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from taste, and lessened need for control compensatefor uncertainty as to the continuing efficiency ofso small an excess of chlorine is a matter for carefulconsideration. The degree of pollution and the

liability of this to vary will be deciding factors.

PSYCHIATRIC DEMONSTRATIONS AT

ST. GEORGE’S HOSPITAL

MANY years ago Dr. James Collier started a seriesof neurological demonstrations at St. George’sHospital which, since his death, have been con-

tinued by Dr. Anthony Feiling at fortnightly intervals.These demonstrations are held at 5 P.M. on Thursdaysduring term time. They are not confined to studentsof the hospital and attract large audiences fromoutside. It is now proposed to start psychiatricdemonstrations to alternate with these neurologicaldemonstrations, which will be continued as before.Dr. Edward Mapother and the senior medical staffof the Maudsley Hospital are cooperating with Dr.Desmond Curran, psychiatrist to the hospital, ingiving these lectures. This will have the additional

advantage that the cases can be drawn from theabundant clinical resources of the Maudsley Hospital.The first of the new demonstrations will be given byDr. Mapother on Thursday, Oct. 15th, at 5 P.M.

THE HYPOCHROMIC ANÆMIA OF PREGNANCY

HaeMATOLOGY is growing so complex that it isdifficult to keep abreast of its developments. Nosooner have the aetiological factors in the develop-ment of a particular anaemia been satisfactorilydetermined, than a mass of new evidence is producedwhich necessitates a completely different view. Ithas been generally accepted in the last six yearsthat the hypochromic anaemia of pregnancy is largelydue to the increased demands made by the fcetusfor iron ; that the ansemia, in fact, is due to the

pregnancy. H. W. Fullerton now declares thatthe assumption that uncomplicated pregnancy fre-

quently produces a severe degree of hypochromicanaemia is not tenable, and that even in women ofthe poorer classes the transference of iron from themother to the uterus and its contents is compensatedwholly or to a large extent by dietary iron. F. H.Bethell in America has come to a similar conclusion.2He believes that the occurrence of hypochromicanaemia in pregnant women is not to be found primarilyin the circumstances incident to gestation but shouldbe sought in the status of the haemopoietic mechanismprior to conception. Both workers consider that theanaemia is one which has existed before pregnancybut has been unmasked by physiological hydraemia.Bethell describes iron balance observations continuedover the last 63 days of pregnancy and the first 12days after delivery which show that the iron andcopper output during the period approximatelyequalled the intake. In spite of the fact that theseelements were not retained there was no anaemiain mother or baby. Fullerton calculates that theiron saved by the absence of menstruation during theperiod of gestation and lactation more than compen-sates for any iron lost to the foetus. On the other hand,he considers that the blood loss at parturition thoughvariable in amount may in many cases, especiallyin the presence of severe dietary deficiency, result ina severe hypochromic anaemia. He believes that theblood loss of menstruation and parturition are morepotent factors in causing anaemia than pregnancy

1 Brit. Med. Jour., 1936, ii., 523, 577.2 Jour. Amer. Med. Assoc., 1936, cvii., 564.

itself. Owing to the iron - poor diets of so manyworking women this blood loss can never be corrected.This work is obviously of great theoretical interest.Whatever the cause of the so-called hypochromicanaemia of pregnancy the practical truth remains,as clearly demonstrated by J. C. Corrigan and M. B.Strauss 3 and Fullerton himself, that the haemoglobincan be kept at a satisfactory level with real benefitto the general health of mother and child by givingthe mother large doses of iron throughout pregnancy.The woman may be ansemic before pregnancy, but shedoes not consult a doctor. It is only when pregnancyintervenes that medical aid is sought. The availablefigures show that it is essential that for the presentall women should take iron in adequate doses

throughout pregnancy.

