,CPRL 7,I906.]MEMVORANDA. LTEIz BRITISH 797

APRIL 7, i9016.J [V~E~~JI.MEDICAL JOURNAXr. 9

bacillus. In presence of these and other considerations, wemnay, therefore, say that the diphtheroid-bacillary origin of thetabetic toxin is at least not proven.

In the absence of any living organism capable ofvgenerating the tabetic toxin, it may be that the syphiliticvirus under certain conditions so affects some viscus orgland that in time it develops, and continues to elaborate,some toxic internal secretion which exerts its noxiousinfluence on the nervous system.

In view of the brilliant therapeutic triumphs of the pre-:sent day, it is not, I think, too optimistic to hope that,with the progress of bio-chemistry, we may yet discover-the source of the tabetic toxin, its nature, and the means-of neutralizing it and staying its ravages. We cannot-expect to repair damage already done, for intramedullarydegeneration is irreparable, but we may at least succeedin arresting the disease. This not infrequently happensspontaneously; and the therapeutic measures last em-ployed are apt to get the credit of the happy result. Butbeyond palliation, or the temporary relief of urgent sym-ptoms, no remedy, chemical or plhysical, has as yet been4discovered which materially influences the morbid process.Antispecific treatment may be of service against possiblecoinicident tertiary lesions; or may even cure pseudo-tabetic syphilitic symptoms; but certainily ordinary anti-:specific treatment exerts no beneficial influence on truetabetic degeneration, and may. if carried to extremes,prove positively harmful. If, however, we believe, as Ithink we must, that the syphilitiv virus is the sine qud nonin the etiology of tabes, it ought to be our endeavour tocombat this with all the resources at our command.The comparative mildness of the primary constitutional

symptoms in those who ultimately become tabetic, wouldLlmost seem to indicate that when the syphilitic virusexpends itself in severe primary and secondary manifesta-tions there. is less tendency to the subsequent develop-ment of the subtle poison whiclh proves so disastrous tothe nervous system.This mildness of the primary symptoms without doubt

leads in many cases to insufficient treatment. Even themost efficient antispecific treatment, however, may fail toprevent the subsequent development of tabes in certaincases. But the facts recently brought by Fournier beforethe Acad6mie de M6decine in reference to the relationbetween general paralysis and syphilis and its treatmentare, worthy of careful consideration and probation.

Fournier states that of 79 cases of general paralysiscoming under his own observation, in which he was ableto obtain precise data as to the character and duration ofthe treatment to which they had been subjected, only5 per cent. had been treated with thoroughness; while inat least 80 per cent. the antispecific treatment had beencarried out in a more or less perfunctory manner. It isvenough, he says, to treat constitutional syphilis for weeksor months only. Fournier contends that mercurial treat-ment should be administered for at least two years con-tinuously, and intermittently for several years longer."' Treat syphilis well, and you will have few cases of generalparalysis," lie says. The same would hold true of spinaltabes. These views deserve the special consideration ofthose who have most opportunities of treating syphilis inits earlier stages. If they are substantiated, tabes bothcerebral and spinal will become one of the rarer, insteadof one of the most common, and, it is to be feared,iniereasing forms of organic nervous disease.[The bibliography will be given at end of third lecture.]

SCHOOL. HYGIENE.-On the initiative of Dr. CUsar Rouxthe sanitary card has been introduced into the municipalsehools of Nice. Each pupil is provided with a smallbook, in which are recorded all particulars as to his age,domicile, place and date of birth, successful vaccination,weight, height, chest girth, and aptitude for spor'ts. Thebooklet also contains elementary notions of hygiene,advice for the correetion of wrong positions in reading andwriting, and on the dangers of alcohol and tobacco. Acard attaclhed to the book is handed to the medical in-.spector, who is thus enabled to advise the parents of theehild as to the eare to be exercisedl in his bringing-up. Aspecial advantage of the sanitary card is that, by means ofthe observations recorded thereon, chlildren whom theteacher mighlt otherwise punish for idleness or mis-behaviour are showvn to be suffering from -adenoidgrowtls, nlervous troubles, or hereditary taint of one kindor anotlher.

4

M E M OR A N D AMEDICAL, SURGICAL, OBSTETRICAL.

FETUS ANENCEPHALUS: TWO CASES WITHINTHREE MONTHS.

IT is very unusual to meet with two cases of anencephalicmonsters in private pra.ctice within three months, and

therefore I think it worth whileto forward photographs of twoinstances of this type of mon-strosity which came under myobservation last year witliin thatlimited period. The smallerfetus was born prematurely atthe sixth month; the largerspecimeni nearlycaused the mo-

After consulta-tion with twoothier practition-ers prematurelabour was in-duced at theeightlh monthowing to verysevere albumin-nuria and' gene-ral dropsy. Thepatient made anexcellent an dspeedy recovery,and was able toattend to her4duties in tendays. In the

larger specimen there was a complete absence of theposterior bones of the skull, and the spinal columni waswidely open down to about the seventh dorsal vertebra.

