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increase in the blood urea. They therefore suggestthat the increased excretion of urine is dueto the diuretic action of this urea, and in

support of this they find that large doses ofurea given to such patients also lead to a dis-

appearance of the dropsy. They are of opinionthat the new forms of treatment may enable such

patients to survive the dangerous dropsical stageof parenchymatous nephritis and pass into the lessdistressing chronic interstitial stage. Here theyallow that limitation of protein intake may bebeneficial, but they strongly deprecate the very lowdiet to which these patients are often condemned.The paper as a whole teems with practicalsuggestions and will be of great service to the

practitioner who wishes to diagnose and treat hiscases of renal disease on sound and scientific lines.It marks a notable advance in our knowledge ofcertain difficult and distressing diseases.

The Research Defence Society.THE annual general meeting of the Research

Defence Society will be held next Wednesday at11, Chandos-street, the house of the MedicalSociety of London, when the chair will be taken byLord LAMINGTON, the President. Lord KNUTSFORD,the Chairman of Committee, will submit theannual report. That report will show greatactivity on the part of the Society, and theChairman, with characteristic humour, suggeststhat any fall away in the amount of work donebefore the war may be attributed partly at leastto "the prevalent indifference towards our oppo-nents." With regard to that we wish to lay stressupon a point, taken up also by Lord KNUTSFORD,that the Research Defence Society has to reckonwith a wider sort of attack from those hostileto research than marked the earlier campaigns.Resistance to experimentation on animals no

longer marks the scope of their blindness aliketo facts and to the calls of real humanity. The pro-tective treatments, founded on and emerging fromsuch experimentation, are all in the near future

likely to be impeded in their beneficial influenceby the opponents of the applications of physiologyto therapeutics. The admirable address by SirWALTER FLETCHER on the work of the ResearchDefence Society, which we noticed in these columnsa fortnight ago, shows well that the Society hasbefore it a great task to educate the ignorant,appease the fanatic, and convince the reasonableman. Sir DAVID FERRIER is the honorary treasurerof the Research Defence Society; Mr. STEPHENPAGET is the honorary secretary, assisted by CaptainW. E. ELLIOT, a medical Member of Parliament;and all communications should be addressed to11, Chandos-street, Cavendish-square, London, W.1.Money is needed.

UNIVERSITY OF LONDON.-The Senate has resolvedto institute a diploma in psychological medicine which shallbe open to all registered medical practitioners. The standardin psychological medicine required for the purpose of theproposed diploma will be approximately that required bythe University of Cambridge for its diploma in psychologicalmedicine.

GIFT TO BELFAST HOSPITAL.-Mr. George L. Moore,of Forest Hill, formerly in practice as a solicitor at Belfast,has intimated his intention of making a gift of ot20,OOO to theRoyal Victoria Hospital, Belfast, in grants of not less thanX1000 every year. A scheme is being formulated for theestablishment of a ward to be called the " Moore Ward."

Annotations."Ne quid nimis."

A MEMORIAL TO VICTOR HORSLEY.

A MOVEMENT has recently been initiated by friends andformer colleagues of the late Sir Victor Horsley towardssome form of permanent recognition of his services tomedical science, and a preliminary letter appealing forsubscriptions to this end has appeared in the dailypress. The endowment of a Victor Horsley lectureshiphas been suggested as a suitable memorial, and theSenate of the University of London as its most appro-priate trustees; the exact form of its scope andconstitution will be decided by a committee of whichthe officers are Sir Charles Ballance, chairman, SirArbuthnot Lane and Dr. E. J. Domville, joint honorarysecretaries, and Sir Frederick Mott and Dr. H. H.Tooth, joint treasurers. The present idea is thefoundation of an annual lecture, the subject of whichshould not. be confined to medicine, while it may bedelivered by any prominent man in any field of

progress. Sir Victor Horsley’s death from heat-strokein Mesopotamia is so recent, and his personalitywas so forcible, that it would be superfluous to

