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African foodstuffs is worked out by indophenoltitration and confirmed in some cases by biologicaltests. Indophenol titration is admittedly a roughmethod of estimating vitamin C, being subject tocertain well-recognised sources of error, but its useserves to give a general idea of the vitamin-C contentof foodstuffs. One material, lucerne, receives specialattention, since the leaves were found to have a

very high vitamin-C content, about four times that offresh citrus fruit juice. Lucerne, which is a vetch, iswidely used as a food for domestic animals-in SouthAfrica especially for ostriches-but there seems tobe no reason why it should not be adapted for humanconsumption as a salad or spinach, where there wouldotherwise be a shortage of fresh antiscorbutics.From Calcutta R. K. Chakraborty publishes a similarstudy,2 in which special attention is paid to theantiscorbutic value of milk, human, cow’s, goat’sand buffalo’s, and of foodstuffs of plant origin.Three fruits were found, species of zizyphus, physalis,and citrus, all of which were more potent sources ofvitamin C than the best Indian fruits previouslyknown, the Indian lemon and orange. Both theIndian and African studies will no doubt be extendedand investigations of the same sort will eventuallyhave to be undertaken in all parts of the world wherethe less usual foods are eaten.

ELEPHANTIASIS IN BANCROFTIAN FILARIASIS

DURING the last four years Prof. C. K. Drinker andhis colleagues have been working on the lymphaticsystem of the dog. They have produced typicalelephantiasis by repeated injections of two sorts

given slowly into the lymphatic trunks of the lowerlimb-namely, a watery suspension of crystalline silicawith particles about 1 !J. in diameter, and a solutionof quinine hydrochloride with a strength of 2-5 percent. In the lymph glands the particles of silica getcaught up in the endothelial reticulum of the sinuses,and these become filled with large pale cells whichlater form fibrous tissue ; the effect of quinine inbringing about the closure of varicose veins is wellknown. These repeated injections, made at normallymph pressures, act upon new collateral channels asthey are formed; and the final effect is that, as theresult of lymph blockage and transient periods ofsterile inflammation produced by purely physicaland chemical means, the part becomes typicallyelephantoid. Further inflammatory attacks are aptto occur in it, just as they do in elephantoid tissue inman ; they last normally about 48 hours, and eachof them adds to the amount of elephantiasis.

It has been much debated whether attacks of thiskind, occurring in elephantiasis due to Wuchereriabancrofti infection in man, are caused by the filaria,adult or embryo, or by an added bacterial -infection.Drinker has probably explained the different findings,on which these differing opinions are based, byshowing that in the first few hours, and in the firstfew hours only, of such an attack in a dog a h2emo-lytic streptococcus is present in the oedema fluidfrom inflamed elephantoid tissue, and that this fluidcan be obtained from a dependent leg without priorinjection of salt solution. If this pointer is followedit should be possible to settle whether or not these.attacks in man are due to bacterial infection seededon to a suitable soil. That the elephantoid tissue doesafford such a soil is seen in the fact that inflammatoryattacks could be induced by injecting into it a smallfraction of the number of streptococci needed toproduce the same effect in a healthy animal. During

2 Indian Jour. Med. Research, 1935, xxiii., 347.

these attacks the lymph of the inflamed part has ahigh protein content, amounting to about half thatof the plasma, instead of the normal percentage ofabout one; and in such a medium, used in vitro, con-nective tissue cells grow well. Further, when therupture of dilated lymph vessels has allowed of

escape of lymph through the epidermis, the proteincontent of the oedema fluid becomes low and the dogin question has shown little permanent fibrotic

enlargement of the limb. The disadvantage of

attempting to reproduce this state of affairs in manare clear, but there may be conditions in which

upward drainage is possible. The means of doing sowere apparently added to in the case of a womanof 19 with double elephantiasis nostras of the lowerlimbs. The obstruction was high up in the abdomenand by incising large lymphatic vessels lying on theiliac arteries the lymph was made to run into theretroperitoneal space-with what permanent resultcould not be stated when the report was published. 1

There is another feature in which these experimentshave fallen in with experience in man. In the typicalinflammatory outbreaks which have been mentionedthe blood has at all times been free of bacteria ; butin one dog, evidently as the result of infection by amore virulent strain of streptococcus, a septicaemiadeveloped reminiscent of the grave cases which havebeen so striking a feature of Bancroftian filariasis inBritish Guiana. In these various ways the newmethods used by the physiological laboratory of theHarvard School of Public Health have given a welcomeimpetus to the study and explanation of this infectionin man.

