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In his " Prevention of ," under the head- axis and give a brilliant light remarkably free from ing of " The Appearance of Sexual Forms," Sir shadows. The glass globes are watertight and Ronald Ross states :- allow of the ceiling being hosed with the rest of the The malignant gametids begin to appear about a week theatre. For operating at the bottom of long and after the onset of the fever, and may remain circulating in narrow cavities either a reflected light or a small the blood for several weeks. We do not know what deter- lamp of the cystoscope type inserted in the cavity mines their appearance, but the asexual forms and the fever is usually essential. frequently vanish when appear. they For operations performed in daylight a theatre Again, under the heading " The Parasites during with a south, rather than the usual north, aspect states :- the Rallies," the same writer has considerable advantages, which include an In the rallies between few relapses, sporids. frequently excellent light, even on dull days, and a natural none at all, can be discovered, though gametids which do warmth which minimises the amount of artificial not seem to produce fever may still abound. heating required.-I am, Sir, yours faithfully, is a of the absence Here, then, partial explanation Plymouth, Jan. 12th. 1916. C. HAMILTON WHITEFOBD.WHITEFORD. of fever in this case; the cause of the absence of fever at a time when sporids were in abundance is, however, not very evident. LOSS OF SPEECH AND SHELL-SHOCK. Finally, under the heading "Probable Causes of To the Editor of THE LANCET. Rallies and Sir Ronald Ross states :- Relapses" SIR,—During my years service in tne army Cases are often in which the reported patient during I can recall five cases of men having been suffers from and so rather brought relapses malaise, dyspepsia, on, to suffering from sudden loss of than fever, although parasites are numerous enough to be hospital speech due to shock. I found were all cases of found. In such, I presume, the antitoxic power of the they blood has become better developed than the germicidal malingering and recovered their voice under an power. anaesthetic. Ether is the anaesthetic to give, and Herein perhaps lies the second half of the it is well to keep the patient under it for half an and he will have to when he explanation of this case, though one is tempted hour, plenty say to ask what determines the development of the recovers.-I am, Sir, yours faithfully, antitoxic of the blood at the of the J. McLAUGHLIN,MCLAUGHLIN, M.D., power expense Bangor, Jan. 10th, 1916. Lieutenant-Colonel (late), R.A.M.C. germicidal power? If we assume that the absence of fever and of the usual clinical manifestations of malaria is the result of antitoxin sufficiency. then THE PREPARATION OF CATGUT BY the patient in this case was well protected. If, on PICRIC ACID AND OIL OF CLOVES. the other the of fever is an index of hand, presence To the Editor of THE LANCET. reaction to infection on the of the and part body, method of a in the course of and SIR,-The preparing catgut suggested phenomenon phagocytosis Roeder is and The bacteriolysis, then, in the absence of evidence by very simple inexpensive. raw gut is placed in a saturated solution of picric of reaction, we must assume that despite his acid in oil of cloves for one week, rinsed thoroughly appearance of well-being, the patient was, or for about ten seconds in sterile water or a 1/5000 would soon be, in a dangerous condition, one bichloride solution to remove the oil globules. perhaps in which the slightest determining cause clinging to the surface, and then stored in 95 per would pernicious symptoms, such as precipitate cent. alcohol. In four it is for use. coma or blackwater fever. Had the amount of days ready Before the in the saturated solution of alcohol taken, virtue of its vaso-dilator effect placing gut by picric acid and oil of cloves I prefer to formalise it on the peripheral vessels and its depressant effect in a 5 cent. solution for 24 hours; this modifica- on the on the per thermogenetic centre, any bearing tion the additional and is .not the of a number of undoubtedly gives gut strength case, presence large and it from The acid and the oil crescents in the circulation and the keeps swelling. peripheral both soluble in alcohol are extracted to a. absence of fever to be thus being explained ? Personally considerable extent from the rendering the I am inclined to the that the case was one catgut, opinion suture to the tissues. in which the symptoms of malaria had been masked unirritating " The claimed for the method are these. and it seems to me that " masked advantages by alcohol, The gut is rendered absolutely sterile throughout,, malaria, as distinguished from " latent" malaria, as the picric acid and oil of cloves have marked may be brought about by influences other than penetrating powers. The oil of cloves, besides being alcohol, and that such a condition frequently a powerful germicide, renders the gut very an attack of blackwater fever, of pliable, precedes though and less absorbed, the course in these cases the blood infection not strong, quickly and, further, may does not deteriorate with I have used be so evident.-I am. Sir. vours faithfullv. gut storage. the modified Roeder method of SAM. L. L.R.C.P.Lond., slightly preparation BROHIER, M.R.C.S.Eng., for some months with and can D.P.H. Lond., L.M.S. Ceylon., gratifying results, West African Medical Staff. recommend it with confidence as one of the best. The Laboratory, Accra, Gold Coast Colony. Nov. 26th, 1915. for the preparation and sterilisation of catgut. I am, Sir, yours faithfully, ILLUMINATION IN OPERATIONS. J. D. SPEID SINCLAIR, M.B., CH.B. Glasg., Jan. 12th, 1916. Resident Medical Officer, Bolingbroke Hospital. To the Editor of THE LANCET. SIR,-After experimenting with ceiling lamps CANCER AND HEREDITY. distributed in various positions, the writer has found the following arrangement to be very satis- To the Editor of THE LANCET. factory and has used it in his theatre for the last SIR,—Though an isolated case in the experience- three years. Four electric lamps, each of 60-candle of one individual be of dubious value the collation power and enclosed in elongated glass globes, are of such instances may be of some importance. attached to the ceiling, which is 13 feet above the With the latter object in view I venture to bring floor. The lamps are arranged, 1½ feet apart, in a to your notice the following family history with single row above the operation table in its long which I have recently become acquainted. 213

