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myelin sheaths. In regard to the lesions them-selves, many revealed areas of necrosis or caseation,such as are seen in tuberculosis, and giant cellswere noted in some numbers, with oval or sphericalnuclei arranged peripherally or centrally. Therecan be no doubt in the writers’ opinion that theorganism is a torula, and the features of the casere analogous, clinically and pathologically, tothose of cases collected from the literature. The

symptomatology of these closely resembles theclinical picture of intracranial neoplasm. A

.chronic, slowly progressing inflammatory process,situated in such a way as to interfere with thepassage of cerebro-spinal fluid and occasion internalhydrocephalus, or leading to the formation ofmasses of parasites in various parts of the- cerebrum or cerebellum, results in the developmentof symptoms of raised intracranial tension whichit may be impossible to distinguish from thepressure effects of a brain tumour. There aresimilarities also, as is apparent, with other chronicinfective conditions of the central nervous system,,such as syphilis. A considerable portion of themonograph is taken up with a valuable investiga-tion into and differential classification of thediseases formerly called blastomycosis. As a resultof much personal experimental research, sue-

cinctly summarised in the monograph, the authorspublish an elaborate table of differential pointsbetween torula infection, oidiomycosis (usuallytermed blastomycosis), and coccidioidal granu-loma. In the general discussion which con-

cludes the paper reference is made to thefact that torulse were proved years ago byseveral observers to have marked pathogenic.action in animals, with frequent productionof brain lesions. How common this type ofinfection is in man is unknown, but many factsindicate the possibility of its being frequentlypresent without recognition. The organism is

probably not always very pathogenic in man, andlesions may be recovered from. In the healedstage the lesions are those of a slightly atypicaltuberculosis, and the condition may thus be passedover. Experimental lesions in animals are some-times quite indistinguishable from miliary tubercleswithout caseation. The general conclusions of asuggestive and valuable piece of work are that thefactors which will aid the recognition of torulainfection consist of: Discovery of early lesions ininternal organs before the parasite is destroyed ;realisation of the finer points of difference fromtuberculosis; complete microscopical brain exa-

mination ; cultures, especially on carbohydratemedia at room temperature; and injections of fluidsand cultures into white rats intraperitoneally, withmicroscopical examination especially of the brain.

EFFECT OF FATIGUE ON GASTRO-INTESTINALACTIVITY.

Dr. Ludwig Kast, of New York, has investigatedthe effects of fatigue on 54 patients and healthysubjects to test the motor power of the stomachand intestines. The stomach-pump and X rayswere employed; to determine the time of elimina-tion of the intestinal contents carmine was used,a standard test diet being given for a number ofdays. By taking the average, it was determinedhow long it took the stomach, and separately, howlong it took the intestines, to propel the givenamount of food. During the period of the teststhe amount of physical activity was regulated andthe mental activity approximately limited. Withoutany change of diet our of mental activity, the

physical activity was markedly increased or de’

creased, and the effects of the same upon theevacuating power of the stomach or intestinesobserved. At other times, without change in thediet or the amount of physical exercise, the amountof mental efforts was markedly increased or de.creased and the effects observed. It appears thatthe healthy individual showed very little variationas regards the evacuating power of the stomachor intestines as long as the physical exercise wasnot excessive. Mental efforts had no perceptibleeffect. In patients with moderate degree’of atonyand splanchnoptosis the evacuating power of thestomach and intestines decreased in direct propor.tion to the amount of mental and physical exer.

tion. Physical exertion had the same effect in suchindividuals if the patient was kept in a horizontalposition during these exercises and during theperiod of observation in order to eliminate theeffect of splanchnoptosis in the erect position. Inpatients who clinically appeared susceptible to theeffects of fatigue mental exertion was more markedin its delaying effect than physical exertion.

RELATION OF HIGH ARTERIAL TENSION TOALCOHOL.

MUCH difference of opinion exists as to the partplayed by alcohol in the causation of high arterialtension, arterio-sclerosis, and interstitial nephritis.After carefully studying the question Lancereaux,the well-known French clinician, stated thatalcohol does not favour the production of arterio-sclerosis. At the Académie de Medecine of ParisM. Camille Lian has reported an interesting investi-gation which his position as surgeon to a Terri-torial regiment enabled him to make. With thePachon-Lian sphygmometer he took the bloodpressures in the afternoon of 150 men, all aged42 or 43 years. Without consulting the results heinvestigated their habits as to alcohol and dividedthem into four classes: 1. Sober, those who tookless than a litre of wine daily and no spirits, (Alitre of cider or beer was considered equivalent tohalf a litre of wine.) 2. Medium drinkers, thosewho took 1 to 1 litres of wine daily and no spirits.3. Great drinkers, those who took 2 to 2 litresof wine or a smaller quantity and one or twoapéritifs or petits Ve1’1’es. 4. Very great drinkers,

, those who took at least 3 litres of wine or asmaller quantity and four to six apé1’itifs or petits6rr6s. The number of each group in whom theblood pressure was above normal-that is, themaximum pressure above 15 em. of mercury and the

i minimum above 10-was then noted. The resultsi were as follows: Sober, 16 men, blood pressure

. above normal 1 (6’25 per cent.); medium drinkers,53 men, blood pressures above normal 4 (7’5 percent.); great drinkers, 57 men, blood pressures abovenormal 10 (17’5 percent.); very great drinkers, 24 men,blood pressures above normal 6 (25 per cent.). The

L greater frequency of high blood pressure as ther consumption of alcohol increased showed that thisL substance was an important factor in causation. ItI might be objected that the increased pressure may. have been due to other causes. But in such a, number of subjects it was to be expected thatE these causes would be distributed without markedL difference amongst the various groups. Moreover,r the men were examined for stigmata of syphilisL and questioned as to other infections and intoxica-

tions. After eliminating the cases in which anotherl factor could have been in play it was found that theb percentages of high pressure in the four groups were not sensibly altered. r . _ _ .. - . : :