F. W. KING, M.R.C.S., L.R.C.P.Auckland, New Zealand.

CALCIUM SALTS IN CHILBLAINS.THE name ' erythema periuio" at once helps us to formsome idea of the nature of the disease. It is associatedwith such general disorders as urticaria and erythemanodosum on the one hand, and with lupus erythematosuson the other. On both sides, therefore, it is associatedwith general diseases due to some poison which has theteffect of producing characteristic local lesions.

Yet, notwithstanding such associations, it is usual toconsider chilblains a purely local affection, aggravated,und-oubtedly, or contributed to, by such general con(litionsas a "weak circulation "or "want of arteiial toIe." Base(on such a pathology, the treatmeint lhas beeit to givecod-liver oil, ilon, digitalis, and suchlike drugs internially,the external treatment being satisfied with paintiing iodinie"till they break," and then applying fomentations.The close association of chilblains with such general

diseases as those above mentioned, and their appearancein persons who have tuberculous tendencies, suggested tome that the cause must be one affecting the body gener-ally, but depending on climatic conditions for the charac-teristic manifestation. Cardiac and arterial tonics havebeen in the majority of eases so singularly unsuccessful,that I thouglht it advisable to administer drugs whichwould alter the character or quality of the blood, especiallyas regards its exudation properties.

Chilblains are particularly prone to occur in certainclasses of the community, such1 as shop girls wlho tend toneglect themselves, and children in orplhanages, and insti-tutions for the deaf and dumb. The neglect referred toin connexion w.ith shop girls shows its results very oftenin the form of anaemia, again helping to emphasize tlhefact that it is to tlle blood that attentioni slhould bedirected.The drug which seemed to me thle most appropriate was

calcium chmloride, experiments having provedl that tin'coagulability of the blood was increased by its administra-tion. In haemophilia and in purpura this drug hlas beenfouAnd useful, and I determined to try its effect on ehmil-blains. I ganve it- inl 10 to '15i gr. dose~s withl liquorice

THni BRITISH 17 9'0 M7DICAL JOURNALJ MEMORANDA. [APRIL 7, 19o6.

extract three times a day, and the patients, most of whomwere engaged in sedentary occupations, began in two tothree days to show remarkable signs of improvement.Some whose chilblains had broken found that these wererapidly healing up, and others who were expecting them tobreak were agreeably disappointed to find them graduallysubsiding. Several of the patients who had had experi-ence of chilblains on previous occasions, remarked on onestriking feature of the cure-namely, that previously, whenhealing, the fingers felt stiff for some time, but after takingthis medicine the stiffness disappeared very quickly.Another series of cases was found amongst the children

of the Deaf and Dumb Institution in this town. One morn-ing I had paraded before me twenty children, some ofwhom had very bad chilblains in the ulcerating stage.I. put them all on 10-gr. doses of calcium chloride, andin three days all were very much better. One boy, whosetoe was almost bad enough to suggest the necessity ofamputation, the ulcer being deep and very offensive,showed a very ready response. Last year a boy with anequally bad toe, which did nlot improve under "generaltonics " and local applications, had to have hiis toeremoved.IMy friend, Dr. Evans of Fforestfach, with whom I had

discussed the subject, agreed to give the treatment atrial, but, instead of giving calcium chloride, he gavecalcium lactate with equally encouraging results. Hewas especially impressed with the rapid removal of theaccompanying stiffness.The only unpleasant effect he encountered was a sensa-

tion of giddiness in two young ladies, which preventedthem from indulging in as many waltzes as usual at a'dance they went to, while still taking the medicine.

G. ARD3OUR STEPHENS, M.D., B.S., B.Sc.Lond.,Honorary Plhysician to the Royal Cambrian Institutionfor

Swansea. the Deaf and Dumb

A CASE OF OCCLUSION OF BOTH EXTERNALAUDITORY MEATUSES.

D. R., a female infant of 7 months, born of healthy multi-para with no aural malformation, was found shortly afterbirth to have each external auditory meatus blocked by amembranous septum at a distance of about i in. from thesurface. This condition appeared identically the same in

each ear, though theoutward form of theright auricle was very

left,

as will be seen from the

accompanying photo-graphs. The right ear

more closely conformsto the normal than theleft in general contour,

Left. Right. the latter showing,besides the marked

alteration in shape, the presence of a very deep fossaabove the rudimentary concha. The sense of hearing iscertainly not in abeyance, and this would appear to pointto the septa being thin.

Is operative interference in this case contraindicated?From the references to similar cases observed it would

appear such are by no means infrequent, but I can find norecord of the after-results of surgical treatment.York. A. B. NORTHCOTE, M.D.

A SIMPLE METHOD OF FREEZING TISSUTES FORSECTIONING.

PROBABLY many histologists have refrained from adoptingthe liquid carbon dioxide method of freezing tissues forsectioning on account of fancied difficulties and com-plications.

