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and every diabetic child should be given enough foodand enough insulin to enable him to live a normal life,feel perfectly well, and develop normally. But ifthis aim can be fulfilled is there anything to be gainedby giving an excess of carbohydrate ? The free dietmust mean occasional big rises in blood-sugar andincreased glycosuria, which are theoretically objection-able and certainly (one would suppose) should not berisked within a couple of years of the onset of diabetes.The disadvantage of three daily injections is alsoobvious, and the regulation of dosage cannot be veryeasy.

LONDON SCHOOL OF HYGIENE AND

TROPICAL MEDICINE

THE first decade of the London School of Hygieneand Tropical Medicine is briefly surveyed in theannual report of the board of management to thecourt of governors. Since its establishment in 1924an imposing building, complete with modern labora-tory and scientific equipment, has been erected ;post-graduate courses of study in bacteriology andimmunology, biochemistry, epidemiology and vitalstatistics, public health, and tropical medicine andhygiene have been established and developed underthe guidance of distinguished teachers ; and theseparate institutions for the study of tropical medicineand tropical hygiene, founded respectively byPatrick Manson and Ronald Ross, have beenincorporated in the school. The report of the dean,Prof. W. W. Jameson, for the year ended July, 1935,records the close and happy relations maintainedwith other scientific and professional organisationsand the practical value to the staff of this association.Full advantage has been taken during the year of thepolicy of encouraging members of the staff to visit

tropical and sub-tropical countries for the purposeof conducting special investigations or studying localproblems. For example, Sir Malcolm Watson hasvisited Central and East Africa ; Dr. Wigglesworth,Malaya, the Dutch East Indies, and Ceylon; Mr.J. J. C. Buckley, D.Sc., Assam ; Dr. R. Mellanby,Uganda; Prof. P. A. Buxton, Macedonia; and Mr. H. H.Clay, India. During the year 179 students enrolledin one of the regular courses of instruction in additionto a considerable number who attended for shortperiods of more specialised study. The work on theisolation of a chemical substance of high immuno-logical value from B. aertrycke which is being con-ducted by Prof. W. W. C. Topley, F.R.S., andProf. H. Raistrick, F.R.S., has proceeded most success-fully during the year. The grant which ImperialChemical Industries Ltd. made towards the costof this investigation came to an end on Sept. 30th,1935, and some anxiety is felt about the moneynecessary to continue what is regarded as one of themost important and promising researches of recentyears. Prof. G. S. Wilson has completed a verythorough study of the various methods of assessingthe bacterial content of milk and his report, whichshould be of great practical value, is about to bepublished. The investigation on the lethal effectsof oil on mosquito larvae is now in progress in Prof.Buxton’s department ; the cost of this work is beingborne by three large petroleum companies. Attentionis drawn by Prof. M. Greenwood, F.R.S., to thecloser liaison between the division of epidemiologyand vital statistics and official government depart-ments ; an inevitable result is that still more time hasto be devoted by the personnel of the division to workwhich will either never appear in print at all, or, ifpublished, will not be published over the names of theauthors. Work of this kind is however regarded

as an essential duty, since the division enjoys theconfidence of various public authorities who relyupon the staff to give them frank advice on variousstatistical and epidemiological matters, knowing thatthe confidence will be respected.

THE AIR-SWALLOWING INFANT

THOSE who live on fluid alone are almost boundto gulp in air with it, and Lereboullet and his

colleagues 1 think air-swallowing a common sourceof trouble in infancy. Vomiting from this cause

may begin, they point out, in the earliest days oflife, being seen more often probably in breast-fedthan in bottle-fed babies. It may be explosive ormerely regurgitant, and the milk as returned may becurdled or not, according to how long it has beenin the stomach. The child’s appetite is likely to beexcessive, but after three minutes’ greedy feedingno more food is taken until relief has been obtained

by an eructative vomit. In the early stages of thedisturbance the general state remains good; thestools are normal and weight may be gained despitethe vomiting. If the right diagnosis is made allwill be well; but only too often the vomiting isattributed to dietetic error, and the baby is madeto try a series of foods and formulae, culminatingperhaps in a true breakdown in digestion, with the" diarrhoea and vomiting" syndrome. Since allbabies swallow air with their milk it may well beasked why they do not all suffer in consequence.Lereboullet’s answer is that some swallow more andsome less, and it is the greedy baby who, rapidlydistending his stomach, is most likely to -vomit.The degree and speed of evacuation of the air bothby the upper and lower openings of the stomach alsovaries greatly, and the position in which the childis placed after feeding makes a difference. As partof treatment the French authors recommend thatafter an attempt has been made to " get up the wind "by holding the infant in the vertical position for theusual period, it should then be placed on its leftside for a quarter of an hour, after which it remainson the right side till the next feed. They alsoadvise the use of thickened feeds, or even the intro-duction of the milk through an eesophageal tube.For the breast-fed baby, to whom this programmeis inapplicable, they suggest a teaspoonful of con-densed milk or of a thick farinaceous paste immedi-ately before feeds. Possibly, however, a drink ofwater would be equally effective; and there isanother measure, also favoured in this country,which gets only rather grudging notice-namely,a small dose of a sedative (such as chloral) justbefore the feeds. In practice this problem is of realimportance, for weaning is far too often carried outmerely because of excessive air-swallowing by a babywho is otherwise thriving. Robert Hutchison teachesthat chronic vomiting can be ignored if an infant isgaining weight, and this rule applies especially to thekind of case under discussion.

THE TEACHING OF ANÆSTHETICS

A LIVELY discussion was provoked by the presi-dential address of Dr. H. A. Richards to the sectionof anaesthetics of the Royal Society of Medicine onNov. lst. The points which aroused most interestcentred round the teaching of anaesthetics to thestudent. The difficulties which confront the teacherof this subject are perhaps more formidable than thosewhich the teacher of any other clinical subject must

1 Lereboullet, P., Lelong, M., and Aimé, P. : Presse méd.,Oct. 5th, 1935, p. 1541.