LE ROY EST MORT!

ANY doctor who has tried to make even a tentativediagnosis solely on the patient’s symptoms as

described to him by a friend or relative knows howludicrously he may be led astray. Nfr. Yearsleyis therefore to be congratulated on his courage indiagnosing the causes of death of the Rulers of

England on what, in many cases, is very slenderand unreliable testimony.2 Perhaps, as may be

necessary sometimes in surgery, he has had to learnnot only to make up his mind but also to act oninsufficient evidence. Be that as it may, and althoughwe cannot unreservedly accept all his diagnoses, itmust be admitted that he has written a very interestinglittle book. The Rulers of England, if Oliver andRichard Cromwell and the luckless Lady Jane Greyare included, number forty from the Norman Conquestto the death of King Edward VII. Of these, no lessthan eight (20 per cent.) died violent deaths, eitherin battle or at the hands of the murderer or headsman,but it is reassuring to loyal subjects to note thatthe practice of regicide grows less common as timegoes on. The acute infections and cardio-vascular-renal disease have each accounted for six; syphilis,congenital or acquired, and " dysentery," whichcovers a multitude of ignorances, have each disposedof four. " Senile decay," a diagnosis no longeraccepted as a certified cause of death, is mentionedin three cases and implied in one other. Stephenmay have had an appendix abscess, Edward III.gonorrhoea, and Richard II. anorexia nervosa, butMr. Yearsley thinks that Henry I.’s "surfeit of

lampreys " was more probably ptomaine poisoning.George IV. and William IV., pathologically speaking,had much in common ; both had hepatic cirrhosis,

1 Homans, J., Drinker, C. K., and Field, Madeleine : Ann. ofSurg., 1934, c., 812.

2 An Account of the Deaths of the Rulers of England. ByMacleod Yearsley, F.R.C.S. London: John Heritage, TheUnicorn Press. 1935. Pp. 164. 3s. 6d.

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pericarditis and, probably, pneumonia. Those whothink harshly of James I. will do well to bear in mindthat he had Bright’s disease, enlarged tonsils, renalcalculi, jaundice, haemorrhoids, dental caries and

pyorrhoea, and arthritis-surely enough to sour anyman,

THE WORLD REQUIREMENTS OF NARCOTICDRUGS

THE Supervisory Body acting under the 1931 Conven-tion for Limitation of Manufacture of Narcotic Drugshas completed its estimate of the world requirementsof morphine and its derivatives, and of cocaine, for1936. The estimates for morphine, heroin, andcocaine " for use as such" are respectively 9799 kg.,930 kg., and 4503 kg. Compared with the estimatesfor the two previous years these figures representa substantial reduction of heroin, some decrease ofcocaine, and a slight increase of morphine. No lessthan 34,279 kg. of morphine were however requiredfor " conversion," chiefly for the manufacture ofcodeine, of which 25,710 kg. are estimated as theworld requirement for 1936. The increasing demandfor morphine for " conversion " has attracted theattention of the Supervisory Body and is beingcarefully investigated. For 59 countries and 89 terri-tories the estimates were furnished bv the Govern-ments concerned ; in 11 countries and 9 territoriesthe Supervisory Board, in default of such returns,had itself to frame them. In tables appended tothe report are set out for each narcotic drug theestimated requirements of each country and territoryfor the year 1936. The compilation of this elaboratereturn (C. 429. M. 220. 1935. XI.) reflects greatcredit on the Supervisory Body and the secretariatof the League.

