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books, &e. The late Sir James Risdon Bennett was at one time his pupil. He was also the senior of the two first honorary secretaries of the Sheffield Literary and Philo. Correspondence. sophical Society, founded in 1822 and still flourishing. He II Audl alteram partem." died of aneurysm of the aorta on April 8th, 1830, after having I been previously operated on for aneurysms of both femoral THE QUALIFICATIONS FOR HOSPITAL arteries, by his friend, Mr. Hodgson of Birmingham. " Thus," says Snell, "a life of considerable promise was cut short at " APPOINTMENTS. the early age of 36." To the Editor of THE LANCET. I The following paragraph is copied from the eighth annual report of the Sheffield Literary and Philosophical Society, SiR,-It surely is an anomalous, if not paradoxical, presented January, 1831 :- position in hospital ethics that in connexion with two London advertisements should The committee cannot omit to allude to the heavy loss sustained hospitals contemporaneously appear by the society in the death of one of its vice-presidents. The late Mr. containing these conditions for candidates for positions on Thomas Waterhouse had not only proved a valuable supporter of the their staffs. The West London Hospital advertises for a institute in the several capacities of secretary, member of council, and contributor of papers, but is entitled to especial and honourable mention who must be a Member of the of physician Royal College in this place as one of the founders of the society, who zealously Physicians of London, though a member of the surgical staff took up the cause, when many were lukewarm or desponding, and per- be a Fellow of the Irish or Scotch On the severingly cooperated with heart and hands in its first establishment may colleges. subsequent proceedings. other hand, at West Ham the reverse of this holds good ; the and obligation does not apply to the medical, but only to the It is of interest to add that the bust was executed in 1831 the able Edward brother of surgical staff. That is to say, the qualification which is by young sculptor, Law, Dr. who was for to both the good enough for the one in surgery is rejected by the other, Joseph Law, many years physician and and that that in medicine which is accepted by one hospital General Infirmary and the Public Hospital Dispensary, is ignored by the other. Sheffield, and whose portrait now hangs in close proximity to At the recent dinner of the Irish Medical Schools and the marble bust of Thomas Waterhouse. Graduates’ Association Sir Alfred Keogh, ex-Director- T nm Cir T7nnT’Q -f..it.h-fn1!’17 General, A.M.S., spoke strongly on the absurdity of this R. J. PYE-SMITH, Treasurer to the Sheffield anomaly, and an object-lesson was afforded on the same Medico-Chirurgical Society. occasion, when among other distinguished Irish graduates and were . diplomates present the Director-General of the Army Medical Department, the ex-Director-General, and THE MIAN MIR EXPERIMENTS. Sir Thomas Gallwey, at present holding the chief command To the Editor of THE LANCET. at Aldershot. It is not so long since the post of commandant article of Oct. 26th with a at Netley Hospital was held by a distinguished Irishman, Sir SIR,-In your leading dealing Edmond Townsend, and successive principal medical officers report by the committee appointed by the Government of in Egypt have been Irish graduates. India to inquire into results obtained by anti-malarial experi- ments at Mian note that the has been one of Anyone not in the secret as to the motives which Mir, you subject That this is so is due to the fact under animate hospital boards of management may be excused if controversy. that, in his ignorance he does not quite understand why the lives the influence of ieputed failure in that locality of methods held to be of in other of the the Govern. of His Majesty’s sailors and soldiers are of less importance utility parts world, ment of India has failed to make its local than the patients in public institutions in this country, or, to governments understand that the of anti-malarial measures go even further than this, that His himself should regarding Majesty would have its and it without be rash enough to trust his royal person during his tour seriously approval ; goes saying that in the absence of such declaration of no local throughout India, as Prince of Wales, to the custody of an policy would consider itself safe in Irish graduate, now one of his medical advisers-Sir Havelock government directing any of its own or those of local bodies Charles. Again, one is at a loss to explain how the present appreciable part funds, Governor-General of India has had all through his Viceroyalty under it, to this end. Hence there has occurred a paresis of in a which in natural course of another Irish eraduate as his personal adviser. efforts country should, the have been the first to the benefit of Ross’s I address this letter to THE LANCET, inasmuch as it has events, reap This condition of affairs has been received taken a broad and liberal view on this question. It is discovery. always the with The to be hoped that the time is not far distant when an end will by profession yearly increasing surprise. of the committee was therefore a convenience be to such exclusiveness through the advent of a State appointment put of the usual official of in licence which will entitle the holder to become a candidate type-permitting justification or, its the of the of for any public appointment in the United Kingdom. absence, securing possibility strategic retreat. The the into so a I am, Sir, yours faithfully, enquiry implied entering great mass of details that to have to Mian Ax EX-PRESIDENT OF THE IRISH MEDICAL SCHOOLS’ petty managed inspect examine travel to and from Simla, and com- AND GRADUATES’ ASSOCIATION. Mir, witnesses, pile the report, in