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limited education or with demonstrably psychopathictaint remained on as clinically sick. The follow-upof the cases was the main aim of the author’s studv.In this follow-up of a group of psycho-neurotics Dr.Fenton found that the " 1924-25 group is of muchmore use to society now than they were to the armyat the time of discharge from hospital." This findingneeds more careful statistical analysis. Adaptation tomilitary life was more difficult to the neurotic thanadaptation to civilian life. Moreover, educationstatistics merely indicate a higher social level ofachievement and easier power of return to a morereceptive environment,. The decently educated soldierprobably came from an environment much morewilling to reabsorb him on his return than wouldbe the case of the poorly educated and his less sympa-thetic environment. Again, in America the post-war prosperity made it easier for the war-scarredyoung American to find a place in the communitythan did conditions in England for our men. Many,it is true, were medically unfit for work, but thecriterion of fitness was profoundly influenced by theeconomic depression and by the movements of

population to the big towns during the Great War.In fact, the problem of shell-shock at this stageneeds exploration of two fields. First, what are

the individual characteristics which make for warneurosis ? Secondly, what are the social and economic factors which are at work perpetuating such a condition ? Whether the readaptation frequentlyachieved has been due to the actual healing of psychicscars, or whether society has been able to shut its eyesto them and reabsorb these men, can only be decidedby a more careful consideration of the victim as anindividual mind and as an economic unit. Dr.Fenton’s book is of extreme interest to those who havehad to deal with shell-shock cases, and he has broughtforward data and methods of correlation which oughtto stimulate inquiry in this country where war neurosisand its aftermath remains a problem.

PHTHISIS IN THE SLATE INDUSTRY.

THE question as to whether inhalation of slatedust is associated with a high death-rate from phthisishas often been raised, but never decided. Now,however, a report 1 has been issued from the WelshBoard of Health which bids fair to settle the matter.Slates are nearly a monopoly of North Wales wherethey are quarried in the counties of Merioneth andCarnarvon. The men who get the rock in the openterraced quarries are less exposed to dust than themen who split and dress the slate in sheds. When themortality experienced by these men is considered inrelation to their dust exposure, and to that of othermen in the small rural district of Gwyrfai, which Dr.T. W. Wade intensively investigated, the influence ofthe industry is brought to light. All the slate workers,and in particular the dressers and splitters, experiencegreater mortality from phthisis than other males, and-this mortality exhibits the statistical phenomenacharacteristic of phthisis of silicotic origin, which arethat it occurs later in life than usual and is associatedwith high mortalities from other respiratory diseases.The excessive death-rates are far below what areexperienced by some other industries with a silica,dust risk, such as tin-miners in Cornwall, and metalgrinders in Sheffield, but the exposure to dust in theslate industry appears to be less, as is also the contentof silica in the dust. Interesting mineralogical reportsare given of the composition of the slate dust ; theyindicate that some 35 per cent. consists of silica in theform of quartz and that particles from one to fivemicrons in size are plentiful. On the clinical side thecase waits to be fully established ; post-mortemevidence has not been forthcoming and X ray

1 A Report of an investigation into the alleged high mortality-rate from tuberculosis of the respiratory system among SlateQuarrymen and Slate Workers in the Gwyrfai Rural District.W. T. Wade, Welsh Board of Health, Ministry of Health. ReportNo. 38 H.M. Stationery Office. 1927.

examinations are yet to be made. Now that theexistence of this occupational disease has beensuggested by statistical and mineralogical evidenceclinical and pathological findings will doubtlessfollow, and the attention of technical advisers shouldbe directed to eliminating the dust risk from theindustry. The report takes cognisance of variousother social conditions, such as housing, wages, andgeographical location, and is thereby the more

thorough ; it contains two puzzling tables headed" proportionate mortality," in addition to more conl-prehensible figures, useful explanatory graphs, andexcellent illustrations of the slate industry.

THE PRISON PSYCHOSES.

