JULY I3, 19291 A. M. DRENNAN: IMPACTED CYST IN THIRD VENTRICLE OF BRAIN.

T _Fs-"7rPi S0 mX0^i: ,+ ,,; j; 0:,! ft,;,i,0'-t'¢if;,''R.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~........_ E __ 11__ E S_s _M, '~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.. ...

FIG. 3.-Low power view (x 50) of part of cyst wall of Case i. The homogeneouscolloid content is seen bounded by the thin wall of the cyst. A folding back of thewall is seen with part of it cut tangentially.

FIG. 1.-Horizontal section of brain of Case ii. Thethird ventricle is occupied by a rounded cyst, filledwith colloid material; the lateral ventricles aremoderately dilated. The transverse groove is a cutmade into the brain at iiecrop)sy.

.5.

a

t...

FIG. 2.-Low power view (x 50) of part of cyst wallof Case ii, to show colloid content with a few cellsin it, a layer of lining cells cut tangentially, andpart of the thin wall with lining of flattened cells.

B. PICKERING PICK: MENINGOCELE.

Note absence of greater part of sacrum and the wlhole of the coccyx.The cyst occupied the resulting space.

C. R. NUNAN:__,

FIG. 1.-A, Left kidney. B, Right kidnev. C, Suprarenal gland.D, Enlarged lymphatic gland fotund near the kidneys.

RENAL ABNORMALITY.

FIG. 2.-Right kidnev cut open, with a glass rod passedthrouglh the ureter and the pelvis.

CO -JULY I3, -1929] hME ORANDA. ['MUD1CALJOU3U

as the cricoid and- also below the clavicle; the* sterno-mastoidmuscle was displaced outwards.- The radial pulse could not befelt. The left pupil was slightly dilated, and there was someproptosis. Pain was felt at the site of the tumour. An x-rayphotograph showed a tunmour occupying a big area in the upperchest, . but on attempting, to screen --him he collapsed. TheWassermann reaction was negative.As the tumour was growing so rapidly and appeared likely

to burst, in, spite of his septic condition it was decided to do anlimmediate operation on October 16th.Operation.-The whole of the,right arm was carefully bandaged

with a thick layer of wool. An incision.was made along the.sterno-mastoid to, join a transverse incision along the clavicle. The sacwas extremely thin,.but an attempt was made to dissect it down,when it was found to extend to the left side and under the leftsterno-mastoid. The middle third of the clavicle was resectedsubper-iosteally, and it was then seen that the tumour arose fromthe subclavian artery. The sac ruptured, and the bleeding was verysevere; this. was stopped by the. finger used as a plug to close theopening. The common carotid was exposed and tied, and the vagusnerve demonstrated. There was no part of the subclavian artervwhich could be tied. Traction was now made upon the commoncarotid, the pleura pushed downwards, when the innominate arterywas exposed. No great difficulty was met in passing. the aneurysmneedle, and the artery was tied securely with two ligatures ofkangaroo tendon, side by side. This immediately stopped allhaemhorrhage. The sac was then removed as far as possible, andthe adherent portion sewn over. The clav-icle was replaced, theperiosteum sewn over it and joined by kangaroo tendons.The patient left the theatre in good condition. During the night

and the next two days the right side of the head was obviouslycolder, than the, left; capillary circulation in the hand was presentthe next day, and the arm kept warm. and comfortable.He ran an intermittent temperature and developed bedsores and

some suppuration in the wound; the centre piece of the, clavicleseparated. His mouth gave a gpod deal of trouble, and the rootsand all teeth were extracted. Later he developed an empyema onthe right side; a rib was resected, and the condition healed inthree weeks.He was discharged from hospital on April 10th, rapidly gaining

weight and looking well.I have to thank my colleague Mr. Cecil Burnett for -his able

assistance, and Dr. A. Thomson, the house-surgeon, for skilfulanaesthesia in a poor subject for a long operation.

MEDICAL, SURGICAL, OBSTETRICAL.RENAL ABNORMALITY..

(With Special Plate.)APA.RT from the pathological condition found, the followingcase appears to be interestinig as an example of a physicalstigma of degeneration in a congenital -mental defective.

'The patient was a mentally deficient lad, aged 20. He wasoperated on for acute appendicitis, and died, leaving a faecalfistula at the site of-operation. A post-mortem examinationwas made, and the followin-g are notes having bearing ontho condition found.

Havinig failed to find the kidnleys in their niormiial situa-tion, it was decided to explore a pelvic tumour occupying aposition in the mid-line- below the fifth lumbar vertebra.This tumour was retroperitoneal anid gave a doughy resist-Lnce on palpationl. Wlhen the peritoneum'ivwas ilncised therewas no difficulty in enucleating the tumour, but owing to asingle attachment it could niot yet be removed fironii thebody. This attachment was traced downwards, and turnedout to be a ureter. About two-ilches fromll tlhe bladder thisureter gave offf a brarreh from its-left side, w-hich, when itwas traced upwards, was founid to enter a scarcely developedleft kidney which was lying againist the much larger rightkidney (see Special Plate, Fig. 1). Tlle ureteis tliereforejoined and had a common entry inito the bladder. Bothkidneys were now removed and examined macvoscopically,microscopically, and bacteriologically.Right Kidney (weight 238 grams).-Nodular elevations

filled witlh pus weree present oIn the sulface. On being cutopen (Fig. 2) the kidney was found to consist mainly ofabscess cavities witlh very little normal kidney substance,anld no macroscopic differentiation between cortex andmedulla. The pus contained B. coli communior and Strep.faccalis. Sections showed some normal kidney substance,

enormous leucocytic infiltration of the kidney, and a strepto-coccus; bacillary forms did not show up on sectioln.Left Kidney.--Except for its size and its weight, which

was 17- grams, the condition of the left kidney was similarto that of the fight.The faecal fistula communicated with copious pus in the

appendicular region. There did not appear to be anydirect connexion between this and the kidneys.Didsbury, Manchdster. C. R. NUNA1i, M.B., D.P.H.

INTRAVENOUS ANTITOXIN IN AN OUTBREAK OFSCARLET FEVER IN A PUBLIC SCHOOL.

SCARLET fever of a severe semi-septic type broke out amongthe boys of a public school in Februariy, 1929. The firstnine cases were treated by ordinary expectant methods andwithout antitoxin. The course of the disease in these gaverise to much anxiety, and complications were frequent, asnoted in- the table below.Then occurred the worst case of all, in a boy aged 13,

who, kheii seeln by me about the seventh day of the disease,had already a severely ulcerated throat, enlarged andtenider cervical glands, double acute suppurative otitismedia, and acute miiastoid suppuration on one side. Hewas given 10 c.cm. of scarlatinal antitexin intravenouslv,unfortunately without effect' at this stage. The sepsisdeveloped into pyaemia with multiple purulent arthritis,involving incisions into the hip-joint, the elbow-joint, andboth ankle-joints, and the double mastoid operation. Theserum was given too late in this instance, and the dose wastoo low for such a severe case.The subsequent patients, sixteen in number, were treated

early in. the acute stage withl antitoxin intravenously,according to the -technique. whicih I have previouslydescribed.1 In these sixteen cases the acute stage, thoughapparently of the same sharp type as the others, wasarrested within twelvo to twenty-four hours of the injec-tion. Further, no desquamation occurred; the complica-tions were limited to mild adenitis in one patient, wlhoreceived antitoxin on the fourth day of disease, and oniesimple hordeolum. All the sixteen patients were allowedup within a week, and were discharged from isolation inabout'a fortnight's time. All were boys between the agesof 12 and 18, except for one. master aged 49. All receivedthe ,injections within the first four -days of their disease,generally on the second or third d'ay.No ill effects were noted from the serum administration,

although one boy had a moderately severe rigor, and twohad hyperpyrexia for a few hours after the inijection. Inone case intravenous serum appeared to be contraindicatedowing to a history of Ilay fever. In this case an intra-dermal test injection of 1 in 10 dilution of the serum wasperformed, and it did not produce any reaction. Accord-ingly the usual dose, 10 c.cm. of serum, was injected intra-venously, and no ill effect was noted.The following table gives particulars of the complications

noted in this interesting series.

SCARLET FEVER COMPLICATIONS.Nine Cases not treated with Antitoxin.

Suppurative otitis media with persistent otorrhoea... 2Non-suppurative otitis media ... ... ... 2Albuminuria or nephritis about-third week .. 7Empyema of maxillary antrum and frontal sinus 1.Dacryocystitis ... .... ... ...

Pneumonia. ... . ... ... ... ... 1Jaundice ... ... ... ... 1Adenitis ... ... .... ... 7Nasal discharge . . 6Desquamation ... . .. ... ... ... 9

Sixtcen Cases treated with Intrarenous Antitoxin.Adenitis ... ... ... ... ...1Hordeolum. . ... . 1

The only case omitted from the table is the one pre.viously noted of severe pyaemia, in which the serum wasgiven too late to be effective.The injections, with the exception of the first two, were made by

Dr. Hubert L. Ellison, to whom I am indebted for detailed informa-tionl as to the course of the outbreak.

H. STANLEY BANKS, M.D.Glas., D.P.H.,cMedical Suiperintendent, Isolation IIospital

and Sanatorium, Leicester.-

X Banks and MacKenzie': Lancet, 1929, i, 381.

JULYr 3, 1929] SOME DISEASES OF TiHE JEWISH RACE. [Tz 51

ANTIMONY TREATMENT OF ACNE ROSACEA.HAVING recenitly denmonstrated to my-own satisfaction, andas far as is possible with the limited number of cases at my,disposal, the great benefit to be derived from the use ofantimony in chronic and subacute skin conditions, I recordthe following clinical details.A woman, aged 36, came to me on March 18th, suiffering from

acne rosacea. She had a patch on each cheek about two inchessquare, m-uch thickened and indurated, and very congested and redover the surface, with numerous indurated papules, especially alongthe lower edge. She gave a history of having been treated at aLondon skin hospital for six months without much improvement,and thinking that most of the uisual remedies would have beentried, I decided to put her on antimony tartrate 1/16 grain in halfan otunce of water three times a day after meals. The followinglotion was applied night and morning:

Sulph. praecip.Puilv. zinci oxidi ... ... ... ... aa 2 drachmsMag. carb. levisGlycerini ... ... ... ... ... ... 1 oz.Aquae. ... ... ... ... ... ad 8 oz.

