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the field to the controlled circumstances of thelaboratory will not be interrupted by his recenttranslation to Manchester.

THE SACHS-GEORGI REACTION IN

OBSTETRICAL WORK.

AT a recent meeting of the Budapest Royal Medical ISociety Dr. Bela Var6 read a paper in which he Istated that in the light of results obtained in syphiliticpatients treated at the 1st Obstetrical Clinic at theUniversity, the Sachs-Georgi reaction could bedescribed as indispensable in the diagnosis of latentsyphilis. Its value had been proved in cases wherethe disease could not be detected by the Wassermannmethod ; in 11 women who had borne syphiliticchildren, but had nothing pointing to syphiliticinfection either in the past history or clinically, andin whom the Wassermann reaction was negative, theSachs-Georgi reaction gave a positive result. Sincethen he had analysed by the Sachs-Georgi methodthe blood of every syphilitic child coming under hisobservation, and had not seen one mother whoreacted according to Colles’s law ; the mothers wereall found to give a positive Sachs-Georgi reaction.He admitted, however, that the Sachs-Georgi methodcould not replace that of Wassermann, as some casesof syphilis could only be diagnosed by means of thelatter ; but Sachs-Georgi’s must be considered as avaluable supplementary method.

PROPHYLAXIS OF SIMPLE GOITRE.

THAT iodine deficiency is an important factor in theproduction of simple goitre is now one of the acceptedpremisses in thyroid pathology. It may therefore be

assumed that an adequate supply of iodine in the foodis essential for the well-being of most animals. Thenatural distribution of iodine compounds has beenexamined by E. R. Hayhurst,1 and he has pointedout that owing to the great solubility of sodiumiodide, it tends to disappear from land surfaces and toaccumulate in its chief storehouse, the sea. For thisreason dietary salt prepared from a marine sourceshould contain a proper supply of iodine, but modernmethods of preparation of salt tend to eliminate itsnatural iodine content, irrespective of its source. Thedeficiency will be to some extent remedied by thesmall quantities of iodine present in other foodstuffs,but it becomes more accentuated in a district thehigher it lies above sea-level, owing to the greaterwashing out of soluble salts which takes place inmountainous places. This observation agrees withthe fact that simple goitre occurs with great frequencyin certain high districts, and it is natural that thesubject should receive close attention in Switzerland.Recentlv (June, 1922) a Swiss goitre commission hasreported on the question and an important con-

tribution has been made by Prof. F. de Quervain 2who deals primarily with the prophylaxis of goitre.Prevention has been dealt with by many other writers,but usually the method advocated has been theadministration of iodine or its salts to all school-children in affected districts. But de Quervain pointsout that post-mortem examinations made on infantsin Swiss goitre centres show that an enlarged thyroidgland is always to be found, and he urges thereforethat prophylaxis should begin long before the school-age and should, in fact, begin with the treatment ofthe mothers. The best means he believes to be by theuse of dietary salt with a proper iodine content.Caution should, however, be observed. The dose forinfants and children must be kept well below thatwhich is necessary in adult life, and in schooltreatment the dose must be at the lower limit of thatwhich is known to be effective. Special care shouldalso be taken with girls approaching the age ofpuberty and the treatment should be withheld at the

1 Jour. Amer. Med. Assoc., 1922, lxxviii., 18.2 Schweiz. med. Wochenschr., August 31st, 1922.

first sign of thyroid hyper-activity. All preventivetreatment should therefore only be used with effectivemedical control. This warning as to the possibledangers of indiscriminate prophylaxis is well advised.Man often needs to be protected from the ill-effectsof his own cleverness. ____

A NEW FERMENTATION TUBE.

AT a meeting of the Section of Pathology of theRoyal Society of Medicine on Nov. 21st Dr. C. E.Dukes described a new fermentation tube to be used inthe testing of the fermentation of carbohydrates bybacteria in the presence of peptone. He emphasisedthe serious alteration which takes place in sugarsolutions when sterilised even by steaming in thepresence of peptone, and suggested that many of theuncertain reactions recorded in fermentation testsmight be attributed to this alteration in the sugar.Thus, a non-lactose-fermenting organism might pro-duce sufficient acid from the by-products originatingfrom the sterilisation of the lactose in the presenceof peptone to turn the indicator acid, although thelactose itself had not been attacked. He gave instancesof other confusing results observed, attributable tothis deterioration of the sugar. He mentioned thechemical experiments which had verified the above ehypothesis and showed that no such alteration tookplace in the sugar when sterilised in a simple waterysolution. The new fermentation tube was introducedto avoid this deterioration of the sugar on sterilisation.It is similar to the ordinary Durham’s fermentationtube and is contained in larger test-tubes in a similarfashion, but a small glass cup is fixed to the top of thefermentation tube and into this cup is placed c.cm.of a 10 per cent. solution to the sugar to be tested.The surrounding test-tube contains 4t c.cm. of1 per cent. peptone-water. The test-tubes are sterilisedin the autoclave in the upright position, the sugar beingthus separated from the peptone. After sterilisationthe tube is tilted to an angle of 30° when the sugarruns out of the cup and mixes with the peptone, thusgiving a 1 per cent. solution of the sugar in approxi-mately 1 per cent. peptone. The tube is now readyfor inoculation with the organism to be tested. Theadvantages claimed for the new fermentation tube arethat this method of testing sugar reactions is moreaccurate since no deterioration takes place in thesugar during sterilisation if it be separated from thepeptone, that a more delicate indicator can be

