- Email: [email protected]
A CLINICAL ANTHOLOGY.
609
premature birth, and stillbirth. The work has been -carried out for the Medical Research Council by Dr. J. N. CRUICKSHANK, and has evidently been painstaking and thorough. In the series of 1000 - cases 9-10 per cent. gave a positive Wassermann reaction, and as a certain small number of cases admittedly fail to give a positive reaction in pregnancy, any slight error is doubtless in favour This percentage corresponds of the patients. with that of most recent observers in this field. Dr. CBUICKSHANK found that in practically every case (94 per cent.) the W.R. of the mother was in agreement with the reaction of the child at birth. He ,queries, however, the interpretation of a positive W.R. in the case of the new-born child : Is it the reaction of the child’s blood-may it not be due to transference of the mother’s reacting substances to the foetal An investigation, carried out by circulation ? Dr. H. 0. BRUNNER2 at a maternity hospital in Lausanne, brings out the fact that the Wassermann reaction is not very reliable in the diagnosis of congenital syphilis in the new-born. Among 150 new-born infants whose blood, taken from the umbilical cord at birth, was examined by the Wassermann test, there were only two giving a positive reaction, although at least six of the mothers definitely syphilitic and Wassermann-positive. Curiously enough, in the only case in which the mother had contracted syphilis late in the course of her pregnancy, the new-born infant, as well as the mother, was found to be Wassermann-positive. A oomparison were
of the Wassermann reactions in the mother and child in 113 cases of maternal syphilis of recent or old standing showed that it was positive in both mother and child in 50 cases, positive in the mother and negative in the infant in 35 cases, and negative in both mother and infant in 28 cases. There was not a single case in Dr. BRUNNER’S series in which this reaction was negative in the mother and positive in her infant. As regards incidence of abortion, which Dr. CRUICKSHANK interprets as " birth of child before it was viable "-his figures prove no greater percentage of abortions in the group with positive W.R. over the group with negative results. Stillbirths were proved to be more frequent in syphilitic cases-18-07 per cent. as against 15-15 per cent. of non-syphilitic cases ; and as he further demonstrates that a considerable proportion of the latter were sent into hospital with obstetric complications, almost inevitably causing death of the child, the figures could easily be made more striking if normal deliveries in syphilitic and non-syphilitic cases were compared. The incidence of premature births (after seven months) was vastly greater also in the syphilitic cases-32.5 per cent. of syphilitic cases as against 19-8 per cent. of noninfected women, and in this group of infected cases 68-7 per cent. had stillborn as well as premature babies. No relationship was proved to exist between ante-partum and post-partum haemorrhage and syphilis, nor was syphilis found to be at all an important factor in the aetiology of eclampsia. In the cases which could be followed up for some months after
delivery,
a
definitely larger percentage
of
Annotations. "
Ne quid nimis."
TREATMENTS IN VOGUE IN GERMAN SANATORIUMS. THE pooling of German sanatorium reports and their editing by Dr. H. Ulrici every year in Beitreige zur Klinik der Tuberkulose enable readers to ascertain in a few minutes what are the most popular therapeutic measures in German sanatoriums. Dr. Ulrici’s latest reviewcovers the year 1922, and deal’s with the reports of 40 hospitals for diseases of the lungs. Considering how varied the treatment was, it is disappointing to find that only 15 per cent. of all the cases of " open " tuberculosis became sputum-negative during treatment. Perhaps one of the most important excuses for these meagre results is to be found in the shortness of the average duration of treatment ; in as great a proportion as 84 per cent. of the adult male patients the duration of treatment was three months or less. Only 11 of the 40 hospitals practised artificial 626 of 7068 patients suffering from pneumothorax, " open" tuberculosis in the second and third stages being given this treatment. But whereas onty 8-9 per cent. were treated by artificial- pneumothorax, 26 per cent. were treated with some form of tuberculin. Ten different tuberculins or tuberculin methods were employed by these 40 institutions, and the three most popular methods, to judge by the number of patients treated, were Petruschky’s, Ponndorf’s and Much’s (partial antigens). The least popular was Selter’s " vital tuberculin," which was given in only five cases. Only 28 patients were treated with protein injections, whereas as many as 453 were given some form of chemo-therapy, the gold salt, krysolgan, heading the list with 289 cases. Sun-baths are, apparently, not yet popular in German sanatoriums, and only 1-7 per cent. of all the adult cases of pulmonary tuberculosis were given this treatment. Treatment with artificial light was much more popular, being