FROM time to time in convict prisons examples areseen of certain morbid mental states which have ebeen described as distinct disease forms under thename of " prison psychoses." These have been thesubject of much inquiry, but, on account of thevariation in the material which was available and inthe conditions under which the studies were made.some confusion of thought appears to have arisen asto what may or may not be regarded as belonging tothis class of mental disorder, and whether, in fact,the classification is not redundant. In a recent

paper, published with the sanction of the Directorsof Convict Prisons in England (although it does notnecessarily represent their views), Dr. H. T. P. Youngdefines these states as "special types of mentalreactions developing upon conflicts which arise as theresult of imprisonment, and possibly from the shockattending the criminal act, trial, and conviction."He is careful to point out that in order that theexistence of a separate and distinct disease may bedemonstrated, it is essential that all those cases inwhich the chief external cause cannot be attributed tothe effect of prison surroundings should be eliminated.This, in his study, he has endeavoured to do, con-sidering as strictly eligible for inclusion in the groupas defined only those persons of whom no history ofmental or nervous disease is known apart from theirprison records. As the result of his inquiry, Dr.Young finds that there is such a condition as a true"

prison psychosis " ; that its characteristics are

observable both in first offenders and in recidivists ;that. as a rule, its development is not rapid, usuallya period of 6 to 18 months being required ; thatthe condition appears to form a connecting linkbetween the anxiety neuroses of a traumatic origin onthe one hand and systematised delusional insanityon the other, bordering on the former more especiallyin first offenders who temporarily have lost their

capacity to realise the full responsibility for theircrimes, and on the latter in recidivists whose anti-social feelings are developed more strongly, and whosefacility in projecting their guilt appears to be morepronounced.The material upon which these " Observations are

based consists of male convicts serving terms of penalservitude of three years and upwards, and of habitualcriminals undergoing sentences of preventive deten-tion ; they belong to many races and to all gradesof society, and they vary in intelligence and ineducational attainments, while all the more seriousforms of crime are represented. Among approxi-mately the 300 convicts who had been placed underspecial mental observation, there were 10 cases inwhich these disordered states of a prison type wereobserved. This number does not include others whosesymptoms bore the stamp of their environment, butin whom the disorders themselves varied but littlefrom those to be seen in other situations and underother conditions. Of these 19 cases, five were certifiedas insane, and the remainder discharged from theprison hospital after periods of observation varying

1 Observations on the Prison Psychoses. By H. T. P. Young,M.B., Ch. B. Edin., Medical Officer, H.M. Convict Prison, Park-hurst. Reprinted from the Journal of Mental Science, January,1927.

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from a few weeks to several months When comparedwith their equivalents in the general community,they were relatively inferior in physique ; in none ofthese cases were signs of tuberculosis, or a positiveWassermann blood reaction found ; septic foci,however, were rarely absent. The grosser sequela?of encephalitis lethargica were not detected, nor wasany connexion found in the cases examined betweenfebrile conditions of short duration, such as influenza,and the onset of mental changes. Although nobiochemical tests were done, the routine physicalexamination revealed no gross changes in the thyroidgland, but instances of mild hypothyroidism wereseen in some of the cases in which chronic infectionsincurred. Apart from those prisoners in whorn nopsychopathic taint is known to exist, there is atParkhurst, where this inquiry was conducted, a smallgroup of men, forming about 5 per cent. of thepopulation of the prison, who, because of some

distinct but uncertifiable mental abnormalitv. havebeen brought together from all convict stations forspecial mental observation and treatment, as well asall those whose mental state has given rise to doubtas to their fitness for ordinary convict conditions.The observations and conclusions in this paper,

therefore, refer to a population which is, in part,especially selected, and do not represent the con-ditions at other convict prisons. This must be bornein mind when comparing this paper with previouswritings on this subject. In their " History of thePrison Psychoses," Nitsche and Wilmanns ably havesummarised the more important of these earlier

publications. From them we learn that Reich.Moeli, Ganser, and others reported on insanity chieflyamong those awaiting trial; that Rudin, Birnbaum,and Bonhoffer relied on observations which thevhad made after the cases had been received into aclinic ; that Kirn’s material consisted of short-termpetty offenders who had been in solitary confinement,and Gutsch’s patients developed disease when under-going the same punishment ; that Sommer inquiredinto the cases of men who had been transferred fromprison to a criminal lunatic asylum, and Delbruck,who was, perhaps, the first of the investigators inthis field, was in charge of a prison containing a largeproportion of convicts who had been sent there fromother institutions because thev were not amenable todiscipline, a fact which, as Dr. Young points out. issuggestive of mental abnormality of some standing.Few of these observers, not excepting Siefert, hadaccess like Dr. Young to cases of long-sentence prisoners in their own peculiar surroundings and when the disease was in its earliest stages.

THE OXFORD OPHTHALMOLOGICALCONGRESS.