Certain difficulties do exist when the liquefied gas isused in accordance with published instructions, whilst, inaddition, considerable expense is necessarily involved ifone of the microtomes especially constructed for its usebe adopted. Moreover, some of these instruments appearto lack the precision of movement necessary for the

preparation of perfect sections.There is, however, another method of using compressed

carbon dioxide which is free from difficulty and complica-tion, economical, and effectual. It consists in connecting

the cylinder of compressed gas, which is kept in the erectposition, directly, by means of rubber tubing, with theordinary ether-spray apparatus. The pressure from thecylinder takes the place of the pressure from the bellows,and there is a slight additional cooling effect producedby the expansion of the gas. Ether is employed as usual,but the freezing is accomplished so quickly that the extraexpense may be disregarded.The advantages of the method are its perfect simplicity-

and great convenience. IJissues can be frozen in a coupleof minutes and kept at any desired degree of hardness foras long as necessary by simply altering the valve on thecylinder. One caution is necessary: the rubber tubeshould be loosely connected with the cylinder-that is,.should not be tied on, so that it may act the part of asafety valve, and may be blown off in the event of toosudden an opening of the cylinder tap.As a help in the rapid diagnosis of tumours during

operation the method should be of service, whilst for-ordinary work its convenience is very great.Probably others have used a similar arrangement, but it

seemed worth while to write this note in the interests of'those who have little time for experiment, and who have-regarded the compressed carbon dioxide method ascapricious and its advantages as doubtful.Bristol. A. F. STANLEY KENT-

THE EFFECT OF VARIOUS RAYS ONTRYPANOSOMES.

IN the BRITISH MEDICAL JOURNAL for March 31st refer-ence is made to a paper by Mense (Archiv fur Schife undTrop. lygq., July, 1905), advocating the use of Roentgen rays.in trypanosomiasis. It may prove useful to state that morethan a year ago liquid preparations of blood containing-numerous active trypanosomes were exposed by me forperiods varying from half an hour to one hour to very strong:rays of three kinds-Roentgen rays, Finsen rays, and thoseof radium, the apparatus being kinaly lent to me by Dr..A. S. Grunbaum. No appreciable effect on the organisms.was observed, and I therefore concluded that the action ofall the rays on them could scarcely be immediately lethal]Further researches on the subject may, however, besuggested.University of Liverpool. R. Ross, F.R.S., C.B.

AN UNUSUAL CASE OF ATROPINE POISONINGIT being necessary to determine the refraction of a smallboy of 5, the child of highly neurotic American parents,atropine drops, of a strength of 4 gr. to the ounce, wereordered to be instilled into the conjunctival sac threetimes a day. After a day or two the boy became delirious.his gait staggering, and his temperature went up to 1050,His pupils were widely dilated. I am unable to find thissymptom of pyrexia, described as occurring in belladonnapoisoning, but, as after a careful examination no othercause could be discovered, and the other symptoms wereclearly due to excess of atropine, I think the pyrexia mustalso be explained on the same pathology. The boy, underno special treatment, in a few hours broke out into aprofuse perspiration, his temperature rapidly fell to-normal, and next day he was quite himself again.

I have so frequently of late had cases of poisoningdue to atropine drops instilled for refraction, that I haveadopted a plan which I think prevents it. The cause is,of course, the carelessness of the parents in putting inthe drops so that they run down the nasal duct and areswallowed. (In one child who got delirious after usingthe drops at home, I got a nurse to see to it on anotheroccasion, and no bad signs followed.) I find this bella-donna poisoning occurs more frequently in better-class,private patients than in hospital children, evidently,I think, because the more educated child is morereadily affected by excess of the drug. To prevent itI now use in young children an ointment containing-4 gr. of atropine in an ounce of vaseline, a smallquantity of which is placed in the conjunctival sac-three times a day. This does not run down the nasarduct, and I do not remember seeing any bad effects since!taking to this plan.

L. A. PARRY, B.S., F.R.C.S.,Assistant Surgeon, Sussex Eye Hospita

II

APRIL 7, I 906. MEDICAL NEWS [MTHE BuRITIKI 813APRIL 7, i 9o6.1 MEDICAL NEWS IMEDICAL JOURNAL83

worthy of note is that the Papuan does not eat any fooduncooked. No grain food is grown, and his principaldiet is a vegetable one, consisting of bananas, yams, taro,and sweet potatoes. Fish and shellfish, together withother sea products, such as turtle and dugong, are eatenby the coastal tribes. Pig and wallaby are the most usualmeats consumed, but as a general rule very little meatis eaten except at feast times and during the huntingseason. Fish and meat are often partaken of in a ratherfar stage of decomposition. Referring to predisposingcauses, Dr. Craigen says that scars are common through-out the Possession, and in certain districts it would bedifficult to find a single native without at least one scaron his body. With regard to smoking, although nearlyevery Papuan smokes, he does not use an ordinary pipe,but a section of bamboo which is filled with smoke andinhaled. Dr. Craigen has seen only two cases of anundoubtedly cancerous nature in Europeans; one ofthese was an epithelioma of the face, the other a rodentulcer.

