IN BNt.n, JUNE 22, 1912.J NATURE AND N4URTURE. L MEDCA JouAr. 1439 = I is evidence for believing that colour-blindness,; haemophilia, pseudo - hypertrophic paralysis, and Leber's disease may very probably be included in the list of sex-limited diseases. In the known cases t3rttt' 1ebicat 3ourna. of transmission it is the males who inherit; the females transmit. In studying the transmission of disease the con- tributing factors of nature and nurture have to be SATURDAY, JUNE 22ND, 1912. carefully analysed and weighed. To arrive at an estimate of the proper contribution of the former is the main object of an inquiry into family histories, NATURE AND NURTURE. and Dr. MVott, in the article mentioned, shows the many pitfalls which beset attempts to arrive at just SINCE the days of Charles Darwin three names stand conclusions in nervous and mental out prominently as contributors to the advances diseases. He made gives a word of warning when he states that he is in the theoretical aspects of biological knowledge. " of that various These are the names of Francis opinion causes, such as alcoholism, Galton, Gregor infective diseases, auto-intoxications, physical injury, Mendel, and August Weismann. Not only has the especially head and shocks, individual work of each of these men been of vast injuries emotional shock, importance, but the wlhich their sexual excesses, and unnatural practices are too often impetus investiga- wrongly assigned as the sole cause of nervous and tions have given to researchl into all the many-sided mental disease, to the neglect of the problems of lhas been enormous. In inborn factor." hieredity this There is no doubt much truth in this. Alcohol may country at least the name of Bateson will also always be the cause in a certain number of cases of insanity hold a promninent place, since it is largely throualg him and the school whlichl he has established that the in persons without any hereditary taint; but it more work the Abbot Briinn readily affects those who have an inherited mental epoch-making of of has been weakness and in whom there is less power of control made familiar to us. As one outcome of this may be to withstand the mentioned the increased attention now to temptation. paid the Dr. AMott is evidently a strong believer in the facts of inheritance in relation to disease in the social potency of the inborn factor, and with this .s well as in the individual organism. belief In thus the of many biologists will be disposed to agree; but this accentuating importance the work of very belief raises the perennial question of the the so-called Mendelian school, there is no intention inheritance of acquired characters. Ever since the to minimize the value of the work done by the bio- publication of Weismann's theory of the germ metricians. The ultimate aim of both is the acquire- plasm, the possibility of the transmission of acquired ment of exact knowledge, the application of whiclh characters from parent to offspring has may lead to race betterment, but the very method of generallv been regarded as hiighlv improbable, if attacking the problems differs. The biometrician not impossible. There are iiot wanting signs at deals with statistics, with evidence in bulk. The the Mendelian inheritance in present time that many biologists are beginning investigates individual to waver, and a consideration of the facts of disease cases. The greater the number of cases recorded transmission would appear to have a direct bearing the more reliable the deductions, but the evidence upon the argument. is of necessity based on relatively smaller numbers. To say that a disease, or even the tendency to To mention but one instance, the inheritance of disease, is inherited is but to shift the problem 1rachydactyly. The evidence deduced from the re- a stage further back. Disease is not the normal ported cases is of great value, but from the biometric condition of a healtlhy organism, or to put it standpoint these cases are so few in number as to be another way, organisms were originally by nature of relatively little importance. It is for this reason healthy ; disease must therefore have been at its that the Mendelian principles of heredity appeal most inception an acquired character, that is to say, disease to the clinician, as he can individually, by the careful is a somatogenic character. Weismann defines and exact study of a few cases, materially assist in the advancement of knowledge. acquired or somatogenic characters as " those which The are not preformed in the germ, but which arise only investigation of these principles in their rela- through special influences affectiiig the body or tion to disease-transmission is one of the great individual parts of it. They are due to the reaction features of the past decade. In support of this it is of these parts to any external influences apart from only necessary to mention the work of Nettleship the necessary conditions of development." Many and Mott. In a recent number of Brain the pathological states at the very commencement of their latter has added yet another valuable contribution evolution must have satisfied this definition. If, then, to the subject from the clinical standpoint. In this disease cannot be entirely a matter of germinal varia- article Dr. Mott deals with the "inborn factors of tion, such variation must be due to influences nervous and mental disease," and gives a series of operating upon the germ plasm from without, that illustrative pedigrees. is, influences acting through the somatic cells. The Among the many results brought to light by a existence of such bodies as hormones furnishes a careful analytical inquiry into the facts of the possible explanation of how such influences might lhereditary transmission of disease not one is of take effect. Confirmation of the inheritance of greater interest than the discovery that certain acquired characters is to be found in Bordage's diseases are sex-limited-by which is meant that the observations on peach trees in the island of R6union.2 disease may be limited to one sex, but is transmitted This is no mere academic discussion, for, if disease at by the sex in which the disease does not appear. A its inception is a somatogenic character, then it is very remarkable and complete instance of such a possible that environment may originate it in an case has recently been published by Nettleship otherwise stock. showing the pedigree of congenital night-blindness healthy with Many writers at the present time appear to regard myopia.i In addition to night-blindness, there heredity as the last word in all matters appertaining I Trans. Ophtlial. Soc., vol. xxxii, 1912. I 2 Bxsll. scientifique de la France et de la Belgique, Tome 44. 1910. Tffz zsnmsu 1 1440 Y-RDICAL JOU'RWAL j RUSKIN ON THE -MEDICAL PROFESSION. LJUNE 22, 1912.. 1440 ~~~ZDICALJOUUWAL 3 RTJSKIN ON THE MEDICAL PROFESSION. [JUNE 22, 1912.~~~~~~~~~~~~~~~~~~~~~ to eugenics in the widest sense of the term. Some the general tendency is for insanity to die out in three enthusiasts are even clamouring for a health certificate generations-the power already exists to control the before marriage. Legislation, on the other hand, has insane therefore ilothing more is required. Upon hitherto ignored heredity and has regarded environ- every ground, therefore, the need is urgent for ment as the sole object of its attention. It is obvious statutory powers to deal with aments above the age that both factors must be taken into account con- of i6, and, above all, for the establishment of a central currently, not only in the study but also in the pre- board of control to superintend the care and manage- vention of disease. ment of aments and dements alike. Such a board was A further point to which Dr. Mott directs attention recommended by the Royal Commission. is what is called the " law of anticipation." Nettleship As yet there has not been time to keep records of has also previously discussed the matter. By this the hereditarily tainted for more than three genera- term it is meant that the manifestation of an inherited tions, except in a very few cases. It is of the greatest morbid change tends to appear at an earlier age in importance that they should be carriedl fuirther. successive generations or in the successive children of Adequate provision for the continuation of the in- the same parents. In this connexion Mott makes an vestigation is, no doubt, made in asvlums by the card important pronouncement as the result of his wide system, but this is not sufficient. The establishment experience. He says that he has "often