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congratulations to the recipients of all these honours,not forgetting Mr. (jreorge Groodchild, clerk andsteward of the Hereford County Mental Hospital, andMiss Georgie May Smith, general secretary of theOfficial Medical History of the War.

TRACHOMA IN HOLLAND.

WHEN trachoma was first recognised among thepeople of Holland, about the year 1860, it was giventhe name of "the Egyptian complaint" on the

assumption that it had been introduced by Napoleon’stroops. This legend fails, however, to account for itsspecial predilection for Jews, and in particular forthose dwelling in Amsterdam. In a recent note tothe Hygiene Committee of the League of Nations,Dr. N. M. Josephus Jittal suggests that the historyof the disease, so far as we know it, is best accountedfor by the immigration of Polish Jews into the LowCountries during the eighteenth century. Most ofthem went to Amsterdam, probably carrying trachomawith them. In those days the Jewish immigrantsbelonged to that social stratum which is chieflyattacked by trachoma, and constituted a class whichhad little intimate contact with its fellow citizens.This hypothesis explains many obscure facts.

It was about 1880 that Prof. Gunning first raisedthe alarm and drew attention to the serious endemicamong Jewish children ; in one school 75 per cent.of the pupils were affected, while in schools wherethe children were from equally poor homes, but notJews, the percentage was less than 1. Dr. Westhoff’sreport to a Commission in 1885 ended with the words," If radical measures are not taken it may be statedthat in another century our citizens will be like theEgyptians, who were part-blind and among whomnobody possessed normal vision." In consequencethe municipality founded an ophthalmological clinic,school teachers were warned, and various public bodiesattacked the social side of the problem. The numberof cases gradually declined, and with advancingcivilisation the conditions under which trachomaflourishes became rarer. Nevertheless. in 1913 Dr.

Sajet calculated that there were 1400 persons inAmsterdam with active trachoma, and another 1120in whom the condition was latent. In the same yearthe Municipal Council appointed a commission toinquire into the subject, and their report was pub-lished in 1924.2 These workers examined all thetrachomatous individuals and their families thatthey could find through the schools and clinics. Theyfound 8-8 per cent. of Jewish school-children and0’6 per cent. of others suffering from trachoma, andof these the great majority had no functional dis-turbance and had never had any treatment. Tooculists accustomed to deal with grave cases thiswas naturally a shock. They found further that ifthe children were treated in this early stage theywere cured quite easily and without corneal compli-cations. Their charts show that most children areinfected before their sixth year and that contagion atschool is not an important setiological factor. Thusthe source of infection is essentially in the home,generally the mother. The provision of specialschools would therefore be of little use in checkingthe endemic. In 1918 a special clinic was opened inthe Jewish quarter, an oculist was appointed to inspectpublic schools, and untreated trachomatous childrenwere forbidden to attend school. In 1921 resultsbegan to appear, and for the next two years thenumbers attending at the clinic steadily declined.Moreover, of the 31 children classed as " cured " in1922, only one had visual defect due to cornealinvolvement. The treatment at the clinic began withexpression of the granulations under cocaine-adrenalin,together with firm massage to the extent of drawinga few droplets of blood. Silver nitrate or ichtharganwas then instilled, and most cases were cured without

1 Office International d’Hygiène Publique, Bull. mensuel.February, 1927, xix., 2, p. 200.

2 Wibaut and Smit: Annales d’Oculistique, vol. clxi.

admission to hospital. Dr. Jitta’s note brings tW6story up to date. The diminution in cases lms con-tinued, so that in 1925 only 18 new cases were detected.It thus appears that 50 years of strenuuus spade-work, patience, and perseverance have had theirreward, and that Amsterdam has made it clear thatwhere trachoma is not truly endemic, but imported,and maintained by conditions of poverty and dirt, itcan be effectively combated.

RESISTANCE TO THE METASTATIC SPREADOF CANCER,

ONE recent development of cancer research-viz.,the experimental production of cancer by variousforms of chronic irritation-dates from the well-known work done on spiroptera cancer by Prof.Johannes Fibiger, of Copenhagen. Prof. Fibiger hasnow published, in conjunction with Dr. 1B -Iloller,the results of an important investigation entitledInvestigations upon Immunisation against MetastasisFormation in Experimental Cancer.1 Twent.y yearsago it was shown that if a transplanted tumourunderwent absorption the animal which had carriedthat tumour could not again be inoculated success-fully with a transplantable neoplasm. Thisphenomenon was described as

