1. Though Shanghai is in close communication with ports in which plague is endemic, it has not suffered severely.

2. The number of human cases is small compared with the number of plague-infected rats found.

3. Both X. cheopis and C. fasciatus are found. Reasons are given for considering that X. cheopis is the chief agent in spreading plague, and that infection, being unlikely to reach Shanghai during the season when this flea flourishes, has difficulty in gaining a foothold.

4. The discrepancy between the number of cases of human and rat plague may possibly be explained by the habits of C. fasciatus.

1. Scarlatinal streptococci obtained from the throats of cases of scarlet fever can be divided into various groups by means of agglutination and absorption tests. The same type of streptococcus can on occasion originate at least five separate clinically distinguishable diseases, namely, scarlet fever, tonsilitis, erysipelas, puerperal fever, and broncho-pneumonia, and it would appear that, so far as streptococcic infections are concerned, the nature of the disease entity is determined by the toxigenic qualities of the type of streptococcus, by the susceptibility or insusceptibility of the individual as determined by the absence or presence of the specific antibodies in the blood, and by the site of the infection itself (see p. 330).

2. Strong corroboration for the view that the S. scarlatinae is the causal organism of scarlet fever is obtained from the following findings, viz.:

(a) S. scarlatinae have been isolated from the throat brushings of practically all acutely ill scarlet fever patients (see p. 329).

(b) The whole clinical picture of scarlet fever going on to marked desquamation is produced by the subcutaneous injection of the exotoxin derived from the S. scarlatinae, the exotoxin having been haeated to 55° C. for one hour, with a view to destroying any filterable living virus which might be associated with the filtered exotoxin (see p. 342).

(c) In the Schultz-Charlton reaction the blanching of the scarlet fever rash is caused by the serum of a horse immunised against S. scarlatinae and its toxins.

(d) Dick-positive and Dick-negative reactions as produced by the intradermal injection of the streptococcus toxin have the closet correspondence to the degree of susceptibility or immunity to scarlet fever of the respective reactors (see p. 334).

(e) Susceptible nurses once they are actively immunised by injections of scarlatinal streptococcus toxin have been shown to be immune to the toxin of scarlet fever (see p. 337), and susceptible school children similarly inoculated are likewise immune (see p. 338).

(f) Return cases of scarlet fever can be prevented by actively immunising susceptible contacts with scarlatinal streptococcus toxin prior to the scarlet fever patient being discharged from hospital (see p. 339).

(g) Susceptible contacts can be safeguarded from taking scarlet fever by passively immunising them with a sufficient does of antistreptococcus serum obtained from a horse wich has been immunised by injections of S. scarlatinae and its toxin (see p. 349).

3. The limitations of the Schultz-Charlton reaction as an aid in the diagnosis of scarlet fever have been confirmed (see p. 330).

4. Evidence has been obtained which firmly establishes the value of the Dick suseptibility test as a measure of susceptibility to scarlet fever (see p. 332).

5. Extensive corroboration of the value of the Schick test as a measure of susceptibility to diphtheria has been obtained (see p. 334).

6. The efficacy of active immunisation against scarlet fever by means of scarlatinal streptococcus toxin injections has been demonstrated by the fact that, while scarlet fever has been present in epidemic form in Aberdeen, no nurses or maids in Aberdeen City Hospital have contracted scarlet fever since June 1st, 1925, from which date the nursing and domestic staffs of the hospital have been actively immunised before being admitted for duty to the scarlet fever wards; whereas, prior to that date, an average of 8·5 nurses, or 9·5 per cent. of the nursing staff, and 1·4 maids, or 4·2 per cent. of the domestic staff. annually suffered from scarlet fever (see p. 337).

7. Coincident with the disappearance of scarlet fever in the immunised nursing staff of the City Hospital, there has been a notable increase in the incidence of streptococcic tonsilitis in these immunised nurses, and the streptococci obtained from these cases of tonsilitis in nurses commonly fall into one or other of the serological groups of scarlatinal streptococci; and accordingly it would appear to be proved that immunised nurses, while protected by immunisation from the toxic effects of the exotoxin of S. scarlatinae, are not protected against tonsilitis due to S. scarlatinae (see p. 338).

