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rheumatoid sera but not with normal sera : however,the positive reactions with the rheumatoid sera occurredas frequently with the " normal " antigen as with theantigen from rheumatoid tissue ; so that the experimentslend no support to the hypothesis of an altered connectivetissue acting as an antigen.Whether these two reactions are in any way directly

related cannot yet be said : it has become clear that a

large number of the " colloidal reactions " in hepaticdisease are all essentially modified tests for the presenceof increased quantities of y-globulin, and it seems equallylikely that many of the reactions observed in rheumatoidarthritis may be found eventually to be due to somecommon factor. The rapid progress in the study of thedisease with ’ Cortisone’ and A.c.T.H:makes it likely thatan answer will be discovered sooner rather than later.

ACROSS THE CHANNEL

ONE of the objectives of the Brussels Treaty is ’’ to i

develop on corresponding lines the social and other (

related services " of the five countries of Western Union. ’In public health a beginning has bten made with personal contacts between officials and exchange of information.

Dr. N. M. Goodman, in his Chadwick lecture of Oct. 24, ’

sketched the public-health administration of Belgium,France, Luxembourg, and the Netherlands, and pointedto some of the differences from our own. The French andBelgians, he said, regard administration as a science ;the British regard it as an art (or even a craft) ; and theDutch are somewhere between the two. In other words,the Franco-Belgian approach is logical and sometimes(in British eyes) unpractical ; the British approach ispractical and nearly always illogical. The Dutch traditionof individual and local self-reliance has tended towardsa conservation of voluntary effort in public health aswell as other fields ; the French, and to a lesser extentthe Belgian, systems owe much to the Napoleonic con-cepts of the droit administratif and of centralisation ;while the British tradition of sanitary reform has fixedthe broad lines of our public-health system on a localbasis. Except in the older and larger municipalities(where he is sometimes a part-time clinician) the M.o.H.in the other Western Union countries is generally anemployee of the central government, responsible to theprefect or governor of his department (county) as wellas to the local municipal council. In France each depart-ment has a full-time director of health. In all the

countries, except ours, doctors and other technical healthstaff are eligible for, and in fact hold, executive positionson a par with those of lay administrators ; thus in France,Belgium, and the Netherlands the permanent heads ofthe health ministries are doctors, and so are the directorsof most of the divisions dealing directly with health.In Britain, of course, doctors in central health depart-ments are advisory, not executive ; but Ethiopia, saidDr. Goodman, " is I believe the only other country inthe world, including the Dominions, which follows ourexample." Perhaps we are too apt, he added,

" to thinkof something as strange and peculiar because we do notdo it ourselves, whereas inquiry will show that it is wewho are peculiar and in a minority." In public healththe convergent development aimed at by the BrusselsTreaty will be attainable only if we begin by knowingsomething about the organisation in the other WesternUnion countries.

Jjr. (jroodman also had some cogent things to say aboutinstruction in public health. His impression is that theinstruction of undergraduates in this subject is morethorough on the Continent than in some at least of ourown schools. For postgraduates we have had a statutorycourse and diploma controlled by the General MedicalCouncil for 64 years, whereas in the other countriesuniformity of standards has only lately been introduced.

" On the other hand the creation of a French NationalSchool of Public Health in 1947 in Paris, and the strikingfall in the number of D.P.H. students in this country since1948, make it look as if we were in some danger of losingour longstanding lead in public-health training. Indeed,unless the position here changes-as no doubt it will-we may find it impossible to fill the vacancies for public-health medical officers, which is already causing difficultyin the central services."

TISSUE STAGE OF MALARIA PARASITES

THE existence of tissue forms of the malaria parasitein man and other mammals had been postulated fortwenty years before Shortt and Garnham in 1948 locatedthe long-sought parasites in the parenchyma cells of theliver, where they were unexpectedly large. They weredemonstrated first with P. cynomolgi 1 in monkeys,and then with P. vivax,2 and lastly P. falciparum 3in biopsy specimens from volunteers. These dis-coveries were acclaimed by malariologists throughoutthe world, but a dissenting voice has now been raisedby Dr. Clay G. Huff, one of the leading American parasi-tologists, who has done classical work on the developmentof the sporozoites of avian malaria through cryptozoitesin the reticulo-endothelial cells to reach the familiarforms in the red cells. In a letter published in AmericaHuff 4 points out that no-one has yet demonstrated thestage connecting the sporozoites with the forms foundin the liver four days later. Material supplied by Shortthas been fixed and stained by Huff’s methods and Huffhas found differences- between the bodies that Shorttdescribed and the recognised forms of the avian andsaurian plasmodia. He concludes that " there seems tobe no alternative to doubting the malarial nature of thebodies described by Colonel Shortt and his collaborators."He does not deny -that these bodies may be exoery-throcytic forms of malaria, but he urges that- muchmore work is needed before the claim can be consideredproved.

Further research, particularly into the development ofthe sporozoites during the first four days, is certainlydesirable ; but there are good reasons for expecting it toconfirm the claim. The -objects seen in liver sections,when fixed with Carnoy and stained with Giemsa, arefundamentally similar to the tissue forms of avianmalaria, though Huff’s technique of fixing in Zenker-formoland staining by Maximow’s method has led to differentresults. Then the ripening into merozoites on the 8thto 10th day (P. cy7zomolgi) fits exactly with the time atwhich the blood first becomes infective on subinoculation.Moreover, the findings of Shortt and Garnham withP. cynomolgi have been completely confirmed, on differ-ent material, at the National Institute for MedicalResearch.5 5 The appearance of the parasites with onlya single generation between the sporozoite and the formsin the blood agrees with the fact that liver tissue (evenif it contains parasites) does not become infective onsubinoculation until the 8th day. Large numbers ofhuman liver sections, taken at necropsies, have beendiligently searched as controls and have not yielded anyobjects resembling those found by Shortt and his col-leagues in their biopsies taken from the volunteers

just when the presence of the pre-erythrocytic formshad been foretold. One may therefore safely predictthat future work will remove even the last lingeringdoubts

1. Shortt, H. E., Garnham, P. C. C. Nature, Lond. 1948, 161, 126.With Malamos, B. Brit. med. J. 1948, i, 192.

2. Shortt, H. E., Garnham, P. C. C., Covell, G., Shute, P. G. Brit.med. J. 1948, i, 547.

3. Shortt, H. E., Hamilton Fairley, N., Covell, G., Shute, P. G.,Garnham, P. C. C. Ibid. 1949, ii, 1006.

4. Huff, C. G. Trop. Med. News, 1950, 7, 22.5. Hawking, F., Perry, W. L. M., Thurston, J. P. Lancet, 1948, i,

783.