THE BEEF TAPEWORM IN MELBOURNE

752 Lindau’s tumour, as Bailey and Cushing have pointed out, is essentially a neoplasm. Not only does it invade surrounding tissues but, if incompletely removed by surgical operation, will by active growth recur. The name " angioreticuloma," given to this type of neoplasm by Roussy and Oberling, has been adopted in the present work. There seems however to be no advantage in this, and for most people a multiplication of terms is merely confusing. The authors follow Roussy and Oberling even further in giving a place to angiogliomata as a distinct class, a complication which should be strongly contested. The introduction of a confusing element into the otherwise fairly clean separation of gliomata and haemangiomata should be well supported by facts and reasoning ; in these the somewhat apologetic account of the pathology of this new group is From the clinical standpoint too the defective. distinction is evidently valueless, since the group is dismissed by Olivecrona in a few lines with the comment that angiogliomata are chiefly of interest from a pathological standpoint. In his account of Sturge-Weber’s disease Olivecrona points out that the classical triad of facial nsevus, glaucoma, and cerebral symptoms combined with rontgenological evidence of intracranial calcification is seen in only a minority of cases. He stresses the importance of epilepsy as a symptom, and takes, on the strength of his own experiences, a more optimistic view of the surgery of this condition than has been customary. His optimism is, however, qualified by the necessity of selecting rather strictly the cases that are likely to benefit by operation. Dr. Tonnis finds that cases in

fibromatosis.

the group aneurysma arterio-venosum are seldom approachable surgically, and are more suitable for rontgen therapy. Ligature of the afferent arteries is practicable in very few instances. All who are interested in this branch of pathological anatomy will appreciate the clear presentation of the problems provided by these blood-vessel tumours and malformations and their illustration both by accounts of cases and by excellent photographs and drawings. NON-VENEREAL SYPHILIS

UNDER the name of bejel, or non-venereal syphilis, Dr. Ellis H. Hudsongives an instructive account of a community infection prevalent among the Bedouins from which few of them escape, the majority contracting the disease in childhood. Inasmuch as sexual intercourse is not concerned in its propagation, bejel has the same epidemiology as yaws, which it also resembles in its wide distribution, acquisition in childhood, and general neglect of treatment. The principal grounds for believing that bejel is a nonvenereal infection are first that the Bedouin villagers are prevented from sexual promiscuity by geographical, economic, and social barriers, and, secondly, that they are free from venereal diseases and lesions such as gonorrhoea and penile chancres. The Bedouin child is not congenitally syphilitic, though both parents are usually infected, but contracts bejel at some time in early life. Infection usually takes place orally by drinking from infected cups or from kissing. The lesions on the mucous membrane of the mouth are greyish patches with desquamation but no ulceration. The saliva and scrapings from the lesions show abundant spirochaetes with the characteristic appearance of Treponema pallidum. Papules appear about the same time on the genitalia and folds of the skin. The process in the mouth may 1 Arch. Derm. and Syph., 1936, xxxiii., 994.

extend to the bones of the nose producing collapse of the nasal bridge. Less often there are tenderness and swelling of the epiphyses and periosteum of the long bones. In the course of a year these lesions disappear leaving an apparently healthy child, but the Kahn test remains strongly positive for years even though no subsequent lesions develop. At some time later however, from the second to the seventh decade of life, ulcers of the pharynx or skin or gummata of the nasal or long bones may appear. Serious damage to the cardiovascular and nervous systems and viscera do not occur, and the rate of miscarriage is much less than that in women with venereally contracted syphilis. In a subsequent paper2 Dr. Hudson records the results, the first of the kind to be obtained, of darkfield examinations, which demonstrated the constant presence of abundant spirochaetes with the characteristic morphology and motility of Treponema pallidum in the lesions of fresh bejel infection, while they were less constant and abundant in late cases. THE BEEF TAPEWORM IN MELBOURNE

