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THE RHEUMATIC HEART.THE failure of even a rigid system of rest to stem the

progress of rheumatic carditis once it has manifesteditself is a disappointing fact to which attention waslast year drawn by Prof. J. A. KIXOX1 aftercareful study of children warded in the Southmead

Hospital at Bristol. They do not dispute theobservation made by FRANCIS Smsow in 1877 that casesof rheumatic fever are less often attacked by rheumaticcarditis when kept strictly at rest. This dictumis now regarded as definitely proven, and indeed formsthe basis of the modern treatment of acuterheumatism ; but enthusiasts have hoped that whererest has preceded as well as followed signs of a patlio-logical state of the heart, complete restoration offunction might ultimately ensue. Dr. CAREY CooMBSin a Chadwick lecture, which we print on anotherpage, quotes hopefully evidenco of "

a surprisingnumber of apparent recoveries, even among childrenwhose hearts have undoubtedly been damaged." Theobservations made at Southmead do not encourage thisoptimism. Even if the patient is actually in a hospitalbed when the earliest signs of cardiac involvement arcdetected, Dr. NIXON and his co-workers do not nowbelieve that its progress can be arrested or thathowever long the child is kept at rest a really soundheart will result.

If further experience confirms this distressingprophecy, it is the more urgent to seek means to preventthe primary disease. Dr. NIXON points out that in asense this is being achieved, relatively at least, bymeans of some unknown factor in the life of the

upper classes, since rheumatism hardly exists in ourgreat public schools. In an introduction to a reporton Social Conditions and Acute Rheumatism, whichwe summarise on p. 562, Dr. G. F. STILL confirms the rarity of this condition among well-to-do patients ;indeed, this well-recognised class-incidence of rheu-matic fever, as one of the few things certainly knownabout the disease, gave hope to the investigatorsworking in London and Glasgow under the auspicesof the Medical Research Council that even in theabsence of any secure knowledge of its causation,a careful study of environment might indicatemeans for prevention or at least reduction. Butwhen the hospital patients under investigationwere divided into three classes it was found, contraryto expectation, that a comparatively small proportionof the rheumatic cases came from families belongingto the lowest class, where the children have insufficientand unsuitable food, clothing, accommodation, andoutlet, and suffer also from lack of discipline, regularmeals, and sleep. Nor did inquiry into heredity yieldmuch clearer results. In 260 out of the 721 rheumaticfamilies examined-or 31 per cent.-there were, it istrue, one or more persons in addition to the rheumaticpatient suffering from rheumatism. The generalpicture presented by these family histories, however,is that of rheumatism attacking several members ofone generation rather than of the disease beinghanded down from one generation to another,though diagrams of some 300 family trees set out onpages 23 to 30 of the report suggest that there issome hereditary predisposition to attack in rheumaticfamilies. The infrequency of rheumatism in thefour Poor-law residential schools studied-1 per cent.against some published statistics of 3-6 per cent. inelementary schools-lends no support to a theory ofheredity, while it does confirm the idea that a highstandard of food, clothing, housing, and general carehas some influence in preventing the disease. Dr.

1 Bristol Medico-Chirurgical Journal, 1926, vol. xliii., p. 96.

STILL does not ignore the possibility, however, thatthe comparatively sequestered life of these children

’ in a community which has little contact with the out.side world may involve less exposure to infection.This view would imply that rheumatism may be

conveyed by infection, which assumption is ditticuh- either to accept or to reject. The incidence of rheu-’ matism among those in close contact with a known’ sufferer was high enough to suggest to Dr. STILL and

his co-workers the possibility of transmission of thedisease, though no conclusive evidence of contagionfrom case to case has been obtained. Of 382 personssleeping in the same room as 1 M rheumatic children. 50,or 15 per cent., were rheumatic. In the light of thesefindings the cautious family doctor may consider it lti.duty to advise, at least, some degree oi. isolation.thereby laying himself open to unanswerable questionsabout periods of infectivity and intubation, aml