employed, that the method is rapid, simple, andeconomical. Dr. Dukes described the method ofmaking these fermentation tubes, which can beobtained from Messrs. Baird and Tatlock, HattonGarden, London, E.C. ____

A FACTOR IN MINERS’ NYSTAGMUS.

ACCORDING to Mr. A. S. Percival,1 who has hadconsiderable experience in the examination of coal-miners for nystagmus, the liability to this disease isan idiosyncrasy that affects a certain proportion-some 5 per cent.-of the population. The reason whichhas led him to this conclusion is the frequency withwhich recurrence takes place in those who, once havingbeen cured return to work as hewers-i.e., to under-ground work at the coal-face. Indeed, a recurrenceunder these circumstances appears to be inevitable.Mr. Percival recalls four patients, each of whom wasreported on by him on no less than three successiveoccasions, and each of whom, after intervals of recu-peration and light surface work, had returned tohewing, at some other pit, only on each occasion todevelop nystagmus and obtain compensation. It isobvious, he says, that the unfortunate pitman whoacquires miners’ nystagmus must be given compensa-tion for a limited period, say 12 months or so. inwhich to recover from his symptoms and, if possible,obtain other employment. But it is equally obviousthat he ought never to be allowed to attempt under-ground work again. That he should be awardedcompensation on the scale of total incapacity for work

1 Transactions of the Ophthalmological Society, vol. xlii., 1922.

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appears absurd, if he is as fit as ever he was for anywork except coal-mining ; and yet this is what hassometimes occurred in these cases. The great sumspaid in compensation are reflected in the enormouslyincreased price of coal and the difficulties in the

export trade. We agree with Mr. Percival that theinterests of both workmen and employers would bebest served by limiting the period during which thecompensation can be claimed, and encouraging theworkman to change his occupation. But encourage-ment will have to take some practical form in thesedays of unemployment.

THE TRAPPING OF FLY LARVÆ.

THE problem of the fly is seasonal, and whereas ithas lost interest here until next July the approachingsummer in the southern hemisphere makes it topical.Dr. L. G. Haydon, assistant medical officer of healthfor the Union of South Africa, contributed to theSouth African 111edical Record of June 24th a memor-andum on the disposal of animal manure and garbagein relation to fly-breeding and prevention of entericfever and other intestinal diseases. The methodperfected by Captain E. Baber, sanitation officer to theUnion Department of Defence, is stated by Dr.Haydon to have proved of great use in abating the flynuisance ; the South African Central Public HealthAuthority recommends its adoption, and severalpublic authorities have already made use of the device.In 1918 Captain Baber described his invention in ourcolumns 1 ; he had then dealt with the manure froma thousand horses at Potchefstroom Camp duringsummer and winter with uniform success. The deviceconsists, it will be remembered, of enclosures of wiremesh on cement or brick platforms. A channel sunkin the platform surrounds the enclosure ; the manureand garbage is trodden down firmly in the enclosure,and the heat engendered drives all maggots through themeshes of the containing fence, so that they eventuallyfall into the sunken channel for collection and destruc-tion. Dr. Haydon quotes Mr. Walter Jameson, townengineer, Kimberley, who writes as follows of the firstlarge-scale application of the method in the Union :-"Each trap or enclosure has a capacity of about 240

cubic yards-equivalent to one week’s accumulation of townmanure and garbage. The manure is carted down-some-times three or four days old, which means that the femalefly has already laid eggs in it. It is forked direct into theenclosure and a labourer maintains the level, at the same timetreading it well down, especially round the sides..... Afterthe second day, owing to eggs having been laid in the manurewhile still in town, the maggots begin to show signs ofactivity .... trying to escape the heat of the rapidly decom-posingheap. Finally, seeking cooler regions, the maggots dropon to the ledge between the base of the stack and thechannel..... The ledge of cement heated by the sun provestoo hot and they migrate further, finally falling into thechannel provided, where they are swept up into paraffin tinsfor destruction. In one instance I removed on the ninthday four wheelbarrow loads and ten paraffin tins of larvaefrom one channel. When in full swing the channel and sumphave to be swept up three times a day until maggots ceaseto emerge. At first- it appeared that the maggots wouldhatch into flies at the top of the stack, but careful observationshowed that this did not occur except to a very small extent..... Four enclosures in all-each capable of holding oneweek’s accumulation of manure and garbage-is the idealplan.... On results obtained and noticing the markeddecrease of flies, I am convinced that the fly pest will bereduced to a minimum."