THE Baker Institute of Medical Research has been

inquiring into the presence of infection with Tcenia saginata in man in Melbourne, and of its larval form, Cysticercus bovis, in cattle there. The inquiry arose from the discovery of beef measles in the cattle grazing on a farm which was being irrigated with untreated sewage, and because there was a big economic stake involved ample funds were made available for the investigation. As the result of wide advertising and money rewards 90 cases of this tapeworm were traced,3 most of them in Syrian-born persons who had come to Australia infected. In other words, so far as these methods brought them to light the infection is rare in man in the State of Victoria. The next steps taken were concerned with the infection in cattle.44 They examined many slaughtered at the abattoirs and found them all to be free from cysticerci ; they bought 100 cattle in the open market, killed 12 as controls and found no cysticerci in them, and fed onchospheres of T. saginata to the other 88, with the result that all became infected. These cattle, then, had no natural immunity. From the study of infected beasts, the ages of whose cysticerci were known to lie between 15 days and a year, the investigators became sufficiently skilled to tell from its appearance the approximate age of a cyst and to determine that none lived longer than nine and few longer than seven months. By a series of fully controlled experiments they then got evidence that oxen that had in course of time become cured of this infection could not be given a second one ; they had become immune and this condition was shown to persist for at least 70 weeks. Confirmation of this view was obtained from the state of cattle that had grazed for varying periods on a farm irrigated by crude sewage. The percentages of infection among those who had done so for 6, 15, and 36 months were respectively 46, 33, and 14. It seems then that onchospheres must be present in this crude sewage in plenty, that an active immunity to this worm infection has been brought about, and that, if it is proposed to continue irrigation with crude sewage, the best way of setting up this immunity must be discovered. Of two matters these reports have no note. The one is the local presence or absence of those grave cerebral symptoms, particularly epileptiform convulsions, which are caused by cerebral 2 New Eng. Jour. Med., 1936, ccxv., 392. 3 Penfold, W. J., Penfold, H. Boyd, and Phillips, Mary : Med. Jour. Australia, 1936, i., 283. 4 Ibid., 1936, i., 417.

753

cysticercosis in man and which have shown themselves with relative frequency in those who harbour the intestinal stage of tapeworms ; of this point a mention would have been welcome and apposite, for it will be unexpected if such cases are altogether absent in part only of the world. The other is the wider effect on public health of this objectionable method of the fertilisation of land ; but mention of this could not reasonably be expected since it lies outside the scope of the inquiry. Yet it is of great importance

to the

community.

THE COD-LIVER OIL TREATMENT OF WOUNDS

THE problem of inducing wounds to heal has been approached in several different ways. Primarily there is the difficulty of eliminating or limiting the action of pathogenic bacteria. Attempts to inhibit bacterial activity without damaging the tissues by means of an external antiseptic application have proved elusive. More harm has been done to the tissue cells than to the infecting organisms, and for the most part any antiseptic action has been neutralised by tissue fluids. The conception of utilising and intensifying the natural means of defence was developed by Almroth Wright in his hypertonic salt treatment with encouraging success, and there have been other pointers, for example, the ketogenic treatment of pyelitis, that such physiological methods promise most. A recent application has been the cod-liver oil treatment of septic wounds which was brought to the notice of surgeons by Wilhelm Lohr of Magdeburg.l Further experience seems to have confirmed the early opinion that granulation is encouraged and the wound heals more quickly under the application of a cod-liver oil dressing. How the effect is brought about is not yet clear. It is tempting to accept the hypothesis that the results are due to vitamin A contained in the oil, but it is not evident what part the vitamin plays. The tissues react differently to animal oils than to vegetable or mineral products, cellular activity being promoted to a much greater degree by the former. An attempt to elucidate some of these problems is described in a paper by Dr. Davson published elsewhere in this issue. He studied the healing of wounds in the rabbit’s ear, and came to the conclusion that the stimulating property of codliver oil resides in other constituents than vitamin A. On the other hand, Dr. Sandor, whose observations are also recorded in this issue, concludes from his clinical experience that it is vitamin A alone which expedites the reparative process. In fact he prefers to employ a solution of vitamin A in paraffin, a most inert vehicle. Whatever the explanation may be, a case does seem to have been made out for further trial of cod-liver oil dressings. It must not be overlooked, however, that an essential part of the treatment described by these authors is careful surgical attention to the wound, the provision of free drainage, and absolute fixation of the part in plaster-of-Parisin fact, the meticulous practice of the Winnett-Orr treatment. Under such circumstances it is clear that the difficulty of assessing clinically the virtues of the cod-liver oil are indeed great. WHAT

