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occurs, may be controlled by adrenalin, but adrenalingiven hypodermically has been condemned in hoemo-ptysis. Coagulen-ciba, 5 c.cm. may be given hypo-dermically. This is said to contain bovine blood-

platelets and not to cause serum reactions. A. J.Morland, however, reports a case where the patient,after an injection, experienced a sensation of lumps all over his body and these would appear to havebeen of an urticarial nature. This same author hasinjected coagulen-ciba 5 c.cm. and 10 c.cm. directlyinto a cavity in a case of severe, recurrent, anddangerous haemorrhage, apparently with dramaticeffect, and this is well worth trying in serious caseswhere there is a large cavity in a known position, or Ieven as a hazard, if things are desperate. Two othersubstances which claim to increase the coagulabilityof the blood may be mentioned : throntboplastin andfibrogen. They must be used subcutaneously or bymouth, or both, but not intravenously. Ergot hasbeen extolled by certain optimistic clinicians, but onpharmacological grounds should do more harm thangood. Emetine in gr. ! doses, given hypodermicallythree or four times in a day, is worth trying. Amyl-nitrite inhaled is both extolled and condemned. Ithas the support of many clinicians. The same appliesto nitroglycerin in 2 to 4 minim doses. Oil of turpentine,minims 20, in an emulsion every four hours, is atime-honoured remedy which does no harm. Adrenalincannot be justified on experimental grounds. Givenintratracheally, however, by the oral route, over theback of the tongue, as one gives an oral lipiodolinjection, it is said to be most effective. This isperhaps true, but the obvious objection is theimpossibility of doing it in an emergency whenblood is welling up into the mouth. In a calminterval, however, it might be worth trying.Binding the linibs, but not for too long a period,may tide the patient over a critical period. Evenblood, transfusion may have to be considered.

Artificial Pneumothorax.If none of these things acts, and matters are becoming

urgent, there is only one method that is likely to beeffective and that is the production of an artificialpneumothorax. In hospital where the apparatus isavailable it should not be used only as a desperateresort. If it were known from which side the bloodwas coming it would be used early, but it is notalways possible to determine this. Even so, it wouldbe better to induce a partial bilateral pneumothoraxthan to do nothing. The time is long overdue whenevery practitioner of medicine should know theinestimable value of such induction. If the affectedlung can be compressed by this procedure, all bleedingis stopped and its recurrence absolutely prevented.For recurrent small haemorrhages, whether from

tuberculosis or bronchiectasis, if the disease isunilateral, some form of collapse therapy is the best.First and foremost comes artificial pneumothorax.This is simple, painless, and safe. If not hinderedby adhesions, it will stop haemorrhage and it willpromote healing. There is no point in delaying thistreatment, for everything is to be gained by it. If,because of adhesions, an artificial pneumothoraxcannot be obtained, phrenic evulsion and thoraco-plasty may have to be considered. Apart from thesemeasures the patient must avoid strains, excitement,and alcohol. Yet, not infrequently, haemorrhage willoccur when the patient is at complete rest. Calcium11la.y. be given, for example, calcium chloride grs. x.,calcium lactate grs. x., three times a day, and this,I believe, to be of great help. In conclusion, the fearinspired by a big haemoptysis must not be forgotten.Our efforts to control a haemorrhage must neversubject the patient to further risk ; insistenceon the prone position, for example, may cause greatsuffering and almost choke the patient, and, moreover,make it difficult for him to eject the blood. An over-dose of morphia may be disastrous by promoting.aspiration, while injections of serum may produceintolerable urticaria. While one should never remainpassive and inactive in these cases, a fussy interference

may do more harm than good. The injection or

application of one of the above-mentioned remediesat regular intervals undoubtedly gratifies both thepatient and the relations. The best way to treat ahaemoptysis is to prevent it. This may be impossible,as haemoptysis is sometimes the first symptom. Whenthere is a known focus from which a recurrent heemor-rhage is arising, artificial pneumothorax treatmentshould be attempted without delay in some cases,even if the disease is bilateral.

