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judge what in those days the ordinary man andwoman felt towards contemporary events ; emotionalreactions there surely were among the civilian victimsof the Thirty Years War or of the earlier Hun inva-sions, yet in our own Civil War it is possible toimagine a body of unconcerned and inarticulate

people who, being neither Cavalier nor Roundhead,carried on with their daily tasks whilst hoping that thecombatants would keep away from their farms orwarehouses. Jane Austen, picturing in minute detailsociety during the Napoleonic wars, makes such scantreference to those wars that we have to imagine herpeople carrying on with their daily lives whilst givingscarcely a thought to the historical happenings aroundthem-perhaps so confident in the final outcome thatthey left the thinking to the statesmen and soldiers.These were gentlemanly wars, and the edifices, publicand private, still standing in the Continental citiesthrough which Napoleon’s armies had swept, markhow the destruction not of cities but of armies wasthen the soldier’s aim. We can again picture, evenon the Continent in those eventful times, a civil

population not immediately affected by the fightingand able to remain emotionally aloof.Now war comes into the daily life of every one of us

and emotional reactions towards it are unescapable.Much has been written about our reactions, and facedby danger of death, maimings, and material destruc-tion of a kind new to humanity, we have agreeablysurprised ourselves by accepting it calmly and with alow incidence of the kind of nervous trouble that wasso manifest in all the armies engaged in the FirstGerman War. Making all allowance for the inabilitynot to recognise these nervous disorders in theirvarious disguises, we can safely say that their civilianincidence is lower than it was in front-line troopsin that war. Indeed, individual examples are notlacking of nervous folk who, under stress of war, have" found themselves " and shown endurance and

courage which surprise those who are not aware of thecuriously specific nature of pathological anxiety.Factors in this relative immunity are the need of thecivilian to make self-preservation a duty, and his rightto show fear if he chances to feel it, this latter being aprivilege that avoids one of the greatest fears of theover-conscientious man turned soldier ; but perhapsthe strongest factor is the emotional solidarity broughtabout by the knowledge that we are all in the frontline. Buckingham Palace and an East End tenementshare the same fate, and a spontaneous emotionalsolidarity is the result of a

" total " war against apeople already united by the live-and-let-live senti-ment that underlies democratic government in normaltimes. The Colonel’s lady and Judy O’Grady are morethan ever sisters under their skins. The nervous

subject lives in normal times emotionally isolatedfrom the rest of the herd, but in a time of- total waithis isolation is overcome and replaced by a feelinthrough which he becomes again one of a communit3and thus satisfies a primary need of man, the sociaanimal. And, since the nervous person serves as {delicate indicator of the effect of general influence:that act upon everyone, we can deduce that whaistrengthens him strengthens also the ordinary manBecause none can escape its effects this war has give]us a new confidence in each other and has become igreat emotional unifier.

SULPHONAMIDES LOCALLYA LITTLE over a year ago the local use of sul-

phonamides had barely begun. Since then clinical

reports have been made of its efficacy in conditionsranging from epidermophyton of the toes upwards.But clinical impressions alone are dangerous evidence ;the variable factors are many and include the depthand extent of the wound, the tissue affected, thevirulence and type of the organism, and the resistanceof the patient. These can largely be controlled inanimal experiments and it is on such experiment thatclinical work can be most securely based. Enoughlaboratory work has been done in the last few monthsto indicate that clinical optimism is justified ; not

only has the local bacteriostatic action of sulphon-amides been confirmed, but Colebrook,2 Fleming,3and Reed and Orr 4 have shown that there is nointerference with healing processes and that phago-cytosis, leucocytic infiltration and the formation ofgranulation tissue are not impaired even by highlocal concentrations. Of the three sulphonamidepowders usually employed-sulphanilamide, sulpha-pyridine and sulphathiazole-the last, as Fleming hasshown, is by far the most potent against the strepto-coccus and pneumococcus, and even influences the