observed of a statistical bureau connected with the local that there is a general tendency for inisanity not to authority of each of our large towns to keep, over proceed beyond three generations. There is frequently a period of several generations, a record, as far as either a regression to a normal type or the stock dies possible continuous, of all personis mentally affected, out. Not infrequently the stock dies out by the in- either aments or dements, would be of the greatest born tendency to insanity manifestinig itself in the value. It can hardly be doubted that the information form of congenital imbecility or in the insanity of so obtaiined would enable action to be taken whichl adolescence. Stuch patients, especially paupers, are would in the long run result in economies that prone to die of tuberculosis; thus rotten twigs are would much more than counterbalance the initial continually dropping off the tree of life." In support expenditure. of this conclusion reference is made to Morel, who in 1859 pointed out "that progressive uninterrupted trans- missioni leads finally to special degenerative forms, RUSKIN'S VIEWS ON THE MEDICAL to imbecility and idiocy, and with the diminished PROFESSION. capability of propagation of the latter kind the stock THE appearance of the general index in a volume therefore gradually becomes extinct." of the noble Library Edition (in thirty-nline volumes) Such statements are of hopeful augury, but it is of Ruskin's works ' makes it easy at once to discover necessary at present to accept them with reserve. In all that the scattered the items the first place, Is it true that there is this "diminished author, through 2,750 capability of propagation" in aments'? The report of enumerated in the bibliography of his writings, said the about any one subject in the course of his sixty years the Royal Commission on the Feeble-minded, and of authorship. Passing over Mr. Ruskin's references pedigrees furnished by Mrs. Hume Pinsent and to his friends in the medical profession-amongst others, seem to point to an opposite conclusion. were Dr. Even if it be admitted, for the sake of argument, whom Jephson of Leamington, Sir Henry it at Acland, Sir William Gull ("' the living Aesculapius "), that this power is diminished below the normal, Sir John Simon (" my old friend and Knight of the least appears to exceed the present average capacity Hammer and Dr. course the "), George Parsons of Hawkshead of the desirable stratum of society. Of -we turn our attention to the things said about diminished capacity in the latter may be the result of doctors in general. a purposive artificial lowering, but to whatever cause For instance, in pleading with the architects of it may be due the danger to the community remains. his day for imagination in their work, Ruskin says Again, if by the law of anticipation insanity tends not (The Two Paths): " Observe, nearly every other to proceed beyond three generations, but the stock liberal art or profession has some intense pleasure tends to die out " by the inborn tendency to insanity im- connected with it, irrespective of any good to manifesting itself in the form of congenital others"; and adds: " As lawyers, or physicians, or becility, or in the insanity of adolescence," yet so clergymen, you would have the pleasure of investiga- long as the congenital imbeciles are at liberty to pro- teaches that tion and of historical reading as part of your work; create children at all, present experience as men of science you would be rejoicing in curiosity these children are likely to becomne more or less per- perpetually gratified respecting the laws and facts of manent charges upon the State. There may be a Nature." Now, without pursuing Ruskin's argument natural tendency to a reduction in the total number of with the architects--whom he with an increase in would have to be dements, but, if this is correlated sculptors-we find here a fact often lost sight of by the number of aments, we are, in the present state of in the medical man sick of the monotony of daily the law, in a parlous condition. In those cases practice and unable always to find happiness in the which there is a regression to a normal type is there exhibit good he is doing to others: he can have intense any evidence that the offspring may not again pleasure in investigation, he can perpetually gratify mental instability? It would be quite in keeping his curiosity regarding the laws of Nature, and with Mendelian characters for it to do so. Such considerations do not in the least detract from rejoice. We may smile a little at Ruskini's of enthusiasm; but is there not after all truth, cheerful the value and scientific interest of the investigation truth, in the heart of it, and may not a doctor " with the law of anticipation, neither do they lessen the and even so eminent this clause make drudgerie divine," contract importance of the opinions expressed by practice fine? We must grant him sufficient spare an as Dr. but there is the that authority. Mott, danger time, of course. such statements may be used as arguments in support from the In one of his writings upon political economly (Unto of the policy of legislative inactivity, which this Last) Ruskin enters on the prickly path of community is, in this connexion at any rate, suffering. be so for in I The Complete Works of Johtn Buskin. Library Edition. Edited It would easy self-complacent persons by E. T. Cook and Alexander Wedderburn. Vol. xxxix: General authority to say that expert opinion declares that Index. London: George Allen. 1912. JUNE 22, I912.] SERUM DIAGNOSIS OF HYDATID DISEASE. MEDICALJOUI. I441 .- adequate remuneration. He seems, with delightful advertisement." As an afterthought, Ruskin adds, liberality, to concede the guinea as the medical man's "perhaps, however, you do take medicine by adver- proper fee. " Sick," he says, "' we do not inquire for tisement, but you will not, I suppose, call that a wise a physician who takes less than a guinea. ... proceeding? Every good physician, at all events, Caught in a shower, we do not canvass the cabmen knows it to be an unwise one, and will by no means to find one who values his driving at less than consent to proclaim even his favourite pills by the sixpence a mile." He admits, however, that the town-crier." number of candidates for the office may make a difference. "If it were thought that the labour necessary to make a good physician would be gone THE SERUM DIAGNOSIS OF HYDATID through by a sufficient number of students with the DISEASE. prospect of only half-guinea fees, public consent would soon withdraw the unnecessary half-guinea." HYDATID infection is so rare in the United Kingdom It has, Mr. Ruskin, it has, and that without that few practitioners have had opportunities to waiting for the sufficient number of contented become familiar by personal experience with the students! It is curious to note how fixed our difficulties which may arise in its diagnosis, with the author's view was about the guinea fee. In a risks attending its course, and with the serious later book (Fors Clavigera, Letter 14) he announces problems which arise in its treatment. It is far that his books are all to be sold at half a otherwise in Australia, where the possibility of guinea for those without plates and a guinea for the hydatid disease can never be absent from the illustrated volumes; and he gives as his reason, " I do mind of the physician in any obscure case. In not care that anybody should read my books who British textbooks the diagnosis is not, as a rule, grudges me a doctor's fee per volume." He rather adequately discussed, and, according even to some came to grief over this matter of the doctor's fee per of the most recent, the main diagnostic signs volume, for a Glasgow man wrote to him, saying, " No are the recog,nition of the "hydatid thrill" and doctor, here at least, would ever think of charging me the results of exploratorv puncture revealinig the a fee of Ios. 6d.," and pointing out that "Doctors wfio presence of the characteristic lhooklets. The thrill have acquired, either professionally or otherwise, a is by no means always present. It is not usually competence, often-nay, very often-give their advice to be observed when the cyst is small, a period gratis to nearly every class, except that which is when suitable treatment gives the best result, and really wealthy." Ruskin answered the Glasgow man, is apparently hardly ever present in hydatid of the but we think that he had scarcely the best of the lung. Dr. Lendon, of Adelaide, whose book on argument. hydatid