THE ROYAL MEDICAL BENEVOLENT FUND

WF publish this week a letter from Sir ThomasBarlow, president of the Royal Medical BenevolentFund, asking for support for the Christmas giftswhich of late years have been regularly found for theannuitants. Sir Thomas refers to a hesitation in

asking for more, because of the response to therecent centenary appeal, but he quotes a letter fromone of the annuitants which shows how welcome thesmall addition to resources is to many-some 700 or800 helpless persons, who are compelled to counttheir incomes by pennies. To these the withdrawalof an expected addition would be a sad disappoint-ment, and we are certain that few of our readerswill consider themselves absolved from any obligationto subscribe to the Christmas gifts fund becausethey have already supported the centenary appeal.That appeal, as far as figures have yet come to ournotice, has not had the hoped for result-indeed,without Sir Thomas’s own great donation of 1000,the figure attained was not such that should lead themedical profession to think that when so much hadbeen accomplished no more was required. The Fundhas many on its books for whom the support of thewhole profession is needed if misfortunes in our ranksare to be relieved, and we hope that Sir Thomas’sappeal for Christmas gifts with which to supplementthe annual grants will meet with a generous response.

VASCULAR TUMOURS OF MUSCLE

HaeMANGIOMATA of skin and subcutaneous tissuesare the commonest tumours of infancy and childhood,but these growths are rare in other situations.Mr. F. Forty, who recently described in our columns 4a vascular tumour in the extensor hallucis brevismuscle directs attention to an interesting group ofdeeper-seated haemangiomata which might reason-

ably be diagnosed before operation if the possibilityof their occurrence is kept in mind. Since Listondescribed the first case in 1843, over 260 cases of

haemangiomata in muscle have been reported. AsE. N. MacDermott 5 has pointed out, hardly anymuscle is immune, but the tumours have a predilectionfor the lower extremity, especially the quadriceps,hamstrings, and gastrocnemius. In the upper extremity,the triceps and latissimus dorsi are most frequentlyinvolved. Like haemangiomata of superficial tissues,these are tumours of infancy and childhood, 80 percent. occurring before the age of 20. The clinicalfeatures vary considerably, but the common findingis a tumour mass, round or ovoid, varying in sizefrom a nut to an egg, growing slowly and at first

3 Jour. Amer. Med. Assoc., 1936, cvi., 1088.4 THE LANCET, Sept. 19th, 1936, p. 676.5 Brit. Jour. Surg., 1935, xxiii., 252.

802

painlessly. The tumour is usually diffuse and oftentender. The consistency varies with the amountof fibrous tissue present and may be soft, elastic, orhard. The overlying skin is normal in appearanceor occasionally bluish, and is freely movable over theswelling. Pain develops usually at some time in thecourse of the disease. At first it is an ache comingon with use of the muscle and disappearing with rest,but in advanced cases radiating or tingling pains maybe complained of. Some degree of functional impair-ment of the limb is nearly always present. Diagnosisis difficult and was made before operation in only8 per cent. of the recorded cases. The tumourswere usually mistaken for lipomata, cysts, coldabscesses, or sarcomata. The withdrawal of blood

by an exploring needle and the demonstration of

phleboliths by X rays are helpful indications.Following Muscatello, these tumours have been

classified histologically according to the predominat-ing vascular structure. The cavernous hsemangiomais the most common, but arterial, venous, and capillaryhaemangiomas are also described. Since these tumoursoccur during the first three decades of life, they havebeen regarded as congenital in origin. Haemangio-mata are generally considered to arise from a failure ofcertain angioblastic cells to establish contact with theremainder of the developing vascular network of theembryo. This results in the capillary haemangioma,which consists of a mesh of minute irregular blindchannels through which the blood of the generalcirculation does not pass. The cavernous haemangioma,on the other hand, is held to result from the establish-ment of a connexion between the general circulationand the fine channels of the capillary type of tumour,and this may be initiated by trauma. In musclehaemangioma, trauma is mentioned as a factor inunder 20 per cent. of the cases. R. Mailer stressesthe importance of the traumatic factor in the aetiologyof these tumours, and considers that a congenitalfactor need not be postulated universally. F.Settergren of Stockholm, comes to a similar con-clusion, but points out that it is impossible to excludethe possibility of a small primordial growth whichmay be stimulated by trauma into activity and thusbecomes clinically obvious. The treatment of thesetumours is by wide excision. The prognosis is

excellent; recurrences are rare and are due to

incomplete removal. If excision has been difficult,post-operative radiation is advised.