staphylococcus. But in order to be effective the

drug must have access to the organism ; woundsnever have a smooth even surface-Colebrook likensthem to the fjords of Norway-and the concentrationof a drug in the deeper crevices will depend onthe solubility in the wound-fluids of the compoundused. On another page (786) Hawking shows that,thanks to its greater solubility, sulphanilamide willgive a very much higher concentration in a woundthan sulphathiazole ; moreover it diffuses far morerapidly through dead tissues. The solubility, absorp-tion and diffusion of sulphapyridine are relatively sopoor that its local chemotherapeutic action is not ofmuch value, although it persists longer in the woundsand has a bacteriostatic action which, according toFleming, is 25 times greater than that of sulphanil-amide ; sulphapyridine has no advantages over

sulphathiazole and is even less soluble in wound-fluids. Hawking and Reed and Orr have also shownthat sulphathiazole is the most powerful drug of thethree against gas-gangrene infection, and Hawkingsuggests that, taking all these points into considera-tion, a powder containing equal parts of sulphanil-amide and sulphathiazole is best for local use. The

sulphonamides are thought, by Woods 6 and Selbie, 7to act by interfering with an essential metabolite ofthe infecting organism and it is therefore importantto get as high a concentration of the drug as possibleinto the wound. McIntosh and Selbie 8 have shownthat in order to get the same concentration in a humanwound as they have produced in the wounds of animals

, it would be necessary to introduce 50 g. of powder.

This is not possible : the average wound will onlytake 10 g. of powder and surgeons usually considerit inadvisable to exceed 15 g. The powder must be

I finely divided or it will form lumps which interfere1. Helman, J. S. Afr. med. J. April 26, 1941, p. 156.2. Colebrook, L. Proc. R. Soc. Med. 1941, 6, 337.3. Fleming, A. Ibid, 342.4. Reed, G. B. and Orr, J. N. Lancet, 1941, 1, 376.5. Hawking, F. Brit. med. J. Feb. 22, 1941, p. 263.6. Woods, D. D. Brit. J. exp. Path. 1940, 21, 74.7. Selbie, F. R. Ibid, p. 90.8. McIntosh J. and Selbie, Lancet, Feb. 22, 1941, p. 240.

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with its solubility. Powder sprays are commonlyused, but many surgeons rub the powder gently intothe tissues. A level teaspoonful represents 10 g.Hawking makes it clear that while sulphonamides

are being used locally they should also be given bymouth. Locally they penetrate living tissues onlyto a depth of 2-3 mm. ; thus the live tissues roundthe wound can best be approached through the blood-stream. Reed and Orr have shown that the concen-tration in muscle is always approximately the sameas in the blood, and in treating streptococcal infectionsa blood level of 5-10 mg. per 100 c.cm. must be main-tained, as McIntosh and Selbie have indicated.Blood estimations should be used to check the patient’sprogress ; the technique is so simple that in Francethey are often done by the nurse. The experiencesof Mitchell, Logie and Handley 9 in the Libyan cam-paign confirm that sulphonamides should be givenboth orally and locally ; they found that patientsreceiving the drugs by both routes were fitter andshowed less local sepsis than others. They suggestthat sulphanilamide (15 g.) should be applied to thewound immediately and a further 15 g. introducedat the end of operation. Orally, the patient is given27 g. in 6 days ; doses are temporarily doubled incases of severe infection. Sulphonamides gave betterresults, they found, than local antiseptics such aseusol and acrinavine ; where the response to chemo-therapy was disappointing they found the infectingorganism to be Staphylococcus aureU8. In the attackon this organism sulphadiazine seems to promisewell : Perrin Long 10 finds it to be slightly superiorto sulphathiazole in this respect. Feinstone 11 inti-mates that sulphadiazine is more effective againstClostridium welchii than any other sulphonamide.Its local value, according to Hawking’s work, is

handicapped by its relative insolubility.