There was a very marked improvement in a week, which steadilywent on till April 22nd. when the whole of the skin of both cheekswas quite clear, except' for one small papule low down on the leftside, only noticeable on careful ex'amination. On April 29th theskin was all clear and treatinent was discontinued.

Believing that the above r-esult was due to the use ofaantimoiiy, I have since tiied it on two cases of furunculosis,one of which was affecting the hair roots of the back of thene6k and Causng a condition similar to sycosis; in both casesthe result was markedly an-d definitely belneficial.A man came to see me on January 15th with several boils on his

neck, combined with fairly severe seborrhoea of the scalp. At, firstlie wvs treated with lotio plumbi and collosol- manganese injectionsevery four days, coinbined with activeo treatment for the seborrhoea.The improveiment, if any, was very transient, and soon he began tolose one after another of his finger-nails with a kind of subacuteparonychia ungualis. On Febiruary 18tlh there appeared to be noimprovement, 'and he was put on biniodide lotion 1 in 2,000 andcollosol. nanganese every two days. There,was a slight improve-nment by March 27th, when I decided to try antinmony tartrate1/16 grain thrice daily. Oni April 3rd there was a definite impr-ove-ment; on' April 8th he was better still, all the boils and papuleshavinig quietened down, the fingers having improved, and no freshpoinlt of inflammation having developed. On April 24th, not havingseen iim again, I wrote asking how he was, and he 'phoned tosay lie was going 'on fainously. I have not seen him since.

I have also hiad good riesults in cases of ulcerated legswhen the surrounldinig skin was thickened, red, andindurated; tlho adminiistration of antimony caused ani all-round improvement, anid a miiore rapid healiing of tlhe sores.

()atford, S.E. L. W. BAIN.

SOMIIE DISEASES OF THE JEWISH RACE.A SYMPOSIUMi Ol some diseases of the Jew ish race wa.s heldby the Lonidon Jewish Hospital Medical Society on June13thi. Dr. A. GOODMAN LEVY was in the chair.

Sir HUMPHRY IROLLESTON, in openDilg the discussioni, saidthat diseases had been described as riacial diseases of theJews for no better reasoi) than tllat the first recorded cases ihappened to have occur-red among Jews. Such was thecase with the conldition kniown as dystonia musculoruindeformans, also known) as Oppenheim's disease. But thelewere diseases which, if they did 'lot appear exclusivelyamong Jews, were sai(l -to occur more frequently amonigthem; thrombo-angiitis obliterans was a case in point. Ithad, recenitly beeni suggested that this disease was oni thedecrease among Jews and oIn the increase amuong Gentiles.It was possible that the stress laid on the racial nature ofthis affection had led to its being overlooked when itoccurred amonig Genitiles. Accordinig to Telford andStopford the alleged racial character of this disease wasthe result of a " topographical " accident. A differentcourse for the disease in Jews arid Gentiles respecti-ely hadbeen claimed: it was said that its course iln Jews wasearlier and more severe; but the opposite view hlad alsobeen adv.aInced. On the question of amaurotic familialidiocy he poinited out that there were a series of allied

conditions of which amauirotic familial idiocy and retinitispigmentosa were the extremes, the first occurring early inlife among Jews and the latter coming on much laterin the case of both Jews and non-Jews. Both obesity anddiabetes were relatively common in Jews, and it had beensuggested by Joslin that Jews got diabetes because theywere fat, and they were fat because of dietetic excess. Butit must be remembered that Gaucher's and Niemann'sdiseases, which were disturbances of f-at metaboliim, wereprobably more frequent among Jews. Acromegaly had alsobieen said to be mole common among Jews, and anterior lobepituitarism as a feature of the Jewish race was compatiblewith Keith's contention that the special effects of pituitaryactivity were best seen in the Caucasian type. ThatGaucher's disease was regarded as being specially commonamong Jews was probably due to the accident that it wasextensively investigated at the MouInt Sinai Hospital.Niemain's disease, wlhich was probably a more severe typeof Gaucher's disease, appeared to be more frequent among,them-if one could argue from the fifteen cases of thisdisease which had been reported. It probably exemplifiedthe rule suggested by the relation'slhip of amaurotic familialidiocy and retinitis pigmeentosa-namely, that in theJewish race there was a constitutional factor which deter-minated ani earlier onset and a more severe form of certaindiseases. On the incidence of cancer, the recent work ofSourasky had shown that whilst the total canicer mortalityamong Jews corresponded fairly with that of the countriesin whiclh they lived, there were some (lifferences in tiledistribution of these growths, thouglh these were probablydue to the Jewish mode of life rather than to a racialfactor. Tuberculosis had be-n regarded as rare amongmembers of this race, but according to Feldman and othersthere was a great difference in their mortality and mor-bidity rates. Jews appeared to have a definite resistancet) tubercUtlois infectioin, wlich was perhaps partly to beexplained bv theiir sobriety as a race. There seemed to beno sp)ecial plredilectioll for skin diseases anmong Jews.Mr. A. H. LEVY, speakinig of amaurotic familial idiocy,

pointed out that it was wrong to regard the disease as aspecifically Jewish on,e. Well-authenticated cases in non-Jewish infants were on record. Two such cases had beenreported firom Londoni, one by Mr. Leslie Paton and theother by the speaker. The etiology of the disease wasmost puzzing; consanguinity anid mental instability in thefamily of one of the p)arents had been- blamed. Verv littledefinite was known beyond the fact thlat the disease wasfamilial in more senses than one. it appeared from arecent genealogy that the disease might establish extensiveramifications in a family, appearing in the offspring of anormal sister of victims of this affection. Another clharac-teristic was that the disease miglht occur in only a sinoglemember of a family. The speaker had seen a case whereone of twins had died of the disease, wjhilst the othershowed n-o sign1s of it. The disease was not present atbirth; it appeared at about the age of 3 months, andsteadily progressed towards a fatal. termination, usuallyby the age of 2. Wlien fully developed Sach's symiiptom-tetrad waus present: the ty-p)ical macular appearance-acherry-red spot surrouinided by an area of milky haziness-blindness, idiocy, anid paralysis. Pathologically the diseasewas definitely a degeneration of ganglion cells, not only ofthe retina but of the nervous system throuighout, ev-eninvolving the sympathetic. The appearance of the retinawas striking: it was normal except for the completeabsence of normal ganglioIn cells.: From the racial pointof view there was also some interest in juvenile and inadolescent cerebro-macular degeneration, diseases wlichwere generally regarded as being allied to amauiroticfamilial idiocy. In the speaker's opinion the conditioniswere not at all allied. T'he juvenile and the adolescentaffections 'had no predilections for Jews, and should not beregarded as later and milder forms of the infantile diseaw-;the patlhology apl)eared to be quite different, the firstgroup being in all probabiliWy inflamnmator and the in-fantile form degenerative. Mr. Levy also touched on thequestion of the allegedl greater frequenlcy of glaucomaamong Jews, wJhich h1 eould iiot substantiste from hisexperience, and on the inlcidence of cataract, whiich was

Jvr3Y 13, 19t9] ~ ~~ ANN*JAf~ -iIEeTIiNG -AT' NOHEBTER~~~ - tHA~JOUE"L&

NINETY-SEVENTH ANNUAL MEETING

of the

Brihish Medical Association.

MANCHESTER, 1929.HE ninety-seventh Annual Meeting of the Britishi Medical Association will be

held in Manchester this month under the presidency of Mr. Arthur H. Burgess,F.R.C.S., Professor of Clinical Surgery in the Uniiversity of Manchester, wlhowill deliver his address to the Association, on "The Debt of Surgery to tlhe

t Ancillary Sciences," on the evening of Tuesday, July 23rd. The sectionalmeetings for scientific and clinical work will bs1held, as usLial, on the three

m following days, thie morning sessions being" giveii ul) to discussions a-nd the

. reading of papers, and thie afLernoons to demiionstrations or visits of inspection.-.The-Annual Representative Meeting, for t.le tra%nsaction of .medico-politicalbusiness, will begin on the previous Friiday, July l9ath, at 9.30 a.m. Tlheprovisional programme for the nineteen Scientific Sections was publislhed inthe Stupplem&ent to our last issue. On the last dlay of the Annual Meeting(Saturday, July 27th) there will be an excursion lo Coiwyn Bay. We

1752. pNCblish below the fifth of a series of descriptive and hiis orical not

on Manchester and neighbourhood written for the occasion by Dr. E. M. Brockbank.. The first articleappeared on December 1st, 1928 (p. 1003), the rsecond on January 26th, 1929 (p. 167), the -third on

April 27th (p. 781), and the fourth on June 8th (p. 1051).

MEDICAL EDUCATION IN MANCHESTER.THIs subject is fully (lealt witlh in the account of thefaetilities for education-primary, seeondary, and uni-versity-in the cities of Manichester" and' Salford whichis given in the Ilook of Manchester and Sallord speciallyprel)ared for the miieeting. A brief outline of the histoiyof, awil arranigemellts for, medical education may, however,be given here withl-oult, perhaps, detract-inig fromii the interest --of tile fuller accounit,especially as the Uni-vcrsitv of Manelhesterwas tlie fi rst oif theliTh)iCI'fl i liversities.The first e-ent in thedevelopnment of theMAtancheister RovalSchool of Medicineii-as thc fo)undationl of | -theo Manchester La-firmar-y as it w astlheti ca.lled, in 1752.Tfhei .eln';al studentsof thle distiict niiitil ithat time lhad ieceivedSoMe years of theireducatSion fromn theplh)ysi6aiiiii 01 suigeonto whoni they wereo..apprenticed, and hadto s5)Cii'd somiie monthsin London, Edi.- THE MANCHESTI

buirglh, Glasgow, Aberdeeni, or Dublin befoi e they couldqu-alify for exam-inlation Jy- the licensing bodies of thesetowiis. No lectures niim-iedical subjects or demonstiationsont aniiatomiiy wer'e given (outside- ILondon oi south of theBoider until about 1781. The conception and foindation ofthie inXfirmarT is to he atti-ibuted on the medical side to Mi.Chailes White. In 1757 the fiist rudiments of our hospitalteachinig appeared in the- foinmof -ti-e admission of -apprentices inlto the nle-w infirmnary to stu'dy the cases theae T'hey