F. G. CHANDLER, M.D. Camb.,F.R.C.P. Lond.,

Physician, City of London Hospital for Diseasesof the Heart and Lungs, Victoria Park, E.

Special Articles.STUDIES OF VIRUS DISEASES.

THE MEDICAL RESEARCH COUNCIL’S SURVEY OFTHE POSITION.

No part of the work directly promoted by theMedical Research Council has greater biologicalinterest at the present time, or more vital practicalimportance for the cure and prevention of disease,than the inquiries now being made into variousdiseases in animals and man caused by the so-called" viruses." These inquiries are concerned with aninvisible underworld of bodies that in size standsomewhere between the largest known molecules ofdead organic matter and the smallest microscopicbacteria. These cannot be seen as definite structuresby ordinary microscopic means, and the relation tothem of certain objects made visible by special opticalmethods is still a matter of discussion. They arecalled " filter-passing " because many of them willtraverse a filter fine enough to hold back and strainoff ordinary bacteria from a fluid containing them.Whether these " viruses " are organised as minute, ultra-

microscopic bodies is still an open question ; in any case,they are presumably too small to have an organisationsimilar to that of such cells as have hitherto been regardedas primary units of living matter. Nobody has yet succeededin preparing an artificial fluid which will, by itself, provideconditions in which these viruses will reproduce themselvesand multiply ; some of them, however, will grow in artificialconditions if a piece of surviving tissue, takEn from a freshlykilled animal, is added to a suitable medium. It seems tobe characteristic of a virus that it can multiply only in thepresence of living cells which it can infect.When the virus causing any disease is introduced

into the animal, or the plant, in minute quantity,there may occur a rapid, unseen, and unexplainedmultiplication of it throughout all the parts of theorganism attacked, since a minute portion of any ofthose parts will be found able to infect anothersimilar organism.

Two CONVERGING LINES OF EFFORT.Those now working with viruses are under difficulties

very like those that confronted bacteriologists twogenerations ago, before they had found adequatemethods of microscopic study and of artificial cultiva-tion. At present their endeavours may be thoughtof as following two converging lines of effort : (1) prac-tical devices are sought by which empirical imitationsmay be made of the immunity to a second attack of avirus disease that most commonly follows recoveryfrom the first attack under natural conditions ;(2) investigation is made by every known methodinto the physical properties and natural history of thevirus itself.

Attempts to Produce Immunity.The particular historical method of using cow-pox

as Jenner did to immunise against small-pox in manhas not so far been found applicable to other virusdiseases. Small-pox adapted to living in the tissues

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of a calf becomes cow-pox, and when transferred again to human beings it shows no tendency torevert to small-pox. The alteration in the characterof the virus seems irreversible. In the other virusesthat have already been studied, although there maybe a diminution of virulence by propagation in thebodies of animals which are not their customaryhosts, this is not an irreversible change, and wecannot be certain that their former virulence will notreturn when they are transferred once more to thesusceptible animal.

Immunologists have again and again tried to produceimmunity with virus material that has been acted upon byvarious chemical agents (especially those known to killbacteria) until it is incapable of reproducing the diseasewhen injected into a susceptible animal, and has presumablytherefore been killed. The first successful use of this method

was by Fermi in Italy about twenty years ago with a rabiesvirus treated with carbolic acid. In the last few years thework in the Council’s Farm Laboratories, Mill Hill, oncanine distemper has followed these lines ; -, Dr. P. P.Laidlaw and Mr. G. W. Dunkin use for a protective injectiona virus made harmless by formalin. At the NationalInstitute for Medical Research Dr. Charles Todd has alsolately shown that two or three inoculations of the virus offowl plague which has been treated with carbolic acid andglycerin until it is no longer capable of giving the diseaseto a fowl, makes the bird so resistant to the disease that thesubsequent injection of 300,000 times an otherwise fataldose of infective virus leaves thEm unharmed.

