THE CEREBRO-SPINAL FLUID IN SYPHILIS.

663 absenteeism which among coal-miners is considerable is to improve the conditions of work ; thus air movement within a narrow range is associated with a minimum of accidents and sickness, and at moderate variations to lower or higher velocities the rates rapidly rose. Air velocities of only 18 to 21 feet per minute were found, and are condemned as too low for efficient work or for safety in mines rich in gas. The cause of absenteeism most studied was accident, the frequency of which, so far as minor accidents are concerned, varies with underground temperature. The grading is remarkable ; accidents causing less than ten days’ disablement were 4-3 times more numerous at the highest than at the lowest temperatures ; those causing 10-19 days’ disablement were 2-0 times more numerous ; those causing 20-59 days’ disablement were 1-5 more numerous; but major accidents causing 60 days or more disablement were unaffected by temperature. Generally what holds good for accident frequency also holds good for sickness rates. Undue exercise increased absenteeism ; men who walked from the pit shaft to the coal face, 2800 yards, showed 58 per cent. more than men who walked 1330 yards ; similarly, men who lived 2-6 miles from their colliery showed 80 per cent. more voluntary absenteeism than those living 1-2 miles away, Seasonal fluctuations naturally affected surface The outworkers more than underground men. CHILD WELFARE IN JAPAN. standing conclusion to be drawn is the delicate way WRITING from the laboratory of the University in which the human organism reacts to its environmedical clinic at Kyoto, Dr. Teruko Minouchi describes1 ment ; by controlling the environment its reactions the rethe development of infant and child welfare in Japan. can be advantageously controlled whether " action result in a traumatic or infectious accident." She points out that the changes which have taken place in this country within the last 60 years, while they represent an enormous advance in energy and culture, THE CEREBRO-SPINAL FLUID IN SYPHILIS. seriously threaten the health of the people in several directions. A special feature in the industrial life WRITING on the cytology of the cerebro-spinal fluid of Japan is the greatly increased ratio of female to in syphilis, Paul Ravaut and Raoul Boulin1 say that male workers, especially in the case of the textile dried fixed films made after centrifugation leave such a trades which form the most important industry of the large proportion of the cells disorganised as to be country. The ill-health of the women is increased by valueless, whilst a simple numerical count may give the fact that the girls begin to work while very young no hint of a serious underlying pathological process, and undeveloped. The author briefly sketches the persisting after the cell count has almost reached growth of infant welfare in Japan from its earliest normal figures. After many trials they favour vital beginning 1400 years ago down to the present day. staining with methyl-green pyronine, the deposit In spite of this long period, however, the infant death- after centrifugation being mixed with the stain and rate in Japan in 1924 was more than twice that of the cover-slip ringed. Such a preparation lasts about England and Wales, and three times that of the 24 hours. Living cells may be distinguished by the Netherlands. Dr. Minouchi is convinced that progress fact that they take longer to stain, sometimes even in maternity and child welfare will depend largely hours, the nucleus eventually becoming blue and the upon the development of the women’s movement, and cytoplasm and nucleolus red or rose-coloured. As she urges that women should take a larger share in a result it is claimed that the following types of cell public life and in the general activity of the nation if may be distinguished : unattached nuclei, lymphocytes, any progress is to be made in social hygiene. Dr. medium-sized mononuclears, polymorphonuclears, Minouchi’s paper was presented to the open meeting large mononuclears, and plasma cells. The two last of the Medical Women’s International Association types are always of great importance as indicating recently held at Bologna. involvement of the parenchyma of the nervous system, as opposed to meningitis. In secondary syphilis, a count composed of lymphocytes and medium-sized CONTROL OF INVALIDITY. mononuclears gives a favourable prognosis under NATIONAL attention is being ever more and more treatment ; but if large mononuclear cells and plasma directed to the importance of invalidity, to the cells are also present, they may persist in spite of economic loss it entails through national insurance, treatment, giving warning, perhaps years ahead, of and to the industrial inefficiency thereby created. involvement of the nervous system. Tertiary cases Few investigations have thrown more light on the they divide into four groups : those with no clinical causes underlying sickness, whether due to illness or involvement of the nervous system, those in which only accident, than one made among coal-miners by Dr. the cerebral vessels are affected, tabetics and cases of H. M. Vernon and Dr. T. Bedford.2 Nevertheless, the general paralysis. In the first two groups the same subject is difficult ; and, although records were rules apply as in secondary syphilis, but the significance studied relating to 23,000 miners for periods. of of an abnormal fluid is greater. In an early tabes 21 months to six years, and although the authors lymphocytes and middle-sized mononuclears often can point to the extraordinary sensitiveness of the predominate with perhaps a few small plasma cells, miner to his conditions of work and general environ- or the latter may form the majority. An old or ment, yet the inferences suggested by the facts are arrested case may show very few cells, most of them only cautiously advanced. Some deductions seem dead, and polymorphonuclears are rare. It is often definite. The most valuable method of reducing impossible to tell a progressive from an arrested case by the cells present because, though quiescent in the 1 Die medizinischen Massnahmen zur Gesundsheitsfürsorge meninges, the disease may be active in the parenchyma. für