ER

were alyprenticed for terms varying from two to seveni yeaisfor a sum of thirty guineas, of which the- sti'geons ieceivedfour. At later dates higlheir premitiiswo-re ciai-ged.In 1781 there was founided in our city, mainly thiough

the initiative of Dr. Thomas Percival, the Revei'enid Di'.Thomas Barnes, and Thomas Henry, F.R.S., with the

support of Chai'lesWhite, the ManchlesterLiterary and Philo-sophical Society, whichlhad for its object the

pi onmotioni of litera-tuie and seience." Itmay be noted, in pass-

_ig, that Percival and4 B |Marn-es were born at

WaTiriigtont, and thatthey and Heniry wereJiUnitariaiis, aind it isalso woithy of notethat collegiate anduniversity education'iits ealliest and, aswill be seen later, inits final developments.was initiated by Non-conformity. In 1783this society, chiefly

..... .} ..- through the initiativetw;: ~~~of Barnes, Percival,

and Henry, father edItUNWIVERSrTY * Univ~si~v. an institution whichwas really the beginninig of collegiate or universityeducation in the town. It was called "The Collegeof -Arts - and Sciences in Manchester," and wasdesigned foi the instrudtetion on very broad lines ofthose who, haling finiished the oi'dinary course ofeducation, wxere about to engage in a. commercialoccupl)ationi The pirospectus then issued stated that lectureshad already beeni given during the two previous winters,on anatomy and physiology by Mr. 'Charles White and his

J'UT-Y i3l---19t9l -AKWU.AEr-AIMMING-,-Af - lf"CELLPErrElt. -WRXION. 165I-M,EDICAL JOURNAS

MIEDICAL EDUCATION IN MANCHESTER.

son Dr. Thomas White, aind on clhemlistry by Mr. ThomasHenlry. Owiing to the fear that suich educatioln mightunfit youth for ordinary businiess the institute declined,even from its filust moments, anid after tw o w-initers ofunifavourable trial it was at lenigth reluctantly abanidolned.Some of the early teacliers of the medical students have

left their marak for all timi in the history of m-ledicine.Charles Whithe, the Jolhn Hunter of Manclhester, was a greatmani, and miucli in advance of his contemporaries. Thougnpractising general surgery he was more of a gyniaccologist.He understood l)iuerleral fever, anid treated it on- scienltificlines, and he was the first mani in Englanid to recogniizewlhite leg as a definite morbid condition, whieh he calledphlegmasia alba dolenis puerperarum.

Dr. Tlhomiias Percival was the foun(ider of tthe pi-iiiciplesof medical ethics, the Old Testament of pirofessionialconiduct, anid a pioneer in public lhealtli miiatters, especiallyas the niew cotton factories affected it.

Tlhonmas Henry was an apotilecary alnd chemist, and hasleft his name in a preparation of magnesia which is stillsold as Henry's magniesia.

Dr. John Ferriar was the m-laini for ce in getting; a

committee of puiblic safety. or- a boaird of healtlh, formedto deal with fever el)idemics in tlle towni, and of openin(ga house of recovery,

as they pr eferr ed tocall a fever hoslpitalin those days (circa .....

1796).Peter Mar k Rogt,

matlhemi-atician, after-war-dssecretary eofthe Royal OSociety,taughlit plh yiolo

witl the fii1stpinted. T ROALnsyllabus of lectures.

Iii what peaceful

hompe nowi-adays are

there' no cross-w ords

that canniot be,

smoothued ouit by

Ioget's Thcsac-?tr,,inesofWcords and blut aaseswOther relays of

p)hysiciains anid sinr-

geons cariledenondtaleearly tohlcih of mnedicalteacliniig but th)egreatest credit, miust

be .giveni fiiust to THE ROYAL INFIPR

Joseph Jordafn, andsecondly to Tlomas Turner, at the begintineg of the lastcentury, for beiig therieal foundes of a misedical schoolprpe in Manichester. Jordan- began teachinjg dissectioni-on subjects of whichl he mianiaged to get plenty by the

methods described in thes Tale of Tevo (Ities, whilst otherschools hlad but few-adid included more systdematic i1struc-tioiolnthan had to that date beien given in. other branhes of

the mednical sciences. Jordan and Turner also forced therecognition of the schiool of medicine by the examiningboards of Loidon, and Turiner afd is colleagues secured for

it the -Royal patroniage. In this way was the ManchesterRoyal Schnool of Medicine fouiided. It flourislhed so much

that vairious riival schiools of ephemeral existenitce were

started from time to timiie in the town, anid finally in 1874

it joined fortceswith the Owens College, which hiad been

,founded in 1851 for- genieral nioni-sectariani collegiateteaching, anid which hiad bar-ely escaped the fate of the

College of Arts and Sciences of thei previous century of

dyinig of neglect and mal'nutritioni. it was, hiowiever, saved

chiefly by the enlighitenied anid for-cefuil care of' its second

priniicipal, Professor Grieenwood, and Henry Enhefield Roscoe,the great chiemist, and thle,Owens College, like so many

feeble infants do, grew up into r-obust hii'e. The uinionl with

the medical school gi eatly strenigtlhelled the college, anidit attracted yearly aii increasing iumber of studeints toits teachlinig. The niext stel) was the formiiation of a

university.The Manchester Uniiversity was tle fil.st of the groul of

Bnglish universities wlhich were fouiided in the later

M)

I USDICAL JOUuIWAS.

nineteenthi and early twentieth centuries. With the excep-tion of Oxford, Cambridge, Durham, and Londoni, all theuniversities of England conlform to this new type. Forsix cenituries Oxford and Cambridge held a monopoly ofuniversity e(lucation, but by the middle of the nineteentlhcenitury this was no longer- possible. The two ancient Uni-versities hiad catered for a certain well-defined class of tlhecommunity, but the demand for education lhad become fa1rmore widlespread. Oxford aild Cambridge were still uni--versities of the Anglican Church, fenced in by strict tests,but Nonconformity had greatly increased, not least in theNorth of England, and well-to-do Nonconformists were asanxious as Churchmen for the proper education of theirsons. Moreover, for the niorth countrymen Oxford andCambridge were difficult to reacli anid expensive to live in;nior did their scheme of studies take into account the'conditionis of the North.

Projects for a university of Manchester were in theair as early as the twenties and thirties of the last centuiry,but the first effective step was taken by a private citizen,John Owens, wlho had an aversioni to the religious testsimposed at the older iuniiversities. On his death in 1846 liebiequeathed about £96,000 for the foundation of a collegewhich would teach the subjects usuial in uiiiversitics to

-ouths of the male.. ..........

sex. It was laid (dow i

funidamental prin-

cill)he thtat there were,

to ho religiouistests. Legally, thocollege -as a l)rivatetrust, withl absol l tep:wl r in thle lhans of

...... the trustees.

Th'he ONwenIs College,a's it was -s

op(ilend in 1851 in v- latxi-as formerly a private

*;|1 residenice iln the towlin.After var ious vicissi-tu(les anid almost

complete falliure,college became success-full, an-d in 1873 wia,smioved to thle presentsite. anid to moere coini-ilnodliouis anid better

buildinigs. Bv theActs of 1870 anid 1871

[ARY, MANCHESTER. the college w-as ineor-lporatedl. It nas inow

definitely a unliverlsitV college and received a nlew coni-stitution. The admliission of womiieni w-as sanictioned.Owens College, howev-er, could niot confer degrees; its

students, if they wished to graduate, must sit for the examii-inationis of London UUniversity. in 1875 a pamtiphlet wvasissued advocating the institution of a Univerlsity- of Mar-chester. But the Onwenls College was nlo longer the onilyuniversity college in the North of England, anid Manchesterreluctantly consenited to the inlstitution of a federaluniversity with constituent colleges, of whiclh Manchesterwould only be the earliest. The title of the new univ-ersitywas to hbe the Victoria University, not the Univer sity ofManc'hester. Uniiversity Ccllege, Liverpool, was admittedin 1884, and the Yorkshire College, Leeds, in 1887.The first constitution of the University lhad great advan-

tages. Freedom from the yoke of London had been securi-ed;moreover, the admissioni of Liverpool and Leeds extendedand encouraged university educationi. But there were alsoserious dr awbacks. The staffs of the tlhrce colleges imiettogether perhaps oncec a week on boards or commititees;they hlad niot tlhe daily conitact desirable for tlhe staff of thesame university. Elach college lhad, niaturally, its ownpolicy 'and ambitions, aild these could only-be carried outby the consent and good will of the others, who miglht lieindifferent or even antagoniistic. Hence there was strifeand friction. After twenty years a movemenit arose for tOeabandonment of the federal schleme and-he institution ofseparate univer sities, and, in spite of considerable opposi-tion, it was successful. In 1903 a university clharter*was

16G JULY 13, 1929]I

JULY I3, I929] MEDICAL EDUCATION IN MANCHESTER. I MDICAMJNA 67

granted to Liverpool and a revised charter to Manchester,ill 1904 to Leeds. The uailversity founded in 1880 wasstill to continue in Manichester, but under the charter of1903 it had received a, new niame-the Victoria, Universityof Manchester-and a new constitution which secured itsindependent existence. Owens College closed its half-century of honourable activ-ity by incorporation with theUniversity in 1904.The organiization of tlle Uniiiversity teaching was based

oni faculties. In 1880, when the first charter was granted,there were three-arts, science, and law. Medicilne wasadded in 1883, and other faculties-music, commerce, theo-logy, technology, education-have subsequently been added.