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immunity " of" resistance." The same condition could be inducedby the injection of normal cells of the same species,embryo skin being a particularly active " imniunising "agent. These observations naturally aroused greatexpectations at the time, because they seemed tooffer the possibility of immunising an organismagainst cancer. It was soon found, however, thatcancer spontaneously arose in animals which had beenimmunised. Since the number of cases in which thiscould be observed was for obvious reasons very small,it was necessary to test this important point againin animals in which cancer could be produced experi-mentally. The present paper records observationson 293 mice, which were tarred on alternate days forfour months. Of these mice, 156 received injectionsof embryo skin emulsion during the process of tarring,while the remaining 137 mice were kept as controls.The same number of tar tumours appeared in bothgroups and at approximately the same time. Thisresult confirms the earlier observations in showingthat " immunisation " is no protection against thegenesis of a new tumour. But when the formation ofmetastases in these experiments was examined itwas found that in the immunised mice only half thenumber showed metastatic spread as compared withthe control mice. In the latter group metastaseswere found in 58 per cent. of the cancerous mice,while the immunised mice showed metastases in only30 per cent. of the cancerous animals. The authorsmake a special point of warning their readers againstthe premature therapeutic application of these resultsto human cancer. The nature of this process ofimmunisation is still very obscure, but the con-

clusion seems justified from these observations thatin the metastatic spread of malignant cells theorganism does not play merely a passive part, but iscapable of offering an active resistance.

THE RELATION OF TEMPERATURE ANDPULSE-RATE IN DISEASE.

THE introduction of increasingly trustworthylaboratory methods of diagnosis in febrile illnesses issaid to lead to some degree of carelessness in clinicalobservation. There remains, happily, a host ofcareful clinicians who guard against this tendencythemselves and check the medical student’s besettingsin of piecing together reports. In the Afc(Hea{Journal of Austradia for April 2nd Prof. D. W. Carmalt-Jones, of the University of Otago, N.Z., contributesan interesting series of clinical observations on the

1 Kgl. Danske Vidonskabernes Selskab, Biologiske Meddelelser,vol. vi., 1927.

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relation of temperature and pulse-rate in disease.After illustrating the close correspondence betweenthe pulse-rate and the temperature chart when bothare plotted in acute infectious diseases, he emphasisesthe clinical significance which attaches to deviationsfrom this rule. It is assuredly true that though theclinical thermometer supplies a means of graphicallyrecording the body’s response to infection with arelatively small margin of error on the part of theobserver, the pulse-rate will frequently give warningof grave complications, especially of a myocardialnature, which may be overlooked if the temperaturechart alone is considered. During the influenzaepidemic of 1918, when cases were admitted to militaryhospitals in thousands daily, it was a common experi-ence that selection for immediate special treatmentof those patients who exhibited marked pyrexia wasa very poor guide to the real gravity of the cases,whereas an experienced nurse could, by observation Iof the pulse-rate, pick out the more serious cases with ’,a high degree of accuracy. In surgical practice thisaspect of clinical observation has long been recognised,a rising pulse with a falling temperature being, asProf. Carmalt-Jones points out, of the gravest signi-ficance. In some hospitals it has been found that incases of suspected spreading peritonitis the surest

guide during the hours immediately following admis-sion is to keep a record of the pulse-rate every halfhour, without reference to the temperature, and onthis indication alone early and successful operationhas been performed at a time when the other clinicalsigns remained doubtful. In more chronic pyrexialconditions it is as a guide to the condition of themyocardium that a pulse chart becomes most useful.In cases of good resistance in which recovery occurswithout damage to the heart muscle, the pulse-ratefalls with the temperature, and any delay in thefall of the pulse-rate relative to the temperature is inproportion to the myocardial damage done. Itremains to be recognised that pulse-rate recordsrequire more care on the part of the observer thando similar records of temperature. Even a juniornurse will look twice at her thermometer, and possiblytake the patient’s temperature again, when thereading is in any way surprising ; but we have againand again been struck by the unwondering calmnesswith which a normal pulse-rate is recorded by anotherwise skilful nurse in cases of heart failure, whereonly a proportion of ventricular pulsations is inreality reaching her fingers over the radial artery.This is a point which seems to escape proper commentin many teaching hospitals, and it is one whichProf. Carmalt-Jones might well have stressed in hispaper. In continental hospitals the daily volume ofurine secreted is sometimes used as the most accurateindex of the cardiac function ; again, accuracy andsimplicity of recording are the criteria which mustdecide the utility of the method, and again it mustbe admitted that, like pulse charts, urine charts arenot as easv to obtain as are the more familiar recordsat the bedside.