given in 11-1 per cent. Of 2373 children, only 3-5 per cent. were given sun-baths, whereas 24 per cent. were treated with some form of artificial light. With regard to the results claimed for these various methods of treatment, even the most ingenuous and impressionable reader must be tempted to draw the conclusion that it is the nature of the disease rather than the nature of the treatment that determines the issue. Tuberkulomucin achieved good results in 56 per cent. of the first- and second-stage cases, and the same measure of success was claimed for old tuberculin, albumose-free tuberculin, and bacillary emulsion. Petruschky’s tuberculin inunction was beneficial in 61 per cent., partial antigens in 65 per cent., artificial radiation in 63 per cent., and, in the case of children suffering from surgical tuberculosis, in 99 per cent. Until therapeutic claims are supported by an account of the exact nature of the disease and its activity in the patients cured, the sceptical will continue to doubt the efficacy of the vis medicatrix hominis. A CLINICAL ANTHOLOGY. INDIVIDUAL feelings as to the general value of anthologies vary. Some regard them as a superfluity ; others may find in them a pleasant form of reading, which demands no great intellectual effort. Usually such compilations of other people’s works are extracted from poetical or prose literature dealing with some particular aspect of life or nature. The of this principle to medical books is a new idea which may well make an appeal to certain practitioners and students. Dr. W. F. Dutton has
I application
infants with a positive W.R. died, compared with those non-infected. While not providing any strikingly new data on the subject, this independent and patient compiled an anthology of intravenous therapy, which study of 1000 cases is well worth recording as con- will be valuable for reference and will certainly appeal flrmation of previous knowledge in a field not yet fully strongly to all those who intend to devote their lives
explored. 2 Schweiz. med. Woch., Jan. 24th, 1924.
1 Beiträge, 1924, lvii. 332. 2 Intravenous Therapy. By Walton Forest Dutton, M.D. Philadelphia : F. Davis Co. 1924. Pp. 542. $5.50.
610
attaining a special skill in this branch of medicine protein meal, the office-worker can be quiet in a long (or is it surgery ?). The insertion of a syringe needle chair, not further raising by muscular activity his into a vein is an operation which requires much skill temperature, already slightly raised by digestion. for its certain performance, and it will be encouraging In Java, Dr. Kipping tells us, doctors not vegetarians to the intending specialist to find that so wide a field in principle took to living exclusively on vegetable will be open to him. Several chapters are devoted to food. He puts forward himself the following scheme an account of the theory and practice of blood for food for a tropical day-Breakfast : tea or coffee, to
transfusion. Other subjects discussed at length are the use of arsenic compounds and intravenous anaesthesia. The second and larger part of the book deals with all the other conditions for which medicaments may be injected into a vein. These are arranged alphabetically and number no less than 108. All forms of treatment available for each condition are mentioned, as well as those that are more strictly intravenous. The book may be depended upon to give the most recent form of treatment available in each case. Thus the author emphasises the importance of the intravenous injection of caseosan for the various complications of gonorrhoea. The value of the book is enhanced by a number of excellent illustrations, some in colours, depicting the median basilic vein, the best method of constricting the upper arm with a bandage, and other points of importance. Dr. Dutton does not, as an honest anthologist, claim any originality for his book except as regards the idea. He is unable to find that any similar work has yet been published. ____
bread, butter, jam, pineapple or banana fritters, fruit. At midday : rice (not too much) with vegetables, salads, a little fish, fowl, or egg ; all to be nicely cooked, but taken in small quantity. In the evening comes the main meat meal. The moral of Dr. Kipping’s articles may be put briefly: Self-denial at lunch will keep you cooler through the afternoon. GENERAL PARALYSIS IN OLD AGE. Dr. Paul Carretti,l who has devoted his inaugural thesis to the consideration of the clinical aspects of general paralysis in old age, records 19 cases in patients aged from 60 to 72, including two which came under his observation in the service of Dr. Capgras in the Maison Blanche Asylum. The course of the disease is, as a rule, more rapid in old age than in earlier life, and remissions do not occur. Although there are a few instances on record in which senile general paralysis has lasted several years, in the majority of cases the disease proves fatal within 12 months. The interval between the primary syphilitic lesion and the appearance of the first signs of general paralysis is very variable and does not affect the course of the disease. In two