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- sir. She agreed with Dr. Agassiz, that there was.a marked contrast between the radiographic andphysical signs in non-tuberculous fibrosis of thelung.

Dr. GEORGE JESSEL (Lancashire) agreed withDr. Burton Wood that the tuberculous child wasnot the precursor of the adolescent consumptive,- and that in the diagnosis of intrathoracic tuberculosiscommon sense and not far-fetched physical signswere necessary.

Dr. ESTHER CABLING (Peppard Common) wishedto know what was going to be done about the childwrongly diagnosed as tuberculous. All of them couldnot be sent to open-air schools, because these wereonly to be had in the large towns. In her opinion,delicate children should be treated in sanatoria

. without notification.Dr. WARD was in accord with the prevalent view

- about the value of paravertebral dullness. From thepractical point of view one need not wait for elaborate- tests to be done before treating a delicate child.

Dr.W. C. FOWLER (Pinewood) thought that negativePirquet cases should be treated rather than cases-giving a positive reaction, which he regarded as

an indication of protection against tuberculosis.Dr. HERBERT said that the question of physical

signs in enlarged mediastinal glands needed furtherinvestigation. Although he did not very oftenfind paravertebral dullness in children’s chests,one could not, he thought, arbitrarily dismissthe sign as valueless. The dullness might not bedue to the actual presence of glands, but tosome reflex irritation. Dr. A. I. G. McLaughlinand he were at present engaged in the analysis ofa series of cases in order to estimate if possible thevalue of the various signs said to indicate the presence-of enlarged mediastinal glands.

Dr. MARGARET SHARP (Bradford) and Dr. NIVENROBERTSON (Chesterfield) were both sceptical aboutthe value of paravertebral dullness, and the latterthought the diagnosis of intrathoracic disease inchildren an extremely shady business, althoughhe admitted that the use of lipiodol made a verypretty radiogram.

Dr. G. M. MAYBERRY (Dagenham) said that hehad not heard the importance of temperatures indiagnosis emphasised as much as he would haveliked, and drew attention to the number of cases ofso-called tuberculosis cured by attention to thetonsils and adenoids.Dr. PEARSON thought that there was a great

difference to be observed in the incidence and typeof tuberculosis in children between 1 and 4 yearsand after that period. He also stressed the valueof taking rectal temperatures.

Dr. DICKINSON said that in his experience patientswith bronchitis did not readily develop tuberculosis.

Dr. C. H. C. TOUSSAINT (London) stated that ina series of 60 cases labelled as tuberculosis in childhoodhe knew of only two who had developed true pulmonarytuberculosis in early adult life. It seemed that wemight be compelled to change our views and directmore attention to the young adult contact whoappeared to be in good health, but who might wellbe in the latent stages of pulmonary tuberculosis.The question of tuberculosis in childhood was of

great administrative importance. It seemed to bethe unanimous opinion of the meeting that therehad been gross over-diagnosis of the condition, andif this were so much money had been and morestill was being wasted on treatment. In Londondifficulty was arising owing to the fact that theCounty Council had limited certain open-air schoolsto notified cases of tuberculosis. Dr. Toussaintconsidered this to be a great mistake.

[The report of the two remaining sessions isunavoidably held over. These dealt with III. TheCorrelation of X Ray Findings in PulmonaryTuberculosis, and IV. Gas Poisoning and GunshotWounds of the Chest in relation to Tuberculosis.]

A NATIONAL CAMPAIGN AGAINSTRHEUMATISM.

AT a meeting held in London at the house of theRoyal Society of Medicine on June 26th, a new

association having for its object an organised campaignagainst rheumatic diseases was inaugurated underthe title of The National Association for CombatingRheumatism. Sir THOMAS HORDER took the chair.

