494

shows the curious distribution of language over whichthe visitor is apt to be more sensitive than the native,Most Swiss are polyglot, but in all the cantons thereis a considerable proportion of those who speak thelow German dialect left by the Alemanni ; Italian-speaking is confined exclusively to the two cantons ofTicino and the Grisons, while Romansch still comesnaturally to some 40,000 inhabitants of the Grisonsdescended from an islet of Roman soldiers maroonedin the high valleys. Burgundian French is the languageon and around the Lake of Geneva. Baedeker,.fortunately, is written in perfect English.

REALITY IN THE MARRIAGE SERVICE.

FOR a long time past many people have felt hesi-tation in regard to the treatment of marital relationscontained in the preamble to the Church of Englandform of solemnisation ot matrimony, and we are gladto note that, in the form adopted for use at the recentRoyal Wedding the phraseology was altered tobring it more into accordance with present-daysexual ethics. We set out in parallel columns theform as printed in the Book of Common Prayer andthat adopted by the Dean of Westminster at themarriage service.

07. New.First, it was ordained for First, it was ordained for

the procreation of children, to the increase of mankindbe brought up in the fear and according to the will of Godnurture of the Lord, and to and that children might bethe praise of His Holy Name. brought up in the fear and

nurture of the Lord, and tothe praise of His Holy Name.

Secondly, it was ordained Secondly, it was ordainedfor a remedy against sin, and in order that the natural in-to avoid fornication ; that stincts and affections, im-such persons as have not the planted by God, should begift of continency might hallowed and controlled; thatmarry, and keep themselves those who are not called ofundefiled members of Christ’s God to remain unmarriedbody. should live chastely in matri-

mony and thus in holinessand pureness of living man-kind should dwell together infamilies.

Thirdly, it was ordained for Thirdly, it was ordained forthe mutual society, help, and the mutual society, help, andcomfort, that the one ought comfort, that the one ought toto have of the other, both in have of the other, both inprosperity and adversity. prosperity and adversity.The change, which although not legalised has

received the approval of Convocation, is welcomeevidence of the spread of reality of thought on sexmatters among all classes of the community. To allwho have been brought up with a full knowledge ofthe place of sex in human economy it must seem asordid view to speak of marriage as being ordainedfor a remedy against sin ; nevertheless, the hallowingand control of the natural instincts and affections isan object which will command the loyal support ofthe medical profession. j

INTERNATIONAL PROBLEMS OF WAR

DISABLEMENT.

THE International Committee of Experts set up bythe International Labour Office of the League ofNations to consider some of the problems of wardisablement met in Geneva on March 2nd. Amongthe members of the Committee are Major J. B. Cohen,M.P., treasurer of the British Legion ; Dr. Meier, ofthe German Labour Department; Dr. Foth, repre-senting the disabled ex-Service men of Germany ;Dr. Brandeisz, representing Austrian disabled men ;Dr. Ripert, consulting physician to the militaryfitting centre of the Paris district; Mr. Cassin, Vice-President of the Union of French Disabled Men’sAssociations ; Prof. Levi, representing Italy; Dr.Mammalella, President of the Italian Association ofDischarged and Disabled Men ; and Dr. Kikiewicz,of Poland. The Health Section of the League ofNations, the Red Cross organisations, and the Inter-Allied Committee of Disabled Men were also repre-sented at the meeting. The intention is to discuss theorganisation of an international prosthetic exhibition,

to show the progress rnade in the manufacture anduse of artificial limbs; another subject of discussionwill be the administrative systematisation of prosthesisand orthopaedics, to be considered from two points ofview-first, a comparative study will be made ofexisting organisations and results in the variouscountries, and secondly, the future of the supply oflimbs will be considered. The experts will be askedwhether they think it desirable to maintain thesupply organisations permanently, in collaborationwith insurance societies and hospitals, for the benefitof men disabled in industry, and if so, in what formthey should remain. Another question before themeeting is the organisation of medical treatment fordisabled men-a question also to be dealt with by acomparative study of the existing national systems.Here again the Committee will discuss the methods bywhich men disabled in industry may receive the samebenefits as men disabled in the war, and by whichpresent legislation concerning industrial accidentscan be modified to allow a permanent right tomedical treatment for injured persons. Specialconsideration is being given to the position of disabledmen living outside their own countries ; reciprocalagreements for cases of this kind have been concludedby Great Britain and the Dominions, by Canada andthe United States, and by Germany and Austria.The Committee is considering the possibility of wideradoption of agreements of this kind, and the prac-ticability of securing a convention laying downfundamental principles for international protection ofmen disabled in the war.