of Dr. Carretti’s cases the first symptom of general paralysis appeared 12 years after the chancre, which is the ordinary period in adult life, but more frequently the syphilitic infection had been contracted much earlier-namely, 30,40, or even 45 years before. Only three of the present series occurred in women, a fact which shows that the influence of sex persists in old age. The symptoms consist in dementia with all the features of senile enfeeblement, such as diminution of memory for recent events, impairment of affectivity and judgment, relative preservation of consciousness of a morbid state and of the moral sense, frequent absence of delirium, and focal signs of dementia such as paraphasia and agnosia. The cerebro-spinal syndrome, which consists in abundant lymphocytosis, a positive Wassermann reaction, moderate increase of albumin, and slight diminution of the sugar and chlorides ia the cerebro-spinal fluid is constantly positive and i’3 a valuable guide to the diagnosis of the condition, which otherwise might be mistaken for ordinary senile
A DIET SCHEME FOR THE TROPICS. special physiology of the white man in the tropics has recently been enlightened by two suggestive papersl from the pen of Dr. H. W. Kipping, of the Physiological Institute of the University of Hamburg. In these he points out that, apart from diseases, the great problem of the tropics is how to keep cool. The environment of the body cannot usually be much z, altered, but, within that environment, the temperature ’ of the body is raised by work and food and lowered by sweating, which, however, gives little relief if the surrounding air is very damp as well as hot. It must be, therefore, our endeavour to avoid raising the body White temperature, carelessly, without reason. men are more liable than natives to heat-stroke, because they work harder and so raise their temperature more. Dr. Kipping gives instances of healthy European firemen whose body temperatures, when working in the fire-room during the passage of the Red Sea, rose to 101’5° F. The maximum safe output of work is, he thinks, a matter for calculation, being a function of the drying power of the air, its temperature, and its movement. But taking food also raises temperature, especially protein food ; dementia. fats and carbohydrates exert less effect, and can be stored if taken in excess of immediate requirement. ZOOLOGY AND EUGENICS. Proteins break up into amino-acids which, circulating IN the last four or five years a good many zoologists in the blood, stimulate the tissues to increased[ metabolism, so raising the temperature of the body ; have been interested in the application of their science this is their specific dynamic action. Since they cannot to the welfare of mankind, and it is round this central be stored, any excess taken in must be at once furthernotion that a diversity of essays has been collected Prof. Holmes writes well and broken down, whereby temperature is still furtherinto one volume.2 raised. Dr. Kipping concludes that in the tropics, interestingly on many topics--the present tendency proteins should be taken only sparingly during the; of evolutionary theory, heredity and the mind, the hotter part of the day, the main protein meal being, biological fortunes of the negro, birth control, panarranged to occur in the cooler evening. Where fruits; mixia and degeneration, civilisation" and natural are plentiful, the need for vitamins is supplied. selection. He has the usual chapter on our deterioraProtein is more of a difficulty ; 100 g., according to, ting inheritance," and draws the usual gloomy Voit, are required daily, but to get that from rice, picture of the college graduates who won’t heed, and for example, would compel the eating of five pounds; the degenerates who heed too much. But he differs daily, with a total caloric value of 5400, or about double from most writers on this well-worn theme in pointing what is required. The protein must not be supplied out that, while it is useful to control the multiplication from a single source, as the right proportions of, of the mentally defective, it is far more important cystin, tyrosin, tryptophane, and the like, do not, that those who chide such prolificity should themselves exist in every food. As to cellulose, Dr. Kipping be fruitful. A community, he says, can do alright holds strongly that there must be in the food some; with a few degenerates if it has also great men and element, bulky, unabsorbable, and yet unirritating, women who really make a difference in the world; to increase the mass of the intestinal contents and, the chief danger at present is a uniform mass of dull by assisting peristalsis, to prevent constipation. mediocrity. Biologically his doctrine is sound enough. This cellulose is easily obtained from fruits, salads, 1 Thèse de Paris, 1923, No. 392. 2 and bread made from coarse flour. After this evening Studies in Evolution and Eugenics. By S. J. Holmes, Ph.D., Professor of Zoology in the University of California. and 404. London : and Sons. 1923. 1 Archiv für Schiffs- u. Tropen-hygiene, 1923, pp. 177 Routledge Pp. 261. 12s. 6d.