association of ossific centres with vascularity, and the

the practically nonThese matters were well vascular calcified area. brought out in THE LANCET of Sept. 8th by Prof. 11. A. Harris writing on Bone Formation and the Osteoblast. Readers interested in the questions from a pathological or morphological standpoint will find Dr. this paper of considerable reference value. Harris says truly that we wait for the chemist to explain the colloidal processes which lead to the deposition of calcium in two tissues so fundamentally distinct as dying cartilage and living bone. It does not seem that the anatomist and the embryologist can advance much further without some widening of the horizon. The modern view of living substance compares it with a reversible colloid, and researches along the lines indicated by such a comparison, researches dealing with suspensions and emulsions and the effects on them of various salts, will without doubt open up new avenues along which the investigator of ossification will be able to progress. There will still remain a vital activity (in the form of cellular regulating processes) which will be outside the chemist’s province, and it is in the elucidation of this process that the opportunity of the experimental embryologist will come. way

they destroy

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Kinder, insbesondere Säugling und Kleinkind, und für Jugendliche in Japan. 2 A Study of Absenteeism in a Group of Ten Collieries. By H. M. Vernon and T. Bedford. Industrial fatigue Research Board. Ref. No. 51. H.M. Stationery Office. 2s. 8d.

1 Presse Méd., July 14th. This paper summarises one appearing in the Annales de Dermatologie et Syphilographie for last December.

664 the very process of its attainment, bonification may temporarily increase malaria, so that in the meantime antilarval and other measures must be employed. Time is the essence of the contract for this as for all general antimalarial procedures, and unless adequate time be conceded adequate results will not be obtained. Time, too, is concerned in obtaining that " minimum effective degree of " which must be reached before any perfection individual antimalarial measure produces visible results. The most important of these is the treatment of the sick ; it is the primary obligation, whose good results will, however, be apparent rather in the reduction of the severity of infection than of its incidence. In the choice of other intermediate methods which shall be employed in any particular local campaign, imitation of those which have already proved their value elsewhere is actually dangerous. Quite otherwise is the imitation of the confidence, energy, and perseverance which gave them their earlier success, and of the discernment which chose QUESTIONING THE PATIENT. those measures which have proved applicable to No one will dispute the importance of thorough each particular locality. In effect, this advice from physical examination before diagnosis, but the stress the Subcommission implies the selection of an laid upon it Tends to relegate history-taking to a executive officer with wide knowledge and shrewd second place. The main reasons for a relative neglect mind, -who is allowed time in which his schemes may of this fundamental part of the examination are show their value. The report also emphasises how essential is the setting apart, in every country connervousness or incoherence on the part of the patient, cerned, of special research workers ; for very much a preconceived idea of the diagnosis either on his or the doctor’s part, and, most important of all, lack of still remains obscure in malaria, and antimalarial time. The time available for a consultation has its measures cannot reach their full effect till that shadow limits, and it can only be used to the best advantage is enlightened. if patient and are prepared to assist each HOUSING IN CITIES. other. We have just received the second edition of a little book 1 designed to meet these difficulties and DURING the coming autumn session Parliament will prepare the patient for consultation. It opens with a have to review the position of the subsidy granted short preface in which the duties of the patient to out of the national exchequer in order to expedite the physician are explained, and emphasises especially the of adequate housing for the existing popusupply the need for early consultation, so that tendencies lation. The Minister of Health, who has the Rating to disease may be recognised before they become and Local Government Bill on his hands, will no doubt incurable, and the desirability of giving an accurate be guided mainly by the experience of the public account of the symptoms themselves rather than of health authorities in the large urban areas concerned, deductions and theories. This advice is followed by from medical officers of health of three Reports lists of questions arranged under various headings industrial cities contain comments of moment on the