THE ENERGY DISCHARGE OF THE HUMAN

ORGANISM.

WE have been taught by the American School of Physiology-Benedict and others-that a man ofs average weight gives off at rest something like 1 kilo-- calorie (or 425 kilogrammetres) of energy per kilo-

gramme of his body-weight per hour. During muscularr work he gives off four or five or more times as much.i One method of measuring it is by determination of the) rate of oxygen consumption. Dr. A. D. Waller claims1

that the variations of CO 2 output with variations of, respiratory quotient are small enough to be negligible without involving any serious error. The majority of physiologists do not agree with this and consider itI necessary also to measure the oxygen direct. Dr.

E Waller’s simple method of measuring the energy

emission of the human machine by the rate of CO 2

l production has accordingly not been regarded withr much favour, except in Trance, where his contention

: that the shorter method involves (according to his; statement) an error of only ±5 per cent. is admitted.

by some, and his claim that the method is valuablefor the rapid approximate estimation of human energyexpenditure is being submitted to trial. Dr. Boigey,the medical officer in charge of the military gymnasticschool at Joinville, has applied the short method tovarious kinds of physical exercise, marching, running.boxing, &c., and clinically to cases of pyrexia. Hefinds--e.g., for marching at a speed of 1-42 metres persecond an expenditure of C0s==12’8 c.cm. subtractingfrom this gross value 3-32 c.cm. per sec. as the restingor basal value, gives 9-48 c.cm. for his 71 kilogramme

subject-i.e., a net cost at this speed = .—..c.cm.1.42 X71c.cm.per horizontal kilogrammetre-i.e., 0.094 c.cm.-a

value not very divergent from that assigned by Wallerand De Decker to the actual route-marching of Belgianrecruits-viz., 0-1 c.cm. per horizontal kilogrammetre.1Dr. Boigey’s results on subjects of pyrexia are remark-able. His gross values for the resting metabolismof such subjects are remarkably high-e.g., 24 and] 7 c.cm. CO2 per sec. in two cases-i.e., according toDr. Waller’s formula a resting metabolism of approxi-matelv 480 and 340 kilocalories Der hour. values that

1 Bulletin de l’Académie Royale de Belgique, December, 1920,La dépense physiologique mesurée chez le soldat en marche deroute.

495

are many hundreds per cent. above the normal andthat illustrate very clearly and simply the funda-mental principle that pyrexia consists essentially inincreased heat production and not merely increasedheat retention. The principle of Dr. Waller’s methodis obviously susceptible of control by direct oxygenmeasurements, by means of Fredericq’s oxygenograph,or of the beautiful apparatus for the clinical estimationof the rate of oxygen consumption that has recentlybeen placed upon the market in this country byMessrs. Sanborn. We think that, in fairness to Dr.Waller’s claims, it should be so tested and comparedwith the standard method by any who might profitablyemploy it, say for examination of exophthalmicaoitre cases. ____

THE ROLL OF THE ROYAL COLLEGE OF

PHYSICIANS OF LONDON.1

THE list of the Royal College of Physicians ofLondon for 1922, which has just been issued, includes 1the names of 367 Fellows, 573 Members, and 14,177 1Licentiates. The senior Member is now Dr. Clarence iCooper (1860), the senior Fellow is Dr. Peter WallworkLatham (1866), and the single Extra-Licentiate isDr. Edwyn John Slade King (1857). The Roll is nowswelled by the addition of 982 diplomates in publichealth, 112 in tropical medicine and hygiene, 10 inpsychological medicine, and 39 in ophthalmic medicineand surgery. The classified list shows that 2 Fellowsand 9 Members practise, during part of the year atleast, on the continent of Europe. In Asiathere is 1 Fellow and 40 Members, in South Africa1 Fellow and 4 Members, in Australasia 5 Fellowsand 22 Members.

____

THE CALCUTTA SCHOOL OF TROPICAL

MEDICINE.

