MEDICINE 171 



maize or corn. Still, it is not impossible that, years hence, some modified form of the 

 maize-theory may be put forward which shall be more or less adaptable, at some level 

 not yet reached, to the theory of an insect-borne infection. At present, the latter 

 theory is rapidly growing in favour: and the discovery of undoubted cases of pellagra 

 in the British Islands strengthens its claim. 



Phlebotomus Fever (Sand-fly fever). In Malta, Crete, Dalmatia, Egypt, and India, 

 there has long been known a common type of fever, which mostly went by the name of 

 " simple continued fever." Its chief months of occurrence are between June and Octo- 

 ber: it is characterised by sudden onset, with pain and stiffness of the muscles: it is of 

 short duration, and not dangerous to life: it leaves no permanent ill-effects; and the 

 patient rarely suffers a second attack. During the past few years, the nature of this 

 fever has come to be clearly understood.' Its distribution, seasonal prevalence, and 

 conditions of occurrence indicated an insect-borne infection: and suspicion rightly fell 

 on the sand-fly (Phlebotomus) as the probable agent. By a long series of experiments 

 on volunteers (see Birt, Journ. R.A.M.C., Feb. 1910) this suspicion was verified. It was 

 proved, that sand-flies do convey the infection from man to man; that the blood is infec- 

 tive on the first day of the fever; that the fly becomes infective seven 

 days after biting, and remains infective for ten days, or longer; that the 

 incubation-period of the fever may vary from three days and sixteen hours to seven 

 days; that the fever may also be induced by direct transmission of infective blood, and 

 that the virus of sand-fly fever, like those of yellow fever and of cerebro-spinal fever, 

 will pass through a fine Chamberland filter. The habits and breeding-places of Phlebot- 

 omus have been very minutely observed: and some progress has been made toward a 

 reduction of the fever by protective measures. For example, the Journal of the R.A.M.C., 

 xix, 4, October 1912, contains an article by Col. Robinson and Major Blackham, on 

 " Sand-flies and Sand-fly Fever on the North- West Frontier of India." To the fever, 

 in this part of India, the name of " Chitral fever " was given, in 1906, by Col. McCarri- 

 son. Two types of the fever are found in the Peshawar Valley, a three days' and a seven 

 days' fever. The writers recommend, as preventive measures (i) the use of netting of an 

 extra-fine mesh, (2) the use of a strong punkah or electric-fan, (3) the counter-attraction 

 of a bright lamp, (4) early isolation of cases, (5) evacuation of barracks. This last meas- 

 ure " has been tried extensively in this Division at Drosh. The Fort, which has hither- 

 to been a hot-bed of sand-fly fever, was evacuated by June i, 1911." The number of 

 cases, which in 1910 had been 75 per cent among the native troops, was in 1911 only 27 

 per cent. " Other factors contributed no doubt to this happy result, but the evacuation 

 of the barracks was undoubtedly the main one." 



The Pituitary Body. From the time of Pierre Marie's classical work, some thirty 

 years ago, on acromegaly, the fact has been recognised that the pituitary body, a minute 

 glandular structure at the base of the brain, exercises a profound effect on the general 

 growth; and, as science gained more insight into the activities of the thyroid gland, the 

 suprarenal capsules, and the parathyroid bodies, so the pituitary body likewise became 

 an object of exact study by all possible methods of scientific observation. Within the 

 last few years, it has been brought within the range of operative surgery. Certain opera- 

 tions have been performed in cases of disease of the pituitary body in man; and, for 

 therapeutic use, an extract has been made of pituitary substance. 



Much has been learned by the experimental removal of the pituitary body in animals. 

 See the very important papers in the Bulletins of Johns Hopkins Hospital, May 1910 

 and June 1911. For a detailed study of the whole subject, from all points of view, we 

 now have Dr. Harvey Cushing's book, The Pituitary Body and its Disorders (Lippinc'ott, 

 Philadelphia and London, 1912). 



Plague. In the winter of 1910-1911, came the outbreak of septicaemic and pneu- 

 monic (not bubonic) plague in Manchuria. For this outbreak, see the Report of the 

 International Plague Conference held at Mukden, April, 1911, Pp. 483 (Manila, Bureau 

 of Printing, 1912). See also Dr. Douglas Gray, Lancet, 1911, i, 1152. 



The Proceedings of the Royal Society of Medicine, November 1911, contain Dr. 