Federated Malay States.Dr. C. W. Daniels (Director of the Institute for Medical

Research at Kuala Lumpor), writing on May 26th, 1905,reports that malignant growths were noted only amongthe Chinese. The number of Tamils (32) was too smallfor any conclusion to be drawn from the absence of sucheases; and as no post-mortem examinations were made onMalays, no information is obtainable as to the frequencyof inaccessible malignant growth in that race. Malignantgrowth was present in 10 cases. The total number ofdeaths was 805, so that the percentage of deaths fromcancer was not less than 1.24. In 7 of the cases theorgan affected was the liver-in 5 primarily, in 2-secondarily to disease of the stomach or pancreas. Theenormous preponderance of hepatic malignant growth wasllot limited to the District Hospital; similar cases weremet with at the General Hospital and elsewhere. Dr.Daniels says it is a common feature of the distribution ofmalignant disease in other tropical countries, as inBritish Guiania, and is not restricted to any one race, ashe has observed it in negroes, Indians, and half-castes.The adeno-carcinoma of the liver is certainly thecommonest malignant growth in the Federated MalayStates.

Sierra Leone.The Acting Principal Medical Officer, writing on

July 8th, 1905. reports that there have been only 2 cases ofmalignant tumours operated on this year. He adds thatmalignant disease is not very prevalent either in theP'rotectorate or in the Colony.

Jamaica.Dr. J. A. Allwood, Senior Medical Officer and Registrar

of the Public Hospital, Kingston, reports that of 16,996patients admitted into the hospital during the five yearsfrom November, 1900, to October, 1905, the number suffer-ing from malignant disease was 110; of these, 32 weremales and 78 females. In 71 of the cases the disease wascancer; in 39 it was other than cancer. Of the cancercases, the patients in 20 were males, and in 51 females.Of the cases of malignant disease other than cancer, thepatients in 12 were males and in 27 females. Dr. Allwoodstates that malignant diseases are fairly common inKingston, the bulk of the cases being cancer. The mostcommon sites of cancer are the generative organs, thisbeing especially the case among females. Cancer of thetongue and lip are curiously uncommon in a country inwhich smoking is almost universal among both sexes.Women, as a rule, smoke pipes, and, in the event of-smoking cigars or cigarettes, do so generally with thelighted end in the mouth.

Ceylon.Sir Allan Perry, Principal Civil Medical Officer and

Inspector-General of Hospitals, writing from Colombo onApril 4th, 1905, states that there were in 1904, 234 personsreported from the various medical institutions of theisland suffering from cancer in a population of 3,812,931,which gives an incidence of 1 in 16,200. The racialincidence is shown by the following figures: Sinhalese153, givring an incidence of about 1 in 15,700; Tamils 42,1 inl about 13,000; Malabars 23; Moors 8; Burghers 6(1 in 4.000); Malays 1; Europeans 1. There were 35 casesof sarcoma in the island, giving an incidence of 1 in

108,940. In conclusion, Sir Allan Perry says that theaverage number of cases per annum is about 227. Canceris a rare disease in Ceylon. It is more common in malesthan in females. The average age is over 40. The mostcommon sites are the parts associated witlh masticationand the generative organs. Sarcoma is to cancer as 1 in12. The average age for sarcoma is under 30; and thecommonest site is in the bones.

Natal.Dr. Wilfred Watkins-Pitchford, writing from the Labo-

ratory, Pietermaritzburg, on November 11th, 1905. reportsthat a Standing Cancer Research Committee for theColoiny of Natal has been formed of which lhe has beenappointed Honorary Secretary.

An Alleged Cancer Cure.The Secretary of the Natal Medical Council reports

that the Council, having fully considered reports onMr. Spearman's alleged cancer cure, is unanimously ofopinion that there is no evidence that the alleged remedyis a cure for cancer, and that there is nothing to show thatthe so-called cures would bear the test of scientificinvestigation.

Other Colonies.The replies from other colonies are simply formal state-

ments of the readiness of the authorities to take thenecessary measures for the collection of the informationrequired by the Cancer Research Fund.

Printers' Errors.We regret to notice in a document published under the

auspices of a great department of State such gross mis-prints as "eancer en cuiram" and "excema" (p. 27)." Noevus " appears at p. 5.

MEDICAL NEWS,THE Clinical Record of Chicago says it is estimated that

there are 140,000 doctors, " good, bad, and indifferent," inthe United States.THE jubilee dinner of the Society of Medical Officers of

Health will be held at the Hotel Cecil, London, on Friday,May 11th. Particulars can be obtained on application toDr. Priestley, 22, Telford Avenue, Streatham Hill. S.W.AN anonymous donation of £10,000 was received last

week by King Edward's Hospital for London, the stipula-tion being made that the sum should be treated ascapital.DR. CHARLES J. RENSHAW of Ashton-on-Mersey has been

appointed a delegate of the Apothecaries' Society of Londonand of the Lancashire and Cheshire Branch of the BritishMedical Association to the International Medical Congressat Lisbon.AT the weekly meeting of the Managers of Edinburgh