General paralysis has more definite characteristics. The cells often show great vitality and diversity of type and it is only in these cases that the large and polynuclear plasma cells are found. Lymphocytes and medium-sized mononuclears still, however, often form the majority of the cells present. Ravaut and Boulin claim that the technique is simple, but it is clear that a considerable experience would be necessary before the different types of cells could be distinguished with certainty, the more so as moist preparations are Confirmation of the results is also necessary. clearly necessary and this can only be obtained, as the authors have found, by years of comparison with clinical findings. But the importance of the spinal fluid as a guide to prognosis in secondary syphilis is now becoming recognised ; and the assistance promised by the present work should not be ignored where there is enough material at hand to allow mastery of the technical difficulties.

by

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physician

general information, family history, nutritional local housing problems. digestive disorders, and respiratory troubles, In Birmingham the City Corporation has since which the patient, according to his complaint, can 1920 built the numbers for the years in order that when the 1925-6-7 17,682 houses, prepare himself to answer, and 4007 respectively. 3066, 5159, being actual consultation arrives nothing will be missed and Dr. H. P. Newsholme remarks that while this steady answers will be clear and to the point. There is progress is being made in the provision of new houses, no doubt that if this book were used intelligently the of housing continues to rank as one of history-taking would be made easier and more speedy. the problem most urgent and fundamental questions conBut there are great disadvantages in putting a book the city. Much is being done, through of this kind in the hands of patients. The people fronting and in other ways, to improve the sanitary inspectors who most need such a guide are exactly those who often deplorable, of the least satisfactory would be most confused by the possibility of having conditions, but there is great need for more radical to answer a formidable array of questions, whilst the houses, treatment of a mass of mean houses spread suggestive effect of studying queries like, Have you through various large portions of the city-houses which a very sharp pain which starts from the region of the dilapidated, insanitary, and lacking in heart and goes towards the left arm ? " might be are dismal, amenities. It is not possible, says Dr. elementary unfortunate. The book useful to be the very may to measure the loss to Birmingham Newsholme, physician in re-emphasising the value of a careful arising from the effects of such surroundings, not only history, but in the hands of patients it would certainly through their adverse effect on welfare, but give rise to more mistakes than are traceable to the far more fundamentally throughphysical their hindrance to surreptitious leading questions which a medical man any real fullness of life. The problem calls all the must introduce into his catechism. more strongly for a solution through the contrast between this old and insanitary property and the remarkable new housing estates which have sprung MALARIA AND COMPROMISE. up so rapidly. It is to be hoped on the one hand that THE 33 members attending a session of the First the proposals of the Government for facilitating slum Subcommission of the Malaria Commission of the treatment will mature quickly, and on the other League of Nations have issued a unanimous report that the rehousing scheme is approaching a stage at on antimalaria methods.2 The final aim of all which the problem of the slums can be systematically such as

and

"

measures directed towards the eradication of malaria is regarded as being an " integral bonification," which may perhaps be defined as the sum of economic, social, and hygienic betterment induced by development of the land and growth of civilisation. But

attacked. In Manchester a special report on housing was submitted by Dr. R. Veitch Clark to the City Council on Sept. 30th, 1927. Dr. Clark can give no real evidence of a reduction in overcrowding although there may be a tendency in that direction, and the 1 Comment consulter ? By Léon Schekter. 2nd edit. Paris : increased proportion of cheaper houses in the present Octave Doin (Gaston Doin et Cie). 1928. Pp. 170. Fr.15. schemes is to hasten the tendency. likely of Health Nations : 2 League Organisation. C.H./Malaria/121. London: Constable and Co. There is no noticeable slackening in the demand for

I housing