All the necessary certificates of attendanice for ordinary.unidergraduate clinical instructioni have always been andmust still be received at the Royal Infirmary, the presentbiuilding having been erected on land provided by theUniiversity for convenience in teachinig. In this way thereis no difficulty for the dean of clinical instruction to keepani eye on the attendance of that certain proportion ofstudents who are affected with " wanderlust " before itsl)poper time. Courses of post-graduate in-struction arear-ranged by the University at all the leading hospitals ofthe town.The Manchester Royal Infirmary is a- general hospital,

which admits patienits whlo are curable or capable ofmaterial relief; and who are riot infectious. Childrenlunder 6 are not admitted unless urgently ill, nlor arephlithisis cases, except in acute stages, suich as hiaemoptysiganid pleurisy. Many early cases of phthisis naturally arediagnosed for the first time in the wards.Students can be signied up for all necessary clinical

work--medicine, surgery, " eyes, ears, thrioats, skins,"pathology; all except fevers, midwifery, anid mental andci.ildren's diseases by attendance at the Infirmary. ThoEye Hospital, a branch of St. Mary's Hospitals, wherestudents attend for instruction in diseases of children, thePublic Health Laboratory, whlere instruction is given for thediploma in the subject, and the new pathological labora-tories are all oni the same plot of land, 400 yards square,as the Infirmary, and within two minutes' walk of eachotlher, and five minutes fromii the University. The Radiuminstitute aind the Christie Ca'ncer Pavilion are also on thesaiiie plot of land, an aerial view of which was reproducedin the Jout:nal of April 27th.-Midwifery is taught at the Materniity Branch of St.

Mary's Hospitals, which is residential-for students duringtheir course of practical work. Students from other towns-ire attracted to the hospital by its very large practice,hospital and domiciliary.The professors and lecturers of the medical school, in

medicine, surgery, and tlheir special depalrtments, are, at theplresent time, almost without exception graduates of theUntiversity of Manclhester in consulting practice. Theyare well acquainted with the conditions of medical workaind the peculiar characteristics of the people in the neigh-bourhood, and therefore of the requirelments of would-bepractitioners. Whole-time professors of medicine andsurgery have certain advantages, but are not the lastword in preparing men for genieral practice.The important function of a university-of research work,

of searching for " what is hidden, wlhat is lost beyond theranges "-is enicouraged to the fullest extent, and thedegree of M.D. is generally obtained by original work,muclh of it carried out in laboratories. Fellowships of theRoyal Society. have bee¶t award'ed to the heads of theanatomy and physiology departments for their scientificwork. Several scholarslhips aid. fellowships are availableto provide financial hell) for those students wlho are anixiousto. follow ouit some scientific plroblem or to work for tlleirM.D. degree. Each student has to be, signed up for dis-section of the whole body, and there is no scarcity of sub-jects in the anatomical room to provide the necessary

)parts " for this.Anl importanit feature in the system of teaching anatomy

wand physiology inl the school is to minimize the purelyscienltific aspect Qf these subjects and to pay great atten-tiOll to their application to medicine anld surlgery with thehelp) of x lays and instruments used inI clinlical investiga-tion. Thle laboratory accommodation in these dlepartments

and in pharmacology has been considerably extendedreceiitly, and meets all the needs of the students. Appliedphysiology and anatomy courses, modified to meet theprogress of the students in clinical knowledge, are givenuntil the final year of study.

Instruction in menital diseases, as old Manchesterstudents know, used to be received at Chieadle RoyalMental Hospital (a branch of the Royal Infirmary), anldthe lectures there were a gieat chan-ge and pleasant breakfrom the " intramural " ones, and were much appreciatedby students. This, hoNwever, is a registered mental hospitalfor private patients, and it was fouind that the visit of ascore or two of students was objected to -by relatives ofpatients. Iinstruction is therefore now received at theCounty Asylum, Prestwicli, with its 1,000 and motrepatients, and the Cheshire County Asylum, Macclesfield;tlhe students thus have every opportunity of studyingwhat is one of the most importanit branches of generalpractice and one which has caused some alarming legaldecisions in recent years.Fevers are tauglht at the Corporationi Hospital at Mionsall

with its 600 beds, and pulmonary tuberculosis at BaguleySanatorium, also belonging to the Manclhester Corporation,with its 300 beds.When Sir William Osler was paving his last visit to-

Paris he wrote to me saying that the tendency in themedical schools there was to reduce academic lectures onthe principles of this and that subject to a minimum andto get to the bedside as muchl as possible. He added thatthis was his oNvn idea of the way to teachi medicine andsurgery. It is becoming more and more the tendency ofBritish schools nowadays to adopt this plan, and a verygreat feature of the Manchester school is the clinicalexperience which students get of being taught from avariety of cases such as can- hardly be seen in any similarteachinig hospital. -'There are 600 beds in tlhe Royal Infir-mary, 280 in St. Mary's, and 148 in the Royal EyeHospital.At the- Royal Infirmary there are so many beds that

students, large as tlley are in number, have several allottedthem for note-taking during their clinical instructioni; thleyhave thus every opportunity of learning on their owninitiative to diagnose diseavse.The dental school, with its own degree and diploma, is a

very flourishing member of the nmedical school, and pro-vides practical teaching at the Victoria Dental Hospital,which adjoins the UJniversitv.-Women students are admnitted to the medical school and

to the hospitals for teachinlg purposes. The advantagesand disadvantages of such mixed teaching are as mnany andvarious as the London schools have found.The Views of the Uniiversity Buildings are reproduced by

courtesy of the Warwick Brookes Studio, Manchester.

CHANGES IN LONDON LOCAL GOVERNMIENT.

NEW ADMINISTRATIVE SCHEME OF THE COUNTY COUNCIL.THE first announcement of the character of the nlewadministrative schleme for the C6ounty of Lonidon, in accord-ance wvith the Local Government Act, 1929, for dischargingthe functions transfer red to the London Countby Counciliunider that Act, is nmade im -a report to the council forits meeting on-July 9tlh by the special committee appointed,under thle chairm-i-tanslhip of Sir Cyril-Cobb, to deal with thisimportant subject.The special committee advises the couniicil to declare that

as soon as circumstanices permit, all assistance which couild,after April 1st next, be provided eitlher by wyay of poorrelief or by virtue of certain special Acts (hereafter mlien-tioned) shall be provided exclusively ulnder the appropriate-Act, and, not by way *of poor relief. The special Acts inquestion anld the transferred services to wlhiclh they relateare as followvs:Maintenance and treatment of sick persons and pregnant

women in hospitals. (Local Government Act, 18E8, as extendedby Section 14 of the Local Governuient Act, 1929.)Maintenance of mental defectives-.in institutions. (Mental

Deficiency Act, 1913.)

JULiyY I3 g19291. UNIVERSITIES AND COLLEGES. TapTDI 75

generalizations: (1) careful selection of- cases is not veryInecessary, as already the- very wo'rst are -passed on to it;(2) any apparatus requires keeping in perfect Workinigorder to secure efficient working; (3) no mani who gives gas-oxygen anaesthesia can afford to go to sleep on the job.-I am, etc.,

Doncaster, July 4th. E. J. CIIAMBERS.

CONSULTATIVE COMMITTEES UNDER THELOCAL GOVERNMENT ACT.

SIR,-It appears to mo important that action taken inreAgard to the constitution of the Consultative CommitteesulifIdr Section 13 of the Local Government Act should berel)orted. I therefore send you the following facts for theinformation of your readers.

In Liverpool the Consultative Committee has beenappointed, and consists of twelve members, six representingtthe governing bodies of the voluntary hospital and sixrepresenting the medical and surgical staffs. The sixmiedical representatives have been nominated by the Liver-pool Hospital Staffs Assoeiation, a body which includes inits miiembership all those who are on the staffs of the localvoluiltary hospitals.

Ili Lncashire the Conisultative Commuittee has- alsoalready. been constituted. It is to consist of onle lay- andone medical representative from each of the voluntaryhospitals in the county area; the medical representativeshave in each case been nominated by the medical boardof the hospital concerned.

Several of the neighbouring county boroughs have electedtheir Consultative Councils-on the same lines as thosefollowed in Liverpool. A coiiference to conistitute the Con-sultative Committee for the county of Cheshiro is shortlyto be held.-I am, etc.,

Liverpool, July 8th. K. W. MONSARRAT.

M31EDICAL ATTENDANCE ON PATIENTS IN PRIVATEWARDS OF HOSPITALS.

SIR,-In your issue of Juno 29th (p. 1181) Dr. R. H.Dix- comments on the proposed poliev for the above-mentioned patients as,outlined on page 127 of the Supple-ment for April 20th in Section XI, paragraph 29. He statesthat " hitherto the policy of the Associationi has grantedto these people complete freedom of choice of medicalattendant "; and that " the new policy deprives them ofthis riglht."Up to the present the British Medical Association has had

no policy at all with regard to these patients. It would seemthat Dr. Dix is confusing with this group those in nursinghlomes or annexes attached to hospitals, for whom a quitedifferent policy is outlined in the followinig section (XII).The time is so pregnant with- far-extending changes in therelationship between State and voluntary hospitals andtheir effect on medicine and private practice that it is to beearnestly hoped that everyone will fully acquaint himselfwith what is going oni and assist in formulating anequitable policy.-I am, etc.,Hove, July 6th. E. ROWLAND FOTHERGILL.

PRURITUS ANI.Sit,-In his article on the treatment of pruritus ani

(June 15th, p. 1070) Mr. Gabriel did not mention the useof ultra-violet rays in the treatment of this intractablecolnditioni. I havo had some satisfactory results with ultra-violet rays after many forms of treatment have been tried,iiinlluding x-ray radiation. For some little time now I havebeen using an electrodoe which contains titaniunm, and I con-sider that the results are quicker and better with this metaltilan witlh tungsten. In hospital, the cases under me havebeei treated by the tungsten arc, anld the results have beenvery satisfactory, but in private I lhave used the titaniumarc witll moro rapid success. The treatment should be given.daily, and I have founld that natural sleep is forthcomingafter comparativel'y fewv administrations. With pruritusvulvac the; results are equally gratifying.-I am, etc.,

E. G. FRtENCH M.D., M.R.C.P.-Physician in charge-of the Skin- Department, London

July 2nd. Temperance HospitaL

DIFFICULT LABOUR.SIR,-Pro1fe&sO R.X.V. Johnstone's British Medical Asso-

ciation Lecture on diffi-cult labour, published in your -issueof Juno. 22nd (p. 1105), remiinds nme of a case of non-rotated occipito-posterior -presentation I treated some yearsago. The lhead had come low- doNwn without rotation, anidit occurred to me that by insertinig one blade of the forcepsbelhind it miight bo possible to lever it forward. I did this,and, taking great care not to use muclh pressure on thesoft parts, I found it quite easy to rotate the head, andinflicted no injury in doinlg so. I iiiay mention that I didnot rota-te the shoulders at the same time, and time childwas born alive.May I also mention a simple method of using a gum-

elastic catheter for reducing the prol'apsed cord ? Thebooks miientioll passig a tape or thread down the lunmenof the catheter beforeolooping it .round the cord. It is fai'easier to bring the stilette out through the eye of thecatheter, loop the thread round it, and reinsert the poi-ntwithin the catheter. Whlen tho cord has been replacedwvithdrawal. of a couplo of inches of the stiletto releases it,and the tape is born with the placenta.-I am, etc.,Wokingliam, July 1st. F. R. HUMPHREYS.