disease of the lung is probably the most He is on safer ground when he deals with the duty comprehensive hitherto published, at any rate in the medical man owes to the public, and for the doing English,' says that " the peculiar fremitus of the of which he is honoured. " Whatever his science," hvdatid cyst-which is a rare sign at any time- says Ruskin, " we would shrink from him in horror is still more rare in connexion with thoracic cysts," if we found him regard his patients merely as subjects and adds that he has only met with it twice. From to experiment upon; much more, if we found that, his discussion of the diagnosis of an unruptured receiving bribes from persons interested in their cyst of the lung-and to make the diagnosis at deaths, he was using his best skill to give poison this stage is the chief aim of the physician- in the mask of medicine." He sets a highi standard it is to be gathered that impairment of the move- for the medical profession. There " have hitherto ments of the chest, enlargement of the chest and existed," he says, " five great intellectual profes- possibly some obliteration of the intercostal spaces, sions, relating to daily necessities of life-three exist alteration of resonance on percussion over the area, necessarily in every civilized nation: the Soldier's of deficient movement and loss of the respiratory profession is to defend it; the Pastor's is to teach it; murmur in the same area, are the most characteristic the Physician's is to keep it in health; the Lawyer's physical signs of a cyst which has not attained a size to enforce justice in it; the Merchant's to provide for large enough to produce obvious pressure symptoms. it. And the duty of all these men is, on due occasion, It is clear, therefore, that the diagnosis may raise very to die for it." Ruskin defines " on due occasion" for nice problems. Dr. Lendon sums up by saying that the soldier as " rather than leave his post in battle," "there is no single physical sign which is patho- and for the physician as "rather than leave his post gnomonic of an unruptured pulmonary cyst; that in plague." But, of course, " the labourer is worthy localized bulging, though most suggestive, may be of his hire," and in another book (The Crowv of Wild also caused by a localized empyema; that a curved Olive) Ruskin puts the fee question fairly and finely upper border of dullness is common in pleurisy with for all time: " Doctors like fees, no doubt-ought to effusion; that when situate in the upper lobe it may like them; yet if they are brave and well educated, simulate phthisis, and in the lower lobe it closelv the entire object of their lives is not fees. They, on resembles pleurisy; that pleural effusion may co-exist the whole, desire to cure the sick; anid-if they are and mask the hydatid disease; and that a secondary good doctors, and the choice were fairly put to them- growth in the lung may be mistaken for a cyst. We would rather cure their patient, and lose their fee, may be, and frequently are, right in our diagnosis; than kill him, and get it. Their work is first, their we can never be absolutely certain." fee second-very important always, but still second." Formerly, as some textbooks still advise, it was We shall all agree with Ruskin here. the rule to establish the diagnosis by making a We have not by any means exhausted Ruskin's puincture, and occasionally this simple procedure references to doctors; but we must close with two was followed by cure; but Lendon, in accordance more, and two only. One is the remark in a letter to with most authorities, says that the dangers of his Edinburgh friend, Dr. John Brown (author of the this method of treatment far outweigh any possible world-famous Rab and his Friends): "I cannot fancy advanitage, and that "4it is now on all sides acknow- any study or work in this age so noble as that of a 1 Clinical Lectures ont Hvdatid Disease of the Lungs. By A. A. physician." The other is in Fors Clavigera: "You ought Lendon, M.D.Lond., Lecturer on Obstetrics and Clinical Lecturet on Diseases of Children ia the University of Adelaide. London: to read books, as you take medicine, by advice, and not Bailli6re, Tindall and Cox. 1902. 1442M4D4.a.TE BaismJOuAL IJ BIRTHDAY HONOURS. [JUNE: 229 1912. BIRTHDAY HONOURS. [JUNE 22, 191.. ledged that the only effectual treatment of hydatid More work will probably be required before the true cysts of the lung is surgical, and that such treatment value of this last reaction in hydatid disease can be should, if possible, be radical in it3 scope, and not ascertained. In any case, however, we appear to merely palliative." A piece of rib is excised, the cyst have .obtained in the complemenit deviation method a incised and emptied, and the mother cyst extracted very valuable and important means of diagnosing a with appropriate forceps from the cavity in the lung. highly dangbrous disease. It remains to be seen As early operation before the cyst has attained a whether Henius's encomium,3 "one of the most large size or ruptured is obviously the object to be brilliant advances of serum diagnosis," will he aimed at, any new method of examination which justified by results. would enable an early diagnosis to be made with increased confidence will be welcomed by those who ha-e most to do with the disease. As in several othler cases, wlhere or(linary clinical BIRTHDAY HONOURS. signs and symptomiis have proved inadequate for THE birtlhday honours list issued on June 14th made the diagnosis, recourse has been had to serological announcement that the King had conferred a baronetcy methods, and such good progress has been made that upon Mr. Rickman John Godlee, President of the Itoyal already, it may be assumed, the tentative stage lhas College of Surgeons of England, Honorary Surgeon in been passed, and there is some slhow of practical Ordinary to the King, Surgeon to the University College applicability. Although the subject is not yet more Hospital, and Holme Professor of Clinical Surgery in the than six years o0l the output of literature dealing with University College Hospital Medical School: Mr. Godlee, it has already become very considerable. An im- who graduated M.S.Lond. in 1873, and took the diploma of portant monograph on the serum diagnosis of hydatid M.R.C.S.Eng. in 1872 and that of F.R.C.S. in 1876, was disease has just been completed by Pfeiler of Berlin.2 elecled President of the Royal Colleae of Surgeons in He enumerates over I2o references, representing work succession to Sir Henry Butlin last November. Tlle list of some 70 independent observers. All the methods in also contains the announcement that the King lhas con- common use in serum diagnosis have been applied, ferred the honour of knighthood upon Mr. Berkeley G. A. in particular tlhe precipitin reaction, the complement Moynihan, F.R.C.S., Surgeon to the Leeds General deviation method witlh its several modifications, and Infirmary, and Professor of Clinical Surgery in the nmeiostagmine reaction. Chief attention lhas been University of Leeds; upon Lieutenant-Colonel I)avid the Prain, F.R.S, late I.M.S., formerly Director of the Royal directed to the first two, and with regard to them a Botanical Gardens, Calcutta, and since 1905 of the Royal large nuimiber of reliable observations are available. Botanic Gardens, Kew; Mr. John Bland-Sutton, F.IL.C.S., Fromn these it may be gathered that the method wlich Surgeon to the Middlesex Hospital; Dr. StClair Thomlson, offers the mllost promise, whichi affords indeed a very Physician for Diseases of the Throat, King's College sound and reliable means of diagnosis, is the com- Hospital, and Professor of Laryngology in the College; plement deviation method. It would appear that it and Dr. Abraham Garrod Thomas of Newport, Moniuouth-i- is certainly as least as reliable as the corresponding shire, who was President of the Soutlh Wales and reaction in syphilis, and probably more so. Estimates Monmouthshire Branclh of the Britislh Medical Associa- vary as to the percentage of equivocal or erroneous tion in 1900-1, and is now Chairman of the Monimotutli- results, but probably they do not greatly exceed shire Division, Consulting Physician and Chairman of the io per cent.; a positive reaction may be regarded as Board of Management of the Newport and Monmoutlhshire almost absolutely diagnostic of EchinoCOCCUs. The Hospital, which, largely through his exertionis, was re- antigeni is specific to a very high degree. The only erected in 1895 on a better site with suitable surroundings. possible exception to this is afforded by some