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hepatitis among them was 1-3%. Among those who hadbeen transfused and received no globulin the incidencewas 8.9%, and among those who had had no transfusionit was 63%. Two of those in whom prophylaxisappeared to have failed had already developed hepatitisbefore the injections. It is disappointing that an

addendum to this paper reports complete failure in asimilar experiment done elsewhere and differing onlyin the administration of one instead of two doses of

globulin. Furthermore neutralisation experiments withgamma globulin against one agent of serum hepatitisusing human volunteers were also unsuccessful. Possible

explanations are that the dosage in the second trialwas insufficient, that the potency of globulin varies,or that more than one infecting agent is concerned in

producing hepatitis.It is believed that gamma globulin will soon be

generally procurable in this country. It will be usefulin combating institutional outbreaks of infective hepatitis,but it brings no promise of prophylaxis or treatment- insporadic cases. If its value in the prevention of post-transfusion hepatitis is confirmed, its administration- might well become a routine after the giving of blood orplasma. But points in dosage and’ time of injectionclearly need elucidation before it comes into generaluse; and it would not be wise to build too great hopes

°

on its general utility as a prophylactic on the analogyof the undoubted success that it has had in measles andepidemic hepatitis ; it has, for instance, proved of nomore value than convalescent serum in the pre-paralyticstage of poliomyelitis.6One way of enhancing the effect of gamma globulin

is suggested by a successful attempt to reduce the inci-dence of orchitis in mumps.’ Of 102 American soldiersadmitted to hospital with mumps, alternate cases weregiven 20 c.cm. of gamma globulin prepared from theserum of men who had had mumps within 1-3 months.The injections were given within 24 hours of the appear-ance of parotid swelling. Of the 51 injected men, 4developed orchitis, compared with 14 in the controls.Later a similar trial was made with gamma globulinmade from pooled normal serum, the dose being 50 c.cm.This time- there was no significant reduction in theincidence of orchitis: of 67 injected patients, 14 deve-loped orchitis, compared with 18 in the 67 controls. Thedifference may be merely a matter of antibody dosage.Fractionation concentrated the antibodies present in

serum about 25-fold. The second group therefore receivedantibodies equivalent to 1250 c.cm. of normal serum.Estimations by complement-fixation. methods’show thatmumps convalescent serum contains -about 10 times theantibody content of pooled normal serum. The first

group therefore received the equivalent of 500 c.cm.of convalescent serum, equal in antibody content to5000 c.cm. of pooled normal serum. Though the numbersof cases in this trial were small for definite conclusions,the findings suggest that gamma globulin prepared fromconvalescents might succeed where that prepared fromnormal people gives inconstant results.

TRYPANOSOMIASIS AND TSETSE FLIES

No-ONE who wishes to tceep fully abreast of the greatstream of periodical and other publications on tropicaldiseases, hygiene, or war medicine can afford to neglectregular perusal of the abstract journals (TropicaZ DiseasesBulletin, Bulletin of Hygiene, and Bulletin of WarMedicine) produced by the Bureau of Hygiene andTropical Diseases. Publication of these abstracts is notthe only service offered by the bureau, which answersmany direct inquiries, as innumerable isolated workers

6. Bahlke, A. M., Perkins, J. E. Ibid, 1945, 129, 1146.7. Gellis, S. S., McGuinness, A. C., Peters, M. Amer. J. med. Sci.

1945, 210, 661.

in the tropics and elsewhere will gratefully testify. Thelabour of collecting, collating, and disseminating all theinformation which reaches the bureau must be prodigious,and its officers deserve praise for its latest venture. Thisis a review of reports and papers on trypanosomiasisand tsetse flies published during 1932-44, and wascompiled by the bureau for the Tsetse Fly and Trypano-somiasis CQmmittee appointed by the Secretary of Statefor the Colonies ; but in view of its probable usefulnessto a wider public it has now been made generallyavailable.

In the foreword we are told that " this survey is notintended necessarily to present a complete account ofpresent-day information, though in some respects, andespecially in regard to the geographical distribution oftrypanosomiasis, the present position is briefly stated."Nevertheless, a comprehensive summary of all aspectsof recent work on trypanosomiasis is presented. Thecontents are set out under the following five headings :(a) -geographical distribution of sleeping sickness in

Africa ; (b) protozoological research ; (c) chemotherapy ;(d) studies on the biology of tsetse flies ; and (e) controlof trypanosomiasis.

This compilation will be a valuable reference-sourceand record of research in a subject of enormous materialand economic consequence to Africa. In a sense, it turnsthe wheel full-circle, since the Bureau of Hygiene andTropical Diseases was set up in 1908 as an informationservice, under the name of the Sleeping SicknessBureau, to deal exclusively with trypanosomiasis. Otherbranches of tropical medicine and general hygienewere incorporated in its activities only at a laterdate.2 We may confidently hope, therefore, that the

present survey is the forerunner of similar reviews ofrecent and current work in other branches of hygieneand tropical medicine. Indeed, the bureau explicitlyencourages this hope by referring to the publicationas Review Monograph no. 1. ’

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N.H.S. BILL IN PARLIAMENT

WHEN, " before Easter," the National Health ServiceBill comes up for second reading in the House ofCommons, the Conservative Party is to move its rejec-tion. According to the Times the Conservative motion,while Welcoming the principle of a National HealthService, will object to the Minister of Health assumingownership of the voluntary and municipal hospitals. It" will probably complain that the Government’s schemeis being imposed upon the medical profession, and it islikely also to object to the prohibition at this stage ofthe sale of practices." The Liberal National Party hastabled the following motion :

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That this House, while welcoming a comprehensive schemeof health service for the nation, is unable to agree to a measurecontaining such far-reaching proposals involving the entirepopulation without any consultations, having taken placebetween the Minister and the orgariisations and bodies repre-senting those who will be responsible for carrying out itsprovisions ; and that as the measure cannot come into effectwithout the cooperation of the medical and allied professions,it is necessary that the terms of service offered to them by,the State should be incorporated in the Bill.

THE MEDICAL REGISTER for 1946 contains 75,133names, being 1487 more than twelve months ago ; ;2666 names were added in 1945, and deaths totalled 1132.The number of temporary foreign registrations hasincreased by 247 to 3348.

1. Survey of Recent Work on Trypanosomiasis and Tsetse Flies.Obtainable from the Bureau of Hygiene and Tropical Diseases,Keppel Street, W.C.1. Pp. 81. 7s. 6d.

2. Sheppard, R. L. Lancet, 1944, i, 97.