DEFINITION OF RHEUMATOID ARTHRITIS.SIR,-I vwish to endorse the statement implied in the

sentence " there are present signs of a- general disturb-ance," in the third paragraph of Dr. Neligani's letterpublished in the British Medical Journal of July 6th (p. 32).Examples are the frequently associated colitis oni the oniehand -and the liver disturbance on the other. Of thesetwo I regard tho liver as the more guilty.-I am, etc.,

Arnside, July 6th. D. M. MACDONALD.

usW asitisz& attzl tT ltgrMsUNIVERSITY OF OXFORD.

Tim following candidlates have been approvedl at the examinationindicated:FINAL B.M., B.C.-TI. H. Aitchison, G. Campbell. B. R. Caygill,

J. A. Eyres, C. R. Greene, H. E. Mansell, J. C. Nicholson, M. G. Pear-so&, J. W. de W. G. Thornton, W. J. Walter. Forensic iMedici7eand Public Health: H. S. Atkinson, J. M. Gibson. T. N. Gledhill.H. M. Harris, R. S. Harrison, J. M. Lees, A. J. M. Melly, C. N. Milner,

- A. Seeker-Walker, W. B. Williams, Annie D. M. Adams. Pathology:F. Bicknell, J. B. Bishop. J. R. Braybrooks, W. D. T. Brunyleate,F. E. Buckland. E. C. Coaker, C. M.- Duncan, D. G. Ferrim-an,J. H. Hunt, W. E. S. Merrett, C. N. Milner. It. D. Newton, W. R.Pullinger, E. H. Rink, J. A. Scott, A. Secker-Wallier, 0. J.Vaughan-Jackson, Elizabeth C. M. Brunyate, Winifred Mercer. MateriaMedica: J. B. Bishop, J. R' Braybrooks, F. E. Buckland, H. W.Davies, D. G. Ferrimnan, G. S. Grist, H. C. Harley, Al. A. Hatt,G. W. Hincbliff, H. de B. Kempthorne-, R. M. Marshall, N. C. Parfit,N. L. Rusby. J. A. S-cott, R. F. Wooliner, C. H. Yeoh.

UNIVERSITY OF LONDON.AT a meeting of the Setnate of the University of London, lheld onJuly 3rd, Dr. E. Graham Little, MI.P., was elected as a represenita-tive of the Senate upon the Court, anid was re-elected for theseventh time as chairman of the Council for External Students.

Sir Gregory Foster, B.A., Ph.D., has beeti electe(d Vice-Chaucellor for the year 1929-30, anld the Rev. Johln Scout Lidgett,D.D., M.A., Deputy Vice-Chancellor for tthe same period.

LONDON HOSPITAL MEDICAL COLLGE.The Freedoom Researchl Eiitratrce Schiolargsiip in Pathiology, value

£100, opeu to stuidents of thie Uniiversities of Oxford atnd Camblridge,has been awarde( to Mr. J. 1'. Brocl of Uiiversity Colle,e, Oxford.

UNIVERSITY OF DURHALM.AT the convocation lheld oni Jtie 27th the followving medical degireesand tdiplomas were coiferred:M.D.-M; Coll,- 0. C. Dobson, J. Hare, A. H. Holmes, F. W. Marshall,

P. M. Rivaz, Grladys Stableforth. A. J. Watson, It. Wear.M.B., B.S.-S. Adler, J. C. Arthuir. WV. F. Cross, K. Daniels, C. E. Gold-

berg, H. W. T. Hall, -W. Hall, J. Mladdison. It. D. Ord, A. R. D.Pattison. J. K. H. Scott, J. 13. Tilley, Nora Walkinshaw.

B.Hy., D.P.H.-Katherine Al. Cellan-Jones, 0. C. Dobson, A. J. Watson.

UNIVERISITY OF LIVERPOOL.THEI following candidates have been approved at the examinlationindicated:'M.D.-Helen M. Duvall, W. HT. Evans, W. Ml. Frazer, L. S. Goldman,

J. C. 1lcFarland, F. Murgatroyd.M.B.. CH.B..-(New Rintlations): '5L; Findlay.l 3 d T; N. A. Jeffcoate,

123 8 J. Libman, 12 8 H. J. Partington, 25D. A. Jones. 2 9 J. A .Martinez.(Old Regulatif.tts): '28R. K. Bowes, 29GW. 'V. Geirard, 29J. ,N.ILevga.te.' Part B. (N.R : A.- l{. Barzilay, Fr. JT. Beuinett-Jones,A. T.-Hsltop, J. C. Hill, G. A. C. Lynch. C. L. Pratt, G. K. Sconce,H. B. Whittinghams ,T. P.- WoodwrKd. Pairt Ir! (O R.):,S. AlstoadB. J. Doyle, JR. A. Furniss, J. N.- Parringtoii, MIturiel S. Roberts.

16 JULY r3, I9291 TESTIMONIAL TO SIR RONALD ROSS.

N. W. Roberts, J. L. A. Webster. J. Williamson. Par-t A (N.R.):L. G. Anderson, MaTrjorie E. Birch, A. Blumfield, C. G. Burgess,4 7 G. W. Causey, W. N. Chalmers, J. W. Cheetham, 6D- H. Collins,A. Curtis, P. P. Fox, 7 D, 0. Hughes, V. S. Hughes-Davies, A. T. Jones,.R. P. Kemp, F. R. Kitchin, E. W. Malconiison, J. L. Mewton,W. J. Poo!e, M. Solomon, 4 5 6 7 Honora J. Twomey, 6 T. P. Twomey,,7R. Wright. Part I (O..): E. H. Williamis. Part 11 (O.R.): B. G.Walker, 6E. H. Williamls.

DiPLO,m iN PUBLIC HEAALTH.-Part 1: R. L. Corlett, R. W. Eldridge,A. B. Follows, Susan H. Gilchrist, E. Hulme. Part II: KathleenEdgecolibe, R. R. Evans, Bridget M. 0. Gordon, F. C. S. Hinsbeck,J. S. lIogan, F. L. Smith.

DIPLOMA iN TROPICAL HYGIENE.-G. D. Drury, N. D. Fraser, J. A. L.innes, C. Ramdeholl.Distinction in miiedicine. 6 Distinction in public lhealth.

2 D)istinction in surgery. 7 Distinction in pharmacology and8 Distinction in obstetrics and general therapeutic.

- g3IlaecoIog,sr. 8 First-class honours.4 Distinctioni in special patlhology. 9 Second-class lionours.I Distinaction in forensic medicine

and toxicology.

UNIVERSITY OF MANCHESTER.THE. following candidates have been approved at the exanmlnationindicated: .

FINAL M.B., CH.B.-*D. Sheelhan, H. S. Bagshaw, F. H. Bentley, L. Bold,Blessie HI. E. Cadness, T. H. Chadwick, Ni. A. Chamberlaip, D. L. Cran,W. W. Fox, J. M. Greenwood, R. W. Luxton, A. S. McGowan,Maxy I. C. Mackintosh, A. B. Moffatt, W. H. Newton, J. H. Pattyson,'G. E. Plowright, Mariani M. Reekie, C. F. Stott, Alan Taylor,L.; 0. Wright. Forensic Medicive: 'l. J. B. SeWell.- (New Regu'a-.tions-Part I,Forensic MIedicine and Hygienie and Preventive Medi-cine): R. Barnes, A. Bigham, A. N. 13irkett, A. P. L. -Blakely,Barbara E. Bleasdale, Edith M. Casasola. S. T. Cowan, Frank Cor,Winifred Dean, J. Dobson, C. G. Eastwood, J; tR. P. Edkins,E. G(. Elwell, Mlargaret M. Ferguson, Dorothy A. Geiler, N. IHarburn,E. W. Hardman, L. Jones, W. W. Kay, A. L. Kenyfn, C. D. Leflaive,JT. C. Nicholson, D. Ockuan, G. J. Phillips, D. A. Richards, E. Riley,B. Sandler, M. W. Smiiith, H. W. Thomp3on, C. Verity, N. S, WallsG. H. C. Walnmsley.

DIPLOMA IN BACTEIUIOLOGY.-A1\. UI. Barritt, R. Lyth, R. W. H. Miller,Lois Stent, Mlary Mi. Stewart, Emmeline Wade, P. M. Wagle.

DIPLOMA IN PUBLIC HEALTH (Part 1).-J. -R. Beal- C. Canmpbell,A. H. Heyworth, D. Kemp, A. Meiklejohn, J.. S. Sewell, R. Walshaw.

* With second-class honours.

tINIVERSITY OF SHEFFIELD.TrE tollowing candidates have been approved at the examiniationid(l icated:M.D.--Janet Breakey.M.B., CH.B. (with second class honours).-F. Ellis, T. H. Pullar.

UNIVERSITY OF DUBLIN.TRINITY COLLEGE.

AT the later summer commencemenits of Trinlity term, held -nJuvl 2nd, the foll6wing degrees were coiferred:

M1.D.-H. G. Holdbrook, B. Schaffer.M.B., B.CH.. AND B.A.O.-W. R. Fearon, H. T. Flenitng, M. H. Fridjohn,

L. L. Griffiths. L. B. Harris, A. F. Kennedy, B. St. J. Lyburn,Anna M. E. M'Cabe, J. T. M'Ginn. T. B. M'Mahon, B. F. S. Morrison,H. J. Reid, E. B. A. Solomdi6nsi C. Af. Taylor, It. IVI. Wilson. J; Beggs(in absentia), N. H. Lindsay (in absentia).

LICENCE IN MEDICINE, SURGERY, AND OBSTETRIC5.-R. Kahn;SCHOOL OF PHYSIC, TRINITY COLLEGE.