THE
____
.
; .
.
-
.
,
premature birth, and stillbirth. The work has been -carried out for the Medical Research Council by Dr. J. N. CRUICKSHANK, and has evidently been painstaking and thorough. In the series of 1000 - cases 9-10 per cent. gave a positive Wassermann reaction, and as a certain small number of cases admittedly fail to give a positive reaction in pregnancy, any slight error is doubtless in favour This percentage corresponds of the patients. with that of most recent observers in this field. Dr. CBUICKSHANK found that in practically every case (94 per cent.) the W.R. of the mother was in agreement with the reaction of the child at birth. He ,queries, however, the interpretation of a positive W.R. in the case of the new-born child : Is it the reaction of the child’s blood-may it not be due to transference of the mother’s reacting substances to the foetal An investigation, carried out by circulation ? Dr. H. 0. BRUNNER2 at a maternity hospital in Lausanne, brings out the fact that the Wassermann reaction is not very reliable in the diagnosis of congenital syphilis in the new-born. Among 150 new-born infants whose blood, taken from the umbilical cord at birth, was examined by the Wassermann test, there were only two giving a positive reaction, although at least six of the mothers definitely syphilitic and Wassermann-positive. Curiously enough, in the only case in which the mother had contracted syphilis late in the course of her pregnancy, the new-born infant, as well as the mother, was found to be Wassermann-positive. A oomparison were
of the Wassermann reactions in the mother and child in 113 cases of maternal syphilis of recent or old standing showed that it was positive in both mother and child in 50 cases, positive in the mother and negative in the infant in 35 cases, and negative in both mother and infant in 28 cases. There was not a single case in Dr. BRUNNER’S series in which this reaction was negative in the mother and positive in her infant. As regards incidence of abortion, which Dr. CRUICKSHANK interprets as " birth of child before it was viable "-his figures prove no greater percentage of abortions in the group with positive W.R. over the group with negative results. Stillbirths were proved to be more frequent in syphilitic cases-18-07 per cent. as against 15-15 per cent. of non-syphilitic cases ; and as he further demonstrates that a considerable proportion of the latter were sent into hospital with obstetric complications, almost inevitably causing death of the child, the figures could easily be made more striking if normal deliveries in syphilitic and non-syphilitic cases were compared. The incidence of premature births (after seven months) was vastly greater also in the syphilitic cases-32.5 per cent. of syphilitic cases as against 19-8 per cent. of noninfected women, and in this group of infected cases 68-7 per cent. had stillborn as well as premature babies. No relationship was proved to exist between ante-partum and post-partum haemorrhage and syphilis, nor was syphilis found to be at all an important factor in the aetiology of eclampsia. In the cases which could be followed up for some months after
delivery,
a
definitely larger percentage
of
Annotations. "
Ne quid nimis."
TREATMENTS IN VOGUE IN GERMAN SANATORIUMS. THE pooling of German sanatorium reports and their editing by Dr. H. Ulrici every year in Beitreige zur Klinik der Tuberkulose enable readers to ascertain in a few minutes what are the most popular therapeutic measures in German sanatoriums. Dr. Ulrici’s latest reviewcovers the year 1922, and deal’s with the reports of 40 hospitals for diseases of the lungs. Considering how varied the treatment was, it is disappointing to find that only 15 per cent. of all the cases of " open " tuberculosis became sputum-negative during treatment. Perhaps one of the most important excuses for these meagre results is to be found in the shortness of the average duration of treatment ; in as great a proportion as 84 per cent. of the adult male patients the duration of treatment was three months or less. Only 11 of the 40 hospitals practised artificial 626 of 7068 patients suffering from pneumothorax, " open" tuberculosis in the second and third stages being given this treatment. But whereas onty 8-9 per cent. were treated by artificial- pneumothorax, 26 per cent. were treated with some form of tuberculin. Ten different tuberculins or tuberculin methods were employed by these 40 institutions, and the three most popular methods, to judge by the number of patients treated, were Petruschky’s, Ponndorf’s and Much’s (partial antigens). The least popular was Selter’s " vital tuberculin," which was given in only five cases. Only 28 patients were treated with protein injections, whereas as many as 453 were given some form of chemo-therapy, the gold salt, krysolgan, heading the list with 289 cases. Sun-baths are, apparently, not yet popular in German sanatoriums, and only 1-7 per cent. of all the adult cases of pulmonary tuberculosis were given this treatment. Treatment with artificial light was much more popular, being given in 11-1 per cent. Of 2373 