Royal Infirmary on March 26th it was intimated that Con-sols to the value of £5,265 ls. ld. had been transferred tothe infirmary out of the residue of the estate of the lateDr. W. W. Allan of Dawlish, Devonshire.AT the meeting of the Royal Sanitary Institute at the

Parkes Museum on Friday, April 27th, at 5 p.m., a discus-sion on the consumptive at home will be opened byDr. Heron. The a.nnual dinner of the institute will takeplace at the Langham Hotel, London, on Wednesday,May 9th, when the Duke of Northumberland, thepresident, will take the chair.AT the annual general meeting of the governors of the

Queen's Jubilee Hospital, Earl's Court, on March 31st, itwas stated that Mr. R. Fitzroy Benham had executed adeclaration of trust, in which he had consented to assignthe deeds of the hospital, which had hitherto stood in hisname, to the trustees. It was resolved to change the nameof the institution to " The Kensington General Hospital,"and to take steps to incorporate it.DR. G. DALGADO asks us to invite the attention of

members of the International Medical Congress in Lisb onto two health resorts in its immediate vicinity. The oneis Cintra, frequented as a summer resort, and the otherMont'Estoril, thirteen miles from Lisbon, at the mouth ofthe Tagus. During the winter Mont'Estoril has a smalldaily range of temperature, and the number of rainy daysin December, January, and February is few; the drainagesystem is stated to be modern and the water supply verypure.

8 MLDIA Ik%AITSBI 181X4 'MkI)Ic."il, JOURtNAL.] MEDICAL NEWS. L[A'atIL 7, I906.

TIIIn. London, Brighton, and Soutlh Coast RailWayCompany gives notice that it is prepared to issuereturntickets from London to Irun to menmbers of the Inter-nationial Congress of Medicine, their wives, and childrenuntil April 19th, at the Victoria and London Bridgestations of the L.B. and S.C.R., tile only formality neces-sary being thle presentation of the carte d'identiti. Tlhetickets are available for sixty days via Dieppe-Paris andBordeaux. Tlle rieturn fares from London to Irun are£5 15s. 5d. first class, and £4 ls. Od. second class.

IT having been proposed by some friends to presentDr. T. J. AWalker with a testimonial oni the occasion of hiisretirement from the office of Surgeon to the PeterborouglhInfirmary after forty years' service, a letter was recentlyaddressed by 1)r. AWalker to the Commlittee whliehl lhad thematter in hand, expressing his appreciation of their kindintention, but asking that the proposal should not becarried into effect. 1)r. Walker considered that a singlemember of the staff of a liospital should not be picked outas a recipient of a testimonial simply because successlhad crowned Ilis efforts to advance the interests of theinistitution.THE Organizing Committee of the Second Internationial

Coongress on Scllool llygiene held a meeting on March 30tlhait the UJniversity of London, South Kensington, to con-sider tile arrangements for the Congress wllicll is to beheld in London in August, 1907. The objects and aims oftIle Organizing Committee were briefly explained by tIle('Clairman, the Duke of Nortlhumberland. Sir LauderBr3unton llaviilg made a statement as to the airangemeintsalready made, said tilat teacllers at training colleges mustbe taught not only albstract notions concerniing lealtli butalso practical ideas. It was resolved to open a guaranteefund, and Dr. James Keir and Mr. E. White AWallis wereappointed secretaries.ME'DICAL LEGIST-A ORS IN AUSTRIA.-TIle representatives

of the medical profession in tIle Austrian Clhamber ofDeputies are: Drs. Adler, Ciliari, Ellenbogen, (-1ladys-zowski, Gregr, Jaeger, Kiindermann, and Ossydo. ThePresident of tlle Clhamber (Count Aetter) studied medi-cine at a comparatively advanced age, but his studieswere interrupted by h1is election to the presidential chair.

BRITISIH OPUTnIAL-MIC HOSP'TvAL, JERUSALEM.-The reportof thle British. Ophthalmic hospital, Jerusalem, for tilefifteen montils endiing December 31st, shows that 1,062persons were treated in its 42 beds, and 10,088 in the out-patienit room. Seme 1,761 operations were performed,includinig 947 under anaesthesia. Tile financial rieport fortIle year ending September 30tlh shows a debit balance of£700 oni a total expenditure of £1.300.TILE NOTIFICATION OF P1lTI1SIs.-Tile guardians of tue

Searborougli IJnion, lhaving been asked by the Hull Unionito support it in a request to the Local Governimenit Boardto class phthlisis as a notiflable disease. souglt opinionisfrom the medical officers within tile Union area, and theletters sent in reply were considered at a meeting onMarch 22nd. Five out of the seven- were entirely favour-able to notification, and after some discussioni it wasresolved to support tlle Hull Unlioni.

D)ISCUSSION ON SYPHIrIs.-Tile Ilunterian Society willdevote two evenings this month to a discussion onsyphilis. At tlle first meeting on Wednesday next at8.30 p.m. the discussioin will be opened by Mr. JonathanIlutehiiisoni he will be followed by Dr. Savage (syphilisandl menital disease); Dr. Purves Stewart(syphilis and tlhenervous system); and Dr. Ihale White (,visceral syphilis).The evening of April 25tlh will be devoted to the considera-tionl of conigenital syphilis and syphilis of the eyeanid skin,an(d geineral treatmenit.