A had six brothers; four of these married, all dying adopted in other schools, transalpine as well as without issue. A himself died at the age of 36 from Italian; and he devoted special study to malarial pyloric cancer. He had three daughters and five sons. fever, in connexion with which he published a The eldest, a daughter (B) died, unmarried, from treatise on the spleen, and drew attention to the. carcinoma mammæ. Five of his children married; phenomena of the "malaria perniciosa" and the form " two died childless ; the eldest son had one child, a which he designated subcontinua." In therapeutics, girl, who died young; a daughter married twice, he was among the first to practise intravenous having one child by each husband, and both died injections of mercury in syphilis, while his experi- young. Another son (C) died, aged 67, from cancer of ments in treating traumatic tetanus by the intra- the bowel; his wife’s mother and sister, as well as venous injection of phenic acid, initiated in 1901, an old servant who lived with them, all died from have gradually found acceptance, and in the war cancer in the same house. Another son has two now raging on the North-Eastern frontier the children, the only representatives of the third method is reported to have proved highly generation, and the father-in-law of one of these successful. died from cancer. With all this varied work he never lost touch It would seem almost as though the vis medi- with his country’s general progress; particularly ,catrix nature were applied in this family to was he interested in the all-important sphere of suppress it, for three members of it have died education. With well-nigh half of her population from cancer, six are childless, and two others who unable to read or write, possesses 23 universi- have married into other families with a history of ties, each duchy, archduchy, or kingdom absorbed cancer are also childless. A comparable case is into her unity having contributed one or more of recorded in the Gazette des Hôpitaux for May, 1914. these " seats of learning." Graduation thus This refers to an officer of the First Empire who cheapened and utilised, the country became died from cancer of the stomach ; cancer appeared in inundated with briefless barristers and practi- the two succeeding generations of his descendants. tioners without patients, so as to create that These may be coincidence, but abundant coinci- most dangerous of all classes, the " educated un- dences form a law. employed." Having, after his return for a Roman I am, Sir, yours faithfully, constituency, become Minister of Public Instruc- Farnborough, Jan. 16th, 1916. JAMES RAE. tion, Baccelli’s chief concern was to reduce this plethora of degree-giving schools and retain only four, whose efficiency would be ensured by better emoluments for the professoriate, and whose Obituary. degrees could be accepted as adequate to modern standards. Under the present system, he said, " we are an ’academic which is GUIDO BACCELLI. creating proletariat,’ responsible for much of the agitation, political THE "Third Italy" has just lost one of its and social, which has proved a real hindrance creators in the veteran clinical teacher and con- to the country’s development." The speech in sultant who was revered throughout its borders as which he introduced his proposed reform was typical of the forces, moral as well as combatant, one of the most memorable ever heard at that inspired and promoted that " Risorgimento." Montecitorio-a specimen of the finished oratory Born in on Nov. 25th, 1832, Guido Baccelli which he could always command on critical possessed a hereditary love of the medical art and occasions. But the short-lived Ministeries in began his preliminary studies in the Ghisleri which he held the portfolio left no time for the College at Pavia in the early forties of the century. carrying out of his reforms, and Italy remains, to Those were the days when Italy was agitated "from her own disadvantage, a victim to what he termed the Alps to Etna " with the yearning for freedom "academic hypertrophy." A brief tenure of the and unity, and young Baccelli was among the Ministry of Agriculture gave him another oppor- keenest in the patriotic ranks. He ran away tunity of introducing salutary innovations--the from college to enrol among the volunteers and reclamation or "bonifica" of the ; was with difficulty brought back to his studies. At but it was always in his control of public instruc- the end of the scholastic years indeed he joined tion that he achieved, wherever practicable, the Garibaldini in the defence of Rome against the the most conspicuous results. An accomplished French till at the close of that heroic but abortive classical scholar, able indeed on the spur of the struggle he had to fly the city as an exile. That moment (as at the Berlin International Congres& of was in the early summer of 1849, and then began Medicine in 1890) to deliver an address in the Latin those medical studies which were ever after the tongue which from its clear intonation, assisted by ruling passion of his life. Having graduated with attitude and gesture, was wonderfully intelligible great distinction at the Sapienza, he was, when and impressive, he took the deepest interest in little over 24 years of age, elected to the chair of archaeological research, and, aided by the Cavaliere Legal Medicine from which, after a brilliant dis- Rodolfo Lanciani, he excavated the Hall of the charge of its duties, he passed to the professorship Vestals and brought to light in the Forum not a few of Pathological Anatomy, and thereafter to that of monuments which solve many problems, historic Clinical Medicine, a post which he never aban- and other, long prolific only of barren discussion. doned. An admired and diligent student of the But these undertakings were by-works to his main great Morgagni, he translated and edited the works programme, which was to rehabilitate his com- of that pioneer and followed up his researches on patriots, physically, morally, and intellectually, and cognate lines, corresponding with contemporary he laboured throughout his life to develop and German pathologists, Leube in particular, and to make ever more efficacious the science and introducing, while developing, their findings in art of medicine. His crowning effort in this the Roman school. He devised methods of diagnosis direction was his founding the great hospital in thoracic diseases which, after their soundness of the Policlinico, which remains a monument not had been confirmed in his own clinique, were only of his enlightened acceptance of wholesome