children, only 3-5 per cent. were given sun-baths, whereas 24 per cent. were treated with some form of artificial light. With regard to the results claimed for these various methods of treatment, even the most ingenuous and impressionable reader must be tempted to draw the conclusion that it is the nature of the disease rather than the nature of the treatment that determines the issue. Tuberkulomucin achieved good results in 56 per cent. of the first- and second-stage cases, and the same measure of success was claimed for old tuberculin, albumose-free tuberculin, and bacillary emulsion. Petruschky’s tuberculin inunction was beneficial in 61 per cent., partial antigens in 65 per cent., artificial radiation in 63 per cent., and, in the case of children suffering from surgical tuberculosis, in 99 per cent. Until therapeutic claims are supported by an account of the exact nature of the disease and its activity in the patients cured, the sceptical will continue to doubt the efficacy of the vis medicatrix hominis. A CLINICAL ANTHOLOGY. INDIVIDUAL feelings as to the general value of anthologies vary. Some regard them as a superfluity ; others may find in them a pleasant form of reading, which demands no great intellectual effort. Usually such compilations of other people’s works are extracted from poetical or prose literature dealing with some particular aspect of life or nature. The of this principle to medical books is a new idea which may well make an appeal to certain practitioners and students. Dr. W. F. Dutton has
I application
infants with a positive W.R. died, compared with those non-infected. While not providing any strikingly new data on the subject, this independent and patient compiled an anthology of intravenous therapy, which study of 1000 cases is well worth recording as con- will be valuable for reference and will certainly appeal flrmation of previous knowledge in a field not yet fully strongly to all those who intend to devote their lives
explored. 2 Schweiz. med. Woch., Jan. 24th, 1924.
1 Beiträge, 1924, lvii. 332. 2 Intravenous Therapy. By Walton Forest Dutton, M.D. Philadelphia : F. Davis Co. 1924. Pp. 542. $5.50.
610
attaining a special skill in this branch of medicine protein meal, the office-worker can be quiet in a long (or is it surgery ?). The insertion of a syringe needle chair, not further raising by muscular activity his into a vein is an operation which requires much skill temperature, already slightly raised by digestion. for its certain performance, and it will be encouraging In Java, Dr. Kipping tells us, doctors not vegetarians to the intending specialist to find that so wide a field in principle took to living exclusively on vegetable will be open to him. Several chapters are devoted to food. He puts forward himself the following scheme an account of the theory and practice of blood for food for a tropical day-Breakfast : tea or coffee, to
transfusion. Other subjects discussed at length are the use of arsenic compounds and intravenous anaesthesia. The second and larger part of the book deals with all the other conditions for which medicaments may be injected into a vein. These are arranged alphabetically and number no less than 108. All forms of treatment available for each condition are mentioned, as well as those that are more strictly intravenous. The book may be depended upon to give the most recent form of treatment available in each case. Thus the author emphasises the importance of the intravenous injection of caseosan for the various complications of gonorrhoea. The value of the book is enhanced by a number of excellent illustrations, some in colours, depicting the median basilic vein, the best method of constricting the upper arm with a bandage, and other points of importance. Dr. Dutton does not, as an honest anthologist, claim any originality for his book except as regards the idea. He is unable to find that any similar work has yet been published. ____
bread, butter, jam, pineapple or banana fritters, fruit. At midday : rice (not too much) with vegetables, salads, a little fish, fowl, or egg ; all to be nicely cooked, but taken in small quantity. In the evening comes the main meat meal. The moral of Dr. Kipping’s articles may be put briefly: Self-denial at lunch will keep you cooler through the afternoon. GENERAL PARALYSIS IN OLD AGE. Dr. Paul Carretti,l who has devoted his inaugural thesis to the consideration of the clinical aspects of general paralysis in old age, records 19 cases in patients aged from 60 to 72, including two which came under his observation in the service of Dr. Capgras in the Maison Blanche Asylum. The course of the disease is, as a rule, more rapid in old age than in earlier life, and remissions do not occur. Although there are a few instances on record in which senile general paralysis has lasted several years, in the majority of cases the disease proves fatal within 12 months. The interval between the primary syphilitic lesion and the appearance of the first signs of general paralysis is very variable and does not affect the course of the disease. In two of Dr. Carretti’s cases the first symptom of general