CLINICAL, RhESEAtRCII AT CMvBInlDlGu.-The Committee forthe Study of Special Diseases at C'ambridge announcesthat its Treasurers will slhortly proceed to elect a researclscholar to investigate the diagnosis or treatment of rlieu-iniatoid artliritis and allied diseases. The scholarship is ofthle annual value of £100, and the Committee is enabled tomake the appointment throughl the generosity of ani anony-mous friend. (Candidates must be recentlv qualified, andprefeience will be given to those wio hlave lleld a residentpost at some hlospital. The appointment will be made inthe first instance for six montis, but this period may beprolonged. The lholder of the scholarshlip will be requiredto work under the direction of the Huddersfield lecturer inspecial pathology. Tile results obtailled may be used for atreatise if desired. Letters of application should containa full account of tile medical curriculum througlh whichtlle applicant lhas passed, but testimonials are not required.Further particulars can be obtained from Mr. T. S. P.

Strangeways, Department of Medicine, the University,Camibridge.STREET ACCIDENTS.- The provisioII of ani ambulance

system for London seems at length to be really WithiliSight, tIlouglh the scileme will apparently be at firstof a tentative character. The Bill wlich the London('ounty Council is promoting came before tile l'olice andSanitary Committee of the H-fouse of Commonis this week,and its purport was explained by counsel and by SivWilliam Collins, MI.P., who has been principally re-sponsible for the adoption of the schleme by the LondonnC(ounty Council. The (Committee approved the clauses inlthe Bill relating to tlle provisioll of ambulances, but,exempted tile City area from their operation. Ihitlhertoctllere hlas beeni ani inlcliniation in the City to inisist on tileestablishmenit of ani independent service of its owii on tllelines recommended by tlle Plolice Committee. Now, how--ever, tilat the City lhas successfully opposed its compulsoryinclusioni in tile Londoni Counlty Council schieme, it mayperhaps be less disinclined to take part in a comnorn.arrang,ement. In many ways tilis would seem to be verydesirable, for, apart fromi financial considerationis, tile dis-tribtution of anmbulance statiolls and of call boxes would bemucll more likely to be satisfactory if tie wliole servicewere arranged and admninistered by oile autllority. TheLondoin C.ounity Council's present sclieme contemplates tlheestablisilment an(d equipment of two stations, one near St.ThoImias's Hospital, and one at Charing C0oss. Eacli ofthese statiolls would serve a radius of at inost two miles.and cover tile ar-ea in wlhiel at present street accidenlts aremost commiioll. If tile system proves successful otilel-stations will be establislied elsewhere. The ambulancesare to be electro-motors, and stand-posts in telephonic com11-munication witlh the stations will be placed at selectedspots within the areas mentioned. Under the City schemetilere will likewise be two stations, one at St. Barthiolo-mew's hIospital to serve the AWestern half of the City, andthe otliler somewlvere between Guy's Ilospital and thieLondon Ilospital. Tile ambulances will be liorsed and til(system will be workedby tlle City Police.SANATORIUMS FORt CONSUlwTIVES.-Tile MeItropolitaln

Asylunls Board lhas liad under consideratioin for a longtime past, as our readers are aware, a sclleme by wlhielcit would virtually become the tuberculosis autlhorityfor tile wliole of London, and sougit views upon thesubject froom tIle Local (overnment Board, borouglhcounlcils, boards of guardians, and many other localbodies. Tile replies from local bodies were in the mainfavoui'able to the project, while the Local Govern-men-t Board abstained from committing itself to an,opinionl. Tile Metropolitan Asylums B3oard thereforerecen-tly againi addressed tile Local Government Board,supplying it witll copies of the statements frcm thelocal bodies, and pressed for ani authoritative deliverance.This it lias now received in tile form of a letter stating tlhat.tile informationi received does not appear to affordsuflicient justificationl for tile very lieavy outlayinvolved by tile propcsal, and forwarding a copy of a:communication receive(l from Sir WVilliam Broadbentstating that since sending to the President of the Board acopy of the memorial ile hiad addressed to the MetropolitaisAsyluma Board on the subject of tuberculosis, lie hacklearned tilat that body was too extensively associatedl witlh.Poor-law administration to act as a tuberculosis authorityfor non-pauper classes. These commumiicationls werereferred, at a meeting of the Metropolitan Asylums Boardon Saturday last, to the General Purposes Committee, so-the final result remains to be seen. It seems probable,however, that the project must be regarded as dead, sincethe attitude assumed by the Local Government Board, if itdoes not make any further action in the matter impossible,will at least strengthen tile liands of those wlio have beenkopposed to the scheme from the commencement. Theoutcome is one whiclh many will regret, for, though tie-Mletropolitan Asylums Board may not be an ideal autllority,tile proposal that it slhould assume t}lat position lladLcertain advantages. For instance, apairt fromn the facttllat there is at present no otiler body wilicil canstep into the lbreachl, the Board already has atits command several buildiings wiliieh could be readilyconverted into sanatoriums, so tilat muci of thesexpense whiclh would have to be faced by any otherhtavIng the provision of sanatoriums for the wlhole ofLondon in view wouild be saved. It is true, too, thattuberculosis lias very direct connexion witlh tlhe Poor-law-aluthorities whose medical work the Metropolitan Asylums;Board already iln soml degree supplements and co-ordinates,for notiling-probably not even alcoholisrmi-drives moreworkers from tile self-supporting into the rate-supportedclasses than does tuberculosis.