An examination of the literature shows that there is considerable difference of opinion on this subject. Some workers found that sera obtained from cases of scarlatina agglutinated scarlet fever streptococci to a high titre, while others believed that no agglutination could be obtained unless the sera were concentrated.

Pneumonia in well known to be extremely fatal at both extremes of life. In 1923 it was the cause of 3671 deaths per million living at ages under 5 years; between ages 5–24 the death-rate fell to 177 and rose to 376 at ages 25–44. after 45 the increase was rapid and the death-ate reached 2279 per million living for the ago group 65–74 and 4100 for all ages over 75 years.

1. A collection was made of organisms of the coli-aerogenes group; 100 from the human intestine, 50 from animals, and 50 from the soil. To these were applied the indol test, the methyl red and Voges-Proskauer tests, and Koser' citrate test. The citrate test was also applied to certain non-lactose fermenters.

2. 89·4 per cent. of 150 faecal organisms gave the combination of a failure to grow in citrate solution, the production of indol, an acid reaction with methyl red and a negative Voges-Proskauer reaction.

3. There is a probability that some faecal organisms have crept into the “soil” series, but the contamination is not heavy enough to make the results useless. The figures show that the citrate and indol test are both useful, the citrate being a little better. The methyl red and Voges-Proskauer reactions were not helpful.

4. In the bacteriological examination of water in Shanghai it is safe to take those organisms which can grow in citrate but do not produce indol as being non-faecal.

Rickets is produced in rats by feeding exclusively with cereals and yellow peas. Whereas feeding with polished rice results in typical rickets, feeding with rice-starch alone will only produce osteoporosis. This difference is not attributable to nitrogen starvation.

If oatmeal is extracted with hydrochloric acid and the extract is given in addition to the starch, the animals develop rickets. The rickets-producing factor of oatmeal must therefore be ascribed to some toxic substance. Evidence is given to show that this substance can pass through parchment-paper and that it can be precipitated with alcohol. Rickets produced by feeding with cereals can be prevented by the administration of calcium-salts, whereas phosphates have no such effect.

In 1921 Arkwright described two distinct types of colonies which appeared when cultures of Bacillus dysenteriae Shiga were plated on agar. One which he called the “rough” type had a coarsely granular surface rather like morocco leather, and an irregular margin. The other which he called the “smooth” type had a regular edge and a smooth surface. He found the same differentiation into rough and smooth colonies occurred among other member of the group, in B. typhosus, in B. paratyphosus B, and in B. enteritidis Gaertner. Since then these two types of colonies have been described in many other organisms; in streptococci by Cowan, in pneumococci by Griffith and by Reimann, in pasteurella by de Kruif, in meningococcu and gonococcus by Atkin, in the cholera vibrio by Shousha.

Two epidemics among mice are described that were closely associated with Morgan's No. 1 bacillus. In both of these epidemics the mice, which were fed on oats and raw beef, were found at autopsy to be suffering from peculiar lesions—an advanced degree of anaemia, pale and swollen kidneys, and general pallor and dryness of the tissues—not hitherto encountered in any other epidemic. Evidence is advanced to show that Bact. morgani was the specific cause of these epidemics; and it is suggested that the peculiar lesions described were the result of a chronic intestinal infection with this organism.

The close analogy existing between the bacteriological findings in summer diarrhoea and in our experiments is discussed. The tentative conclusion is advanced that summer diarrhoea is not a bacteriological entity, but is a disease that can be caused by a number of different members of the non-lactose-fermenting group.

The British genera of blowflies, if the term be restricted to members of the Muscid subfamily Calliphorinae, are Calliphora with the two species erythrocephala Mg. and Vomitoria L., Lucilia, with several species, of which the commonest in the Manchester area are caesar L. and simulatrix Pand., and Protocalliphora, withe two species azurea. Fln. and groenlandica Ztt., of which the later alone concern us.

