure venous thrombosis of which the first and finalclinical manifestation may be a pulmonary embolus.As a physical sign of visceral malignant disease,these peripheral cedemas must usually be regarded asmanifestations of an advanced stage of the malignantprocess, or as evidence of a profound nutritional

disturbance determined by the site of the diseaseand its interference with function. The relative

importance of oedema and swelling of one or bothlower limbs as physical signs of malignant diseasemay be gauged from the fact that they occurred inonly 8 out of 506 cases of cancer of the stomachadmitted to the wards of St. Bartholomew’s Hospitalduring the years 1921-32.

I am, Sir, yours faithfully,REGINALD T. PAYNE.

Harley-street, W., March 7th.

OBITUARY

THE LATE PROF. MAX NEISSER

THE death on Feb. 25th of Emeritus Prof. MaxNeisser in his sixty-ninth year creates another blankin that distinguished roll of German bacteriologistswho have occupied Chairs of Hygiene modelled on theKoch tradition. The name of Neisser bulks largelyin bacteriological literature. Albert Neisser ofBreslau, the discoverer of the gonococcus, was anuncle of Max, and the veriest tiro in bacteriology is,at a very early stage, introduced to at least oneachievement of the latter-the Neisser stain forC. diphtheriae.Born in 1869 at Liegnitz in Silesia, Max Neisser

removed with his parents to Berlin where he receivedhis schooling andhis medical train-

ing. The workinvolved in thepreparation of histhesis for the doc-torate in medicine,which he obtainedin 1893, was carriedout in Rubner’s

laboratory. From1894 to 1899 hewas assistant toProf. Carl Fliiggein the HygienicInstitute, Breslau.In 1899 he metPaul Ehrlich-a

great event in hislife-and in Juneof that year joinedthe staff of the Kgl.Institut f. experi-

mentelle Therapie at Steglitz near Berlin, later inthe same year transferred to Frankfurt. He wasthere given charge of the Department of Bacteriologyand became a professor in 1901. In 1909 he was

appointed director of the new Stadtisches HygienischesInstitut, later to be named the Stadtisches Hygien-isches Universitats Institut when the University ofFrankfurt was founded in 1914. His post thenbecame that of Professor (Ordinarius) of Hygieneand Bacteriology.During the war Neisser did valuable service, first in

a field dressing station and later as a consultanton hygiene. In 1918 he was given the title of Geh.Medizinalrat.When the war ended, Neisser returned to his

professorial duties, resumed his scientific work, andtook a prominent part in the organisation of publichygiene in the city of Frankfurt. In April, 1933,he retired, at the age of 63, and has since held thetitle of Professor Emeritus.

Since he embarked on his research career 45 yearsago Neisser has been a most devoted and assiduousstudent, and his contributions, which cover a sur-

prisingly wide range, embracing bacteriological,immunological, and hygienic studies, have beenmany. Before me is a list of no less than 156 titlesof contributions by him in the period 1893-1935.Here I can do no more than refer briefly to someof the more outstanding achievements to his creditin the field of bacteriology and immunology.

His sojourn at Breslau under Fliigge in the closingyears of the nineteenth century gave him an oppor-tunity of studying what was then a very acute andpressing problem, the differentiation of diphtheriabacilli from other diphtheroids, and the elaborationof a working technique for use in institutionsconcerned with the diagnosis of diphtheria.The well-known Neisser stain for demonstration of

the metachromatic bodies in diphtheria bacilli datesfrom this period. As one of Ehrlich’s band of workersin the Frankfurt Institut, Neisser, with his colleagueWechsberg, took a prominent share in those pioneerstudies conducted under Ehrlich’s guidance on thenature and mode of action of haemolysins, antitoxins,and bactericidins in immune sera during the earlyyears of the present century. The Neisser-Wechsbergphenomenon (1901), which disclosed the fact thatexcess of immune body in relation to available com-plement interfered with bactericidal action, was animportant outcome of this period of his activity. Its

precise mechanism is perhaps not even now elucidatedand may have to await progress in the physico-chemical attack now being made on the nature ofantigen-antibody combinations.

Neisser devoted much attention to the elaborationof accurate plating technique for evaluating bacteri-cidal action, and in connexion with the staphylo-coccus, on which he wrote widely, he explored withWechsberg the possibility of detecting by aid ofmethylene-blue the killing power of staphylococcalleucocidin on leucocyte suspensions (so-called bioscopicmethod).

In 1903 Neisser’s demonstration of the fact thatinfluenza bacilli can be grown on ordinary agar insymbiosis with B. xerosis is of considerable historicalinterest in the light of later developments in our

knowledge of the essential growth factors of the

haemophilic group of organisms.In 1906 a most interesting and fruitful field in

bacterial variation was opened up by Neisser’sobservations on an organism (B. coli mutabile) which,when grown on lactose agar, was capable of throwingoff variants endowed with the power of fermentinglactose. The analysis of this " mutation " phenomenon,pursued by Massini and Reiner bZiiller and particu-larly by Penfold in this country, added much to ourknowledge of variation phenomena in bacteria, in sofar as their fermentative properties are concerned.