experi- He was High Sheriff for Cardigan in 1900-1, and is a ments of AMeyer which go to show that aniimals Justice of tlle Peace for Monnmouthshire, Cardigaishlire. harbouring Taeniia in their intestine may exhibit a and the County Borouigh of Newport. Surgeon-Major- positive reaction. That the same applies to man lhas General Alexander Frederick Bradsliaw, C.B., who lhas not -vet been demonstrated, but the possibility is one been appointed K.C.B., served in the Indian Mutiny wlhichl slhould be borne in mind. With regard to 1857-9 and accompanied the Zhob Valley Expedition in negative results there is one universally recognized 1884 and the Hazara Expedition in 1891 as Principal source of error-namely, cases in which the cyst has Medical Officer. TIle following have been appointed as become septic. Such cases almost invariably give Companions of the Bath: Surgeon-General Williarn a negative reaction. Most of the technical modifica- Babtie, V.C., C.M.G., Deputy Director-General, Army tions employed in the case of syphilis-such1, for Medical Service, and Colonel Robert N. Campbell, C.I.E., instance, as those of Stern, Bauer, Hecht, and I.M.S., who served with the Naga Hills Expedition ill Noguch i-have been made use of, and successful 1877-80 and with the Akhla Expedition, 1883-4. The results hiave been obtained with each of those by King has conferred the dignity of K.C.V.O. upon Professor various observers. Alexander Ogston, M.D., Surgeon in Ordinary to the King In comuparison with the complement deviation in Scotland, Consulting Physician to the Aberdeen Royal method the precipitin reaction has given miuch less re- Infirmary, and Emerituis Regius Professor of Surgery, liable results. It is certainly accurate in a considerable University of Aberdeen. The distinction of C.V.O. is percentage of cases, but unfortunately there appears conferred upon Mr. G. L. Cheatle, C.B., F.R.C.S., Surgeon to be no doubt that for some reason or other it fails in to King's College Hospital and to King Edward VIl not a few instances. It has therefore not the absolute Hospital, and upon Dr. P. Horton-Smith Hartley, M.V.O., value of the deviation method, but it may be ascribed M.D., Physician in charge of Out-patients, St. Bartliolo- a certain importance as an aid to diagnosis. In regard mew's Hospital, and Physician to the Brompton Hospital to Ascoli's meiostagmine reactioni, which is a surface for Consumption, and upon Inspector-General Belgrave tension phenomenon, much less work has been done, Ninnis, R.N. (retired) M.D. The distinction of M.V.0. of and the results are conflicting. Ascoli made two the Fourth Class is conferred upon Mr. Willie Nettervih¢i positive observations, and Izar ten but, on the Barron, M.R.C.S., of Ascot, Surgeon-Apothecary to tIme other hand, Weinberg and Jonesco-Mihaiesti report Household of Their Royal Highnesses Prince and Princess ten absolutely negative results. Christian. The distinction cf C.S.I. is conferred upon Surgeon-General Henry Wickham Stevensonu I.M.S., 2Zeitqcql, . f. Infektionskrankh. der Haustiere 1912. Bd. xii. Heft 1, pp. 70-96; Heft 2. pp. 153-169; Heft3X, pp. 255-304. 3 Deut. med. Woch., 1911. p. 121L 22, EXTENSION OF LEEDS GENERAL JUNE 1912.] INFIRMARY. JOUNwA 1443 a EDITCAL I Surgeon-General to the Government of Bombay, and an THE PSYCHOLOGY OF " MARROWSKYING." additional member of the Council of the Governor of ALL actors live in dread of " marrowskying," that curiouis Bombay for making laws and regulations; and that of transposition of syllables which often illustrates the truth C.I.E. upon Lieutenant-Colonel Charles Henry James, of the saying that from the sublime to the ridiculous there I.M.S., Medical Adviser, Patiala State. The Kaisar-i-Hind is but a step. The actor who said, " Stand back, my lord, " Gold Medal for public service in India has been conferred and let the parson cough (instead of "c offin pass ") upon M. R. Ry T. Madlhaven Nair Avergal, M.D., a com- may have made a solitary slip, but in some persons " mar- missioner of the Madras Municipal Corporation. The rowskying" amounts to a veritable infirmity. We knew distinction of C.M.G. is conferred on Dr. Andrew Balfour, an excellent clergyman who was the delight of the more Director of the Wellcome Tropical Researclh Laboratories frivolous among Ihis ilearers because he was never known at the Gordon Memorial College, Klhartoum. The King to preacil a sermon without introducing a reference to a has conferred the Decoration of the Royal Red Cross upon "farren big tree," or dwelling on the fact that " many are Miss Amy Nixon and Miss Mary Wilson, matrons, Queen called but chew are fosen," ending the text witil the im- Alexandra's Imperial Nursing Service. pressing exhortation, " Be ye tlierefore of the fosen chew." We remember a fastidious lady shocking the porter at a railway station by telling him that she had only a " rag THE PROPOSED EXTENSION OF THE GENERAL and a bug," meaning, of course, a rug and a bag. The INFIRMARY AT LEEDS. name of the head of a famous college at Oxford has become THE selieme for the enlargement of the Leeds Infirmary, proverbial for this kind of defect of speeeh. How does of wlhich we gave an account in our last issule, is one which this kind of inversion arise? Professor Joseph Jastrow, inust commend itself to all tllose who are interested in the the well-known American psycilologist, says it is due welfare of the institution, wlhetlher that interest depends to an " intrusion of the subconsciousness " of the speaker. mainly on its charitable or on its teaehing aspirations. As We subconsciouisly construct our sentences before uttering was pointed out in the description by our Leeds correspon- them, and sometimes the preliminary framework gets dent, there is but one general voluntary hospital in the mixed up with the permanent timnber. According to city, and this is an advantage as leading to concentration the Literary Digest, Professor Jastrow says: " The of teaching and as guarding against overlapping in the complexity of speech requires the occupation with dispensing of eharitable benefits. Any one who studies many processes at once, and some of these-the nicer, the seheme in detail, more especially any one wlho is well more delicate, less familiar ones-will receive the major acquainted with Leeds and witlh the surroundings of the attention, while the routine factors engage but a minor infirmary, must be struck with the boldness of the scheme degree of concern. Slight fluctuations in the condition and witlh the enterprise wllich lias been shown by the of the speaker-physiological ones, such as fatigue, and, board in taking steps to secure the various properties for the most part, psychological ones, such as excitement, required for carrying it out before the matter was made apprehension, embarrassment will induce variations in public. Especial credit is due to tile chairman of tile tile nicety of adjustment that are recognizable as typical weekly board, Mr. Charles Lupton, for it was in Ilis mind slips of tongue or pen, and, still more significantly, of the that the seheme originated, by him the board have been tongue-and-pen-guiding meehanism. . .. There are the guided in completing the purchases, and he it is who has anticipations, the persistencies, the interchanges, the sub- enlisted for the scheme the sympatliy and tile support stitutions and tile entanglements of letters, and of words wilich its intrinsic merits indeed should command, but and parts of words, and of phrases-all of them indicative which might not lhave been forthcoming had the present- of shortcomings in the minute distribution of attention ment of the case from the point of view of the infirmary and co-ordination." He gives a nunlb3r of examples, and been in less capable hands. The cost of the seheme shows tllat "marrowskying " is not confined to the tongue, would of course have been much greaterhad the intentions but occurs in writing. This is one of the many sources of the infirmary as to the purchase of the adjoining of error in copying printed or manuscript matter. The property leaked out, and when one considers the large mind runs on ahead of the eye, and a jumble of syllables number of people who were of necessity cognizant of what is the result. Should this by any chance happen to make was going on, it is, if not indeed matter for surprise, at sense, it leads to a corruption of the text which may have least creditable that no such leakage did take place. After far-reaching consequences. Copyists' errors have been the matter was brought before the city council it was classified ; it would be interesting if "marrowskyers"' referred to a special committee, which we understand has blunders could also be classified and the etiology and reported favourably on the scheme as a whole, though mechanism of the condition elucidated. The occurrence there are some matters of detail calling for discussion and of an accident of the kind engenders a fear of a repetition possibly amendment. There is, however, every prospect of the misadventure, which may lead a man to give up all of the immediate requirements of the infirmary in the way attempts at public speaking. of extension and improvement being generously met; pro- vision will be secured for furtiler extension when that is RAG FLOCK REGULATIONS. necessary, and a great public improvement will be carried FoUR years ago inquiries were inade on behalf of the Local out at a cost which will be much less than if the property Government Board by Dr. Reginald Farrar with respect had had to be purchased after the intentions of the cor- to the manufacture and sale of unwashed rag flock, poration had been made public. It must be pointed out samples of which were examined bacteriologically by that the appeal for £150,000 was made at a time when the Professor Nuttall and Mr. Graham-Smith and chemically larger scheme was not in contemplation. As thlis larger by Dr. F. C. Garrett, D.Sc. Mr. Cecil Warburton at the scheme appears to be essential for the future development same time made an investigation into the possibility of of the infirmary, it is unavoidable that a large proportion vermin being distributed by means of this material. The of the money must go in land. About £110,000 has been reports of these investigators published in 1910 were very either promised or subscribed; should the terms men- disquieting.1 Dr. Farrar was able to show that the rags tioned in our last issue as having been submitted to the employed in the manufacture of the flock were of the corporation be agreed to, then the infirmary will have lowest and cheapest grade, consisting generally of cast-off expended some £50,000 in the purchase of land. If the clothing and strips of old carpet, which might have been public of Leeds and of Yorkshire generally desire an altar picked out from refuse heaps. From 70 to 90 per cent. for their offerings we can commend none better to them of the flock was neither washed nor sterilized. Mr. than that which is afforded by the present and pressing Warburton found that lice and, a fortiori, tfieir eggs, requirements of the General Infirmary at Leeds. 1 BRITISH MEDICAL JOURNAL, April 23rd, 1910, p. 1013. TErz BRrTISH THE REMAINS OF NAPOLEON. -1 r444 MZDICAL JOURNA.L I MsnAJuNLITERMISO AOEN LJUNEJN 22)2 1911.gt 1444~~~~~ ~~ might pass through the flock-making machine without which has life." It is interesting to recall that among those being crushed, and that although the lice themselves present when the remains were brought back to Paris was were incapable of surviving more than three or four days an old man of 74, representing, among so many heroes of without food, the eggs, which take a month or the sword, that war-surgery in which he had won such more to hatch, might quite possibly be found renown. This was Larrey, clad in his old uniform, and in bedding. One result of the disclosures made in wrapped in his campaigning cloak, leaning on the arm of his these reports was the passing last session of the son Hippolyte. To him it may be remembered Napoleon Rag Flock Act, whicil enables the Local Government left £4,000 as to the most virtuous man he had known. Board to make regulations prescribing the standard The remains are now enclosed in five coffins, made re- of cleanliness whlich mllust be adopted for flock manu- spectively of tin-plate, mahogany, lead, a second one in factured fromii raas. The Act comes into force on lead separated from the other by sawdust and pieces of July lst next, and after that date it will not be lawful for wood, and one of ebony. For a long time the face of any person to sell or to have in his possession for sale rag Napoleon was shown every year on August 15th, the flock which does not conform to such standard. The anniversary of his birth. Crowds passed before his bacteriological examinations of rag flock which were made tomb; the upper part of the coffin was raised, and by Professor Nuttall and Mr. Graham-Smitlh led themii to through a glass could be seen the face of the Em- express the opinion that it was irnpracticable to set up a peror. But it is to be presumedl that at length signs bacteriological standlard of tlle purity of flock. Dr. of decomposition became visible, and the order was given Garrett was, however, more successful as regards a that the face should no longer be shown. M. Jean clhemical standard, and he came to the conclusion that by Richepin, the poet, has described wlhat lie saw. In a lec- estimating the amount of chlorine there would be little ture delivered on January 25th, 1909, he said: " The General difficulty in discriminating between clean and dirty flocks. (M. Mellinet, then Governor of the Invalides) took us- Dr. Farrar suggested that it would be reasonable to fix -down into the crypt. . . My father took me in his arms, 30 parts of clhlorine in 100,000 parts of flock as the per- raised me in the air, and I saw the Emperor. I lhave missible limit of impurity, and this is the standard which never forgotten that sight. I was eleven years old. What the Local Government Board has prescribed in the Regula- is seen at that age makes a deep impression, and nothing tions it has made under the provisions of the Act. The can remove from my brain that extraordinary image: duty of administering the Act has been entrusted to the the eyes closed, the beard slightly grown, the face of the local sanitary authorities, the method of procedure whiteness of marble, on wllich spread some yellow spots following very closely that of the Food and Drugs Acts. whiclh seemed a bronze. Wlhen there mingle in my The penalty for contravening the Act is for a first offence memory that face of wax, showing some signs of de- £10, and for a second or subsequent offence £50. composition whiclh I have seen, and those eyes wvhich I have seen, I see the Emperor truly as if I had known THE REMAINS OF NAPOLEON. him." Dr. Billard attributes the preservation of tlle IN the lives of saints it is often stated that the body vas remains during their long repose at St. Helena to the founld incorrupt long after deatlh. For instance, the body hermetic closure of the coffins in which they were en- of St. Charles Borromeo, preserved in a crypt in the enclosed, preventing the access of the micro-organisms- great cathedral of Milan, is slhown to the curious-for the real "conqueror worms," to use Edgar Allan Poe's a consideration. It is said to be incorrupt, but a very phlrase-that cause decomnposition. cursory inspection shows that it is mummified. In other cases the flesh of the holy person has been transformed TABLES OF STATISTICAL ERROR. into adipocere. It is a fact, however, that decay may be MANY biological and medical investigators are now fully delayed sometimes for centuries by natural causes, and thus alive to the importance of applying some quantitative test there are many cases of the bodies of persons wlho lhave of the accuracy attaching to the results obtained from no claim to a place in the Calendar being found incorrupt. limited samples. Thus, having ascertained from a sample In a recent number of the Journal MTdical de Br-uxelles of 500 leucocytes that 15 per cent. of them are large mono- there is an article by Dr. Max Billard on the exhumation nuclears, what is the likelillood that another sample of of Napoleon's remains in 1840. Although, owing to the 200, found to contain 12 per cent. of large mononuclear lack of the necessary materials, it had been imlpossible cells comes from the same "population" as the first? to embalm the body after death, the remains were found Numerous other questions of a similar kind often require in an almost perfect state of preservation. They were an answer, and although in the majority of cases the enclosed within four coffins, one within the other, problem presents no difficulty to a trained statistician, the one of mahogany, one of lead, a second of ma- laboratory worker may be puzzled to lay his hand upon hogany and one of tin-plate. Wlhen the last of these the correct solution. Inquiries of this kind would be much was opened the whole body was seen as if enveloped in a facilitated by the existence of a set of numerical tables transparent cloud. The head