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solutions intrathecally I had no experience of solutionsstronger than 2 per cent. in the skin, and that suchsolutions, in the absence of adrenaline, " cobefrin,"&c., were vaso-dilator. The solutions used by mystudents, in the practical classes, are 0-1 per cent.solutions of procaine and percaine, with and without0.001 per cent. adrenaline.As suggested by Dr. Harris, I have since examined

the effects of 5 per cent. procaine (adrenaline-free)both in and under my skin. Apart from the stretch-ing of the epidermis by the solution no blanching isproduced, and considerable vaso-dilatation - follows.I have checked these observations on another subjectand a dental friend assures me that similarly 5 percent. procaine solution without adrenaline causes

no vaso-constriction and only a brief anaesthesiawhen injected into the gum.

I am, Sir, yours faithfully,A. D. MACDONALD.

Department of Pharmacology, The University,Manchester, April 15th.

" WHAT IS OSTEOPATHY? "To the Editor of THE LANCET

SIR,-Even the more vocal of the medical opponentsof osteopathy are prepared to admit that certainconditions of strain or fixation, which are often notdemonstrable on X rays, exist in the lumbar area.These joint conditions are sometimes accompaniedby pain along the sciatic nerve or in the lumbarmuscles. That a similar condition may exist in thecervical and upper thoracic areas and be accompaniedby pain in the arm or shoulder has received attentionin recent papers. It is equally an accepted fact thatthese conditions often yield to manipulation. Nowthe American-trained osteopaths are exceedinglyskilled in the quick specific movement of spinaljoints, and because of constant practice and teaching,their dexterity makes the efforts of the averageorthopaedic surgeon look clumsy to a degree. Becauseof this dexterity the osteopath obtains much moresatisfactory results in the long run, with less dis-comfort to the patient, and without having recourseto anaesthesia nearly so often.

It is accordingly submitted that even if all theother conditions which have benefited by. osteo-pathic treatment are discounted, the osteopaths havecontributed something to the art of medicine, and itbehoves the medical profession to see that thoseamong their members who set out to do manipulativework acquire " a good pair of hands " by practice,and by taking every advantage of opportunities ofseeing the work of experts at manipulation. It is

just as foolhardy to entrust the manipulation ofcervical vertebrae to a general surgeon as it is to

expect a radiologist to be able to perform a Wertheimhysterectomy.

I am, Sir, yours faithfully,W. HARGRAVE-WILSON.

AMBULANCES AND STRETCHERSTo the Editor of THE LANCET

SiR,—The question of standardising the size ofBritish ambulances is one which I think deservesconsideration. At present ambulances may be dividedgenerally into short and long. The short type (mostcivil ambulances) is capable of carrying only shortstretchers-i.e., those with folding handles-while thelong type is capable of carrying stretchers with fixedhandles such as the Army and St. John Ambulancestretcher. In times of national emergency it wouldbe most desirable that all ambulances should becapable of carrying any type of stretcher ; otherwise

during an air raid, for example, St. John Ambulancemen, having collected a casualty, might find thatthey could not load him straight into the ambulancewhich had driven up. Delay is undesirable on suchoccasions, and on all occasions the less a badly injuredman is shifted about the better.As the vast majority of British stretchers to-day

are of the long type-Army, Air Force, St. JohnAmbulance, and so forth-it appears desirable to

encourage the production of long ambulances only,which could be relied upon for the rapid collectionof all casualties at home or abroad. It is understoodthat the London County Council have already movedin this matter and our latest naval ambulances arelong. I feel sure that if this aspect of the matter wasbrought to the notice of firms concerned, they wouldadvise their patrons accordingly when future orderswere being considered. And as other countriessuffer from the same difficulty, this should become a.matter for international consideration ; for there canbe no question of international rivalry here.

I am, Sir, yours faithfully,R. A. W. FORD,

Surgeon-Commander, Royal Navy.

TREND OF THE POPULATION’1’0 ine 1!.iatwr OJ ’I HF, .uANUEl’

SIR,-Please allow me to make the followingcomments on the valuable article by Mr. C. A. Gouldon p. 944 of your last issue. (1) The populationof England and Wales has indeed been ageing since-1870, but let no one overlook that this was due to.reduction in the mortality of the young. (2) Mr.Gould says that the population will attain a maximumof 40,800,000 about the year 1944 ; yet the Registrar-General takes it to be more than that already. (3) Itis not a serious matter that trade should decline ifthe amount of it per inhabitant increases. (4) Thesplendid diagram usefully shows that, on the worst.estimate, the workers will outnumber the childrenand aged for a century; so Great Britain shouldcontinue to have a high standard of living althoughit may cease to be a dominating power. I mayadd that if our farms become larger they will moreeasily compete with the food from the sparselypeopled countries, and if wages rise there will bean increasing demand for home-grown produce.Mr. Gould ignores the possible effects of migration,but a relatively high standard of living would drawfrom the Continent as many young workers as wemight choose to admit.

I am, Sir, yours faithfully,B. DUNLOP.

PAGE NUMBERS ON REPRINTS1’O M6 liJa’btor oj ’l.HE LANCET

SIR,-From time to time I am the fortunaterecipient of reprints of papers which have appearedin various periodicals. May I call attention to a notuncommon fault in these reprints ? It is the omissionof the number of the first page of the article. I havebefore me a reprint from a well-known scientific

publication. It gives the name of the journal, thenumber of the volume, the number of the issue, andthe date of publication but no page. In a countrylike this it is impossible always to get into touch witha library to supply the omission, and in my editorialwork I find the impossibility of inserting the pagenumber a difficulty in carrying out properly theHarvard system of references.

I am, Sir, yours faithfully,JAMES H. SEQUEIRA,

Editor, East African Medical Journal.