MEDICAL PLANNING RESEARCHTHE several published designs for postwar medicine

-from TAYLOR’s " Plan for British Hospitals " oftwo years ago to RoBEBTS’s " Future of GeneralPractice ’’ last week-have at least demonstrated thevastness and complexity of the subject. No singleplanner or small body of planners can hope to designmore than a part of it in any detail. This principlehas been recognised by the B.M.A. Planning Com-mission in its appointment of five committees to dealwith general practice, special practice, public health,hospitals, and the teaching hospitals-with a sixthto coordinate their ideas. It has been carried a stepfurther by Dr. PERRY and his friends, who in drawingtheir rough sketch of postwar hospital services whichwe published on May 17 no doubt came to realisehow much more information they needed before theycould begin to make a finished picture. They havetherefore gathered a team of some forty planners,which through their call for volunteers on anotherpage they hope to expand to at least a hundred.These researchers will be split into groups to study thesix general and nine special problems which togethermake up the large query of Medicine after the war.Finally the whole will be collated,* criticised andedited, and published in book form. With the

9. Mitchell, G. A. G., Logie, N. J. and Handley, R. S. Ibid, June 7,p. 713.

10. Long, P. H. Ibid. Feb. 22, p. 259.11. Feinstone, W. H. Ibid, May 24, p. 681.

Dawson report, the findings of the B.M.A. com-mission, and the views of individual prophets, it willprovide the Royal Commission on Medical Services,when it comes, with something to bite on.

Annotations

BIRTHDAY HONOURS

THE list of honours (see p. 800) conferred on doctorsis a striking record of the variety of ways in which the-medical profession has served the commonwealth. Onlycivil honours have yet been announced ; decorations forthe fighting services will follow. Six knighthoods headthe list. Dr. Hone has deserved well of the city ofAdelaide where he has spent his life as hospital physician,director of the radiotherapy clinic and councillor of the-university. Dr. Scott as director of the Bureau of

Tropical Diseases in London has done much to helpsolve the health problems of the Empire. General’

Jolly with 33 years behind him in the Indian MedicalService has guided hospital policy and hygienic measures-in Burma and the Punjab and waged constant war onthe mosquito. Dr. Macgregor, the people’s friend inGlasgow, has shown the ability of a city health departmentto handle the transition from peace to war. Dr.Manson-Bahr has added lustre to the name he bears and

placed his unrivalled knowledge of tropical diseases at-the call of the Colonial Office. Professor Stopford’s-brilliant teaching of anatomy and deanship of the-Manchester medical school have been overlaid by seven-years as vice-chancellor of the university. The thirteen:commanderships in three orders of chivalry are awardedfor the most part for services in India, Rhodesia,.Mauritius, Malta, Newfoundland and Tasmania. Dr.AIisonGlover receives the C.B.E. on his well-earned retirementfrom the Board of Education. Dr. Massey’s devoted work-as M.O.H. for Coventry and Dr. Knox’s organisation ofScottish emergency hospitals receive like recognition.Three awards of the O.B.E. also are for municipal health.officers : Dr. Ethel Cassie (Birmingham), Dr. J. A. Scott(Fulham) and Dr. Williams (Southampton). To thosewe have named and to the many others on the list weoffer the sincere congratulation of colleagues whorejoice with them in their honourable estate. Themedical profession will also welcome the C.B.E. conferredon Mr. Walter Deacon, just re-elected president of thePharmaceutical Society.A BIOLOGICAL MEASURE OF X-RADIATION

RADIATION of malignant cells is followed by micro-scopic changes, among which are decrease of cells inmitosis and in resting cells, and an increase in differentiat-ing and degenerate cells. Cell degeneration is thevisible sign of lethal action ; a tendency towards differen-tiation is commonly seen in irradiated squamous car--cinomata in which large masses of keratin are formed.A decrease in the number of cells showing mitoticactivity can be determined only by counting. Itsoccurrence depends on dosage : an insufficient dose isfollowed by restoration to the ordinary rate of division-only an adequate dose causes a real decrease.! An

attempt has been made by Glftcksmann 2 to find a

quantitative relationship between these changes and the*number of cells which appear unaffected (called restingcells) by irradiation. He claims that there is a numerical

relationship and that it forms a good guide to prognosisin certain forms of human cancer. Biopsies from the-growing edge of tumours are examined before, and asoften as possible after, irradiation. The number of

dividing, degenerate, differentiating and resting cells is-counted. About 500 cells are thus classified and plottedin a graph as percentages of the total number of cells,

1. Lasnitzki, I. Brit. J. Radiol. 1940, 13, 279.2. Glücksmann, A. Ibid, June, 1941, p. 187.