The following candidates have been approved at the exa'mina-tion indicated:FINAL M.B.B.-Part I, Maleria Medica and Theraperutics; Medical

Juri.prsdeence atid Hygienie; Pathology atnd Bacteriology: *Eliza-beth K. Rtoberts, *A. H. Thomi)son, D. B. Bradshaw, I. G. L. Ford,T. A. Bouchier-Hayes, F. P. FitzGerald, D. J. O'Ryan, A. J. O'Codnnr,H. H. G. Dorman. J. Miller, P. H. Peacock. Isn completion: H. W.Dalton, G. F. West. Part II, Medicine: G. -R. Beare, J. N. U.Russell, H. T. Fleming, U. T. O'Shea, A. H. O'Mialley, L. L. Griffiths.R. St. J. Lyburn, C. SI. Taylor, Frances E. Wilson, P. O'Shea,B. I. Reid, G. K. Graham, Anna M. E. IICabe, J. F. K. MacCarthy-Morrogh, E. J. MI. BDai. Surgery: V. R. Fearon, *C. M. Taylor,H. T. Fleming. A. F. Kennedy, E. B. A. Solomons, R. St J. Lyburn,-1. B. Harris, T. B. M Mahoni, L. L. CGriffiths, N. H. Litidsay,J. Willoughby, U. Kahn, Lilla 1i]. Spiller, A. J. Gardle, J. T. l'Gin,R. T. Reid, M. H. Fridjohn, R. Al. Wilson, E. F. S. Morrison,Midwifery.: -S. Levy. A. J. Garde, F. 0. Pilkington, W. Caldwell,E. S. Tweedy, A. Rakoff, J. L,-. Keymus, F. MI. Lyons.

D.P,H.-Part I, Chemistry; Bacteriology and Parasiteloov; Physics,M,etenroloovs. and Clia.tolog: H. E. S. Richards, D. H. F. Milmo,A. Fava, W. J. Kerrigan, G. M. Tyrrell. P-art 11, Sanitation(iniclud-ing SaxitarV COns-trucltion) ; Public Health Administration;Hygiene and EpideminlgV; Sanitary Law and Vital 'Statistics;*1R. A. Q. O'Meara, A. Fava.

DIPLOMA IA .GYNAECOLOGY AND OBSTETRICs.-A. El S. A. Ammar,F. E3l Ahmadi, A. W. Atichie.

* Passed on high marks.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.EiLE,,CTION TO THE COUNCIL.

ON JU13 4th fouir Fellows were elected inito the Coulnicil to fill thevacancies cau-sedi by the resignation of Sir James Berry aind theretiremenit in rotatibui of Sir-Holbturt Warinig, Mllr. C. H. Fagge, anidMr. W. Samp)son ilaudley. The restult of the )oll wvas as follows:

Votes. Plumpers.WILLIAM SAnPsOn{ HANDLE{Y (?Jiddlesex) . ...................627....10CHARLES HERRBE3RT FAOGE (Guy's) .....................587...14Sir HOLBUR^T JACOB WARING (St. B inrtholomew's) 560 ... 30GRAEAX SCALES S31n'soN (Sheffield) - ..527 ... 48

* Charles Coley Anhoyce ........ .. .. .. 489 .. 2lThomlas Percy Liegg ........ .. .. .. 384 ... 4Robert Mine .'.. .. . . ; 41

In all 1,091 Fellows voted, including 160 Fellows xesident out ofGreat Brtain au(d Ireland; in adlditioin 5 Votes werejfon-tid to beinvalid.

fr. Simpson becomes sibstitute Member of Council for SirJJtesBerry until 1931; aniid Mr. Haudley, Mr. Fagge, and Si-r HolburtWaring are elected for the full period of eiglit years.

ROYAL COLLEGE OF PHYSICIANS OF IRELAND.THE following, having passed the Coiljoinit Fiiial Examinuation,have beeni a(lfllitte(l to thie Licenices in Medlicinie au(I Midwifery:T. G. De V. Coneys, T. J. Gilmartin, W. C. B. Harrison, D. J. Mangan,

P. F. Murray, J. F. O'Haflbran, M. H. O'Reilly, H. D.TPltinkett,M. A. Roddy.

PARKES MEMORIAL PRIZE.THE'essay for the next avard of the Parkes Memorial Prize will-be "The Causes and Means of Prevention of Tonsillitis, withSpecial Reference to Naval and Military Service." The prize,which consists of 75 guineas and a gold medal, is given everythird year for the best essay dealing with hygiene; it is- open to.certain medical officers of the Royal Navy, Army, and IndiajiArmy of executive rank on full pay.

TESTIMONIAL TO SIR RONALD ROSS.SECOND LIST OF CONTRIBUTORS.

ON May 1lth1 (p. 879) we published a letter from Sir JamesBarr and others informing our readers that a fund, called theRoss Award Fund, was being started in order to' give some.recognition to-Sir Ronald R6ss for his discoveries on the modeby which m-alaria is -carried, and for his lifelong effortsyegardiing the. preventitin of- that disease. The letter stated thlatdonations should be sent to Lloyds Bank, Ltd., 110, Hightreet,' Pstney, S.W.15, cheques to be crossed " Ross Award'und a/c." The names of those who lhad contributled to theFulnd- up to May lTth were printed in our issue of June 8th(p. 1065s, the total amount then a&knowledged -being £2,490.W,.e now print -a second list of donors, whose contributions,amounting to £706 18s. -d, were received between Mav 18thand iMay 29th, makiitg a total of £3,196 18s. 6d. on May 29th.'The -list publishe-d below does not include anonymous -contri-butors or conitributors whose initials only. have been supl-4ied.Dr. R. Aitken, Dr. R. G. Alford, Miss Anderson, Mliss Arbuthnot,. Misses

M. T. and A. M. Ashburner, Edmund I. Ahns, B. E. Alston,' Miss It. J.-ALborne.John Bain, Miss Ellen Baxter, N. E. Ball, F. L. Bradley, Rev. J. T. and

Mrs. Barlley, Miss Eliza Broughton, Marion Bruce, Maiss 'Bannister, Mr.and Mrs. W. Blyth, Mrs. MI. M. Bevinigton, Mrs. J. -M. Blomfield, MissBowie, John Fuilton Barr, Mrs. Herbert Brock, Mis A. F. 'Bladtm, MissBoyd, B. H. Briggs, Lady Grace Baring, Miss L. E. Broadwood, Miss M.Bartteet, J.. Stark Browne, Mr. H. Beddington.Dr. Ernest Carer, Mrs. Campbell, Mrs. Scot.t Coope?r, The Misses Clark,

Dr. Collier, Major' Brmiel Ooh6ii, Mrs. A. Campbell, Iis.. Croassley, Mr.Edward W. Cox, Miss Ethel Charles, WV. P. Connell, R. H. Cotton,J. Campbell,' W; F. Carslake, James D. Cowan, W. Roler Caldbeck,Cheviot Rubber, Ltd.:Miss.J. Duncan, Miss Marv Duncan, Mrs. Davison, Mrs. Davenport, Mrs.

RX Dixon, Dr, M. Dawson, Colonel J. Day, I1. Ml. and W. Drake, G. B.Dibbler, W. S. M. D'Urhan, George Drinkwater.Captain Arthur K. Ewart, Edith N. Evans andi H. Winifred Cooke,

James IT. Edwards, Miss D. H. Fowle, M. A. and A. Eddy and. SisterHarriett.'Mrs. A. Flanelle, Miss Franklin, Miss Constance Fenwick. Mrs. Frere

Fred. Fuller, AMiss Fovargue and Miss Powell.De. E. W. Goodall, Miss G. E. Gage, Robert M. Galloway, Dr. L. P. and

Mrs. Gibson, Miss Gardner and Miss Lawrence, Miss F. Gray, Dr. W.Gosse, Sir Frederick Gardiner, Mrs. S. B. Gorst, P. 0. Gordon, StephenGillanders, E. M. Gallie.Dr. C. 0. Hawthorne, Miss E. J. Heyworth, James Ilarper, Dr. Riclhard

Ilaigs(on, Mrs. A. M. Ilolderness, Miss A. E. F. Itornimant, J. A.1-lutchinson, Mrs. Ilurwortlb, G. C. flay. I. lHarrison, M1rs. ')Corcas [hart,Miss A. S. Harrington, W. J. Hiarcding-King, Dr. It. A. Ilaviland, MissDorothy Ilolinani, Miss II. Clements Ilassell, J. 0. Hickman, 0. N.Ilollely, A. W. Jones, C. A. Jebens.

F. A. S. King, Alfred Kingdoni, ?Mr. and M'ls. Ki-eisler.Professor Luigi Liugi-gi, C. Lamb, P. Makepeace Lott, Mr. antl Mrs.

L. C. Lowther, Misses Leslie, Misses Lever, Misses Lewis- Mrs. A. Lane,Mrs. vmnd Mr. J. Lee, R. G. Lawson, If. Lloyd, Lillian M. JLeary. Dr.E. le C. Lancaster, Miss Luard, Labu (F.M.S.) Rubber Co., Ltd., irs. F.Littington.Dr. F. G. Mackereth, Dr. E. Marsden, N. Martland, Mary Mlonkilmose,

John Milligan, Mrs. Frank C. Minoprio, Mr. Julian D. 31ariks, C. Airitin,Mrs. A. M. Morris, W. H1. Marsh, Miss M. E. Mawson, S. AMeakin, R. E.MaInprice, Miss S. Macpherson, Misses Morley, MIrs. Maurice Macmillan,Daniel Murphy, liss H. M. Mainprice.William Niuittall, Mrs. Nuttall, Mrs. S. Newman.Mrs. Oldham.Sir Horace Pinching, Julian Phillips, Dr. J. Wdilson Paton, IT. S. Part,

A. M. Partridge anid Sister, Miss Peck, Miss Pea.rson, Aliss A. Pliyi nan,Arthur Peto, C. P. Peak.Mrs. J. J. Richardson, Mrs. Reid. Miss Mt. Kate Robinson, Tliomnis 0.