recapitulate in any detail the long list of his activitiesor to recall the brilliance of his career. It will be remem-bered that the connexion between myxoedema andathyroidism-long a commonplace of the text-book-was first established by Horsley by means of experi-mental work on monkeys at the Brown Institute.Here he also carried out extensive researches on rabies.As professor of pathology at University College hedeveloped his bent for experimental research in physio-pathology ; and when, as surgeon to the National Hospitalfor Diseases of the Nervous System, he met again his.old friend Charles Beevor (who, as house physician,had taught him the rudiments of medicine) togetherthey mapped out the motor area of the orang. Theirwork, published in the Proceedings of the Royal Society,1886-7-8, in delimiting the cortical motor areas was formany years the standard reference on the subject. Inthe surgery of the brain and spinal cord Horsley soonbecame undisputed leader, and, to quote only one of hisspecialties, his method of performing the Hartley-Krause operation for extirpation of the Gasserianganglion brought him much fame. One of his latestdiscoveries was the recognition of loculated spinalmeningeal cysts as a cause of paraplegia, and theiroperative treatment.Horsley was a born fighter. And his love of the

struggle did not always help his cause. He was a mostsuccessful champion of freedom for the physiologistin the cause of research, but the enthusiasm whichled him ever to consider his own side right wasnot in other directions so successful. Thereforewide recognition of his splendid ideals is called fornow that he is gone. In his later years he turnedto medical politics, being elected as a Direct Repre-sentative to the General Medical Council in 1897,and remaining a member till 1907. He did admirablework, but his contentiousness sometimes impededbusiness. He also took a prominent share in inspiringthe policy of the British Medical Association, as repre-sented by the present Articles. His aspirations towardsParliament never materialised, though he held strongpolitical views; but it is difficult to imagine his everserving under a party chief. He was a man of extreme andtireless energy, at play as well as at work; at his ownshooting parties he would walk all his guests off their feet.But more than all sport in any field, he loved his workin the laboratory. Though somewhat critical of theefforts of his colleagues, his generosity to his juniors.was amazing; he would spend an incredible amountof time and money in helping a younger man in experi-mental work, and in encouraging his investigations.His own surgical technique was superb. The son of aRoyal Academician, he was no mean draughtsman, andwas unusual in being almost ambidextrous with pencil,pen, or scalpel. His optimistic manner inspired the

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greatest possible confidence in his patients. The manwas like a diamond of many brilliant facets-smallwonder that their cutting edge occasionally scratchedand scarred those with whom he came into conflict. Noother medical man of his time was associated with suchdiverse movements down so many streams of publiclife. None of the crafts piloted by him ran the slowerfor his intervention; in fact, he rejoiced in steeringthem near the rapids, and if necessary through therapids. There should be no difficulty in obtainingthe requisite support to any testimonial to hismemory. Among those anxious to be representedwill be his scientific colleagues, the Fellows ofthe Royal Society and of the Royal College ofSurgeons of England; his personal friends, and evenhis personal enemies, who for the most part recog-nised his sincerity; those women who rememberhis help in the struggle for political and educationalfranchise and their younger sisters, more especiallythose whose admission as medical students to Uni-versity College Hospital, he did not live to see; and,lastly, members of University College Medical School,from his colleagues to his dressers, who will be proudto perpetuate the memory of a worker who broughtso much fame to their school, and who would haverejoiced so heartily in its present magnificent oppor-tunities for development.

APPARENT PULSUS PARADOXUS.

IN pulsus paradoxus the normal increased rapidity ofthe pulse during deep inspiration is replaced by slowing;the cardiac contractions are correspondingly slowed.In the Boston Medical and SU1’gical Journal of May 20thDr. Paul D. White has reported an interesting case inwhich the pace-maker of the heart and the auriclesacted normally during inspiration-that is, respondedby increased rate-but heart-block was also produced,which led to slowing of the ventricles and therefore ofthe pulse, simulating pulsus paradoxus. The patient,a soldier, aged 23 years, was admitted to a base hospitalon Nov. 10th, 1918, with influenza. There was a historyof severe double pneumonia at the age of 5 years, sincewhich time his pulse had always been slow. He saidthat the fact that his pulse got slower on excitement orexertion had been noted for years. He had sufferedfrom typhoid fever flve years ago. Examination showedthat he was convalescing from influenza. Polygramswere taken as follows :- .

Auricular Ventricularrate. rate.

