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A case of primary amebic meningoencephalitis due to Naegleria fowleri in a Nigerian child is described. This is probably the first authentic case from West Africa. The clinical manifestations, isolation of the ameba from the cerebrospinal fluid and nasal passages, poor response to amphotericin B, and ultimate fatal outcome all are consistent with the diagnosis of primary amebic meningoencephalitis. Subsequent identification based on morphologic features, flagellation, animal pathogenicity, and nuclear division proved conclusively that the ameba was Naegleria fowleri. The route of entry of the ameba proved to be nasal. In the absence of the history of swimming and in view of the dusty harmattan period during which the child was admitted, a possibility of infection by inhalation of dust harboring amebic cysts is suggested.

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PLATES XLI. AND XLII.) THIS case of acute haemorrhagic encephalitis (for literature see Baker, 1935; Russell, 1937) is of interest because there was a clinical association with acute rheumatism but no evidence of specific rheumatic change in the brain. We know of only one other similar case (Alpers, 1928). Clinical history.S. E., aged 8 years, was admitted on 2nd October 1937 to University College Hospital with the following history. Two days before admission she had complained of malaise, nausea and a pain in the left knee. The following day there was pain in the left wrist and left ankle and she felt cold. On the clay of admission she had slight headache and a sore throat and the joint pains were more severe, especially in the left knee. There was never any symptom indicating involvement of the central nervous system, nor was there a history of vomiting.She had had diphtheria at 4 and measles at 6 years of age, otherwise the past history was uneventful. The father was alive, well and in work. The mother had died six years previously of cancer.The patient was a well developed, rather thin girl, lying very quietly in bed. She appeared to be only moderately ill and complained chiefly of pain in the left knee and to a less extent in the left ankle and left wrist. Temperature 100*5'F., pulse 125, respirations 30. She was flushed and perspiring slightly. The apex beat was forcible and best felt half an inch outside the nipple line. There was a soft systolic murmur at the apex, conducted into the axilla. The left knee was hot, swollen and acutely painful on movement of the joint or even on slight pressure. The left wrist and left ankle were both slightly tender and acutely painful on movement but not swollen. The right knee was slightly painful on movement. There were no abnormal physical signs in the lungs, abdomen or central nervous system. There were no nodules or skin rashes, nor were there any abnormal constituents in the urine.The case was considered t o be a straightforward one of acute articular rheumatism with carditis, and treatment with salicylates was started immediately. The patient was given 20 gr. each of sodium salicylate and She was one of a family of four healthy children.

Last month Sir Robert Macintosh, Professor Ian Aird, and Dr. Dobbs visited Poland at the invitation of the Polish Ministry of Health and under the auspices of the British Council. Their visit, which was the first of its kind to Poland for some years, coincided with an exhibition of British medical books and periodicals in Warsaw, arranged by the British Council and the Medical Group of the British Publishers Association. Dr. Dobbs gives below the impressions he gained of medical practice in Poland.