1142 A SIMPLE INDEX OF AN1EMIA.

method. He then indicates certain modificationswhich he has made in it, and he believes, as theresult of eight counts only, that he has rendered itreliable. In all the circumstances, confirmation on aconsiderably larger scale is likely to be expected beforethis conclusion is generally accepted. In this instanceinter-reaction between medical and veterinary prac-tice has not yet proved particularly fruitful, themethods used not having an entirely sound founda-tion. But where conditions are more strictly com-parable, there may at any time recur such remarkableresults as have just been obtained by Hindle, whoseknowledge of the work of Laidlaw in dog distemperand of Charles Todd on fowl plague led him so

directly to the preparation against yellow fever ofthe vaccine whose potentialities for good are of sucha promising nature.

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DR. OLIVER GOLDSMITH.

THIS week sees the bicentenary of the birth ofOliver Goldsmith. He was born on Nov. 29th, 1728,the second son of the Rev. Charles Goldsmith, whosecharacter is portrayed by his son in his descriptionof the preacher in the " Deserted Village." " A manhe was to all the country dear, and passing rich withforty pounds a year." Res angusta domi was suchthat it was proposed that Oliver should qualifyhimself for a trade, and with this end in view hewas sent to the village schoolmaster to be instructedin the three R’s. This worthy also figures in the" Deserted Village." To the importunity of Oliver’smother is due the fact that his father made some effortlater on to give the boy a decent education in order toqualify him for one of the liberal professions. He wassent to the school at Athlone and at the age of 15went to Dublin, where in June, 1744, he was admittedsizar at Trinity College. He ran away to Cork, afterbeing chastised by his tutor, but thinking better of it Ihe returned and took his B.A. in 1749. After manyvicissitudes he went to Edinburgh in 1752 to studymedicine and later to Leiden. Returning to Englandin a penniless condition, he accepted the post of usherin an academy at Peckham ; this proving uncongenial,he became assistant to a chemist in the city, andafter working in his laboratory for some time he atlast began practice in Southwark and later movedto the Temple. In 1761 he made the acquaintanceof Dr. Johnson and became a member of the LiteraryClub. He died, heavily in debt, in his forty-fifthyear in 1774. His death was accelerated by taking aJames’s powder, which he insisted on doing despitethe advice of his apothecary and physician who toldhim not to do so. Whatever his shortcomings inphysic and his financial difficulties may have been," Poor Goldie" certainly contributed some imperish-able works to English literature, while the elegy onthe death of a mad dog, with Caldecott’s pictures,is among the childhood recollections of most of us.Horace Walpole called him " an inspired idiot," andGarrick protested that " he wrote like an angel andtalked like poor Poll," but we can all of us nowsubscribe to surly Sam’s sentiments as recorded in

. his epitaph in Westminster Abbey, "nihil quodtetigit non ornavit." Goldsmith’s memory is amongthe chief glories of the medical profession. I

A SIMPLE INDEX OF ANÆMIA.

THE colour of the face is admittedly a poor guideto the presence or absence of anaemia ; the colour ofthe conjunctiva, as observed in the lower lid, mayserve somewhat better, but the information it affordscan hardly be described as accurate. Estimation ofhaemoglobin and a count of the red cells carry us’further, but it is necessary to bear in mind thatwithout a knowledge of the volume of the circulatingblood even these modern methods may give informa-tion wide of the mark. So far as the oxygen-carryingfunction of the blood is concerned, the importantfactor is the amount of haemoglobin available per unitof body tissue ; whether the haemoglobin be con-

centrated or diluted does not, within limits, greatlymatter. Dr. W. W. Duke, of Kansas City, has drawnattention 1 to what would appear to be a valuableclinical test for the determination of the presence orabsence of ansemia, depending upon the observation ofthe colour of the palms of the hands. The fact thatthe colour of the palms when held in the sameposition is much the same in all healthy personsseems to have escaped the clinician. It is, of course,well recognised that the vessels of the palms are notsubject to the same variations in calibre as those ofthe face ; it is equally well known that even in dark-skinned persons the palms are relatively free frompigment. There are, it may be, limits to the truthof this statement, but the fact remains that thepalms of most individuals of European extractionshow little pigmentation. This being the case, it isobvious that they offer an admirable field for theobservation of the concentration of haemoglobin inthe circulation, at least in those who do not habituallydo manual work. For control a standard palm isnecessary ; this should be the palm of the observer,if he has first made sure that his palm colour is thatof the healthy young adult. For the actual observa-tion it is essential for observer and observed to be inthe same posture and for the palms of both to beheld at the same level. The difference in palmcolour brought about by variation of level in respectto the heart can be demonstrated by anyone who willhold one hand above the head and allow the otherto hang for a minute and then rapidly compare thetwo. Using this method, Dr. Duke states that he isreadily able to identify even comparatively slightdegrees of anaemia and plethora, while it serves as aready means of following the degree of haemoglobinrestoration in the course of infusion of blood. Thisis the sort of observation that might have beenexpected of Hippocrates ; it is refreshing to find sucha simple and yet scientifically sound method turningup nowdays. ____

THE LIVER IN PRIMITIVE MEDICINE.

I THE great and sudden popularity of liver treatmentprompts inquiry into the part it has played inmedicine in the past. According to the Babylonians,says Dr. H. Vorwahl,2 the fiver was the central organand liver inspection was the chief form of augury.In man it was considered the source of the blood,and after the psycho-physical parallelism of thetimes, as the seat of the affections. This beliefdescended to the followers of Mithras, who recogniseda triple fire-goddess corresponding to the three partsof the soul, and located the passions in the liver ; itis also reflected in the Old Testament.3 Horace wroteof it as the seat of love in words with a somewhatstartling significance to clinical ears-" non ancillatuum jecur ulceret ulla " !-and Juvenal spoke of theliver of an angry man as burning with fury. TheGalenic conception of its function, which prevailed formany centuries, was that it converted chyle intoblood. Megenberg, a leading anatomist of thefourteenth century, stated that it separated the

valuable components of the chyle from the wasteand transmitted them to the limbs as blood. This,however, is somewhat sophisticated lore, and in manyregions where science has not penetrated the oldBabylonian beliefs survive. Sir James Frazer says ofthe natives of Darfur, in the Western Sudan, that theyeat the liver of animals to increase their health, andconsequently the health of their souls. The custom isuniversal among the Arabs and other Sudanese tribesof taking every opportunity to eat raw liver, which issupposed to confer virility. Women, Frazer remarks,are forbidden to eat liver, as they have no souls.South-West African tribes excise the liver of a braveenemy and burn it to ashes, which are employed in thecircumcision ceremonies to confer courage upon theiryoung men. Our phrase,

" white-livered coward,"1 Arch. Int. Med., 1928, xlii., 533.

2 Deut. Med. Woch., 1928, xlii., 1769.3 Lamentations, II., 11.