of the conqueror rested on with a clearly worded introduction, and this has been a a pillow. The large head with the lofty brow was seen long-felt want. Sir Ronald Ross and Mr. Walter Stott have covered witli yellowish, hard, and very adherent in- recently done a good deal to smooth the path of the labora- teguments. The same condition was observed about the tory worker in this way, and their Tables of Statistical contour of the orbits, on the upper edge of which the eye- ErrorI should receive a general welcome. The tables, brows were visible. Under the eyelids could be seen the wlhich are provided with adequate numerical examples, eyeballs, which had lost little of their volume and shape. will be found very useful in answering questions similar Some hairs were still seen at the free edge of the eyelids. to that proposed above, and the labour involved in their The bones of the nose and the integuments covering them preparation can only be realized by those who have them- were well preserved; the nostril and the alae alone had selves attempted to construct tables. It is, however, suffered. The cheeks were puffy; the integulinents of necessary to remark that there are limits to the applica- that part of the face were remarkable by their softness bility of these tables. The authors write: "If the and suppleness to the touch and the whiteness of their observed result, plus the error, exceeds 100, or if the colour. Those of the chin were slightly bluish. The chin observed result, minus the error, is less than 0, we con- itself showed no change. The thin lipswereparted; under clude that the number of things hitherto examined is the upper one, which was a little raised on the left side, not large enough to yield a useful result." This is were seen three extremely white incisor teeth. The I Tables of Statistical Error. By Professor Sir Ronald Ross, K.C.B.. hands showed no change; " the skin seemed to have pre- F.R.S., and Walter Stott. (Reprinted from the Annals of Tropical Medicine and Parasitology. V. 1911. Price 2s. 6d. Liverpool: The served -that particular colour which only belongs to that; University Press.) JUNE 22, -9r2.] HIOSPITALS AND RELIEF COMMITTEES. 445 I TICAL JOURNAuJOURNAL IEDICAL 44 liardly a sufficient account of a difficulty whicll will In corr-elation with this fact it must be remembered that arise if the tables are used in all cases. The entries the strain of trypanosome causing infection in Rhodesia seem to have been based upon the assumption that what is different from Trypanosomra gambiense. The out- is called the " normal curve of probability " describes the standing importance of this new discovery is that it frequency of random errors. As a matter of fact, this appears to prove that a much vaster expanse of the African assumption is not justified in cases where the character continent is open to infection than was previously believed. miieasured occurs in a very small or a very large pro- It was one of the few consolations in connexion with sleep- portion of the population. Roughly speaking, we should ing sickness in Uganda and the neighbouring regions that say that the values deduced from these tables cannot the carrier of the disease was such a species as Glosoina properly be employed in testing samples which yield less palpalis, which is of markedly restricted distribution. than 10 or more than 90 per cent. of a character; in such The fact that this tsetse fly is confined to certain localities, cases the frequency distribution of deviations on either and is rarely found at any great distance from water, gave side of the most probable value is not symmetrical. We a complexion of comparative simplicity to the problem of believe that tables covering these extremes will shortly dealing with it. The entry of Glossina morsitans as a be published, and in any case the medical worker should " carrier," however, places a much more serious aspect on be thankful for Sir Ronald Ross and Mr. Stott's useful the whole matter. Its distribution is very much wider publication. than that of Glossina p)alpa1is, and it is not handicapped by the necessity of living close to water. It is on that THE POLLUTION OF SWIMMING BATHS. account a much more formidable transmitter, of disease. AT a recent meeting of the Medical Officers of Schools The full significance of these new facts and their bearing Association a discussion on the pollution of swimming on administrative measures have been discussed by Dr. baths was introduced by Dr. J. Graham Forbes, who gave Oylmer May, Principal Medical Officer of Northern an account of investigations lie had made in connexion Rhodesia, who, in an address delivered to the South with a small swimming bath at the London County Council African Branch of the British Medical Association at Industrial School in Drury Lane. An examination of the Johannesburg, gave a detailed account of the work of water in the bath before and after it had beenl used resulted Kinghorn and Yorke and other members of the Sleeping in evidence being forthcoming of definite pollution, thle Sickness Comimission in Rhodesia. So far as known at micro-organisms which were found after a few days' use, present, there are only three affected areas in this region, but which were absent in the fresh water, including B. coli namely, the shores of Lake Tanganyika, the banks of the coiwemunis, B. p)yocyaneus, and Streptococcuts faecalis. river Luapula, and the Luangwa Valley. In the first two Several methods of purifying the water in swimming areas the " carrier" is G. p)alpalis, in the third G. mor- baths have been introduced, one of the best known being sitans. It was the occurrence of cases of the disease in tllat which has been applied for the past three years to the this last-named district and the absence of G. palpalis five public baths in the metropolitan borough of Poplar. which first drew attention to the necessity of incrimi- " Dr. Alexander, the medical officer of health of the nating some other carrier." That G. m1o0sitans has been borough, has for some years used for disinfecting pur- found guilty accords with the views held by some poses an electrolytic disinfecting fluid containing hypo- authorities for some years past. It has been shown, chlorite of magnesia, and which is said to yield 4 to 6 further, by Kinghorn and Yorke that a single feed on grams of chlorine per litre. This fluid has been added an infected animal renders a fly infective, and that it to the water in the Poplar swimming baths, when they remains infective all its life. An added source of danger is are first filled, and again at intervals of two or three days, that infected animals may harbour the trypanosomes and until the baths are completely emptied. Bacteriological yet slhow no signs of dlisease. The administrative problem examination of the water has shown that the fluid has a has been rendered exceedingly more complex by these new very.distinct germicidal effect, and it is maintained that findings. The difficulties of the situation are serious the water, from its purification, is far pleasanter to bathe enouglh even in the case of G. palpalis, but there is no in, is clear and invigorating, and free from the unpleasant doubt that its evil influence has been materially arrested odour so often associated with public baths. There must by the expedient of removing the population from the obviously be difficulties in directly connecting either a infected areas. In the Luangwa Valley, however, even single instance or outbreaks of disease with the water in this measure is denied us. The population there is com- swimming baths, though an outbreak of typhoid fever in paratively large and difficult to handle; it would be an the Royal Marine Dep6t at Walmer in 1908, and investi- enormous task to transfer them all to positions of safety, gated on behalf of the Local Government Board by Dr. and, moreover, they are not particularly anxious to be R. J. Reece, was most probably due to the water of the interfered with in such a manner. This measure, how- swimming bath having become infected with specific ever, is being adopted to the modified extent to which it organisms. There is, however, quite sufficient evidence of is practicable. We are again faced with the old question the p.ossibility of pollution of public bath waters to warrant of destruction of game and destruction of flies. Dr. May the utmost care being taken to minimize the dangers is not one of those who favour the former measure. Hle more in the fact arising from such pollution. sees hope that the British South Africa Company is about to appoint