possibly even to reproach for previous negligence. Theresults of this careful survey of rheumatic disease willthus bring little practical help in the solution uf theproblems involved. If some doubt has been thrown onthe evil portent of such well-established bogeys a,toxxsillitia and damp houses, a new source of anxietyhas been raised. It would be unsafe to behttle thevalue of even slight indications of a way to prevent adisease whose sequelæ may he so severe, but theevidence is happily not sufficient at present to impo.ethe boredom of quarantine on the patient during thelong recumbent period wdiich modern treatmentexacts.The ingenuity and tact shown by the group of

workers conducting this investigation in devising andcarrying out inquiries as to family incidence, assoeia-tion with sore-throat, and with various social and

housing conditions deserved a more dramatic outcome.The inquiry has given provisional answers to manyinteresting questions, even if it has failed to give anyclear view of the lines on which prevention shouldbe sought. We must reluctantly agree with thestatement made by the Medical Research Council ina preface to the report-that it seems improbable thatmuch further progress can be made until the causative

agent of acute rheumatism is identified.

MEDICAL RESEARCH IN DANGER.THE Dogs (Protection) Bill, now in print and

awaiting its chance of discussion in the House ofCommons, is framed in language identical with thatof Lord Banbury’s Bill rejected in 1925. It propose"that it shall be " unlawful to perform any experimentof a nature calculated to give pain or disease to anydog for any purpose whatsoever, either with or

without anaesthetics," and that no such experimentsshall be licensed. If these proposals were to becomelaw, they would place an insuperable and permanentbarrier across some of the chief paths of medicaland veterinary research. Evidently support for tht,Bill is being canvassed by means of the old prejudices.and is based upon the old misunderstandings anddistortions of the truth. It is therefore necessaryto repeat once again what has been said before inopposition. Many supporters of the Bill undoubtedlythink of vivisection as the dissection of a living animalwhile it is fully conscious of pain ; they undoubtedlybelieve that vivisection in this sense can be, and is.freely practised by medical research workers withoutrestraint under the existing law ; they are convincedthat fresh legislation is essential in order to protectlive dogs from the callous and inhuman infliction ofpain. On no other basis can anyone explain thestatements made in support of the Bill.

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The petition to be addressed to Parliament by theNational Canine Defence League, with which the

Royal Society for the Prevention of Cruelty to Animalsnot associated, expresses the opinion that

" thedog has of late years been specially selected by, i: ectors for extensive and peculiarly revoltingand painted experimentation.’’ The same petitionspeaks of " demonstrations of a prolonged and

agonising nature before classes of students." SirFHEODORE COOK, in a letter in the Times ofMarch 7 the, recalls the fact that on the back of the entryforms of Cruft’s Dog Show was printed an imaginarypicture representing an operation performed inFrance about 100 years ago by a man who died in1855; beneath the picture was displayed the followingsentence: 209,014 experiments on living animalswere performed during 1925, many of these being upondogs." Obviously, as Sir THEODORE COOK observes,the uninstructed reader is intended to infer that

aoerations of the kind illustrated in the picture areconstantly happening in England to-day. He askswhether Lord BANBURT or Sir ROBERT GOWER knew.’f any instances of dogs suffering severe pain aftercovery from anesthetics which were not put todeath as humanely as the 28,565 dogs destroyedio the Battersea Dogs’ Home during the same year.We look in vain in all the mass of antivivisectionist

propaganda for any fair admission of the extentto which dogs are protected by the existing law, orof the measures taken (under strict Home Office

regulation and inspection) to prevent the infliction"t pain. Nothing is said of the elaborate precautionswhich govern the licensing of the research worker,of the substantial safeguard which insists that hisapplication for a licence shall be signed and counter-signed by responsible authorities, of the specialcertificate which is required if feeding experimentsor inoculations are to be done, or of the fact that 95per cent. of the total number of so-called vivisectionscome within the class covered by this special certifi-cate. Nothing is said of the fundamental restrictionsimposed by the Cruelty to Animals Act of 1876,or of the further restrictions made by the HomeOffice thereafter. Nothing is said either of theadditional safeguards (under Section 5 of the