APRIL 7, 96.] PUBLIC HEATH. [ TaxI BRITiSH

.any fee to a professional colleaguie, but there is no objectionin principle to receiving payment for services if pressed.We think where gratis services are expected they should be-asked for, and in the case of a servant it is only courteousand right that the employer should send a note asking hiscolleague to be so good as to give the needful advice. In thepresent instance this does not seem to have been done, so it-would be well to call upon -the employer in a friendly wayand.put the matter upon.a proper basis. In return for suchsmall services, if there is no likelihood of repayment in kind,it is usual to send some acknowledgement, if only a letter ofthanks.

MEDICAL AID ASSOCIA-TIONS.SIMP.ISSIMUs has probably overlooked the resolution of theGeneral Medical Council adopted on June 6th, 1899, which is.as follows:That the Council strongly disapproves of medical practi-tioners associating themselves with medical aid associa-tions which systematically practise canvassing andadvertising for the purpose of procuring patients.

UNIVERSITIES AND COLLEGES.UNIVERSITY OF LONDON.

THE LONDON HOSPITAL ME;DICAL COLLEGE.THE following sums have been received during March for therEndowment Fund of this College: Anonymous, through theHon. Sydney Holland, Chairman of the London Hospital,-£500; E. P. Thompson, Esq., £100; Martin Sutton, Esq., £5 5s.In addition, the anonymous donor has promised a further sumof £1,000, provided an additional sum of £5,000 be obtained byAugust 1st from others. It is earnestly hoped that, by the'kindness and liberality of those who know the London HospitalMIedical College and the excellent work carried on there, therequired amount may be forthcoming by that time.

UNIVERSITY OF EDINBURGH.First Professionat Examination.-The following candi-

-dates have passed in the subject of Botany in the firstprofessional examination:Eveline R. Benjamin, J. Gx. Boal, H. R. Borcherds, C. M. Bradley,

E. C. Buirke. L. D. Callender, Andrew Campbell, J. A. H. Carter,R. B. Cliamberlain, J. P. Chlarnock, G. J. Cillie, T. D. Crawford,M. J. Dolan, T. R. Evans, J. D. Gunn, H. J. Gutlhrie, T. E.Guthrie, T. E. Harwood, A. B. Jamieson, A. M. Jones, G. J.Joubert, S. G. Kriegler. A. S. Loutit, W. W. M'Cowat, A. E.Mackenzie, A. H. G. Mackintosh, Robert M'Larcn, MaryMacmillan, D. F. MacRae, R. C. Malhotra, D. B. Maunsell,S. P. Moore, Rlhoda M. Murdoch, K. Nehru, F. H. Noronha,Dora E. Paterson, C. R. Pattoni, J. A. Pienaar, S. Pinion,(G. Ram, D. R. B. Sivright, T. C. Smith, R. 0. Spencer, C. B.Tudehope, Jaue A. Walke.

IJNIVERSITY OF LIVERPOOL.7l'HE following candidates have been recommended for theDiploma in Tropical Medicine: F. A. Arnold, M.B., D.P.H. ;J. B. Bate, L.S.A.; J. Dundas, M.B.; N. Faichnie, Major,R.A.M.C., M.B.; D. F'. Mackenzie, M.B.; A. Pearse, Major,R.A.M.C., D.P.. ; R. D. Willeocks, Captain, I.M.S., M.B.

TRINITY COLLEGE, DUBLIN.THE following candidates have been approved at the examina-tions indicated:

Intermediate Medical Examination.-Part II.-*W. Pearson, *J. C.Pretorius, *R. E. Wright, *W. E. Hopkins, *J. A. W. Ponton,WV. S. Thacker, D. J. Miller, D. P. Clement, J. F. Clarke, W. J.Duune, T. P. Dowley, A. H. Smith, J. C. C. Hogan. G. A. Jackson,J. HL. Morton, T. P. S. Eves, N. P. Jewell, A. T. Powell, J. B.Jones, J. R. Yoiirell, E. C. Lambkin, 0. Gogarty, E. H. Sheehan,A. S. M. Winder, W. Knapp, F. R. Seymour.

Final Examination in Medicine.-Part I.-*T. 0. Gralham, F. W. H.Bigley, C. T. Conynglliam, H. D. Woodroffe, E. C. Crawford,C. G. Sherlock, A. E. Knapp, A. T. J. M'Creery. F. O'B. Kennedy,W. L. Hogan. H. B. Leechl, J. A. Hartley, J. C. Ridgway, W. D.Mitchell, G. H. Stack.