The correlation of high goitre incidence in New Zealand with low soil iodine having been established previously, the distribution of iodine in its relationship to the goitre problem is further considered in this study. The method of analysis used throughout has been that of Th. V. Fellenberg, with certain minor modifications. The findings are summarised as follows:

1. In a general survey of the iodine content of foodstuffs in New Zealand, it has been shown that the foods richest in iodine, arranged in descending order of iodine content, are edible seaweed, sea fish, eggs, wholemeal cereal products, leafy vegetables and milk. Refined cereal products, root vegetables, and fruits are shown to be of low iodine content. Dried foods contain more iodine than the corresponding fresh foods.

2. A comparative study of the iodine content of foodstuffs from goitrous and non-goitrous districts establishes the fact that the soil-iodine is accurately reflected in the food-iodine.

3. The difference in the daily iodine intake in the food supply of typical goitrous and non-goitrous districts is calculated to be 14·35 micrograms.

4. The iodine content of certain vegetables and animal foods is shown to present a well-marked seasonal variation. The maximum iodine content of vegetable matter is reached in the late autumn and winter when growth is at a minimum. In the case of eggs the maximum is reached in summer, in milk in the spring. In the latter case calving and lactation are shown to be disturbing factors of importance.

5. Cooking is shown to have little effect on the reduction of the iodine content of root vegetables, seaweed, fish and bread, but to reduce the content of green vegetables by about two-thirds.

6. Commercial salt is shown to be an unreliable source of iodine supply, the majority being practically iodine-free.

7. Tobacco smoke is a negligible source of iodine supply.

8. The iodine content of the artificial manures commonly used in New Zealand is determined, and their probable effect on the content of crops is calculated.

9. The iodine adsorptive powers of different types of soils is estimated experimentally. Loam is shown to have marked retentive powers for soluble iodides. In clay the retention is less and in sand nil.

10. Experimental studies on the influence of iodine-rich manures on plant life are presented.

11. A well-defined relationship is shown to exist between goitre incidence and iodine excretion in the urine.

12. The iodine content of human milk in the goitrous woman is shown to be lower than in the non-goitrous, and a relationship is shown to exist between the amount of iodine excreted in the urine and milk during lactation.

13. The flesh of fish is shown to vary in iodine content according to its “iodine environment.”

14. Small amounts of potassium iodide added to the diet of various animals is shown to increase the iodine content of the thyroid glands and of the food products.

15. Certain intestinal bacteria are studied in regard to their power of absorbing iodine from an alkaline medium rich in iodine with negative results.

16. Certain data with regard to the iodine content of the thyroid glands of various animals are submitted which suggest that certain animals can live on a lower iodine threshold than man without developing goitre.

FROM time to time certain organisms, all closely similar, have been encountered in this laboratory which from their unusual occurrence and unfamiliar behaviour presented some difficulty in their identification. An account of some of them and of the cases from which they were derived is here given, and an attempt is made to correlate the organisms. If the result of the investigation shows that they belong to a single group of pathogenic bacilli, the important fact will be illustrated from the short accounts of the cases that a wide range of clinical manifestations may be met with in association with this group of bacteria.

In his classical treatise on Contagions, Hieronymus Fracastorious of Verona has the following passage: “I recollect a singular contagion of the year 1514 which affected only oxen; it first showed itself in the district of Frioli, then gradually extended to northern Italy and thence reached our country. At first the ox went off its feed without any obvious cause, but if the herdsmen looked into the mouth a certain roughness and small pustules were noted on the palate and the whole oral cavity. It was necessary at once to isolate the infected beast from the rest of the herd, otherwise all became affected. Gradually the disease descended to the shoulders and thence to the feet, and almost all the beasts in which this happened recovered, but when it did not, they usually died” (Fracastorii, pp. 63–4). Probably, as in the parallel case of influenza, a careful search of earlier literature might show that foot-and-mouth disease had played its part before 1514. It is sufficient for my present purpose to establish that it has been recognised, very much in its actual clinical form for more than 400 years.

A Report of the Medical Research Council (1926) was published last year on the results of extensive investigations, carried out under the auspices of the Scottish Child Life Committee of the Medical Research Council, on the environmental and parental conditions affecting the growth and nutrition of the slum child. This showed that while there were great differences in the growth and nutrition of these children as indicated by weight and height, these differences could not be correlated with such environmental factors as income and air space (degree of crowding), nor with the parental factor maternal health, while the evidence adduced did not indicate that diet was a determining factor. In fact the only significant correlation discovered was with the efficiency of the mother.