THE seventeenth annual meeting of the OxfordOphthalmological Congress is to be held from Thursday,July 7th, to Saturday, July 9th, and an interestingprogramme has been arranged. The sessions are to beheld in the Department of Human Anatomy in theUniversity Museum, and on Thursday, at 10 A.M., theopening address will be delivered by the Master,Mr. Philip Adams, after which Dr. William H. Wilmer(ophthalmologist-in-chief to the Johns Hopkins Hospital, Baltimore) will open a discussion on theResults of the Operative Treatment of Glaucoma.Amongst those who will take part in this discussion areProf. Felix Lagrange (Bordeaux), Mr. T. H. Bickerton(Liverpool), Mr. A. L. Whitehead (Leeds), Lieut.-Colonel H. Herbert (Brighton), Mr. Malcolm Hepburn(London), Lieut.-Colonel R. E. Wright, I.M.S., Dr.C. F. Bentzen (Copenhagen), Prof. J. Szymanski(Wilno), Dr. T. Harrison Butler (Birmingham), Mr.R. Davenport (London), Mr. J. Hern (Egypt), andDr. L. Preziosi (Malta). The Doyne memorial lecturewill be delivered on July 8th by Prof. K. K. Lundsgaard(Copenhagen), his subject being the Pneumococcus inConnexion with Ophthalmology. At other meetingsthere will be numerous addresses and communications

dealing with research and clinical practice. Theannual dinner uf the Congress will be held on Thursdayin the hall of Keble College, where members are

offered accommodation. A full programme «f the.

arrangements may be had from the hon. secretary.Mr. Bernard Cridland, whose address is SalisburyHouse, Chapel Ash, Wolverhampton.

A CARNIVOROUS RACE.

IT is generally believed that much renal andcirculatory disease is due to impairment of nitrogenousmetabolism by a diet too rich in animal protein, andit is therefore interesting to read an account 1 ofsome research undertaken by Dr. William A. Thomason the Eskimos of Northern Labrador and Greenland.who subsist exclusively on fish and meat. Hederived his information from personal examination ofthe natives, and from the records and knowledge ofthe Danish physicians. The hospitals of Greenlandare excellent, and Dr. Thomas had access not only tolaboratory facilities but also to statistics coveringmany years. The diet consists of whale, walrus. seal.caribou, musk ox, hare, polar bear, sea-birds, andfish-all preferably eaten raw. The Eskimo actuallyeats very little fat, but uses it for fuel ; he prefersthe red meat and liver, eating the entrails in time nfscarcity. The results of the inquiry showed no

unusual prevalence of either cardiovascular or renaldisease. The average blood pressure of 142 adultswas 129/76, and the highest was only 17U,’1U0. Inthis series albuminuria was found in 12 persons. ofwhom only three had a systolic pressure of morethan 140 ; the other nine had moderate amounts ofserum-albumin. Two of the three who had bothhypertension and albuminuria had casts in the urine.and casts were also found in the urine of two of theremaining six who had hypertension only. and inthree of the nine who had albuminuria withouthypertension. Nephritic oedema was seen in onlyone subject. Of nine persons over 60 years of age.only one had any albuminuria. These natives leacllives of great physical activity and hardship. andseem to be quite capable of dealing with their highprotein diet. It is also remarkable that in carnivorousGreenland both scurvy and rickets are unknown.Children are suckled until they are 4 or 6 years oldand can eat meat. In Labrador, however, wherecivilisation has trained the natives to buy cereals anddried and canned provisions, Dr. Thomas notes thatscurvy and rickets are universal. The abundance ofsummer sunlight seems to give no effective protectionagainst the latter disease. The explanation maybe that fish, and fish-eating animals, contain muchvitaniin C, as well as A, in their tissues. Its sourceis presumably the marine vegetation on which thefish feed. Stefannson, the explorer, was the first topropound the theory that a white man could findsufficient animal food in the polar seas to keep himin good health, and he had the courage to stakehis life on it. It is probable, Dr. Thomas thinks,that most healthy white men could quickly adaptthemselves to the natural carnivorous diet of theEskimos ; the raw skin of the white whale is anantiscorbutic as efficient as orange juice or banana.What he must resist, apparently, is the temptation toeat polar bear’s liver, as for some reason this is verypoisonous. _ _

POST-MORTEM CIRCULATION.

Dr. R. Eisenmenger, a specialist in physical therapyat Vienna, has succeeded in producing artificialcirculation of blood in the human bodv after death.2An air-puinp 3 placed over the abdomen producespositive and negative pressures of 40 to fi0 mn. of

mercury, these pressures alternating at the usual rateof the respiratory rhythm. Positive pressure driven

1 Jour. Amer. Med. Assoc., May 14th, 1927.2 Wiener klinische Wochenschrift, 1927, No. 23, p. 755.

3 Ibid., 1924, No. 15.