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oxygen is excluded on sealing-are not as great aswas formerlv believed or as was the case with theolder methods of manufacture.The influence of the ascorbic acid oxidase in

vegetable tissues, and the curious and seeminglycontradictory behaviour of vitamin C to which its

presence may apparently give rise, are discussed ina particularly useful section. Altogether, no dietitianor practical nutrition worker of any kind should bewithout this pamphlet,’ which can be obtained as areprint separate from the journal.

TROUBLE AFTER PROCAINE INJECTION AND

ITS TREATMENT

UNFAVOURABLE reactions to procaine are fortunatelyrare, but they have occasionally been fatal. Thepossibility of abnormal sensitiveness to this drugarising after a previous injection is pointed out byGilman,2 who distinguishes several types of reaction.The first and commonest is of short duration, followsquickly on the injection, and is mainly suggestive ofcirculatory failure. The patient is pale with rapidpulse and low blood pressure and he usually recoversrapidly on lowering the head and briskly stimulatingthe skin of the face. In another variety of reactionthe trouble seems to be due chiefly to action of thedrug on the central nervous system. In these

patients, at a variable period after the administration,excitement appears which may go on to delirium,convulsions, and respiratory failure. Gilman givesdetails of a typical example in which it was possiblethat the undue sensitiveness was the result of a

previous injection. In a number of the reportedfatalities the history of sudden death within a fewminutes of administration of a small quantity-e.g., 1 c.cm. Novocain-to a patient who had pre-viously tolerated a much higher dose is suggestiveof sensitisation by the first injection. The patientwhose case is given recovered completely afterintravenous administration of sodium phenobarbitaland artificial respiration for an hour and a half.This is the kind of case, rare in anaestheticemergencies, in which a mechanical respirator is ofreal service, and actually a Drinker apparatus wasused in the saving of this woman’s life. The valueof barbiturates in combating poisoning by drugs ofthe cocaine type is well proved ; but whether theyhave any prophylactic effect in the same directionis not at all certain.

THE TRANSMISSION OF SKIN SENSITISATION

THE route by which a local cutaneous sensitisation ,

to a given antigen travels to the rest of the body Jhas long been in dispute. There are three I

possible alternatives. First, the antigen may becarried by the blood and lymph channels to the <

participating cells throughout the body. Secondly, <

the antigen itself may remain localised at its pointof entry, and the antibodies there formed may bedistributed by the blood and lymph channels. Finally, j

the blood and lymph streams may play no part inthe transference and the sensitisation may be conveyed by the intercellular nbrillae from one epithelial .

prickle-cell to another. At the suggestion of H. T. ISchreus, Schreiber and Muller 3 have made experimentswith a view to settling the question, and their results i

1 The Vitamin Content of Human Foods as Affected byProcesses of Cooking and Canning (with tables). By M. A.Boas Fixsen, D.Sc. Obtainable from the Imperial Bureau ofAnimal Nutrition, Rowett Institute, Aberdeen. 2s.

2 Gilman, S., New Engl. J. Med. Nov. 24th, 1938, p. 841.3 Schreiber, W., and Muller, W., Derm. Wschr. Nor. 26th,

1938, p. 1393.

may have far-reaching effects on our present con-ceptions of allergy as a whole and of eczema in

particular. Incisions were made in the interscapulararea of nine guinea-pigs so as to isolate islets of

epidermis without interfering with their vascular,lymphatic, or nervous connexions with the sub-cutaneous tissues. These living epithelial pedicleswere painted daily with a 5 per cent. solution ofdinitrochlorbenzene. After 5-7 days, varying withthe colour (from white to piebald) of the four animalsselected, a severe eczematous reaction, with erythema,vesicles, and crusting, developed in each of the isolatedareas. The areas had become sensitised to theirritant. The reaction of the rest of the skin wasthen tested with a 0.25 per cent. solution of the samecompound, but even after 8 days there was not theslightest tendency to the production of eczema

in other areas. In other words, a general epidermalsensitisation had not taken place. The reverse

experiment was equally decisive. The nve other guinea-pigs were universally sensitised to the chemicaloutside the isolated interscapular areas, and it wasthen found that the islands did not respond to applica-tions of the weaker solution. If they are confirmedthese results will certainly be important, for not

only do they solve the problem of epidermal allergictransfer but they also throw light on the natureand function of the intercellular " prickles," the

meaning of which has puzzled histologists from thedays of Hebra.

EXPERIMENTAL H&AElig;MOLYTIC AN&AElig;MIA

EARLIER this year we commented on the finding,by Dameshek and Schwartz, of isohaemagglutininsof the immune-body type in the serum of three casesof acute baemolytic anaemia. Further experimentalobservations on similar lines are now recorded by thesame investigators.2 They began by preparinganti-guinea-pig hsemolytic serum by the injectionof guinea-pig red cells into rabbits, and they foundthat this serum had all the immunological propertiesof the serum obtained from their patients-i.e.,it was inactivated by heat, reactivated by the additionof complement, made slightly more active by storagein the ice-box for several hours and made somewhatless active by prolonged storage. It was inactivatedby incubation with normal serum. After the injectionof such a hemolytic serum into guinea-pigs an anaemiadeveloped, which varied in severity according to theamount of serum used. Fulminating haemolyticanaemia with haemoglobinuria, acute haemolyticanaemia, and subacute haemolytic anemia, could beproduced at will. In the first instance the red cellcount fell from approximately 5,000,000 per c.mm.to 1,000,000 or less, and the animal died. The redcells assumed the appearance usually consideredcharacteristic of acholuric jaundice-i.e., the majorityof the cells became smaller in diameter but greater inthickness. In fulminating cases almost all the redcells were spherocytes and showed also an increasedfragility in sodium chloride solutions, which islikewise a striking feature in acholuric jaundice.In less acute cases there was a more gradual fall inred cells and a large number of circulating cellswere reticulocytes or nucleated cells, though manyspherocytes were also present. Dameshek andSchwartz conclude that spherocytosis, both in theseguinea-pigs and in man, is due to the activity of

1 Lancet, 1938, 1, 504 Dameshek, W., and Schwartz, S. O.,Ibid, 1938, 1, 913.

2 Dameshek and Schwartz, Amer. J. med. Sci. December,1938, p. 769.