These two examples of protection, against dogs’distemper and fowl plague, have led to the successfuluse of closely similar methods in the protection ofmonkeys against yellow fever. It is still doubtful,however, whether a treated vaccine derived from"

monkey " virus, although it was originally derivedfrom human yellow fever virus, will protect men.Immunity from rinderpest, again, can be given tocattle by a treated virus, but this bovine virus isineffective for goats or pigs. This " specificity " ofviruses offers many baffling problems which are notso prominent in the field of bacterial infections.Thus in canine distemper the infection can be passed

to and fro indefinitely from dog to ferret and back. Suitably " attenuated " virus of dog will immunise dog, and that offerret will immunise ferret, but equivalent results are notgot when the ferret " vaccine " is used for dogs, or vice versa.The practical results in the prevention of dog distemperdepend upon the device just mentioned of securing temporaryimmunity by " attenuated " virus which is quite harmless,and of giving during that immune period some full viruswhich now brings lasting immunity to distemper, withoutinflicting the disease itself except in shadow form.

Unfortunately, these methods are not applicablefor various reasons to other virus diseases, such asfoot-and-mouth disease or measles, or to the plaguesof influenza and of "common colds" that are

believed by some to be virus diseases. As to foot-and-mouth disease, it has already been found thatimmunity can be given by treated virus, but inasmuchas the disease itself, unlike most virus diseases, givesno lasting immunity, this has a limited value. More-over, at least three different types of virus exist, andthe effects of one do not protect against the others.As to measles, the only animal that is affected by thevirus is apparently the monkey, but it seems also thatthe disease cannot thereafter be passed from monkeyto monkey. If influenza, as many believe, is a virusdisease, progress is barred at present, since it appearsnot to be transmissible at all to animals ; and this,in view of the complete impracticability of extensivehuman experiments, forbids the experimental methodthat is essential to any measurable advance.

The Nature of the T’-irus Particles.In the meantime close investigation is being made

by every available method of the actual nature ofthe virus particles-for we know them to be particulatein the sense that they are acted on by gravity in awatery suspension. Methods of direct physicalexamination of the nature and properties of virusesare being used. Mr. J. E. Barnard has made advancestowards the better optical examination of virus byusing shorter wave-lengths of light, outside the visible

spectrum, with suitable devices to protect the virus-under examination from the destructive action of therays directed upon it and to secure photographicimages. Side by side with these optical studies,efforts are being made by Mr. W. J. Elford, Ph.D.,working under Mr. Barnard in the Department ofOptics in the National Institute, to improve themethods of filtration, which offer physical problemsof which the difficulty comes from the scale of minute-ness that is involved. His general aim is to gainbetter methods of separating and of measuring virusbodies of different kinds.Another line of inquiry lately pursued at the

National Institute has been to examine the reactionsthat actually occur between the virus as such and thenew substances (" immune substances " or " anti-bodies ") that appear in the blood to counteract it,and by which immunity is gained.

In many bacterial diseases it is known that the toxin ofthe invading microbe can be neutralised by the antitoxinin the blood of the immune animal entering into som&

chemical combination with it. Dr. Todd, for the fowlplague virus, has shown that the virus can be made harmlessby addition of the right amount of immune blood fluid.But so little is this a fixed chemical union that simple dilu-tion with water makes the mixture again virulent. Similarly,Dr. C. H. Andrewes with vaccinia virus has shown thata neutral-i.e., non-infective-mixture of virus and immunesubstance can be separated out again by simple filtration,.and by that means and also in other ways, the virus can.be readily recovered in active form. It should be notedthat some other observers, using different viruses, have-found a firmer union between virus and immune substance,analogous to what is found for bacterial infections.Another interesting line of inquiry has been that of

finding the distribution of the virus in the blood..It has been shown that in certain diseases the virusdoes not float freely like a bacterial invasion in thefluids of the blood, but is wholly contained within;the bodies of the white blood corpuscles. This istrue in typhus, rinderpest, fowl plague, caninedistemper, and vaccinia ; in foot-and-mouth disease.however, the virus is almost wholly and at allperiods of the disease found free in the blood fluid.There is much reason from evidence of various’