paralysis appeared 12 years after the chancre, which is the ordinary period in adult life, but more frequently the syphilitic infection had been contracted much earlier-namely, 30,40, or even 45 years before. Only three of the present series occurred in women, a fact which shows that the influence of sex persists in old age. The symptoms consist in dementia with all the features of senile enfeeblement, such as diminution of memory for recent events, impairment of affectivity and judgment, relative preservation of consciousness of a morbid state and of the moral sense, frequent absence of delirium, and focal signs of dementia such as paraphasia and agnosia. The cerebro-spinal syndrome, which consists in abundant lymphocytosis, a positive Wassermann reaction, moderate increase of albumin, and slight diminution of the sugar and chlorides ia the cerebro-spinal fluid is constantly positive and i’3 a valuable guide to the diagnosis of the condition, which otherwise might be mistaken for ordinary senile
A DIET SCHEME FOR THE TROPICS. special physiology of the white man in the tropics has recently been enlightened by two suggestive papersl from the pen of Dr. H. W. Kipping, of the Physiological Institute of the University of Hamburg. In these he points out that, apart from diseases, the great problem of the tropics is how to keep cool. The environment of the body cannot usually be much z, altered, but, within that environment, the temperature ’ of the body is raised by work and food and lowered by sweating, which, however, gives little relief if the surrounding air is very damp as well as hot. It must be, therefore, our endeavour to avoid raising the body White temperature, carelessly, without reason. men are more liable than natives to heat-stroke, because they work harder and so raise their temperature more. Dr. Kipping gives instances of healthy European firemen whose body temperatures, when working in the fire-room during the passage of the Red Sea, rose to 101’5° F. The maximum safe output of work is, he thinks, a matter for calculation, being a function of the drying power of the air, its temperature, and its movement. But taking food also raises temperature, especially protein food ; dementia. fats and carbohydrates exert less effect, and can be stored if taken in excess of immediate requirement. ZOOLOGY AND EUGENICS. Proteins break up into amino-acids which, circulating IN the last four or five years a good many zoologists in the blood, stimulate the tissues to increased[ metabolism, so raising the temperature of the body ; have been interested in the application of their science this is their specific dynamic action. Since they cannot to the welfare of mankind, and it is round this central be stored, any excess taken in must be at once furthernotion that a diversity of essays has been collected Prof. Holmes writes well and broken down, whereby temperature is still furtherinto one volume.2 raised. Dr. Kipping concludes that in the tropics, interestingly on many topics--the present tendency proteins should be taken only sparingly during the; of evolutionary theory, heredity and the mind, the hotter part of the day, the main protein meal being, biological fortunes of the negro, birth control, panarranged to occur in the cooler evening. Where fruits; mixia and degeneration, civilisation" and natural are plentiful, the need for vitamins is supplied. selection. He has the usual chapter on our deterioraProtein is more of a difficulty ; 100 g., according to, ting inheritance," and draws the usual gloomy Voit, are required daily, but to get that from rice, picture of the college graduates who won’t heed, and for example, would compel the eating of five pounds; the degenerates who heed too much. But he differs daily, with a total caloric value of 5400, or about double from most writers on this well-worn theme in pointing what is required. The protein must not be supplied out that, while it is useful to control the multiplication from a single source, as the right proportions of, of the mentally defective, it is far more important cystin, tyrosin, tryptophane, and the like, do not, that those who chide such prolificity should themselves exist in every food. As to cellulose, Dr. Kipping be fruitful. A community, he says, can do alright holds strongly that there must be in the food some; with a few degenerates if it has also great men and element, bulky, unabsorbable, and yet unirritating, women who really make a difference in the world; to increase the mass of the intestinal contents and, the chief danger at present is a uniform mass of dull by assisting peristalsis, to prevent constipation. mediocrity. Biologically his doctrine is sound enough. This cellulose is easily obtained from fruits, salads, 1 Thèse de Paris, 1923, No. 392. 2 and bread made from coarse flour. After this evening Studies in Evolution and Eugenics. By S. J. Holmes, Ph.D., Professor of Zoology in the University of California. and 404. London : and Sons. 1923. 1 Archiv für Schiffs- u. Tropen-hygiene, 1923, pp. 177 Routledge Pp. 261. 12s. 6d.
THE
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.
; .
.
-
.
,