Ruston, Mrs. Jesse Roberts, R. E. Robinis, fir. F. MA. Rowvlanl, It. J.Rndyard, A. Carnegie Ross, Col. A. S. Rooke, lI. Ropner, Mliss Kale RBugers.Professor anid Mrs. A. W. Stewart, MIisses Stitlinlg, It. D. Sistenn, Nmmrs6

Stonebam, Margaret Sherwin, Mrs. Staffiord, Jesse II. Slatford, Mrs. A.Storey, Emma Snmith, Miss Agatha Sadler, Rev. A. Spofford, MIr. andMrs. Thornton Sharp, R. W. Spranger.Ernest Taylor, A. J. Tweedie, Dr. If. Twyford, MIrs. Gerald T)omlpson.Dr. F. Wvatt-Smith, Miss Watson, Dr. Edwalr. A. Wilis6n, Mrs. Mary

Woodward, Frederick Wagner, B. M. Ward, Albert L. Wriglh, Mr's. C. T.and 'Miss D. J. Wilson, Claude F. Westbury, Dr. G. H. IBate.soni Wriczht,Charles Wilson, Mrs, E. Walker,- Mqjor N. F. WNebb, A. Welbster, 'Mrs.Wrench, J. W. Wail

JULY 13, I9X9] MEDICAL. NEWS. [ Tim BRInTISH 79JULY I3, I(291 [MEDICALJOURELU

aware that a scheme had been submitted by the British SpaFederation to provide hydrotherapeutic treatmenit for insuredpersons suffering from clhronic rheumatism as an additionial benefitunder the National Insurance Act. This scheme hiad receivedcareful consideration, but- had not yet beeln salnctionied. Thepresent' list of additional benefits afforded to approved societiesa wide variety of remedial treatment from among which theymight select those to which to allocate funds available for thepurpose out of their disposable surpluses. Before adding furtherbenefits to that list the Minister of Health would require to besatisfied thlat there was a fairly. widespread desire on the partof the societies for such an extenision.

Mcdical Rcscrch ins India.-On July 8th Mr. BENN (Secretaryof State fos India) told Major Graham Poole that the report ofthe Committee on the Organizationi of Medical Research in Indiawas published, about five weeks ago. Some protests were madeagainst the location of the Central Medical Institute at DehraDun; but the expenses for the scheme as proposed were approvedon January 29th by the Standing Finance Committee of theLegislative Assembly.

Virisection.-On July 8th Sir ROBERT GoWER asked if the HomeSecretary intended to introduce legislation prohibiting the vivi-sectioIn of dogs. Mr. CLYNEs replied that on this subject theGovernment must be guided by the best possible advice which itcould command. Having regard particularly to the carefullyconisidered opinion which was expressed in, the memorandum ofthe Medical Research Council presented to Parliament in 1927, liecould not undertake to introduce legislation on the subject.Dumping of London Refuse.-Mr. GREENWOOD told Sir Alfred

Knox, on July 4th, that he was aware of the complaints aboutthe dumping of London refuse at Iver and Little Britain inMiddlesex. One district council had adopted special by-laws, andconditionis had improved. He had no legal power to deal withparticular cases of this kind, but where there was a niuisanceor a danger to health the local authority could move. He hadpower to declare local authorities in default, but that could onlybe applied oii overwhelming proof that a local authority deliber-ately intended to evade its responsibilitv. Compreheirwive actionmust await the report from the departmental committee whichwas considerinig the general problem of refuse disposal.

T'rainin2g of Veterinarians in London.-Mr. BUXTON (Minister ofAgriculture), replying to Dr. Fremranitle oii July 8tlh, said he hadnot yet received the report of the committee appointed to considerthe existing facilities for traininig veterinarians in Loiidon. Heunderstood that the committee was considering a draft reportThat report, when received, would be printed and published atani early date.

Colonial Veterinary Scrviccs.-Mr. PONSONBY (Unider-Secretaryfor the Dominions) told Dr. Fremantle, on July 8th, that lastApril a dispatch was addressed to Colonial Governments dealingwith the recommendations of Lord Lovat's Committee on thedevelopment of veterinary services in the colonial empire, andasking for observations upon them. Replies were beinig received.In view of the present 'ack of qualified candidates the Secretaryof State was of opirnion that the first step towards the furtherdevelopment of the Colonial Veterinary Services should be theinstitution of the scholarship schemne which the commnlittee recom-melnded. It would niot be possible to bring this 'scheme intooperation this year.Proposed AdditioIal School Dcntist for Wcst Haem.-Sir C.

TREVELYAN told Mr. W. Thorne, oii July 8th, he was aware thatthe West Ham Education Committee proposed to appoiint aiiadditional schlool dentist. It had not been brought to his noticethat anl advertisement inviting applications for the appointment ata salary of £450 a year, rising to £500, had been declined bythree professional publications on the ground of the salary beingbelow scale. The Board of Education had not prescribed orauthorized the salary of this or any other school dentist.Pr otection Against Gas Attacks.-On July 9th Mr. MAcDoNArD

told Brigadier-General Clifton Browni that, in view of the recentratification of the Geneva Gas Protocol of 1925 by most of theimportant European States, including this country, he did notthink this was a moment to press the local authorities to developplans for the protection of the civil populationi against gasattack. Mucll preparatory work had been donie by the Com-mittee of Imperial Defence upon this problem prior to theratification of the protocol, and that work would not be thrownaway if, unforttunately, a situation should arise requiring as ameasure of pruidence the development of plans for this purpose.Radiuni.-On July 9th Mr. GREENWOOD told Commander Bellairs

that the report' of the Radium Subcommittee of the Committeeof Civil Research had been brought to the notice of tlle Leagueof Nations Healthi Organization. He could add nothing to areply given on Aptril 18th in regard to international action onthe sulpply alnd priice of radium.

Notes in Brief.Tlle Coloniial Secretary is niot satisfied with the iniformation

received withi regard to the health of the miners in NorthernRhlodesia. He has called oii the Governor for a further reportand reconmmenidatiols.The Government proposes to continue anid extenid the industrial

transference sclhemtle, witlh modificafions designied to mnake it more.elastic and( more closely adjusted to thle circumnstances of thevarious distressed'nraI<s.

Modet1l by-laws providing, for the nlsa of a mechanical instrumentfor the slaugtl er of cattle hiRs now been adopted by over' 300authiorit.ite inl Engoland andl Wales. and thle Minister of Health'proymises to consilder legislaticis mrakinlg this use cempulsory.

IT is proposed to hold an informal luncheon for all Leelsmen who are visiting Manlchester for the Annual Meeting' ofthe British-Medical Association this nonth. Those whoawisl.to be present at the lunicheon are asked to communicate assoon as possible with Dr. J. N. L. Thoseby, 42, East Road,Longsight, Manclhester. The time and place will be announcellater.THE annual old students' dinner of St. Bartholomew's

Hospital and College will be held in the great hall of thehospital on Tues(lay, October 1st, at 7 for 7.30 p.m., withSir Frederick Andrewes in the chair.THE annual old stu(dents' dlinuer of St. Thomas's Hospital

will be held at St. Thonmas's House, Lamibeth Palace Road,London, S.E.1, on Friday, October 4th, when Dr. H. G.Turney will be in the chair.THE annual dinner of past an(d present students of St.

Mary's Hospital Medical School will be held at the TrocaderoRestaurant, on Friday, October 4tlh, at 7 p.m.As already announced the third Victor Horsley Memorial

Lecture will be given by Sir Thomas Lewis at UniversilyCollege Hospital Medical School, Gower Street, W.C.1, otnTuesday, July 16th, at 5 p.m., on " Observations relating tothe mechanism of Raynaud's disease." The chair wvill betaken by Sir John Rose Bradlord, President of the RoyalCollege of Physicians of Londion. Admission to the leetureis free on presentatiou of visiting cards.AT a meeting of the house comimittee of the Royal Victoria

Infirmary, Neweastle-upon-Tynie, held on July 4tb, it wasreported that a Rockefeller Travelling Fellowship had beeniawarded to one or the assistants in the pathological depart-ment. The comnmlittee expressed its appreciation of thledistinction obtained, andl noted that this was the thirdoccasion in the last three years on which RockefellcrFellowships hadl been awarded to members of the pathio-logical staff of the Iunfrmary.THE Fellowship oqt Medicine announces that it is proposed

to hold a week's course in gastro-enterology from July 22ndto 26th at the Prince of Wales's Hospital, Tottenhanm, iticonjunction with the Nortlh Middlesex Hospital; post-graduates interested in such a course are asked to coml-municate as soon as possible with the secrelary of the Fellowv-ship. From July 29th to August 24th there will be a coui sein urology at All Saints' Hospital, Vauxhall Bridge Road,occupying afternioons and eveniugs. A course in diseases ofchildren will be held at the Queen's Hospital for Chil(lret,Bethnal Green, frnom August 12tlh to 24th. An intensiVecourse in' medicinie and surgery at Queen Mary's Hospital,Stratford, from August 26th to Septemnber 7th, will consist oflectures, demonstrations, and operative worlk, occupying thewhole of each day. The general course of work, consistigof attendan_e at the clinical practice of about forty Lonidolnhospitals, continues throughout the year, and attendancemay commence at any time. Details of clinics are providt dand the post-graduate is free to arrange his timije-table inaccordance with his requirements. Copies of syllabuses anicall information may be obtained from the secretary of theFellowship, 1, Wimpole Street, W.1.THE forty-seventh annual dinner of the Wert London

Medico-Chirurgical Society took place at the TrocaderloRestaurant on July 4th, with the president, Dr. HaioldlSanguinetti, in the chair. There was a large attendlanceof members an(d visitors, and a very agreeable evcniiiig wasspent. After the loyal toasts had been honoured Mr. IvorBack deftly proposed the toast of "Success to tho WestLondon Medico-Chirurgical Society," and in the course ofhis speech in reply the chairman gave an account of thesociety's work during the past year, referring particularlyto the conversazione on June 21st, when Professor ClaudeRegaud delivered the Cavendish Lecture on the treatmentof malignant disease by radium, and vhen the triennial goldmedal was presented to Sir Ronald Ross. The healti- of" The Guests" was proposed by Dr. Julius Burnford, an(d wasresponded to by Sir Nigel Playfair anid Dr. F. G. Crookshanlk.Dr. Frederick J. McCannl welcomiied the representatives ofkindred mnedical societies, on whose behalf Dr. Walter Care(president, of the Medical Society of London) an(d Dr. Eriie!-tYoung replied. 'T'lhu formal proceedings en(led witlh complments addressed to the chairman by Dr. Artlhur Saunders.THE London County Council is proposing to suggest to tlhe

Ministry of Health that a conisultative commrnittee should beset up to consider thie question of the suitabilily of filmns(before they are shlown) inltenlded for exhibition to adlolescenltsas a means of illStl'UCtiOIl in sex hygiene, such comumittee tobe composed of representatives af the Ministry, the3 Boalrdof Edlucationl, and thle LJondon County Coun)cil in its capacit,iesas public hlealthl authority andc local educationl authorityr.