the short time allowed, must have left the London, Nov. 29th, 1910. committee little time to consider its conclusions ; and it is certainly here that the weak point of its labours is evident. WHO IS HE ? In the face of knowledge that mosquito-reduction methods have elsewhere successful, and being of that To the Editor of THE LANCET. proved opinion SiR,-The excellent photograph which appeared under the committee has marshalled the local physical conditions as above heading in Dr. Thomas Bushby’s letter in THE LANCET presenting unusual difficulties, and as all-sufficient reasons of Nov. 26th enabled me at once to identify it as that of the why success had not been attained. It has apparently bust of Thomas Waterhouse, which stands in the library of assumed as unquestionable that efforts which it testifies to the Sheffield Medico-Chirurgical Society at the University as energetic were also discreet and were correctly carried of Sheffield. A short account of his life is given by the late out ; but seeing that these experiments were specifically of the Simeon Snell in the century history of the Sheffield Royal nature of a test of the utility or inutility of methods which Infirmary,1 from which I extract the following facts :- deeply concern the sanitary and economical condition of over Thomas Waterhouse was born in 1793, and commenced 230,000,000 of the people of India, it would have been practice as a surgeon in 1816 at Sheffield. In 1820 he reasonable for the committee to have established their was elected one of the honorary surgeons to the infirmary. correctness. Hence, from the facts as recorded by the com- He took considerable interest in the establishment of the mittee and experimenting officers respectively, I would Medical School in 1828, and contributed E110 to the build- invite attention to this aspect of the matter, as affording a ing fund. He also presented to the school his excellent simple solution of the differences of opinion which have collection of specimens of morbid anatomy, as well as arisen on this subject. The experiments were inaugurated by the Royal Society 1 Sheffield General Infirmary, now the Sheffield Roval Infirmary, in 1901 11 two demonstrate the reduction of malaria in a 1797-1897: a Brief Sketch of a Work, by John Daniel Leader, Century’s cantonment measures based the recent of F:S.A., together with Reminiscences and Biographical Notices of the by upon etiology Medical Staff, by Simeon Snell, F.R.C.S. Ed. Sheffield, 1897. this disease." The officers of the expedition were Dr. Stephens 1647 and (then) Mr. Christophers. Preliminary investigations by in the Indian Medical Service, relieved Major James ’of these officers occupied about six months. On their departure to duty at Mian Mir in July, 1903. He describes the area England, Major James, I.M.S., was deputed by the Govern- selected by Major James as "to a large extent isolated from ment of India to carry out the anti-malarial operations, and the rest of the cantonment." Yet he held that a bazaar, was in charge of this work from April, 1902, to July, 1903. 400 yards from the barracks within the protected portions, He elected to follow certain dicta of Professor Ross, as was an infective centre. As he held this opinion, it is gathered from his speeches and publications as to the difficult to understand the rigidity with which he excluded advantage of "mosquito reduction." The quotations thus the Native Cavalry Lines and the East Infantry Lines which relied upon (pp. 6 and 7 of the Report) discuss applicability were within an additional 100 yards-that is, a total of of methods, not in special, but in general, cases. The most 500 yards-of the most external of the dwellings to be pro- definite of the quotations is as follows:- tected. At the end of August he found that mosquitoes invade from a distance of of a and It is now a matter of the general experience of many investigators might three-quarters mile, that where mosquitoes abound in a house, their larvse can easily be then determined to enlarge Major James’s area by three- found at a short distance, within a few hundred yards of the house. quarters of a mile "in every direction." This would have Occasionally, where the house is isolated, and no stagnant water is in been a but some error in its immediate vicinity, mosquitoes may attack it from a greater logical sequence; occurred his distance; but this is exceptional, and in the great majority of cases, measurements, as the text of his account of his labours, and especially in towns, almost every house breeds its own mosquitoes in a of his for difference of scale- or in or in drains in the streets close comparison map 2-allowing its backyard, puddles by. with that supplied by the committee, show that had Now the average mortal would think before making a test such extension been carried out to the north, west, and east, experiment that would take several months to work out, based not only would the lines mentioned have been included but on a statement of this general nature, the first step would be the West Infantry Lines also. Both within and without these to ask the it to as as authority making define, precisely lines the possible breeding places for mosquitoes were very what is meant "a few hundred or feasible, by yards" numerous, as shown by witnesses examined by the com- distance." No reference made to "greater was, however, mittee ; and, indeed, up to date these have not been com- Professor Ross on the subject. Failing this mode of arriving pletely got rid of under Surgeon-General Hamilton’s scheme. at a at least an determination of basis, independent distance As a result, therefore, even the pools recognised by Captain should have been arrived whatever that in at, and, might be, Christophers as offering danger of invasion were not treated it to the area applying selected for operations it should have until the three