1. Without exception, ninety-eight strains of haemolytic streptococci isolated from scarlet fever cases have been found to produce a toxic principle which in high dilutions is capable of evoking a cutaneous reaction in sus ceptible persons.

2. A certain proportion of haemolytic streptococci from other sources possess a similar toxigenic property. In the majority of such cases this property is only weakly developed as judged by quantitative tests. In a few instances a “toxin” is produced which is equally active with that of scarlatina strains.

3. Certain non-scarlatina strains produce “toxins” which evoke a cutane ous reaction both in known positive reactors and also in persons who do not react to a standard toxin from a scarlatina strain.

4. In the majority of cases the toxins produced by scarlatina strains are neutralised by the scarlatina antitoxic sera at present being used for therapeutic purposes, but a certain proportion of such toxins are not in the neutralised

5. The “toxins”produced by non-scaralation strains are in the majority of cases neutralised by the antitoxic sera.

Although the common cold may appear to form a relatively trivial constituent of the mass of acute respiratory disease, which presents the student of preventive medicine with one of his most difficult and pressing problems, the total sickness and incapacity to which it gives rise is by no means small; and there are adequate reasons for regarding it as the occasional precursor of far more serious troubles. It is, therefore, not without interest to enquire, whether or no those procedures, which are commonly recommended as possessing prophylactic value, can make good their claim when submitted to an adequate test. The enquiry here recorded suffers from the fact that the total number of individuals at risk was relatively small; but the answer to the main question posed is so unambiguous, and accords so well with the results obtained in the only other adequate tests of which we have knowledge, that it seems desirable that it should be briefly recorded. It is possible, also, that some little interest attaches to the figures of frequency, duration and severity of common colds within a particular community

Guinea-pigs living on a diet restricted in quantity but not deficient in vitamin C survived inoculation with T.B. but half as long as others which had received a similar diet in abundance.

Sodium chaulmoograte did not inhibit the development of the omental tumour that appears in rats after intraperitoneal inoculation with tubercle bacilli.

On the other hand, there was some evidence for assuming that a large excess of fat-soluble vitamins in the diet, as supplied by cod-liver oil, inhibits the formation in rats of these tuberculous tumours, but such evidence was by no means conclusive.

Similar inhibition of omental infection was obtained on exposing rats to ultra-violet light.

Ultra-violet irradiation or the inclusion of large amounts of cod-liver oil in the diet of the rats produced a slight but constant leucocytosis.

No evidence was obtained that lack of fat soluble vitamins in their diet renders tubercle infected rats susceptible to tuberculin shock.

1. The development in typhus fever blood of agglutinins for a bacillus of the colon-paratyphoid group, which was isolated in 1921 from the faeces of a typhus case is shown to be a frequent occurrence in the disease as met with in Ireland, Poland and Syria. The bacillus has preserved its agglutina-bility up to the time of writing—a period of five years. Owing to its similarity to a bacillus previously isolated by the writer and which was designated bacillus “U,” this bacillus has been named B. agglutinabilis “U2.”

2. It has been shown that bacteria preserved in alcohol even for 3 years are sensitive for use in the serological test, and that sera to which equal volumes of pure glycerine have been added retain their agglutinins for atleast 5 years.

3. Five strains of B. proteus “X 19” fermented salicin with the production of acid and gas. Ordinary Proteus strains had no action on this glucoside and neither had the anindologenes strain “Kingsbury” although belonging to the “X 19” group.

4. Strains of B. proteus “X 19” show great differences in their sensitiveness to typhus fever agglutinins.

5. Views which have been advanced to explain the Weil-Felix reaction are discussed and the conclusion is reached that to label it as an instance of paragglutination does not account for the rise and fall of the agglutinins—agglutinins which are formed not only for B. proteus “X2” and “X 19” but for certain strains of the B. pyocyaneus and colon-paratyphoid-typhoid groups.