a staff of expert entomo- logists to investigate the wlhole question, and to determine THE CARRIERS OF SLEEPING SICKNESS. the manner best suited for dealing with and destroying IN the JOURNAL of April 27th, 1912, p. 969, reference was the flies. Witlh regard to the extension of the disease made to the remarkable new results obtained by Drs. further south, a certain measure of safety is afforded by Kinghorln and Yorke in the course of their investigations the Zambesi river. No sleeping sickness has yet occurred on sleeping sickness in Nyasaland and Northern Rhodesia. south of this, and stringent precautions are being taken to These investigations have brought to light several facts prevent infected persons crossing, and so spreading tlle which are of the most far-reaehing importance. In our disease. previous note we dealt more particularly with the game "reservoir " question. Here we wish to draw attention to HOSPITALS AND RELIEF COMMITTEES. the matter of the " carrier "-namely, the tsetse fly. For IN the Charity Organization Review1 for June there some years it has been an accepted doctrine that the only appears an article by the almoner of St. Thomas's tsetse fly wshich carries the disease is Glossina jpalpatlis. Hospital, entitled The Co-operation between Hospitals Kinghorn and Yorke, however, have demonstrated that in and Relief Committees, whicll is- deserving of attention. Northern Rhodesia the "carrier" is Gtossina morsitans. 1London: Longmans, Green and Co. T3rw:IPRITWn ,-, 1446 MEDICAL JOURNSAL J MEDICO-PSYCHOLOGICAL ASSOCIATION. [JUNE 22, 1912. It is an admirable summary of wlhat is being done through a number of tlle variations in the normnal disc that may voluntary workers to assist the deserving poor in various simulate stulch patlhological states as optic neuritis or optic ways, and to promote the teaching of sanitary science atroplly. His coloured pictures slhow very clearly how the among the masses. It shows how muclh can be done by colour of the optic disc, the sharpness of its margins, tlhe sympathetic ancl intelligent health visitors to improve the promi-inence witlh wbhich it stands ouit beyond the rest of condition of many of the sick anld helpless poor by secing the fundus, and the arrangement or tortuosity of its blood that the advice of the meclical men they have consulted is vessels, may simulate disease. Tllths the healthy disc may carried out in their lhoma-es as far as possible, and ,,liereby be almost wlhite, wlhether from deep physiological excava- rendering efficacious,what otherwise would have been of tion or from other couse, giving tlle appearance of total little utility. Aniid the hurry and ruslh of tlhe out-patient optic atroplhy. Piofessor Salzer leaves it uncertainl how far department the sufferer is apt to be confused by the direc- thlis healthy pallor may be due to poverty in capillaries. tions given by the consultant, often ignorant of hiis or lher to greater or less transparency of the inon-miiedullated lhome conditions; and althougb, if regarded intelligently, fibres of tlle optic nerve, to variations in tlhe denisity of its they might often be conveniently modified by thc patient to neuroglia, or to the persistence of meduillated fibres furtlher suit his or her particular case, unfortunlately, it too ofteni forward in the papilla than is normal. He is of opinion that lhappens that the intelligence is lacking, and tlle advice is suclh terins as "pallor," " redlness," and "temporal pallor of like the good seed that fell by the roadside. The healtlh the papilla " should be employed witlh great reserve, except visitor supplies this intelligence, and points out to the in cases that lhave been under observation for some time. patient how the advice may be utilized, and how by some In the same way lhe points ouit that a normal blurring of the little variation in the home life very considerable advantage edges of the disc, particularly by meains of fine radiating may be obtained from it. But it is not all healtlh visitors streaks that seem to spread- fro-m its centre an(d are -who can do tlhis, and the almoner alludes to a class-we reflections from non-medtullated nerve fibres, may be very fear it is ratlher a numerous one-which makes all kinds lhard to distinguish from a pathological blurring. And of impossible suggestions, and whose members are satisfied in some instances swelling of the disc may be closely and think their duty done, after inculcating a few well- imitated by the non-pathological projection forward recognized health laws, which, however good they may be of one of its vessels, the vessel being accompanie.d by .the in the abstract, are quite useless until their application to retinal elements in its vicinity. Btut it is when tllese the concrete case in question has been explained. To cut variants in colour, margination, and projection are com- the coat according to the cloth is a trite adage, and must bined that the greatest difficulties in diaanosis are never be forgotten by sanitary reformers whlen dealing encountered, and neuritis may be suspected when nothling with the homes of the poor. Tlle writer spealks with some worse than psetido-neuiritis-the bark witlhout the bite-is enthusiasm of the " system of. social service " that has present. sprung up in our midst, and says that without its co-opera- tion to it would be impossible attempt lhalf the work that THE MEDICO-PSYCHOLOGICAL ASSOCIATION. is now done. It is in this respect that so muclh has been THE seventy-first annual meeting of tlle Medico-Psycho- gained. In the past there was a greater waste, but modern logical Association of Great Britain and Ireland will be methods bid fair to check this regrettable loss of power. lheld on Thursday and Friday, July 11th and 12tll, at In the complexity of thle present social system, co- Gloucester, under the presidency of Dr. James Greig ordination and co-operation are the key to progress, Soutar, Medical Superintendent of Barnwood House, and we may well wislh success to the work that is Gloucester. Tlle business meeting will be lheld in tlle here so ably delineated. It is divided into two parts, morning of July lltli, wlhen among other reports from (1) dealing with material relief, (2) the system of friendly comnmittees one on the medical inspection of school visiting, and it is only by a combination of tlle two that children will be presented, and a proposal to elect as really good results can be expected to be obtained. The- honorary mnembers Dr. Thomas Ivor Considine, Superini- illustrations given . are simple and convincing, and we tendemit of Luniatic Asylums, Ireland, and Dr. Henry cordially, commend the article to all interested in the Maudsley, will be macle. After luncheoln the President welfare of the poor. There are many difficult problems to will dcliv-",r an address, and papers will be read by Dr. be faced in connexion with the subject, but it may be in in J. F. Briscoc on appendicitis asylums, and by Dr. safely admitted that following the lines lhere laid down, McKinley Reid on the bacteriology of diarrhoea, witlh we are on sure ground. Whatever modification of our special reference to asylum dysentery. The discussion abstract views the future may bring about, wlhatever on Dr. Bernard Hart's paper on a case of double system in dealing with these problems may finally bo personality will then be resumed. The annual dinlner adopted, work of this kind will always have its value, and will take place that evening at the Guildliall. On will adjust itself to the practical carrying out of that Friday morning, a discussion on mental deficiency will which science and experience teach us is most desirable. be opened by Dr. Theo. Hyslop. On Wednesday, July 10th, when certain commiiittees will mneet, the Gloucester ERRORS IN OPHTHALMOSCOPIC DIAGNOSIS. County Asylums (at Wottoii and Barnwood) and Barnwood THE difficulty of making an exact diagnosis in many border- House will be open to inspection botlh morning and line cases by the use of the ophthalmoscope is familiar to afternoon, and on Friday afternoon Dr. and Mrs. Soutar everybody who is accustomed to employ that instru-ment. invite menmbers to a garden party and pastoral play at To determine whethor tlle appearance of the optic discs in Barnwood House. On Satturday exctirsions will be madle any given case is pathological, or is only some extreme to Berkeley Castle and Church. degree of what may be found withiin the limits of the phy- siological, is by no means a rare experience for even the most expert ophthalmuologist, even wlhel lie has the assist- AN EXHIBITION OF INSTRUMENTS AT THE ance afforded by the history of the ease and by tests of the COLLEGE OF SURGEONS OF ENGLAND. extent or acuity of the vision. In other words, the normal THE Annual Show of additions to the Museum of the fundus ozuli presents most variable pictures in different Royal College of Surgeons of England will be held on individuals, and may even be oplhthalmoscopically indis- July 4th and 5tlh from 10 a.m. to 5 p.m., and on July 6tlh tinguishable fromii the diseased fundus. Professor Salzer from 10 a.m. to 1 p.m. On this occasion a remarkable of Munichl has recently drawn attention once miiore to array of instrubments will be on view. The first place this wvell-kllown fact, dcescribing in -text' alnd pictures mnust be giveu to a collection wIhiich has been presented 1 Diqan7lose U71d Fekldiagnose von Geltierrkrankungenaie s dler by tlme executors of the late Lord Lister through the Papilla nervi optici. Von Professor Dr. Fr. Salzer. Munich: J. F. Lehilann. 