months of the I fever season " (September, been observed without variation from the most external October, November) were actually at hand-a state of affairs inhabited house of the groups of dwellings to be protected. that would not have precluded adult mosquitoes having In aid of arrival at this decision there were several already taken up their abode, with ample nourishment at dis- records of observations in pre-Ross days as to distances posal, within the various houses. Again, therefore, there was of the "diffusion of malaria" substitution of that, by an absence of fixed ideas of procedure to be followed, or the mosquito for air, should at least have dictated caution. at least uniformity in method; and although doubtless in Indeed, the year preceding these experiments, Celli had interesting facts as to mosquito biology were gathered, the drawn attention in his book then published to observations experiment was useless for the sanitary end originally by Ambrosi and Riva on this subject. Moreover, previous to desired by the Royal Society as defined above. Indeed, the inauguration of the Mian Mir operations, Stephens and methods were so lacking in uniformity that it is reasonable Christophers, working in the Central Provinces, had arrived to believe that of the experimenting officers at least Major at the conclusion that the distance of a quarter of a mile was James (who was responsible for the inauguration and the commonly, and half a mile was exceptionally, the flight of longer conduct of the operations) was of opinion that Ross certain anopheles. Yet in attempting to explain his psycho- had pledged himself to the statement that, provided larvæ logical attitude towards the Mian Mir controversy, his "close" to dwellings (again distances being undefined) preference for quinine prophylaxis, and consequent absence were destroyed, no further precaution was required. It is, of adequate anti-malarial measures in India, the Sanitary however, obvious that Ross made no such statement; and it Commissioner with the Government of India, at p. 98 extraordinary that, during the years of inaction which have of his report for 1908, whilst placing stress upon the followed these experiments, this simple fact has been "few hundred yards" phrase and carefully ignoring the lost sight of by a Sanitary Commissioner predisposed to suggestion of "greater distance," would incorrectly desire it " quinine prophylaxis "-a method which the committee to be understood that this observation was not available frankly states "has not hitherto come within the range of or 1903. But for guidance in April, 1902, July, Major practical politics." It is satisfactory to find that the com- James, putting all such considerations aside, was content to mittee whilst providing for those responsible for these experi- select an area for mosquito reduction operations which itself ments a strategic retreat, by adducing the physical conditions and had not equal sides ("one mile north and south rather at Mian Mir as sufficing to account for the indifferent results over mile east and west "), and the treated area round the secured, shows no disposition to deprecate "mosquito reduc- " habitations of which also was not equal. His limit, accord- tion methods per se; on the opposite, it considers their ing to the committee, was drawn < close round the residential addition to the present quinine prophylaxis policy would quarters, no attempt being made to deal with outlying un- offer great possibilities." inhabited areas." Reference to the committee’s map shows I am. Sir. yours faithfullv. that this line abruptly excluded numerous pits and rain-fed W. G. KING, Colonel, I.M.S. (retired). depressions ; and it becomes necessary to believe that whilst on the west he considered 40 yards of treated area would suffice for the protection of external dwellings, 200 and 260 yards were requisite on the east. The position of pits and ACUTE MYELITIS AND ACUTE POLIO- rain-fed depressions, as shown on the map and described by the MYELITIS. committee as still existing, certainly would not justify this differential treatment. Within this dubious area he proceeded To the Editur of THE LANCET. to effect "mosquito reduction" operations-that is, by the SIR,—With much of the article by Dr. Bastian on Throm- abolition of pools, or by the making of them unfit by petrolage botic Softening of the Spinal Cord as a Cause of So-called for breeding by mosquitoes in the "immediate vicinity" of "Acute Myelitis 1" most observers will be in entire agree- houses (the prime point of danger as insisted by Ross), he ment, and in support of the view expressed I may mention brought about a condition equivalent to "no stagnant the recent article on Acute Myelitis in Clifford Allbutt’s water" in the vicinity, well knowing that within a "few "System of Medicine," Vol. VII., p. 645, 1910. With hundred yards" or "greater distance" there existed pools regard to acute poliomyelitis, however, I am afraid I cannot which might favour invasion from a distance. He there- now agree with Dr. Bastian’s view. All the recent work of fore conspicuously failed to take due cognisance of the dicta Landsteiner, Popper, Levaditi, Flexner, and Lewis points to which it is professed afforded him guidance. It is remarkable the fact that poliomyelitis is an infective disease giving rise in contrast that Dr. Balfour,l in his excellent work at to a lymphocytic infiltration of the tissues and walls of the Khartoum, which has recently been eulogised by Lord vessels of the spinal cord. This perivascular exudation, Kitchener, found no similar difficulty in following Ross’s though it may fall with special incidence on one portion of meaning. Captain Christophers having returned from Europe 2 Scientific Memoirs, Government of India, No. 9. 1 Second Report Wellcome Research Laboratories, p. 21. 1 THE LANCET, Nov. 26th, 1910, p. 1531.