Letters of approval and encouragement were

received from Sir George Newman (Chief MedicalOfficer of the Ministry of Health) and others andwere put before the meeting by Dr. M. B. RAY, theacting hon. secretary, who also read the proposedconstitution and policy of the Association. Thisemphasised the great crippling effect of rheumaticdiseases on a large section of the community, and theimportant part they were playing in the productionof sickness and suffering. It was felt by thoseresponsible for starting the campaign that it washigh time to make a concerted effort to deal effectivelywith the problem in all its aspects. About one-sixthof the total invalidity of the country could be chargedto diseases commonly classed as " rheumatic " ; theywere responsible for the loss of three million weeks oflabour, and for the payment of about two millionpounds in sick benefit annually. At present therewere proper treatment facilities for only a minorityof sufferers, and it was felt that, since the causes ofthese conditions were still obscure, adequate facilitiesfor research as well as for treatment should beprovided. In the forefront of the Association’s policywas placed the need for educating medical opinionupon early diagnosis and the importance of con-

tinuous treatment. The public should be told ofthe value of further research, whilst efforts directedtowards prevention were essential. A system offollowing up cases needed to be organised, andefficient home treatment should be carried out.Bound up with this was advice about suitability ofoccupation, in which employers of labour might wellbe invited to interest themselves. Climatic andoccupational factors must be carefully studied, andresearch must not be confined to the laboratory.Cooperation was required between the laboratoryworker, the clinician, the biochemist, and theradiologist, and social workers also should be interestedin the campaign. It was hoped that a system ofuniform reporting of results would be arrived at ;this would certainly aid the collection of statistics,and enable the value of various forms of treatmentto be assessed. Another proposal was the establish-ment of treatment centres.

Sir CLAUDE HILL (Governor of the Isle of Man)formally moved that the Association adopt theproposed constitution and policy, and said that hewas much impressed by the scope of the campaignnow being undertaken. He hoped industrial interestswould be successfully enlisted, and especially thatclinics in different parts of the country would beestablished for dealing with these diseases. He alsosuggested that the organising secretary should be aman who would be able to travel, so as to ensure thesympathy of the industrialists, and persuade themthat their support was needed. The Association, onthe suggested lines, would be in a good position tomeet what everyone cognisant of the facts would feelto be a real need.

’

Dr. MALCOLM CAMPBELL (Droitwich) seconded theresolution, and mentioned the great aid in themovement which could be afforded by the variouswomen’s organisations.The CHAIRMAN agreed about the desirability of a

close liaison between the industrial and the purelymedical aspects of the problem, and said this hadbeen in the minds of the Committee from the start.He mentioned that the Prime Minister had signifiedhis willingness to become a member of the Council.

Mr. HENRY LESSER (President of the NationalAssociation of Insurance Committees) moved the

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acceptance of a list of 74 ladies and gentlemenproposed as members of the Council.

Dr. E. I. SPRIGGS, in seconding, said that indiscussing this matter with people and trying to gettheir help he had found it useful to point out thatthis was not a charitable appeal. Though rheumatismaffected certain classes, no social grade was exempt.It was not proposed to start a new organisation whichshould replace or absorb any in existence, but onewhich should cooperate with other bodies for theprevention and adequate treatment of rheumatism.Much good work was already being done and it was" bad business " to have it done in different placesseparately.The list of names was then accepted by the meeting.Dr. FORTESCUE Fox emphasised the need of

enlisting all who could help this important movementforward, and hoped that the international aspectwould be borne in mind. Good work in thisconnexion was going on in other European countries.

Dr. J. VAN BREEMEN (Amsterdam), speaking ashon. secretary of the Ligue Internationale contre leRheumatisme, referred to the Ligue’s meeting to beheld in October at Budapest, at which ten nationswere already represented. Among points on whichinformation from all sources would be welcomed were :the relation between acute and chronic rheumatismand the significance of serological and blood examina-tions. It would be a great help to receive forconsideration at the Congress information andsuggestions from England.

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

The Water-supply.THE amounts of water in the Edinburgh reservoir

are still extremely low and the Water Committeefind it necessary to issue another warning. It is

suggested that the consumers should aim at saving2 gallons a day, which in the population supplied inthe Edinburgh area would mean a saving of 1,000,000gallons daily or 30,000,000 gallons a month. It waspointed out by the engineer that the use of water forflushing the drains and sewers is not wasteful but anecessary health provision, and the amount so usedis comparatively small. The aqueduct from the Tallareservoir is being duplicated ; but the duplicationcannot be finished in time to relieve the situationthis year. The manager of the Glasgow WaterDepartment says that earlier in the year there wassome anxiety, but at present there is an assuredsupply for four months. The notices posted in thetramcars some time ago calling upon the citizens toconserve the supply as much as possible seem to havehad an effect.