Dr. Haydon recommends the method not only forinstitutions and farms where quantities of animalmanure and fermentable waste have to be dealt with.but also for large communities, with the proviso thatin towns waste materials must be collected in separatereceptacles, so that fermentable matter useful forfertilising purposes-e.g., animal manure, vegetablegarbage, and slaughter-house refuse-are not mixedwith ashes and old tins, which would interfere with therotting process. In South Africa further experimentsare being conducted as to the range of temperature inthe stacks under varying conditions, such as moisture.

1 THE LANCET, 1918, i., 471.

Dr. Haydon states that the experiments hithertoperformed on these lines go to indicate that destructionof such organisms as B. typhosus must occur. Con-siderable public interest would attach to similar experi-ments in Great Britain. Dr. Haydon, speaking fromhis experience in South Africa, regards the questionof the disposal of refuse as of vastly more importancethan, say, the control of plague.

ADULTERATED FOODSTUFFS.

THE annual report for 1921 of the Salford Boroughanalyst, Mr. G. D. Elsdon, contains much interestingmatter. Thirteen out of 25 whisky samples con-

tained added water. Eighty of 898 milk samples, or8-9 per cent., were returned as adulterated. In spite ofthis the average composition of all milk samples for1921 was 3-59 for fat and 8-94 for non-fatty solids.The fat in 1921 was lower than the average for theprevious seven years, but the non-fatty solids werehigher. Many of the adulterated samples were

illegally coloured artificially. Many were dirty,although the standard taken of five volumes ofsediment per 100,000 is, in the opinion of the analyst,a very lenient one. An unusual adulteration-viz.,by potassium nitrate-is reported, the object beingapparently to destroy objectionable odour. lVIr.Elsdon reports with satisfaction that a large proportionof the rice now sold is unpolished, but, nevertheless,he found 7 out of 16 rice samples had been faced withmineral matter resembling talc, and that 3 out of 6samples of ground rice contained an excess of mineralmatter from the same source. The only object of thistalc-polishing, says Mr. Elsdon, is to improve theappearance in order that a higher price may bedemanded from the purchaser. No less than 17 out of59 samples of borax were found to contain excessivearsenic, in eight cases to the extent of 1 gr. or over ofarsenious oxide per pound. As a result of this discovery,the preservatives used in places where cooked meat wasprepared were examined, and 5 out of 10 preservativesused were found to contain from 1/10 to 3 gr. of arseniousoxide per pound. The trouble had arisen throughborax intended for commercial purposes being usedfor food purposes. One of the first lot of sampleswas sold by a qualified pharmacist as " pure medicinalborax," and another by a grocer as " refined borax."The analyst reports having examined 19 samples ofhuman milk, with an average percentage compositionof 9-52 total solids, 2-25 fat, and 7-27 solids not fat.The composition given is so unusual that one wonderswhether due precautions were taken to obtain a fairsample of the whole of the milk in the breast.

RECOVERY FROM TUBERCULOUS MENINGITIS.

UNTIL recently students have been taught thattuberculous meningitis is incurable, and that when thepatient recovers the diagnosis should be changed to onemore plausible. There was some excuse for thisteaching before lumbar puncture and the discovery ofthe tubercle bacillus had rendered possible the accuratediagnosis of this disease. Now, however, it is notonly certain that the disease may clear np auto-matically, but that it also does so in a considerablenumber of persons who have passed childhood. Inthe Annales de 1J:íéàecine for September, Dr. A. Cramerand Dr. G. Bickel have recorded a case in whichrecovery followed tuberculous meningitis in a man aged19, whose cerebro-spinal fluid contained tuberclebacilli, as shown by direct microscopic examinationand guinea-pig inoculation. The most interestingfeature, however, of this paper is the authors’ collectionand analysis of similar cases. About 250 have beenpublished, but this number becomes greatlv whittleddown when only those cases are considered in whichthe evidence is irrefutable. Such evidence is thepost-mortem demonstration of old tuberculous lesionsin patients who have died a considerable time afterrecovery from an attack of clinicallv typical tuber-culous meningitis, or the finding of tubercle bacilli in