THE COMPOSITION OF "WHITE BILE "

A GROUP of workers engaged on a study of gall-bladder function have been fortunate in obtaining15 examples of " hydrops " of the gall-bladder frompatients in whom the cystic duct was obstructed.In their opinion the sequence of events in thesecases is : damage to the biliary system ; obstructionof the entrance of bile into the damaged gall-bladder ;dilution of the gall-bladder contents ; and finallydecoloration of the bile by absorption or destructionof the pigment. Whether acute infection plays apart they have not decided. The colourless contentsof the gall-bladder are secreted by its damagedmucosal cells, bile salts and bile-pigment beingabsent. In this white bile chlorides and calcium arefound at approximately serum level though some-times (in 5 of the 15 cases) the calcium content is

considerably higher. The amount of cholesterolvaries : in 9 cases it was either absent or present inproportions under 9 mg. per 100 c.cm., while in theother 6 the figures ranged from 15 to 143 mg. per100 c.cm., the higher cholesterol figures being usuallyassociated with a higher calcium content. Thereis as yet no obvious explanation for these facts. In2 cases in which the gall-bladder was drained, dailyobservations were made of the composition of thefluid obtained. Bile salts did not reappear withinthe period of study, presumably because the cysticduct remained blocked. The chlorides remainedat the usual level of 90-120 milli-equivalents per litre.The calcium figures were very constant ; in one

case they showed a slight gradual decrease, butthey were always approximately at serum level.

1 Riegel, C., Ravdin, T. S., Johnston, C. G., and Morrison,P. J. : Amer. Jour. Med. Sci., November, 1935, p. 655.

The cholesterol content was much higher inone case than in the other. It is hoped by theseinvestigations of the isolated gall-bladder andducts to get information about the functions ofthese structures. Unfortunately, in the humansubject their isolation is often due to a preliminaryinflammatory process which somewhat vitiates the

experiment.THE MARCH OF MEDICINE

THE turn of the year is the traditional time forreviewing the year’s events and achievements. Thefew days that come after the festivities of Christmasand before the New Year’s invitation to good resolu-tions, should be made to yield an hour or two fordetached retrospection, not sentimental, but rathera little critical. Those who have, or aspire to have,a hand in the advancement of medicine, whether bymaking discoveries, by proclaiming them to the

world, or by applying them for the benefit of thesick, may well take the Year Book of General Medi-cine as the basis for their retrospective meditation.The 1935 volume actually deals with work publishedbetween mid-1934 and mid-1935, and can thereforebe in our hands before Christmas. It is edited bysix physicians of great eminence, who have chosenfor abstraction the most valuable papers in theirseveral fields, and have often added for the reader’sgreat benefit their own brief comments. In the

period they cover there has been no single discoveryof startling importance, but the march of medicineon many fronts has been steady and progressive.The impetus given to h2ematology by Minot andCastle has not spent itself, but is spreading ratherto adjacent subjects ; in their section of the book

they call special attention to a report of the pro-duction in pigs, through a vitamin-deficient diet, ofchanges in the oral and gastric mucous membranes,achlorhydria, diarrhoea, muscular weakness, and

macrocytic anaemia-a picture so like that of per-nicious anaemia that it may be a clue to the causationof that disease and perhaps also of some of the chronic"

gastritic" conditions towards which a great dealof interest has lately been directed. In the gastro-intestinal section there are several important paperson chronic gastritis, which is now satisfactorilydefined in terms of structural changes in the gastricmucosa, although its relation to functional changesand to symptoms, as well as its pathogenesis, remainobscure. Meulengracht’s localisation of the sourceof the intrinsic (gastric) factor of the anti-perniciousanaemia principle is another notable advance in thisfield ; medicine is undoubtedly marching, in Napo-leonic fashion, on its stomach.

Three other sections, on cardiovascular disease,on lung disease, and on infections, complete thebook, for " General Medicine " is defined by exclusion,and endocrinology, neurology, psychiatry, and thera-peutics find their places in others of the Year Bookseries. In cardiology, many writers seem to be

re-working old ground, often with greater care andmore precision than heretofore ; the bold attemptto ameliorate cardiac failure and severe angina bytotal thyroidectomy is being continued, and " thisrather radical procedure still seems definitely indi-cated in a number of carefully selected cases." Amongthe infectious diseases, the virus investigators are

working quietly ahead. In the chest section, the

1 The 1935 Year Book of General Medicine. Edited byGeorge F. Dick, M.D., Lawrason Brown, M.D., George R.Minot, M.D. S.D., F.R.C.P. (Hon.) Edin., William B. Castle,M.D., A.M., William D. Stroud, M.D., and George B. Eusterman,M.D. Chicago : The Year Book Publishers, Inc. Pp. 848.12s. 6d.