Act) whereby experiments on a dog or a cat areeven more stringently regulated. Nothing, finally,is said of the profound benefits to the human racewhich have resulted from the carefully restrictedand officially supervised employment of experimentsupon animals in the alleviation of human pain and the cure and prevention of human disease. Infor-mation in this respect has been issued in publicationsmore accessible to the medical profession than to thegeneral public. Of the technical details of thatinformation the supporters of the Bill may naturallyhe ignorant, but there is one aspect of experimentsupon animals of which every dog-lover should know.The study of distemper may not only help us to understand and repel certain obscure diseases fromwhich mankind suffers, it also holds out the reasonableprospect that, sooner or later, a great menace may beremoved from the canine species. The so-called Dogsf Protection) Bill will bar the advance of sciencetowards the finding of a remedy. It may not unfairlybe given the title of the Dogs (Continuance of Dis-temper) Bill.Distemper is but one of many problems for the

research worker, but what is the attitude of the

supporters of the Bill towards it ‘? Their avowed

purpose is the total prohibition of all experimentswhich may promote the cure and prevention of thisdisease. Sir THEODORE COOK quotes the chairman

of an antivivisectionist meeting held last Januaryas having said that the Field Distemper Councilhad spent three years " in torturing dogs in the mostabominable manner." If this were so, why did notthe Royal Society for the Prevention of Cruelty toAnimals, which seems itself to be concentrating upona merely antivivisectionist policy, prosecute theoffenders to conviction ? In the debate on Lord

Banbury’s Rill in 1 925 Lord LAMBOLTRNE, who sup-ported the Bill, found it necessary to concede thatthe Bill might be amexxdecl so as to make an exceptionin favour of distemper experiments. Logic we havelearned not to expect in the discussion of this subject,but, if distemper experiments are admitted to be

unobjectionable, what becomes of the principle ofthe Bill ?

Annotations.

THE LISTER DOCUMENTS.

Ne quid nimis."

DURING the forthcoming Lister centenary celebra-tions the cabinet containing Lord Lister’s instruments,manuscripts, diplomas, and other papers, whichoccupies a position of honour in Room I. of theMuseum of the Royal College of Surgeons of Englandwill be a centre of peculiar interest. A noble piece offurniture, the cabinet was the late Sir Rickman(a-odlee’s tribute to the memory of his illustrious uncle.In it behind glass are displayed Lister’s instrumentsand the same collection is continued in another caseagainst the neighbouring wall, which forms a com-panion collection to the relics of John Hunter in asimilar museum case close by. Lister’s documents,however, are only partially visible to the public eye,and a number of them, beautifully bound and caredfor by his nephew, are locked up in the cabinetdrawers. Very interesting among the latter are anumber of diagrams of bacteria and general pathology,and also the rolls of common paper, some half-dozenin number, on which over 40 years ago Lister caused ahorse, a dog, and a rabbit to place on record therelative pressures of blood in systole and diastole.The elaborate conclusions which he then reachedare fully set out in Vol. III. of his " Common PlaceBook," a work in four volumes here preserved behinda glass door. These books contain the record of thesuccessive experiments in which the great surgeonengaged. They are largely in the handwriting ofLady Lister, who laboured with devotion in herhusband’s behalf till death cut her off, sadly andsuddenly, when the pair were on their travels inMarch, 1893. Sir Rickman Godlee, in his biographyof Lister, has painted a vivid picture of the mannerin which these manuscripts were written, often longafter midnight, owing to Lister’s unwillingness thatanything should be set on record till he himself feltsure of it. The illustrations, almost all by the investi-gator, are fine examples of delicate draughtsmenship,and many who see them will be surprised to learn thathe was an anatomical artist of such a high order. Themost important volume in the collection under dis-cussion is without doubt the slim folio labelled byGodlee " Notes and Drawings. Suppuration. Lister.1851-1907." This is the very scripture of Listerism,a treasure beyond price.

Of the other MSS. in the collection there may bementioned also five letters from Pasteur, in one ofwhich the famous Frenchman speaks of having hearddimly during many years of his English colleague’sspecial investigations and testifies to his own interestin them. He writes as a sick man, his head hangingpainfully in sympathy with his semi-paralysed side.The originals of Lister’s principal courses of lecturesin Glasgow, Edinburgh, and King’s College are also