IS JAM ?

IN the " Concise Oxford Dictionary " jam is defined as a " conserve of fruit, made by boiling it and sugar to a pulp." The housewife who makes her own jam would probably agree with this definition and expect jam purchased from dealers to conform to 1 See THE LANCET, 1934, ii., 367.

But the making of jam at home is a seasonal and part-time job, carried out by extra exertion on the part of its members during the season when fruit is plentiful. The jam manufacturer, if he makes nothing else, is confronted with the difficulties of a seasonal trade. Desiring to keep a more or less uniform staff of workers, either he buys fruit when it is cheap, works up as much as he can into jam at once and preserves the rest for jam-making during the winter; or he buys fruit pulp from firms at home or abroad, who have laid down large stocks of fruit with preservative (usually bisulphite of sodium or calcium) and makes this into jam all the year round. His customers expect a product of fairly uniform colour and consistency, and as the sulphite tends to bleach the fruit to which it is added, and the natural pectinous substances of the fruit cannot always be relied upon to produce a jam which does not run, he takes advantage of the permission to use a harmless dye to simulate that of the fruit and adds pectin prepared from the albedo of citrous fruits and other vegetable materials, possibly with citric or tartaric acid to supplement the natural acidity. Jam made from fresh fruit and sugar is a definite thing, but pulp for jam-making may be of any age and the jam made

it.

from it may be labelled " New Season" which is true so far as the recentness of the jam is concerned, but may lead the buyer to suppose that it is made from new fruit. Strawberry jam, for instance, may be sold as " new season " at a time when the price of the fruit is so high that few people will buy it for dessert, let alone for jam-making. Mr. H. E. Monk, in his annual report as city analyst for Salford, tells of an attempt to enforce the law regarding jam which has met with some success, but he points to the rather unsatisfactory character of the informal standards for different grades of jam agreed between the Food Manufacturers Association and the Society of Public Analysts. " New Season’s Full Fruit Standard Blackcurrant Jam " may, it appears, contain only 30 per cent. of fruit, entirely pulp, stiffened up with added pectin, its colour restored with artificial dyes and its acidity artificially increased. Mr. Monk, whilst admitting the difficulties of the manufacturer, suggests that the research association of the jam trade should tackle the problem of preservation of fruit by better means than now usually used. Until this is done the home manufacture of jam may be the best way to ensure that it is true to

description. JOHN WILLIAM GORDON

Mr. J,

W. Gordon, K.C., who died on Monday last Hampstead home, was one of the oldest members of the staff of THE LANCET ; indeed, he had ceased to cooperate actively with us for some 30 years. But there was a time when we looked to him regularly for assistance along lines that have now become definitely a part of the science of statistics. He had a fine knowledge of chemistry and was a physicist of the first rank, and such medical questions as were laid before him were always dealt with by him in the coldest mathematical way-save in a matter of ophthalmology he seldom made any reference to the sick person, who for him figured as an item in a calculation. To very many Gordon’s scientific record made it a source of wonder that his work was not better known, but he seemed always to be unable to bring his theories and indeed his accomplishments into relation with practical needs-his temperament and methods of work were such that legitimate publicity always escaped him. At the Bar his practice was chiefly concerned with patent cases. and in the at his