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occurs at the height of inspiration. Further,although the tracing is a close likeness, it is nota true picture of the pulsus alternans ; one featureis alien-namely, the length of the downstroke ofthe weaker beat which equals the length of thedownstroke of the stronger beat. In descriptionsof the pulsus alternans hitherto given no mentionis made of the relative length of the downstroke ofthe beats. To determine this relationship I haveexamined a large number of tracings, and I find intrue pulsus alternans that although the downstrokeof the weaker beat may be longer than its upstroke,it is never so long as the downstroke of the strongerbeat. On these considerations I submit, with alldeference, that the presence of true pulsus alternansin Fig. 6 cannot be accepted without demur.With regard to the prognostic significance of

pulsus alternans this has not been worked out, sofar as I know, except in one group of cases-namely,when it occurs in association with myocardial andarterial disease in aged people. I published notesof a number of these cases in the Quarterly Journalof Medicine, July, 1913, and at that time ten of thepatients were living; since, all except one havedied, and none of the lot lived much over threeyears. In other conditions in which the pulsusalternans occurs present experience only warrantsthis conclusion, that it adds to the gravity of theoutlook.In my own experience it is not met with in

rheumatic heart disease, or acute illnesses in theabsence of other signs of danger.

I am, Sir, yours faithfully,June 5th, 1915. J. DAVENPORT WINDLE.J. DAVENPORT WINDLE.

THE GRATUITOUS TREATMENT OFDEPENDENTS.

To the Editor of THE LANCET.

SIR,-I think it is time, if conscription is

approaching, for the profession to reconsider theirattitude towards the wives and children of thosemen who are serving either at the front or trainingin Britain. The number is increasing daily, and islikely to go on doing so. At the present time weare not paid for the insured among these men-aconsiderable loss to those with a large panel list-and we appear to be in danger of having our prac-tices still further decreased by a large increase inthe number of

"

dependents."There is no lack of loyalty in the writer of this

letter; he has done his share so far, but thefuture has to be borne in mind. Loyalty will notfeed the doctor and educate his family. There isno wish to pile extra burdens on those whose menare fighting for us, so surely this is a matter forGovernment to arrange.

I am, Sir, yours faithfully,May 31st. 1915. M.D.

THE USE OF TRAINED NURSES FORORDINARY DUTIES.

To the Editor of THE LANCET.

SIR,-I have before me letters from two trainednurses at present serving in stationary hospitalswith the Expeditionary Force. One takes spellsof duty as cook and housekeeper, while the otherhas to cook her own meals and wash up afterwards.Both are thoroughly good nurses and both, I

believe, are thoroughly bad cooks. I bring thematter forward in the hope that the authoritiesmay be able to prevent such an apparently un-necessary waste of our nursing material. Trained

nurses are scarce, but there are many experiencedhousekeepers, and the women of France have a

deservedly high reputation as cooks.I am, Sir, yours faithfully,

June 4th, 1915. __________________

H. B.

THE MEDICAL PROFESSION AND THENEEDS OF THE ARMY.

To the Editor of THE LANCET.

SIR,-The doubtful manner in which the recordsof our naval and military successes, no less than ofour failures, have reached us-the hesitation as tothe real significance of any news vouchsaf ed-hasbeen as bad almost as silence. Just as in generalaffairs it makes for good if as much information asis possible, having regard always to the militaryand political exigencies of the campaign, were pub-lished in clear language, so the medical man wouldbe helped by definite information. No one knowsbetter than he how seriously anxiety that is

perhaps not justifiable, and puzzledom that neednot exist, militate against the output of good work.As a whole we are an educated people, and the desireto understand before we act has increased amongus. The feeling is there, and though its manifes-tations are sometimes inconvenient, it should notbe ignored, for that only leads to its aggravation.The output of the munitions of war is stated tohave been delayed and even now to be jeopardisedby alcoholic habits in certain centres. The state-ment, while reiterated by some and flatly con-tradicted by others, has a basis of fact which weshould think by this time has been exposed suffi-ciently to the nation. But the position might havebeen made clear sooner, when much ill-will wouldhave been avoided, and possibly ready remedies forsome of the evil would have been found already.

It seems still to be in doubt how far moststringent calls are yet to be made on the medicalprofession, and no definite guidance is given to themedical profession as to how such calls shouldbe met. I am, Sir, yours faithfully,

SENEX.

SCIENCE IN CATALONIA.To the Editor of THE LANCET.

SlB,—The book noticed last week under thisheading may be taken to prove the vitality of therevival of the Catalan language, and we should allwish the revival success.For small states and small nationalities have a

precarious existence to look forward to, should thecentralisation and unification of nations and countriesso vigorously prosecuted by Germany gain any generaladoption in Europe. The principle of nationalityfor which Germany stands is entirely averse from theemployment of their native tongues or dialects bysubject races, thus contrasting with the principleof encouraging national individuality practised byourselves. At no period of her history has Spainproduced many men of science of European reputa-tion, a fact in striking contrast to her centuriesof eminence in the fields of literature and art.Catalonia certainly gave birth to an alchemist ofnote in the thirteenth century-namely, RaymondLully-if, indeed, it be not the case that thealchemical writings ascribed to him are forgeries ofthe fourteenth and fifteenth centuries. The presentrevival of the Catalan tongue undoubtedly gives anadmirable opportunity for the revival of the studyof science in Catalonia. May the opportunity beseized ! I am, Sir, yours faithfully,

HISPANICUS.