Part IL.-*S. G. S. Haughton, *G. W. Thompson, *J. D. Sands, R. A.Askins, J. C. P. Beatty, B. G. Brooke, T. H. Peyton, F. Casement,F. Coppinger, G. Dougan, G. G. Vickery, R. S. Oldham, E.Gibbon.

* Passed on higlh marks.

ROYAL NAVY AND ARMY MEDICAL SERVICES.ROYAL ARMY MEDICAL CORPS VOLUNTEERS

(LONDON COMPANIES).ON March 31st a smoking concert was held by the Londoncompanies of the R.A.M C. (Vols.) at their head quarters,Calthorpe Street, Gray's Inn Road, to bid farewell to Mr. G.Small, -late Sergeant-Major and Senior Instructor to the corps.An address and a purse of money, subscribed by members ofthe corps, past and present, were presented by the commandingofficer. Colonel Matthews, who spoke warmly of Mr. Small'sgood influence on the corps during his connexion with it,extending off and on over a period of nearly twenty-two years,ever since its first inception; at the same time he paid a

graceful tribute to Mr. Small's high personal character. Inthanking the donors, Mr. Srmall expressed the great pleasurehe experienced in accepting the gift.

SIURGEON-CAPTAIN.-A medical officer of Volunteers who hascompleted fifteen years' service may, on the reconlmenda-tion of his commanding officer, be permitted to retain hisrankand uniform on retirement. as the recommendationof the commanding officer is required it may be assumedthat flfteen years as an " efficient" will be necessary.

PUBLIC HEALTHAND

POOR-LAW MEDICAL SERVICES.THE LOCAL GOVERNMENT BOARD ON WHOLE-TIME

PUBLIC VACCINATORS.THE Croydon Board of Guardians on Tuesday, April 3rd, con-sidered the proposal of the Local Government Board that awhole-time public vaccinator should be appointed at a fixedsalary. If the district was not large enough, the Boardsuggested that he should be allowed to engage in other profes-sional work of a public character, but should not undertakeprivate practice, that tie appointment should be- permanent,determinable only with their approval. The question arose inCroydon through the death of Dr. T. R. Adams, who was publicvaccinator for the larger part of the borough. Owihg to thegreat growth of the town since Dr. Adams's appointment, theguardians in January decided to divide his district into fourand appoint a public vaccinator for each. The Finance Com-mittee now recommended that that arrangement should beadhered to, the fees to be the minimum prescribed by the LocalGovernment Board. The Committee were of opinion that thiswould conduce as much if not more to efficiency and economyas the appointment of one whole-time salaried official.Mr. F. SMITH, moving the report, said the Committee con-

sidered that a salary which would economize on the presentoutlay for vaccination would be inadequate for one medicalman attending a district covering such a large area. At thesame time, being a permanent appointment, it would be subjectto a pension. They felt that vaccination could be better carriedout by four local medical practitioners covering comparativelysmall districts.Mr. MENEAR seconded.A letter was read from the Croydon Antivaccination League,

expressing the view that if the proposed appointment weremade the guardians would pay the whole-time public vac-cinator, but probably he would take his orders from the LocalGovernment Board, and thus be practically independent ofthe guardians. A further reason advanced against the pro-posal by the League was that they believed it was " somewhatof the nature of a feeler " from the Local Government Board,it being understood that only Crcydon and Derby had, as yet,been approached with this particular suggestion. The Leagueurged the guiardians to retain the full and complete controlover all the officials whom they appointed.Some surprise was expressed that the antivaceinators were

supporting the guardians in the matter, and the recommenda-tion of the Finance Committee was adopted nem. con. withoutfurther comment.

HOSPITAL AND DISPENSARY MANAGEMENT.THE ROYAL NATIONAL ORTHOPAEDIC HOSPITAL.

THiE first annual meeting of the Royal National OrthopaedieHospital, the institution which represents the amalgamatedNational Orthopaedic and Royal Orthopaedic Hospitals, washeld- on February 28th. The report, after congratulating theGovernors on having successfully effected the amalgamation,recorded the consent of the King and Queen to become Patronand Patroness, and the granting of a Royal Charter. Attentionwas also drawn to the satisfactory results being obtained fromthe tuition given to the children undergoing treatment in thewards, under the direction of the London Education Com-mittee. The income of the new institution for the yearshowed, it was stated, a considerable increase over the com-bined incomes of its predecessors, a similar increase beingnoted in the number of in-patients treated. The out-patients,on the other hand, were fewer. The next step that will haveto be taken is the rebuilding of the premises and the erectionon the site of a new hospital, plans for which are now ready,with every modern appliance.

ROYAL HOSPITAL FOR DISEASES OF THE CHEST.DURING last year, as shown at the annual meeting on March14th, the out-patient total attendances at this hospital werereduced by 5.5 per cent., but still reached nearly 26,000. Thenumber of admissions decreased in corresponding fashion.As for finances, the building appeal fund was shown to havebeen very sucsessful.