1911. (Roy. 8vo, pp. 18-; 29 illus. M. 1.50.) President, Sir Rickman Godlee. It comprises surgical 1447 JUJNE 22, 1912.] 229STATE SICKNESS INSURANCE COMMITTEE. 1912.1 - (URDIGAL JOURNAL 1447~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ instruments, appliances used in early researches, records and tracings of experiments, drawings, and pathological THE INSURANCE SCHEME. specimens. The manuscripts of published papers and the clinical records which were bequeathed to the College are STATE SICKNESS INSURANCE COMMITTEE. now in the library. A fine collection of obstetrical and Thirteenth Meeting. gynaecological instruments, formerly. the property of the THE thirteenth meeting of the State Sickness Insurance Obstetriccl Society of London, has been presented to the Committee was held on June 12th. College by the Royal Society of Medicine. This collection Mr. T. JENNER VERRALL was in the chair, and tlle includes a great part of the celebrated series exhibited at a members present were: England and Wales: Dr. R. M. conversazione held by the Obstetrical Society at the Royal Beaton (London), Dr. John Brown (Bacup), Dr. T. M. College of Phy'sicians in' 1866. Some' foreign pelvimeters Carter (Westbury-on-Trym), Dr. R. E. Howell (Middles- of beautiful workmanship deserve inspection, but their brough), Dr. S. Hodgson (Salford), Miss Frances Ivens, M.S. (Liverpool), Dr. Constance E. Long (London), actual utility seems questionable. The modern obstetrician Mr. James Neal (Birmingham), Dr. F. H. Oldham will view' almost with ani'usement the huge' cephalotribes (Morecambe), Dr. James Pearse (Trowbridge), Dr. E. 0. coilected from; foreign parts fifty years since. It was Price (Bangor), Dr. Lauriston E. Shaw (London), Dr. questioned then, even by Barnes and Braxton Hicks, W. Johnson Smythi (Bournemouth), Dr. D. G. Thomson whether Britislh instruments were superior or inferior to (Thorpe, Norfolk), Dr. D. F. Todd (Sunderland), Mr. the heavy weapons employed in feticidal operations abroad. E. B. Turner (London), Dr. A. H. Williams (Harrow The Obstetrical collection will be most instructive to the on the Hill), Mr. D. J. Williams (Llanelly), Mr. E. H. visitor to the Annual Show, as it marks what progress Willock (Croydon). Scotland: Dr. J. Adams (Glasgow), has been made since 1866, above all in Dr. Bruce Goff (Bothwell), Dr. R. McKenzie Johnston Caesarean section. (Edinburgh), Dr. J. Munro Moir (Inverness). Ireland: Mo3t significantly, it will be on view side by side with the Dr. Mark Cahill (Belfast), Dr. J. S. Darling (Lurgan). instruments actually employed by Lister. Ex Officio: Dr. J. A. Macdonald (Chairman of Council), Dr. E. J. Maclean (Chairman of Representative Meetings), Dr. E. Rayner (Treasurer). A part of the proceedings of this meeting, including the BELL V. BASHFORD AND THE " BRITISH MEDICAL interview which the Committee had, as a deputation, with JOURNAL." the Chancellor of the Exchequer and the Insurance Com- THE report of the trial of the action brought by Dr. missioners, was reported in the JOURNAL of June 15th, Robert Bell against Dr. Bashford, Director of the Imperial p. 1384 et seq. Cancer Research Fund, and the British Medical Associa- We are enabled to publish the following account of the tion is concluded in this issue. The summing-up of the remaining proceedings in anticipation of the confirmation Lord Chief Justice, the judge who tried the case, is of the minutes. The minutes of the last meeting of the Committee, held published in full (page 1461) from the shorthand writers' on June 7th, 1912, were confirmed, and signed by the notes. The jury found a verdict for the plaintiff, with Chairman as correct. damages of £2,000. SUBCOMMITTEE OF ADVISORY COMMITTEE FOR DRAFT REGULATIONS. THE University of Liverpool will hold a special convoca- The Chairman reported that at the meeting of the tion on July 26th, during the Annual Meeting -'of the Advisory Committee the previous day it had been sug- British Medical Association, at which honorary degrees gested that a small medical subcommittee, consisting of, will be conferred. say, ten members, half to be appointed from the medical members of the Advisory Committee selected by the Commissioners and half from the members of that Com- DR. C. J. MARTIN, F.R.S.. Director of the Lister Institute miittee appointed by the Association, should be appointed of Preventive Medicine, London, has been elected an to assist the Commissioners in the actual drafting of honorary member of the Royal Society of New South regulations, and that he understood that such subcom- Wales. mittee would commence its work after the resu-lts of the recent meeting of the medical section of the Advisory Committee had been considered by the Advisory Committee A MEMORIAL service in honour of Robert Kochl was as a whole. recently held in a temple dedicated to him, which has been The Committee resolved as follows: erected at Tokyo. The temple owes its origin to the pious That the following meml)ers be suggested to the Insturance care of Professor Kitasato. Among those present at the Commissioners for appointment upon any subcommittee of service the widow of Robert the the Advisory Committee appointed to assist the Commis- were Koch, German sioners in drafting regulations under the Act: The Chair- Ambassador, and a number scientific men and Government man (Mr. Verrall), Dr. R. M. Beaton, Mr. James Neal, officials. Dr. D. F. Todd, Mr. E. B. Turner. INCOME LIMIT. IN order to facilitate the arrangements, it is very In the course of a discussion which took place during desirable that members intending to be present at the the meeting of the Committee before the deputation that Annual Meeting at Liverpool should fill in and dispatch day, it was agreed that if necessarv the following elabora- the form printed at page 607 of the SUPPLEMENT of June tion of the Association's demands witlh regard to the 8th. On the receipt of the form duly filled in, railway income limit should be placed before the Commissioners: vouchers enabling members and their friends to travel to The claim is that whenever an Insurance Committee Liverpool and back at the rate of a single fare and a third shall make arrangements with medlical practitioners to provide insured persons with ordinary medical attendance will be supplied. at a specified capitation grant per annum, or at a fixed rate per visit, notice shall be given to each insured person A BAZAAR in aid of the Hospital for Women and that his right to participate in the arrangements made on Children, Harrow Road, is to be held at the Knightsbridge his behalf by the Insurance Committee is liable, at any Hotel on June 27th and 28th. The first day's proceedings time, after due notice, to be withdrawn, should he, if will be opened by H.R.H. Princess -Henry of Battenberg, called upon to do so, fail to make a declaration carrying who will receive purses presented by children, and the penalties under the Act which satisfies the Committee that second day's proceedings by the Right Hon. the Lord his average income from all sources does not exceed £104 Mayor of Ljondon. On each day the doors will b~e open per annum or such lower sum as may be agreed upon from 2.30 p.m. to 10 p.m., the prices of admission at between the Insurance Committee and the local Medical various hlours ranging from 5s. to is. on the first day, and CDommittee, and that if such right be withdrawn the from 2s. 6d. to is. on the second day. The Chairman of the insured person will, in lieu thereof, receive from the Com- Committee of Organization is Mr. Ernest Lanee mittee to assist him in making private arranlgements for