kinds and values to think that in general the invadingvirus multiplies within the cells of the living animalor plant rather than in the body fluids. It has beenmentioned already that no means have been found forthe cultivation and reproduction of virus outside thebody in artificial imitations of body fluids. Dr. C. H..Andrewes has lately used a method of studying virusinfection out of the body by infecting with virussmall fragments of animal tissue which are kept" surviving " in suitable fluid media. Evidence ofinfection is seen in the so-called " inclusion bodies "

which are found microscopically in the tissue cells,and are exactly similar to the corresponding appear-ances that accompany infection by the same virusin the living animal. It can be proved that in acultivation of this kind the virus actually multipliesitself. Work by this kind of method is activelyproceeding and seems to hold great promise.

Virus Studies and Cancer.Just five years ago the Council explained that as

part of the general programme of inquiry into virusdiseases which they had planned, Dr. W. E. Gyehad taken up the study of the malignant growth infowls known as the Rous sarcoma. The invisible andfiltra,ble agent of this tumour when injected into afowl multiplies indefinitely and gives rise to a newtumour formation, and presents in that and otherways the characters of a virus. In each subsequentyear the Council have given a full statement in outlineof his observations and the conclusions he had drawnfrom them. In their report last year they explainedin some detail the manner in which he had morerecently failed to obtain with certainty and regularitythe results that in his earlier work had been consistentenough to lead him to a definite view of the mode inwhich a virus conveyed from a pre-existent malignantgrowth interacted with another factor in the invaded

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cell to produce a new tumour. In the past yearDr. Gye has made renewed efforts to find and removethe cause of discrepancies in his results, and has now,with the complete sympathy and approval of theCouncil, decided to leave this phase of his inquiryfor the time being and to turn to other aspects ofthe problem.

AUSTRALASIA.

(FROM OUR OWN CORRESPONDENT.)

Aropointments at Sydney.THE new appointments to the three Bosch chairs 1

in the University of Sydney are as follows : Medicine,Dr. Charles George Lambie ; Surgery, Mr. HaroldRobert Dew ; and Bacteriology, Dr. Hedley DuncanWright. Sixteen applications, it is announced, werereceived for the chair of surgery, 17 for the chair ofmedicine, and 14 for the chair of bacteriology. Thesewere considered in the first place by advisory com-mittees in London, and the recommendations wereunanimously adopted both by the special selectioncommittee in Sydney and by the Senate. Dr. Lambie,assistant physician to the Royal Infirmary, Edinburgh,is lecturer in clinical medicine in the University.Mr. Dew, who was born in Melbourne in 1891, receivedhis medical education in that city, and undertookpost-graduate work in London after the war. Hebecame Fellow of the Royal College of Surgeons ofEngland in 1920, and gained the Jacksonian prizeof the College in 1924. In 1927 he shared the awardof the Syme research prize for observations on

hydatid disease. Dr. Wright, a Tasmanian, receivedmedical training at Edinburgh, where he graduatedin 1916. On returning to Scotland after the warhe was appointed lecturer in the department ofphysiology and was awarded the Lister researchfellowship of the College of Physicians. In 1923he became assistant lecturer in bacteriology atUniversity College Hospital, London, and since1928 he has been reader in bacteriology in theUniversity of London.

Poisonous Spider Bite.The death of a woman in Sydney as the result of

a bite by a Trapdoor spider (Atrax robusta) hasagain brought to notice the danger of bites by theseinsects. There are three variety of spiders in NewSouth Wales which are known to cause severe