Finances of Edinburgh University.At a recent meeting of the University Court Sir

Alfred Ewing, the Principal, said that the ordinaryrevenue had increased from jB110,000 in 1913-14 tonearly job250,000 in 1927-28, and in the current sessionit would probably be z254,000. In these figures noaccount is taken of scholarships or bursaries for whichthe University is only a trustee. Of the wholeregular income, about .848,000 comes as interest fromendowments, Parliamentary grants amount to .891,800,and z107,000 is paid in fees. The ordinary revenueincludes also about 26000 in donations and subscrip-tions (apart from capital donations), and in paymentsby local authorities for services rendered. Ofdisbursements the salaries of the teaching staffconstitute the heaviest item-about 6141,000.Pensions and contributions to the federated super-annuation scheme account for 15,000 ; wages andgrants to departments for expenses require 225,000,and libraries and museums about JE9000. The cost

of administration, including the salaries of the-Principal and of members of the secretarial staff, isabout .818,000. Some 230,000 is required formaintenance of premises, and z310,000 for alterationand adaptation of buildings, and for certain apparatusand equipment. The whole expenditure charged tothe ordinary account for 1927-28 was about z253,000,leaving a deficit on the year’s working of B3490. Forthe current year the estimated deficit is z64676, andis likely to be more. Sir Alfred pointed out thatenlargement of the University, in respect of buildings,subjects, and staff, cannot fail to increase the annualcharges that fall on ordinary revenue. As a rule, theincrease in revenue from fees arising from a newdevelopment does not compensate for the increase inannual charges. Hence new sources of revenue mustbe found. It is for consideration whether, in thedisposal of future capital grants from the CarnegieTrust, the trustees should not be invited to consider-the wisdom of giving some relief from the increasingburden of maintenance, by granting sums for thebetter endowment of existing professorships andlectureships, whose value is established, but whosecost is now a burden on the general funds. Thebequests and gifts which have made the expansionof the University possible have amounted to over21,174,000 since 1916. Fully half of this has beeninvested to provide endowments for particular or

general purposes, whilst the remainder has been or isbeing applied to various extensions of premises andwork, including provision for an extensive andmuch-needed reconstruction of the Medical School.

An Auxiliary Hospital in the Country.The Auxiliary Hospital of the Victoria Infirmary,

Glasgow, at Philipshill, near Busby, was formallyopened on June 27th. Beautifully situated in ruralscenery, the grounds of the extension cover some33 acres, and two of the eight pavilions which willultimately be in use are now completed. It willserve as a convalescent hospital where patients,.having passed the stage for constant medical andsurgical attention, can be transferred to convalesce,and thereby release beds for the long list of sufferersawaiting admission to the infirmary.

Mr. William Gray, who presided, said that thenatural evolution of hospital treatment seemed todemand that buildings in the cities should be regardedas clearing-houses for cases in the acute stage ;when that stage had been passed the patients shouldbe placed in brighter and more attractive surroundingsthan the ward of a city hospital. They would nothave been able to proceed with the work if Mr.Gilchrist Macbeth had not offered to contribute220,000 if it was undertaken. Miss Innes hadcontributed .813,000 for the building of a chapel andto defray the cost of a ward.

i Major Walter Elliot, M.P., late Under Secretary ofState for Scotland, who gave an address on thegeneral hospital problem, spoke of the damaging effectof urban noise on minds and tempers. If this problemcould not be solved for the healthy, let an attempt atleast be made to solve it for the sick. Glasgow wason the verge of a further expansion and the governors.of the hospital were to be commended for having gota little ahead of the procession which would shortlyfollow out of the city. Such expansion had been inthe mind of the late administration in consideringScottish local government and the relation betweenthe voluntary, city, and parish hospitals. Not onlyhad the hospitals of Glasgow to be treated as a unit,but extensions outside the area had to be recognisedas part of the system. The decision that publichospitals should be under one health authority meantthat its relations with the voluntary hospitals mustbe closer than before, and by submission of localreorganisation schemes to the Department of Healthit was hoped that overlapping might be avoided. Hewas certain that they could always look to the centraldepartment and to the present Secretary of State for’Scotland for sound reasoned judgment on these great,matters.