NARCOTIC DRUGS: SUPPLY AND DEMAND

THE report of the Permanent Central OpiumBoard to the Council of the League of Nations at itspresent session dealt among other things with theexcess of estimates furnished by certain countriesof the narcotic drugs required for the current year.These statistics of manufacture for domestic consump-tion, for conversion into other drugs, for stockreplenishment and for export are required from theContracting Parties under the Drugs LimitationConvention of 1931. They enable the supervisorybody each year in Geneva to prescribe annually inadvance the basis on which legitimate trade andmanufacture shall be carried on. They also discloseinstances of excess of manufacture, which in somecases could have been avoided if more accurateestimates had been supplied in advance. In 12 cases

(as compared with 29 cases in 1934) the Boardnotified Governments, in accordance with Article 14

6 Brit. Jour. Surg., 1935, xxiii., 90, 245.7 Acta chir. Scandinav., 1936, lxxviii., 289.

of the Limitation Convention, that certain estimateshad been exceeded, and warned them that, unlessthe circumstances are exceptional, no new exportsto the countries in question will be authorised unlessand until supplementary estimates shall have beenreceived. The total manufacture of morphine for1935 was 31,427 kg., or 4649 kg. more than in 1934,due mainly to morphine manufactured, not for

conversion, but for use as such. There was a markeddiminution in the manufacture of heroin-namely,674 kg.-a reduction of 39 per cent. on the figuresfor 1934. The reduction was especially marked inthe case of Japan, where manufacture had beenexcessive ; 250 kg. of heroin being the output for1935 against 547 kg. in 1934. The estimate forcocaine was 4003 kg., or 539 kg. more than in 1934 ;but neither in this case nor in that of morphine doesthe Board consider that the average manufacturefor the last three years exceeds normal consumptionrequirements.

THE CRYSTAL PALACE BABY SHOW

WHAT was advertised to be a national baby showon a grand scale was held at the Crystal Palace,Sydenham, on Saturday, Sept. 19th. This event,organised, we learn, by a local councillor and

advertising agent of Romford, Essex, was ill conceivedand soon raised opposition which should have ledto its abandonment. But such a venture is easier tostart than to suppress, so the exhibition did takeplace-a pitiable fiasco which has left an evil tasteand might have done great damage to maternity andchild welfare had those responsible for that greatsocial movement had anything to do with it. For-

tunately the official and voluntary bodies whichcarry out child welfare refused to participate in theshow : most, passively, by refusing to countenance oradvertise it ; a few, such as that of Croydon, withpublic protests. If the exhibition had been a successit would have been a serious set-back to the causeof State medicine, so in its failure we have cause forsatisfaction-but not for rejoicing, for the spectaclewas in itself distressing. In 1918, when Parliamentpassed the Maternity and Child Welfare Act, localauthorities and their officers were faced with a newfunction and some means of advertising it was

desirable, for the official method of introducing newlaws and regulations does not easily reach those forwhom they are intended. Amongst means of propa-ganda local baby shows on a small scale had muchto recommend them and were favoured, though thedisadvantages inseparable from such exhibitions wererecognised. The baby show did at first do much tobring infant welfare to the notice of the people;but its value passed quickly and its drawbacks ledto its gradual abandonment. Child welfare now restson its intrinsic merit and though in: some districts itstill needs an occasional fillip, it loses instead of gainsby reversions to such propaganda.

WASTED LIVES

ONE of the distinctive features of our moderncivilisation is its refusal to accept a great deal inthe way of suffering and frustration of human lifewhich our forefathers, and even our grandfathers,regarded as inevitable. At intervals we are pre-sented by some new writer, using perhaps a freshmethod of presentation, with the challenge to lookat the badness of things and to change them. Charles

Kingsley’s " Alton Locke " in the ’fifties, " TheBitter Cry of Outcast London " in the ’eighties,Alexander Paterson’s " Across the Bridges " a couple