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THERMOPHILIC BACTERIA IN MILK.

As our Knowledge or bacteriology extentis we arefinding the range for bacterial growth, both in relationto temperature and to other environmental conditions,greater than was once supposed possible. There are,for example, halophilic bacteria which flourish insolutions of salt, inimical for most bacteria. Anotherinteresting group is that of the thermophilic bacteriawhose optimal growth temperature is well abovenormal body temperature and is generally in theneighbourhood of 55° C. While this group is of nodirect significance in human pathology, it is of someimportance in commercial processes, particularly inrelation to canned foodstuffs. In a recent paper 1Miss Eckford discusses the significance of thermophilicbacteria in milk. A distinction must be drawn betweentrue or obligate thermophiles with a range of growth

1 M. O. Eckford: Amer. Jour. of Hygiene, 1927, vii., 201.

from 420 to 70’ C. and an optimal growth temperatureof 50’ to 60 C., and facultative therm ophiles which growbest at 37° C. or other lower temperatures, but whichcan also grow at 55° C. Many of the common sporingaerobes, such as B. mesentericus or B. subtilis, canaccommodate their growth to the higher temperature.The author introduces a third group, the thermo-tolerant bacilli, which grow best at the higher tempera-tures but which can grow at blood heat. All the strainsstudied from the Baltimore milk-supplies were aerobicspore-bearing bacilli. Their liability to cause decom-position changes in foods depends on the extent towhich they possess proteolytic and fermentativeproperties. While most can liquefy gelatin and someproduce acid from sugars, none caused gaseousfermentation and their proteolytic powers were absentor slight. They are not likely to be a cause of decom-position changes in canned foods or to alter milk,although some of the isolated strains grown in milkat 55° C. in pure culture were able to coagulate it.They have some significance in connexion withpasteurisation, since they survive this treatment.The obligate thermophiles were found not to multiplyin milk at 62° C. On the other hand, the thermo-tolerant types multiplied greatly at this high tempera-ture and particularly at 55° C. These strains, there-fore, may cause trouble to pasteurising plants bymultiplying during the process and giving the milk ahigh count. They may cause pin-point colonies at37’ C. Their existence is one of the causes of highcounts after pasteurisation, a condition which occursfrom time to time. Sweetened and unsweetenedcanned milk tins were investigated but no true thermo-philes were found in them. The only organisms whichdeveloped at 55° C. were bacilli of the mesentericus-subtilis group, This is in accord with the findings ofJ. Weinzirl in U.S.A., although W. G. Savage andR. F. Hunwicke in England found obligate thermo-philes in sweetened milk in a number of instancesand one strain in unsweetened milk. These strainswere, however, unable to initiate unsoundness andwere regarded as of no practical importance by theirdiscoverers. The only exception at present to theview that thermophilic bacteria are not a cause ofdecomposition changes in foodstuffs is the observationby E. J. Cameron and J. R. Esty (1926) of unsound-ness changes from this cause in canned corn and othervegetables, giving rise to what they call " flat sourspoilage. _____

A COMPREHENSIVE STUDY OF POSTURE.

THE subject of correct posture and of departuresfrom it and their treatment has received far moreattention in the United States of America than inthis country, or indeed, in Europe generally. In theU.S. Public Health Reports this subject has beenrecently reviewed 1 boy Dr. Louis Schwartz, who givesa bibliographical list of 154 publications, beginningwith the quaint " Anthropometamorphosis

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by TohnBulwer, of 1650, but not including some articles onthe subject which have been published in the lastyear or two in our pages and elsewhere in thiscountry. Some orthopsedic surgeons in the UnitedStates have attributed far-reaching pathologicalresults to faulty habits of standing and sitting, andthe existence of an American Posture League testifiesto the place such matters occupy in the publicattention. In this country faulty posture is regardedas the result rather than as the cause of illness, anddue to a general weakness and lack of postural tonein the skeletal muscles. Too much, perhaps, has beenmade by some writers of the contrast between thespinal curves of the quadrupeds and anthropoids onthe one hand and of man on the other. In a paperpublished in 1886 D..T. Cunningham showed 2 that

1 A Résumé with Comments of the Available Literaturerelating to Posture, by Louis Schwartz, Surgeon, United StatesPublic Health Service, Washington, May 6th, 1927.

2 The Lumbar Curves in Man and Apes, by D. J. Cunningham.A paper read before the Dublin Academy and abstracted inNature, 1886, xxxiii., 378.