ON Feb. 4th, at Calcutta, the School of Tropical IMedicine and Hygiene and the Carmichael Hospitalfor Tropical Diseases were formally opened by LordRonaldshay, Governor of Bengal. In the course of hisaddress Lord Ronaldshay commented on the satis-factory termination of the anomalous situation wherebymedical men resident. in India have hitherto beencompelled to leave the home of tropical diseases toseek instruction in their treatment at Liverpool andGreenwich. Both he and Lieut.-Colonel J. W. D.Megaw, I.M.S., director of the school and superin-tendent of the hospital, paid tribute to the great workdone by Sir Leonard Rogers, who put forward theoriginal proposal of foundation in 1910, and devotedceaseless effort during ten years to the establishmentof these institutions. After reviewing the history ofthe school, Lieut.-Colonel Megaw described certainspecial features of the work ; he instanced a series ofweekly lectures on special subjects now in progress,given by distinguished visitors and by leading medicalmen in Calcutta to the staff and students of the schooland to outside medical men. Monthly conferences ofthe staff are a valuable adjunct to the research work ;post-graduate teaching and research, indeed, are themost obvious functions of the school, and a promisingprogramme is already being carried out. A portionof the research side has already functioned for morethan a year,l whilst a good beginning was made withthe actual teaching work in November, 1921. So rapidwas the response to the provision for post-graduatemedical study that the problem of future accommoda-tion has already taken shape. Before the end of thepresent year it is expected that the whole of the researchscheme, and the complete course of instruction for thediploma in tropical medicine and hygiene, will be infull working order. The research work already effectedis outlined in the recently-issued account of the school.which also contains the report for 1920 of the secretary,Major R. Knowles, and the director’s report for 1921,Leprosy, kala-azar, hookworm disease, and niariasishave been the subjects of investigation ; inquiry has

1 THE LANCET, 1920, ii., 1268.

also been made into the distribution of various typesof dysentery in Calcutta, and into the causationof skin affections commonly met with in India.Results in some directions are reported as being verysatisfactory. The account of the completion of theschool closes with an expression of hope that meansmay be found whereby a separate institute of hygienemay be built next door to the existing buildings ;the institute is at present housed in limited quarters inthe School Of Tropical Medicine, and its removalwould both allow expansion of the school and enablethe concentration in a single building of all activitiesof the department of public health.

THE HETEROMORPHOSES IN THE HUMAN

BODY.

UNDER this title a valuable article by Dr. G. W.Nicholson appears in the current number of the Guy’sHospital Reports. After a description of an embryonictumour of the kidney, which exhibits heteroplasiato an unusual degree, the author proceeds to discussthe various types of tissue malformations which maybe met with in the human body under normal andunder pathological conditions. He divides theheteromorphoses into the following groups : hetero-plasias, the malposition of normal cells ; prosoplasias,the abnormal differentiations of epithelium ; hetero-topic differentiations, including the formation ofbone in abnormal situations, such as caseous materialin necrotic epithelium ; and metaplasias of epithe-lium. In each of these groups Dr. Nicholson describescases which have come under his own observation,illustrating them by admirable drawings of micro-scopic preparations. Further, he has abstracted theliterature of the subject very thoroughly, a list of noless than 53 references is appended to his paper, sothat the monograph forms a very complete contribu-tion to our knowledge of this difficult and interestingquestion. Variations from the normal of the develop-ing cell may be due to two factors : they may resultfrom vicious tendencies inherent in the cell, or theymay’ depend upon abnormal influences brought tobear upon the developing cells by reason of abnormalconditions in their environment. Dr. Nicholsonreasonably insists that environmental influences mustbe exhaustively considered before we fall back uponhypothetical properties inherent in the cells them-selves, and he explains the conditions he describes asreaction to various external factors. It is a point ofview which has an obvious bearing on many patho-logical processes, particularly the neoplasms, andwould seem to be inherently sound.

GLOMERULAR FILTRATION.

RECENT measurements of the blood-flow throughthe kidneys show that it is much more abundant thanwas formerly supposed. If the blood-flow through thekidneys in man is taken at 2500 litres in 24 hours-afigure obtained by assuming that half the blood in thebody can pass through the kidneys in one minute,a blood-flow which appears usual in rabbits-andthe average urea content in human blood as 0-2 g. perlitre, the total amount of urea which passes throughthe renal vessels each day is 500 g. But the dailyexcretion of urea is only about 30 g., or 6 per cent., ofthe quantity supplied to the kidney by the blood-stream. The relative proportion of plasma andcorpuscles must be considered, as well as the fact thatthe blood urea is distributed equally between plasmaand corpuscles in determining how much urea isactually available for excretion. If we assume thathalf the total volume of blood consists of plasma, then12 per cent. of the available supply of urea iseliminated, which means that 88 per cent. of theplasma has not come into effectual contact with therenal cells, and is altered in its passage through thekidney only in so far as it is diluted with the fluidthat has come in such contact. These considerationsare set out in the current number of the Journal of