570

suspected. The symptoms are gastro-intestinal,jaundice is absent and the mortality is nil. The typedue to L. canicola has chiefly been reported in theNetherlands, though recently the serum of a Glasgowtripe-dresser agglutinated this strain. The onlyknown reservoir of this type is the dog. The most

important type in this country is that due to L.ictero-haemorrhagiae, the chief carrier of which is therat. In some localities more than a third of the ratsare " healthy " carriers excreting the organism intheir urine. Human infection is acquired through thealimentary tract or by contact from contaminatedwater or other material. It was common on allfronts during the war, and during the last few yearsit has been found among the fish-workers in Aberdeen,sewer-workers in London and Glasgow, tripe-dressersin Glasgow, coal-miners, and workers in the beet-fieldsin Ireland, who are probably infected throughabrasions of the hands in the same way as are the

sugar-cane cutters in Queensland. The classical des-

cription of Weil’s disease gives a false impressionof its course, for some 60 per cent. of cases show no

jaundice at all. Many are mis-diagnosed as influenza,and if a patient presents an acute fever of obscureorigin with muscular tenderness, conjunctival in-

jection and a neutrophil leucocytosis, the possibilityof Weil’s disease should be investigated by bacterio-logical and serological tests, particularly when therehas been any risk of infection. Where there is adefinite occupational hazard it may be wise toadminister antileptospiral serum while awaitinglaboratory confirmation.

AGE AND PARITY IN PLACENTA PRÆVIA

FROM an analysis of sixty-nine carefully acquiredmaternal histories, in which there were seventy-two casesof placenta praevia, Penrose concludes that maternalage and multiparity are both likely to be importantfactors in the production of this condition.! If these

seventy-two cases had been randomly distributed

amongst all the pregnancies which these women hadexperienced, then the average age at which placentapraevia occurred would have been 29-10 years. Theobserved average age was in fact 31. 86 years, a differencebeyond what is likely to be due to chance. Mothersof 35 years of age or more produced twenty-sevenout of the seventy-two cases, whereas they wouldhave been expected to produce only fifteen if agehad no effect. The same form of comparison showsa clear tendency for mothers with a high degree ofmultiparity to be over-represented in the series ; theobserved mean birth rank was 3-55 and the expectedmean only 2-58. Similarly there were twenty-threeobserved occurrences of placenta praevia at birthorders of four or more against an expectation of onlyfourteen. Age and parity are, of course, themselvesassociated, and the number of observations availableto Penrose is rather small for the determination of therelative importance of each independent of the other.Using the method of correlation, he finds, however,that multiparity probably has an independent effectthough this may be less important than that ofmaternal age. Further subdivision of the observa-tions shows that the mean maternal age for central

placenta praevia was significantly high while for

marginal and lateral cases it was not abnormal.This observation is confirmed by a further series ofcases collected from the Royal Free Hospital. Onthe other hand the mean number of pregnancies wasalmost exactly the same in both central and non-central groups. Finally, the data gave no evidence

1. Penrose, L. S., J. Obstet. Gynec., August, 1939, p. 645.

that the length of time elapsing between the abnormalpregnancy and the pregnancy immediately precedingit was unduly short in comparison with other preg-nancy intervals in the families studied. There wasalso no obvious tendency for the condition to affectthe firstborn. Incidenta,l observations show that themother survived in sixty-seven of the seventy-twocases but the child in only twenty-five instances.

Judging from these hospital cases caesarean sectionappears to be the most satisfactory form of treatmentfrom the point of view of the child, and scarcely lessfavourable than version and extraction from the

point of view of the mother.

ALCOHOL IN AIR FORCES

THE anxiety expressed in other countries about theprevalence of alcoholism among air-pilots may haveled to doubts about the state of affairs in this country.During the war of 1914-18 heavy drinking becamealmost a convention among flying men, and this con-vention lingered afterwards. It had arisen at a timewhen the inferiority of our machines compared withthose of the enemy was felt to justify an infusion ofDutch courage, but now that its underlying cause hasbeen removed it exists no longer. For junior officersof the Royal Air Force, wine bills are strictly limited ;there are non-treating orders in messes, bars are notopen for alcoholic drinks in flying training schoolsuntil the evening, and drinks may not be consumed inprivate rooms. To break the first two of these rulesis a court-martial offence. In the past few years, too,the mental attitude of officers towards drink haschanged. The Service has become a career and per-manent commissions are hard to get. Promotion hasdepended upon examinations, specialisation, linguisticskill and staff-college work, as well as ability at flyingand games. Heavy drinking cannot and does notmix with these, and the routine medical examinationsserve as a continual check which reveals any incipientphysical or emotional disability.

THE TRELOAR MARINE HOSPITAL

Sir Alexander Maclean’s noble gift will make it

possible to provide the cripples’ hospital at Alton witha complete seaside annexe at Sandy Point, Hayling,where 120 children will continue their recovery frompoliomyelitis under ideal conditions. Pioneer workhas already been done there with the wattle hurdleand the glowing brazier on the sea-beach, but thesewere insufficient to deal with last year’s epidemic ofpoliomyelitis, when Sir Henry Gauvain was fortunatein getting many of the cases at a stage when ortho-paedic treatment is most beneficial. After an initialperiod of entire rest, the patient, still paralysed andimmobilised in splints, is transferred to the poolwhere the splints are removed when the limbs aresupported by water. There being no friction, exerciseis practically effortless. It was the American ex-

perience with such pool treatment that determined thedonation ; there, skilled technicians enter the poolswith the patients and carry out the prescribed move-ments. In the new pool at Sandy Point the buoyancyof the sea-water may produce results which have notbeen possible as yet elsewhere. The sea-water pool,30 ft. by 15 ft. with water at a temperature of 92° F.,will have under-water illumination to assist theexactitude of the treatment. A super-saline pool willbe used for cases of osteomyelitis with dischargingsinuses. A current pool will provide water massagefor scoliosis and polio cases. A super-warm pool,with a temperature not less than 100° F., will offersedative treatment for spastic paraplegia, and airbubbles can be lltilised in a modified Hubbard pool.