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address before the section of the history of medicinein the Royal Society of Medicine with the interestingtitle : the Doctor, the Quack, and the Appetite ofthe Public for Magic in Medicine.

THE KIDNEY IN ECLAMPSIA

THE cause and nature of eclampsia is still so obscurethat any accurate information about it is welcome.And though Prof. J. S. Dunn and Dr. Dugald Baird,of Glasgow, themselves doubt whether their findings

. throw much light on the seizures and fatalities of thedisease, their careful description of the changesin the kidneys is a valuable contribution to our

knowledge of it. In nine out of ten fatal cases ofclinical eclampsia they found the same uniform

changes in the glomeruli-frequently enlargementand increased lobulation and invariably increaseddensity of the tufts with great diminution or absenceof red corpuscles. The deviations from the normalare not dramatically obvious on casual examinationand they are made much more plain if the connectivetissue is specially stained. It appears then thatthe thickening and partial obstruction of the capil-laries is caused partly by an increase or enlargementof their endothelial cells and, perhaps more definitely,by a swelling of the basement membrane. The lesionis diffuse in the sense that every tuft is involved andthe rest of the kidney shows no changes or only suchas may be regarded as incidental. Examination ofold sections of the kidneys from 30 other obstetriccasualties showed the characteristic lesion in 7 ; theother 23 were free from it-which is sufficient evidencethat it is not simply the result of pregnancy. But,Dunn and Baird point out, the change is not severeand, as one of their cases showed, it can be recoveredfrom completely. Hence they suspect that it isthe underlying cause of the common albuminuria andnephritis of pregnancy which is usually mild andrarely threatens life ; it is revealed by the fatal

complication of eclampsia for the developmentof which some impairment of kidney function is

necessary though this by itself will not produce theconvulsions and haemorrhages.

SLUM CLEARANCE

WE have received an influentially signed appealin favour of reserving, in all plans for reconditioningof new houses, suitable sites for the future buildingof nursery schools in convenient proximity to thehouses. The appeal is timely. Public attention hasbeen acutely raised to the urgency of slum clearance,but it is pointed out by the signatories to the appealthat exclusive concentration on the problem of goodhouses may result in the missing of a fine opportunity.For better shelter for a large number of familiesshould clearly carry with it better provision for theirwelfare, and should therefore include attention tothe needs of young children. " Especially we wishto urge the immediate reservation of sites for nurseryschools," says the appeal. " The very young children,not yet of school age, need care which cannot befully given by the mother whose energies are fullytaxed by the claims of a baby, her husband, andthe management of the home. If successful and

happy family life is to be maintained she mustreceive some assistance. It is now widely recognisedthat the open-air nursery school supplies what iswanted in the best way yet devised. It providesthe needed space for the little children’s activegrowth, it supplies medical supervision and healthyconditions, it gives each child opportunity for sound

1 Jour. Path. and Bact., 1933, xxxvii., 291.

and happy mental and social training in closecooperation with the home. Thus physical and mentalhealth for the future is assured, and a measure thatmay look like a luxury to some is seen to be no lessthan a national economy." The appeal is signedby the Archbishop of York and a representativegroup of persons interested in the problems of childwelfare and will, we hope, receive the attention ofthose in whose hands the developments of town

planning lie. For what is sought is abundantlywanted.

THE PROBLEMS OF ASTHMA

WHETHER when its secret is ultimately unfolded thecausation of asthma will be found to be as complexas at present seems likely, may perhaps be doubted.Seldom can the problems of any disorder have receivedattention from so many angles as those of thisparticularly elusive complaint. Hardly any specialbranch in medicine or its ancillary sciences has failedto contribute its quota to the discussion of asthma.In such a welter of opposing views as at presentobtain on the subject of asthma, it is difficult for thescientific mind to move with precision. At thepresent time a discussion on asthma can be reliedupon to produce a stimulating debate, though theviews put forward and the wit with which they arecontroverted will depend largely on what speakershave been invited to attend. The recent meeting ofthe Paddington Medical Society, reported on anotherpage, was concerned for the most part with argumentswhich have been heard before ; particular interest,however, pertains to the strength with which theclaims of psychotherapy were put forward. In

following the psychoanalyst’s approach to asthma,readers will feel themselves on familiar ground;emphasis is laid here, as in connexion with manyother disorders, on the underlying nervous factor, theanxiety state with its obsessions and phobias, andso on.

Unfortunately the discussion coincided in date,though not in time, with another meeting at whichasthma was considered from an entirely new stand-point. It would have been of interest to study thereactions of those who took part to the ideas put outby Prof. J. H. Burn, in his presidential address tothe section of therapeutics of the Royal Society ofMedicine, under the title A Pharmacological Approachto the Cause of Asthma." 1 The facts which his owninvestigations have elicited so precisely give promiseof opening up important avenues towards its centralproblems. The results are so suggestive and so

much in consonance with clinical observations, thatit is to be hoped that further research will add to ourindebtedness to him. His investigations concernedtyramine, the amine obtained by decarboxylationfrom the amino-acid tyrosine. Its action was firstfound by Dale and Dixon some 25 years ago to besimilar to, though weaker than, that of adrenaline;but its power of raising blood pressure, it was laterfound by Tainter and Chang, was abolished by aprevious injection of cocaine, whereas the similareffect of adrenaline was enhanced in these circum-stances. It is the problem created by this dissimilaritywhich Prof. Burn has studied. In the first stage ofhis investigations he found that in a perfused organadrenaline showed its constrictor effect, but thatneither tyramine nor ephedrine could act in this wayexcept in the presence of adrenaline. This suggestedthat the mode of action of adrenaline differed fromthat of tyramine and ephedrine, and this was provedto be the case by perfusion experiments in organs in

1 See THE LANCET, Oct. 14th, p. 867.