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During the period of his Directorship of the

Hygienic Institute (1909-33) Neisser’s activities, sofar as one may judge from the titles of his numerouspapers, were, for the most part, bound up withproblems of public hygiene, over which he freelyranged, the care of the tuberculous, milk provision,bacteriological water analysis, disinfection and waterpurification being particularly favoured subjects. Inthe latter years of his directorship he devoted muchattention to the possibilities of water purification byemploying the bactericidal action of silver ions. Tothis subject he devoted the last of his three Harbenlectures delivered at the Royal Institute of PublicHealth in 1932.There can be no doubt that Max Neisser was

an unusually gifted and versatile occupant of the firstFrankfurt Chair of Hygiene, beloved of his students,and ever ready to spend himself freely in furtheringevery project likely to raise the standard of publichygiene in the city of his adoption.

He leaves a widow and three children. His wifewas the daughter of Charles Hallgarten, one of thegreatest Jewish benefactors of his native town ofFrankfurt and one of the founders of its university.

(To my colleague, Miss E. Klieneberger, a former pupilof Neisser, I am indebted for certain details of his career.)

J. C. G. L.

THE LATE DR. HUXLEY Fisn.—A correspondentdraws attention to the fact that in an obituary noticeof Dr. Fish (Lancet, Feb. 26th, p. 521) his appoint-ment as physician to Harefield Sanatorium lastsummer was not mentioned. This appointment gaveDr. Fish the opportunity of extending the scope ofhis work in a direction which had long been ofinterest to him. Our correspondent adds, "Dr.Huxley Fish was a great man, great in heart, in

intellect, in modesty, and in promise of high achieve-ments in his profession."

PANEL AND CONTRACT PRACTICE

An Inexact Lotion

THE five standing subcommittees appointed to dealwith different types of case referred to insurance com-mittees-allocation, dispensing hours, joint services,medical service, and pharmaceutical service-arenot convened regularly. Some of them may nothave met at all in the twenty-five years during whichmedical benefit has been in operation. Meetings ofthe joint services subcommittee, for example, are

required only when a case concerns a chemist as wellas an insurance practitioner. A case recently arosein Scotland and was referred to the joint servicessubcommittee in which neither practitioner nor

chemist was found to be at fault, but the questionswhich arose during the investigation showed theneed for a more precise definition of a particularlotion.The insured person’s story was that, having just

come out of hospital, he had contracted a " cold inhis eye." He consulted his insurance practitioner,who prescribed an eye lotion which was to be dilutedwith four parts of water. The man carried out thisinstruction, applying the lotion with cotton wooland then blinking the eye in the lotion. Each applica-tion was associated with pain in the eye, but thepatient thought this not unnatural and persevered.As the eye seemed to be getting worse he consulteda trained nurse, who said she did not think the lotionwas for his eye, and applied other treatment whichgave him relief. He then saw his doctor, who toldhim that the lotion supplied by the chemist was notthe " Mackenzie’s lotion " which he had ordered.The patient then obtained a bottle of Mackenzie’seye lotion from another chemist and this, he

said, was not like the lotion supplied by the firstchemist.Evidence was given on oath (in Scotland evidence

in medical and pharmaceutical service cases is so

given) by the wife of the insured person and by thenurse. The practitioner, also on oath, stated thatthe patient had had a nerve section done in thehospital for trigeminal neuralgia. Owing to teni-porary paralysis of the right eyelid and conse-

quent exposure of the eye to irritation the eyebecame infected after the patient’s return home. Theman consulted him, and he prescribed Mackenzie’seye lotion and gave appropriate directions for its

use ; when, later, the patient told him it hurt his

eye he asked to see the lotion and found that itdid not answer to the usual description ofMackenzie’s eye lotion, as recognised in the district.He referred to the formula in the Pharmaceutical

Formulary and said that if the chemist had

any doubt as to the strength of the lotion he shouldhave communicated with him. It emerged that thelocal eye infirmary had in their pharmacopoeia aformula for Mackenzie’s eye lotion which had beenwell known in the district for a number of years.The prescription was dispensed by the chemist,however, according to the formula for Mackenzie’seye wash in the Extra Pharmacopoeia (Martindale)which was the only formula he knew of for Mackenzie’seye lotion. The subcommittee found no evidencethat the lotion was improperly made up according tothat formula and held that neither the doctor northe chemist was in breach of his respective terms ofservice. They noted also that, while the patientmight have suffered some temporary discomfort

following the application of the lotion, there was noevidence of injury to his eye. About a fortnightafter receiving the prescription for the lotion the

patient was declared fit and resumed work.The subcommittee recommended that no further

action be taken in this case, but that the prescriptionshould be referred to the panel committee in order toeliminate any doubts about the dispensing of thislotion in future. The result is satisfactory both tothe doctor and to the chemist. It is possible thatthe patient may not be so well satisfied. Part of hiscase was that owing to the state of his eye he couldnot return to work when he expected to after hisoperation, and that as a result he had lost his situation.Although, as he told the subcommittee, he was

employed elsewhere in a temporary capacity, he willprobably blame the lotion for his ill-luck.

JOURNÉES MBDICALBS DE BBUXBLLES.—This con-gress will be held in Brussels from April 16th to 20th,and on the last day of the meeting a visit will bepaid to Ghent to see the Floralies Gantoises. Thescientific programme includes papers by M. Ascoli

(Palermo), A. Bessemans (Ghent), P. Bordet (Brussels),A. Castellani (Rome), and W. Falta and S. Jellinek(Vienna). Further information may be had from Dr.Rene Beckers, 141, rue Belliard, Brussels.