symptoms as a result of their bite. One is thecommon redback spider (Lactrodectus hasseltii) whichis found throughout the country districts. Theother two are trapdoor spiders, A. robusta and A.formidabills. The former are common in the northernsuburbs of Sydney, and the latter are found on thenorth coast of New South Wales. Though of thetrapdoor variety these dangerous spiders live inholes with no trapdoor. The males seem to benocturnal in habit which accounts for their gettingin shoes and clothing which have been left lying about.In the present instance, the patient put her hand intoan old shoe, and was bitten on the thumb of the lefthand at about 8 A.M. She immediately collapsedand became cold, clammy and pulseless, and retchedfor an hour. She then became dyspnoeic with somelaryngeal spasm. She appeared to be mentallyclear and complained of no pain, but stated that shehad a feeling of numbness all over. The conditionimproved for about two hours and then peripheralstasis and cyanosis gradually increased. She wasadmitted to the Royal North Shore Hospital atnoon, still conscious but cyanosed and very restless.At 2 P.M. she had become unconscious and laryngealspasm, lasting half a minute, came on at half-hourlyintervals. The cyanosis increased during the spasmsand was accompanied by frothing at the mouth.She was very restless. By 4 P.M. she had Cheyne-

1 See THE LANCET, 1929, i., 1377.

Stokes’ respiration, and shortly after 5 she diedsuddenly.There have been several instances within recent

years of death after bites from trapdoor spiders. ’.but it is believed that this is the first time an adulthas died from the bite.

Infant Welfare Ce7it7-es in Australia.Dame Janet Campbell has completed her investiga-

tion of maternal and child hygiene in Australia,and her report to the Commonwealth Governmenthas been issued. Its main provisions will no doubtalready be familiar to your readers. She would liketo see a medical woman directing a special divisionof the Commonwealth Department of Health chargedwith extension and improvement of work for maternal.infant, and child hygiene. Both Commonwealthand State Governments must be prepared to spendmore money to secure those essential facilities whichthe personal resources of the people themselves areunable to supply. Infant welfare centres are verysimilar all over Australia. The accommodation isgood, and in some of the specially constructed buildingsthe equipment is almost luxurious. The clean andcheerful appearance of the centres makes them veryattractive, and must do much to encourage attendanceby the pleasant conditions under which the work iscarried on ; most of the centres resemble privateclinics and are very different from some of the busyand crowded municipal centres in Britain. Thereis also the fact that they are attended by women ofall social classes ; there is no sharp dividing lineof poverty as in England, to separate the Australianmothers into different groups ; it is fully recognisedthat the well-to-do mother is often just as much inneed of advice as her poorer sister, and the facilitiesoffered are such as to encourage her to take advantageof the valuable assistance provided by the centre.On the other hand, although there is a certain amountof more or less perfunctory medical control, there isnone of the close medical supervision which in Englandis regarded as essential to satisfactory work. Inthe English welfare centres there are always regular" medical consultations," and the whole of theadvice given is subject to medical direction. Thebaby is always examined by the doctor when firstbrought to the centre, and at regular intervalsafterwards, even if apparently making good progress.Lack of similar medical control in Australia maybe due to the fact that practically all mothers inattendance have their own family doctors to whom thebaby is taken in the case of illness ; moreover,the centres have a strictly limited function and aremerely striving to keep the healthy baby well, andhave no concern with the cure of disease. There isanother factor not easily assessable-namely, thedifficulty of securing the services of a medicalpractitioner who is specially trained in infant welfare,and who is not in private practice in the neighbour-hood. Dame Janet praises the work done by theNational Council of Women, the Bush NursingAssociations, the Country Women’s Associations,and the Australian Inland Mission, under the auspicesof the Presbyterian Church; she puts in a goodword for the ambulance services in Queensland.But it is not to be denied that Australia providesa difficult problem in establishing a general schemeof maternal and child welfare on account of theimmense distances and comparatively small scatteredpopulation. Dame Janet’s report will do good incrystallising the feelings and desires of maternal andchild hygienists in Australia. The courtesy of yourMinistry of Health in allowing her to visit Australiahas been deeply appreciated here as an Empire-welding gesture.

CONTRIBUTIONS BY HOSPITAL PATIENTS.-The sumcontributed by patients of the Royal South Hants andSouthampton Hospital who do not belong to any contributoryscheme was formerly about 2350 a year, but the appointmentof a lady almoner last year sent up the amount to over Bl 600.