Quiet in bed ............ 43 .................. 43Quiet in bed (later) ...... 40 .................. 40During deep inspiration ... 70 .................. 35Deep expiration ......... 41 .................. 41Immediately after moderateexertion ............ 72 .................. 36

The tracings showed that on deep inspiration therewere two auricular contractions to one ventricular-a2:1 1 heart-block. Evidently the auriculo-ventricularbundle was damaged, probably by the disease in child-hood, and when the auricular rate rose above a certainlevel failed to transmit every other impulse. The pace-maker of the heart responded normally to exertion andinspiration by increased rate, but as this was halved inthe ventricles their rate actually fell, simulating pulsusparadoxus. During the slow rate of the heart auriculo-ventricular conduction was normal. The slow rate ofthe pace-maker under ordinary circumstances is note-worthy. Was this due to the disease of childhoodaffecting the auricle, or did the impaired conductivityof the auriculo-ventricular bundle in some way affectthe pace-maker, causing it to settle down to a ratewhich the bundle was capable of conducting ? Volhard 1has described a similar paradoxical response to changeof position. While lying flat the patient had a pulse of64 and no block; sitting up he had a pulse of 42 with a2 : 1 block, the auricular rate being 84 ; on standing thepulse dropped to 22 and became irregular, due to

varying degrees of block from 2: 1 to 5: 1. Atropinslightly increased the dissociation by increasing theauricular rate, with which the ventricles could not keep

1 Deutsch. Arch. f. klin. Med., 1909, xcvii., 348.

pace. Lutembacher has reported a case of " orthostaticbradycardia due to intermittence of conduction of thebundle of His." 2 With an auricular rate of 60 there wasno block ; at 70 to 80 a 2 : 1 block; and with higherauricular rates 3 : 1 and 4 : 1 blocks.

THE GIFT FROM THE ROCKEFELLER FOUNDATIONTO UNIVERSITY COLLEGE HOSPITAL AND

MEDICAL SCHOOL.THE simple facts of the benefaction to University

College Hospital and School have been obscured by somuch appreciative comment that we propose to setthem out baldly. The figures are in themselves sumciently impressive. The total sum offered is just underjei,205,000—;S835,000 to the University College Hospitaland Medical School and 369,800 to the University ofLondon on behalf of University College. Of the formersum .6400,000 is to be allocated to the building and equip-ment of a nurses’ home, residents’ quarters, obstetricaland bio-chemical departments, and the reconstructionof certain existing buildings. The income from theremaining 435,000 will be devoted to the medical,surgical, and obstetric units, to salaries in the depart-ments of bio-chemistry and pathology, and towards themaintenance of beds in the reconstructed hospital wing.The gift to University College is to be applied to theerection of an anatomical institute and to its main-tenance. It is estimated that the increased costentailed on the hospital and medical school, the pro-vision of which is understood to be an implied conditionof the benefaction, will amount to, roughly, 20,000 ayear. These are the bare facts. The scale of thebenefaction is unique in this country, and our apprecia-tion of the honour to one of the most progressive of theLondon medical schools is not the less because wereserve a detailed discussion until we have been able tostudy the terms more closely. Such generosity fromanother country in the cause of scientific research issomewhat humiliating ; it is a measure of the neglectof medical education in the past that the benefactionhas evoked such widespread notice. King Edward’sHospital Fund has administered larger sums forcharitable purposes without so greatly surprising thepeople. Had the present gift been distributed over allthe medical schools in London it would have been less

impressive, and certainly less stimulating; had itbeen offered exclusively for purposes of research or ofteaching it would have been less interesting. But the

gift is to be regarded primarily as a tribute to the recentattempt at combining research with training. Theclinical unit system, initiated by the Board of Educationand carried out at University College Hospital in

response to official suggestion, was the innovation whichfirst attracted the notice of the two representatives ofthe Rockefeller Foundation, and it is to its adoption byUniversity College Hospital that the gift is mainly due.

THE MANIFOLD USES OF RUBBER.L.ti.l<J-KJ:!] 18 eVIUeUIJ1Y p1eUIJY U1 ruouer I:tValll:tUle nuw,judging from the offer of substantial money prizes byjudging from the offer ol substantial money prizes by

the Rubber Growers Association as an award for

suggestions as to extending the present uses or forencouraging new uses of this singularly resilientmaterial. Incidentally, this should be good newsfor scientific research, as rubber is, of course, a

great adjunct in the laboratories, while also itis an indispensable servant in medicine and insurgery. The offer, however, probably refers towider uses, for the relative value of suggestions whichare deemed practical will, we understand, dependupon the quantity of raw rubber the adoption of thesesuggestions would absorb, and special considerations, itis announced, will be given to practical suggestionslikely to utilise rubber in large quantities. (The italicsare not ours, but appear in the conditions laid down bythe Association.) Our interest, however, lies in thefact that the offer, generally speaking, should mean thatrubber is going to be readily obtainable and at a rela-tively moderate cost, and an ample supply of the

2 Archives des Maladies du C&oelig;ur, 1919, xii., 145.