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formerly attributed erroneously to this disease areno longer so attributed, we might expect increasedmortality from " meningitis," but there has, on thecontrary, been decreased registration of deaths underthis heading. The general conclusion must be thatthe decline shown in the statistics has both fictitious

and real constituents. The subject is one of greatimportance, as bearing on the estimation of success ofanti-tuberculosis work. Events since the beginning ofthe present century are especially instructive ; andthere is reasonable ground for believing that infectionof infants and young children with tubercle bacilliin massive dosage or of frequent occurrence is

diminishing with the development of hygienicprecautions and the general education of the publicin connexion with the administrative control oftuberculosis.

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THE DEVELOPMENT OF FILARIA RECONDITA.BULLETIN No. 1441 of the Agricultural Research

Institute at Pusa contains observations on themorphology and life-cycle of Filaria recondita Grassi,by M. Anant Narayau Rao, assistant professor ofagriculture in the Madras Veterinary College. Thematerial on which these observations are based wasobtained from the in-patients in the dog ward of theCollege Hospital. The microfilariae or embryos aresheathless, 221-225 A in length, with a breadth of4—5, and in common with microfilarise of otherspecies they shoot out from the cephalic extremitya minute spine. An interesting point which the authorascertained, a character possessed in common withthe embryos of Filaria bancrofti, is the habit ofnocturnal periodicity. The embryos increased innumber in the blood after 7 P.M., were swarming atmidnight. Exposure to the sun or exercise reducesthe few microfilariae which can usually be found inthe peripheral circulation during the daytime. At

autopsy the largest numbers of micronlariae are

found in the lungs. Dogs that have died of this infec-tion show characteristic pathological appearances-all the internal organs were anaemic, while the liverexhibited caseating areas surrounded by a zone ofcongestion ; similar, but less intense, lesions were

present in the spleen. The real interest of the paperlies in the fact that the author has traced the full

development of this microfilaria in the thoracicmuscles of Culex fatigans, while he has definitelyshown that Stegomyia cannot serve as an intermediaryhost. The development follows that of F. bancroftivery closely and the mature larvae can be demonstratedin the proboscis on the fifteenth day. They measuredabout 0-5 mm. in length. This work finally disposesof the suggestion of Grassi and Calandruccio thatdevelopment may take place in various species offlea and tick.

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SPONDYLOLISTHESIS.

THE skill, frequency, and financial success withwhich osteopaths are wont to reduce an imaginarydislocation of the spine are apt to blind us to thefact that there really is such a condition. SinceRokitansky in 1836 published an account of two casesof spondylolisthesis many such cases have beenrecorded, and by 1890 Neugebauer was able to collectas many as 101 cases from the literature. It issignificant and humiliating to the medical professionthat the correct diagnosis was made during life onlyin 47 of these cases ; in the remainder the correctdiagnosis was deferred to the post-mortem examina-tion. Records such as these may tempt the osteo-paths and other Philistines to scoff at this exhibitionof orthodoxy, but it would be fair to point out thatthese mistakes belonged to the pre-Rontgen period,and it is comforting to note that all the 15 casescollected by Neugebauer some years later were

diagnosed correctly during life. In Norsk lYl agazin forLcegevidenskaben for July Dr. Sofus Wideröe, one ofthe surgeons attached to the Communal Hospital of

1 Calcutta : Superintendent Government Printing, India.1923. As.6.

Christiania, has recorded two instructive cases offorward and downward displacement of the fifthlumbar vertebra in relation to the sacrum. In bothcases complete recovery was effected by immobili-sation of the affected parts by Hibb’s bone-graftingoperation which established bony union between thelowest lumbar vertebra and the sacrum. The firstcase was of special interest, as it clearly showed themechanism of this dislocation and the diagnosticpitfalls it may dig. The patient was a girl aged 18,who, two years earlier, was indulging in horse-playwith a strong boy standing behind her and archingher body forcibly backwards. She felt a suddenpainful snap in the back and had to stop playing, butshe was able to walk home. The next two years werepassed in pain and invalidism ; when she attemptedto walk she was subject to attacks of violent pain inthe back, making her collapse on the ground. Pott’sdisease was suspected, but a skiagram showed no signof it. Treatment for two months by extension rid hertemporarily of her pain, but after she had beensymptom-free for about 11 months an attempt toreturn to office work provoked a relapse, and shewent from one physician to another, being treated forrheumatism and other hypothetical complaints, andbecoming steadily worse. On admission to Dr.Wideroe’s hospital she showed definite lordosis of thelower lumbar spine, which became painful when sheattempted to stand as straight as a recruit. A skia-gram taken in the frontal plane revealed nothing ofinterest, but a skiagram taken from one side showed thefifth lumbar vertebra to be displaced forwards, thethird lumbar vertebra forming an angle of 80° withthe sacrum. The complete recovery effected byHibb’s operation in this and Dr. Wideroe’s second caseis well worth the notice of surgeons in charge oftraumatic spinal cases with obscure symptoms andwithout the benefits of a skilled X ray examination.

THE RISKS OF THE MECCA PILGRIMAGE.

INTERESTING particulars are given in a recentreport 1 of the measures taken to prevent the spreadof cholera in Egypt. Before the war the pilgrimsleaving Egypt averaged about 13,000 per annum ;during the war the number was greatly reduced andnow the size of the pilgrimage is graduallv incieasing.The numbers for the last five years have been : 1916,1076 ; 1917,281 ; 1918, 464 ; 1919, 444 ; 1920, 167 ;and 1921, 2956. All the pilgrims were vaccinatedagainst cholera before leaving Suez. The medicalofficer in charge reported that there were no facilitiesfor hospitalisation of the pilgrims in the Hedjaz, inJedda and Mecca and that his supply of drugs for theEgyptian pilgrimswas exhausted, owing to the importu-nate demands of the notables of Mecca, before Jeddawas reached on the return journey. In consequencethe Egyptian Public Health Department is drawingup a scheme for a properly organised system of treat-ment and hospitalisation for its own pilgrims andhopes that the Governments of other countries fromwhich pilgrims go will do likewise. No epidemicswere reported from the Hedjaz during the 1921pilgrimage. One returning Egyptian pilgrim was

found to be suffering from cholera at the quarantinestation at Tor. The Egyptian pilgrims were, as

usual, carefully traced on their return to Egypt andthose who showed any intestinal symptoms whateverhad their stools bacteriologicallly examined. Nofurther case of cholera occurred. During the pilgrim-age a bacteriologist and a laboratory attendant aresent to the Suez laboratory to carry out the necessaryexaminations in connexion with returning pilgrims.Patrols are maintained in Sinai and on the Red Sealittoral to prevent Egyptian pilgrims returning byan unauthorised route to escape quarantine. TheSinai patrols intercepted 21 pilgrims. A regulationis in force prohibiting the entry into Egypt of returningnon-Egyptian pilgrims, and difficulties arose in 1921

Report of the Ministry of the Interior on the Health ofEgypt, 1921.