80 JULY I3, I9291 LETTEBS, NOTES, AND ANSWERS.l~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~IMDCLJUA

THE current (June) issue of the Bulletin of Hygiene containsa reviewv by Dr. J. D?. Rolleston of recent literature onalcoholisml-, withl a bibliography of forty references tojournals, theses, or books publishedl in nine differentcountries.THE thirteenth international congress of ophthalmology

will be held at Amsterdam from September 5th to 13th,under the presiclency of Professor van der Hoeve of Leyden.The principal subjects for discussiou will be the controlof trachouia; the etiology and non-operative treatment ofglaucoma; and the diagnosis of suprasellar tumours. Weare asked to remind any ophthalmnologists who intend to goto Amsterdaim for this congress, and whlo have not yet senttheir subscriptions, that it will greatly facilitate the work ofthe national committee if they will do so at once. Sevenhundred inembers have already been enrolled, and 232communications, covering all branches of ophthalmology,have been promised. The Transactions will be published,and promise to form a compendium of recent work in thissubject. Those unable to go to Holland may, nevertheless,become members of the congress, and so be supplied with acopy of the Transactions, when they appear. Subscriptions,25 Dutch florins, equivalent to £2 2s., should be seint toDr. H.. M. Roelofsz, Director of the Ineassobank,Heerengracht 531, Amsterdam.ACCORDING to the R?eichsnZedizinalkalender there were

43,507 medical practitioners in Germany in 1928, as comparedwith 47,338 in 1927. In 1928 there were 3,378 med-ical wornen,as comnpared with 2,078 in 1927. Among the thirteen Germancities .with more than 400,000 inhabitants, Munich in 1928 had'22.5 doctors for every 10,000 inhabitants, as compared with7 doctors for every 10,000 inhabitants for Germany as a whole.THREE fresh cases of leprosy were notified in Germ-any in

1928; four had emigrated or died during the year, and at thebeginnina of 1929 there were nine cases In the country.

All communication's in regard to editorial business should beaddressed to The EDITOR, British Medical dournal, BritishMedical Association House, Tavistock Square, W.C.t.

Oi1GINAL ARTICLES and LETTE'RS forwar ded for ptublicationare understood to be offered to the British Al cdical Journialalone unless the contrary be stated. Correspondenits who wishnotice to bo taken of thleir communicationis shxould authenticatetlhemn with their tnames, Inot necessarily for publication.

Authior s desir ingii REPRINTS of their airticles publislhed in tlheBritisis elcdical Journial must communicate witlh the FiniancialSecIretarY and Business Manager, Briitish MIedical AssociationHouse, Tavistock Square, W.C.1, on receipt of proofs.

All commziuniications witlh reference to ADVEItTISEMENTS, as wellas orders for copies of the Journal, sliould be addressed to theFinancial Secretary and Business Manager.

The TELEPHONE NUMBERS of the Britislh Medical Associationand the British Mlcdical Journal are AlUSEUAI 9DCG, 9S62, 936t,anid 9S64 (internal exchange, four lines).

The TELEGRAPHIC ADDRESSES are:EDITOR of tihe British Jlcdical Journal, Aitiology Westcent,

Londilont.FINANCIAL SECRETARY AND BUSiNESS M[ANAGER(Ad vertiserments, etc.), Articulate Wcstrcc t, London.

M1EI)ICAL SECItETA RY, Aledisecra Wcstcent, Lond^on.The add(1ress of 1ie liisl Office of tlhe Britisi Medical Association

is 16, Soutilh Frederick Street, Dublin (telegramIS: Baeillus,Diiblin; teleplhone: 62550 Dublin), and of the Scottishi Office,7, D)ruznslhctih Gardetirs, Alinbur- li (telegr-amtis: Aasociate,L'dinburgh; tcacpliorie 24361 Ediburgh).

QUERIES AND ANSWERS.

HAY FEVER.DR. J. M. DALZuEL (The Ilerbarium, Royal Botaniic Gardenis, Kew)writes: In reply to Dr. J. D. Hindley-Smitlh's qnery (Junl1e 29th,p. 1189) I wouild suglest that the dlates inidicate the "commonfoxtail grass," Alopecuirus pratentsis L., as thje probable soturce ofthe excitinig pollen.

RETROBULIBAR NEURITIS.IN aniswer to the iniquiry of "Nescio" oni July .6tlh (p. 36.), Dr.

J. ALDINGTON GIBB (Mlaidstonie) writes: Retrobuilbar nieuiritis isniot infrequenitly originated by (lisease of the nasal sinuses. Iumy expei ience the aniterior ethrnoid cells have proved to be themostuistnalcauise of thlis conditioni. In the recenit cases-say, oVeight weeks' dtiration-tbe i mprovemenit followvinug opelling anddraining of these cells was mi1ost dramatic. In a chronic case ofover six moniths' (durationi, wvith conmplete scotoma for colonrs,anid tihe visioon 6/60, the patient's recoveryv lasIbeeni complete, thevisioni returniing to 6/12. He has resumed his employm ent ofshuuter in a large railway yard.

INCOME TAX.Cash Basis.

"J. P." is beinig pressed by the inspector of taxes " to sign a letterpromising to pay tax on all the cash thiat comes in after retire-menit firom the practice." The itnspector affirms that otherpractitioniers in the neighbourhood have signied suchi unider-takings, and that the views expressed in this jouirnial, that theassessmenit of soeb receipts is not legally justified, is withoutauthority anid is inicorrect.

* It is true that there is no specific legal aulthority for theviews in qniestionl; that, is because the authorities hiave niottaken inito couirt tle- contenitioni that such rece.ipts Avere assess-able to tax for periods subsequent to retiremlenit. We have nodoubt wlhatever as to the legal position. As we have alwayssaid, the cash basis is a mere m.atter of mutual convenience;the correct basis is assessmenit oni the value of the bookiings forthe year-that is, the gross amiiount less a careful and(I detailedestimate of that )ortion which is probably irrecoverable.A moment's thjouglht will show that whiere the volume ofbookinigs is fatirly regular year by year, tlhe lnet value after theallowanice iiieiitiouel will be approximnately the sanme as theamounit of the cash receipts-the latter is more easily aud accu-rately ascertainiedl, and thierefore is normally accepted by theauthorities. Sunppose that when "J. P." retires the iuspectorseeks to adjnst lhis assessments, what precisely will the adjuist-menit be? (Leaving aside certaini techlnical objections whichcould be mnade to thtat coturse, he conld, nlo doubt, arrange for therevision of the assessmnents for six years.) It can only betowards the strict legal basis of bookinlgs. If, for instance, hesays, in effect, "1Tis £200 whiclh you received in 1929 after retire-menit represenits bookinigs of 1927, anid that year mtust beadjusted," "J. P." las the obvious rejoinder, "True, but £210which I received-and returued for assessmenit as inlcome of 1927represeuted wvork donie iu 1925, anid that £210 muist come outwlieni you make the adjtustment." The net result of the wholesbifting back of thje receipts to the years when they were earnedwould be negliglible in the case of a niormal practice-if thepractice has been growind it woutld adversely affect "'J. P." tosome extent, and(I viee versa if the practice has been diminishing.

LETTERS. NOTES, ETC.

TEAM WVORK AT THE BRITIsH LEGION VILLAGE.DR. 3. B.'McDOUGALL, medical director, British Legion Village,Preston Hall, Aylesford, writes: In your reviewer's kindlycriticism of my hook on percussioni (July 6th, p. 17) there is animportant omuissioIn for which your reviewer can scarcely beheld responsible. I trust I mqy be forgivein if I veniture to a(ldthat the linle drawiings in thte book were executed by onie of thesettlers in the BritisT Legionl Village, an ex-patient in thesatnatorinm, and thlat the -book itself was printed in the pressassociated with the settlemenlt for ttiberculous ex-servicemen atPreston Hiall.

MALARIA TRE-ATMENT OF GENERAL PARALYSIS.DR. T. GERLI) GARRY (Montecatini) writes: With reference toDr. Dods Browvn's remarks onl the treatmetnt of general paralysisby malaria inifectioni, -reported in the Journal of Junie 22nd((p. 1135), it may initerest lim to know that it is the custom inTIallganyika (a cu3tom which has possibly existed for cenituries)for the native medicitne men to send their patietnts stufferisigfrom general paralysis to malaria districts, and from reliablereports thie results appear to have beeu satisfactory.

THE PHOTOSTAT.IN our report last week (p. 34) of the anniiual general meetingc of theRoyal Society of Medicinie reference was madle to thie fact- that,-in order to make the service of its library better availsbhe toFellows who live at a distanice fromi Lonidotn, the Society hasinsgtalled an apparatus known as the "photostat," for makinigrapid photograptic copies from the pages of books anid jouirnials.This is offered asan alteru4tive to thje old muethod, involving thelaborious copying, of abstracts, whicl eveu thenl failed to repro-duce the illuistratiotns. The photostat is au apparatus of rathersurprising bulk and complexity, anid occupies a large room at theSociety's hotuse. Thle process, however, is simple, the printedpage being placed in positiol), illuminiated by merculry vapouirlamps, anid the exposure miade direct onl to sensitized paper (witha prismatic reversing arrangfemenit, so that'the print comes therighlt way rotnnid in tlhe reproduction), wlichl is imm-iediatelydeveloped and mnade ready to senid to the inquirer. This innova-tion shouild be appreciated by Fellows of the Society ini theprovince3 anid abroad.

VACANCIES.NOTIFICATIONS of offices vacant in universities, medical colleges,ana of vacant resident and other appointnr.ents at hospitals, willbe found at pages 44, 45i 46, 47, 48, 49, 52,- 53, and 54 of ouradvertisement columns, and advertisements as to partnerslips,assistantiships, and locumtene'cjes at pages 50 aud 51.A short summary of vacant p6sts.uotified in the advertisenent

columns appears in the Supplernent at page 23.