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tories. Disappointments follow when a new methodof treatment has not been found to justify in practicethe panegyrics with which a newspaper writer hashailed its introduction or suggestion. There are un-

avoidable failures such as deaths under anaesthetics orerrors of diagnosis, alleged cures by the unqualifiedwhere the qualified practitioner is proclaimed as havingtried in vain to bring relief. The exploitation of suchtopics as these merely for the sake of exciting themorbid curiosity of the public is not unknown here,and we gather that it finds .its parallel in America.There is also to be mentioned the insertion in news-

papers of advertisements of alleged remedies whichwould not find a place in the columns of any respect-able journal, if its proprietors were first to satisfythemselves that the promises of cure held out hadat least a reasonable prospect of fulfilment. A respect-able newspaper does not insert the prospectus of anew company which its financial editor is prepared

. to denounce as a swindle. It would not seem unreason-able to ask for similar discrimination where not onlythe pockets of the public are concerned but their healthas well. We say this while fully recognising the rightof the public to be informed as to subjects affectingits health, and of newspapers to supply it with theinformation. Temperate and well-informed expositionof such matters are of value to all; we only desire theelimination of the merely sensational, and above all ofthe inaccurate or untrue.

EAR DAMAGE IN NOISY INDUSTRIES.

SUCH attention as has been paid to the effect of noiseon the industrial worker has left only contradictory andinapplicable conclusions. The one clearly establishedfact would seem to be that in certain industries theworker’s powers of hearing diminish in proportion tothe sojourn in the industry, and out of all proportionto the onset of deafness in workers at less noisy trades.Dr. D. Gilbert,l the inspector-general -of the newmedical department in the Belgian Ministry of Industryand Labour, issued some months ago a challenge tootologists and physiologists which should be bearingfruit ere long. As he then pointed out, we have nouniform standards from which to deduce rules for theprevention of industrial deafness. Are we, in the firstplace, to accept the theory of Helmholtz or of Bonnieror of Marage to explain the physiological mechanism ofhearing ? What are the respective roles of pitch,intensity, timbre, and duration of sound in producingauditory fatigue and injury to the internal ear ? Howfar is " solid conduction of sound responsible for theinjuries and how best can it be avoided? These areamong the questions of first-rate practical importancewhich need scientific investigation. In the meantimethere are certain standards which might be arrived attentatively by a single conference of factory medicalofficers. Such, for example, as a standard fixing thelimits of auditory acuity between which it should bepermissible to employ workers in a given category ofnoisy trades. Since it would obviously be advantageousthat these standards should from the outset be inter-national, the subject might well occupy the attentionof the International Labour Bureau at Geneva.

A PUBLIC DENTAL SERVICE AT FOLKESTONE.

THE Committee appointed to inquire into the extentand gravity of the evils of dental practice by personsnot qualified under the Dentists Act has emphasisedin a report the fact that the State cannot afford toallow the health of the nation to be continuouslyundermined bydental neglect, and has suggested thatevery possible means should be employed for enlighten-ing the public as to the need for conservative treatmentof diseased teeth. While provision is rapidly beingmade for the treatment of school children, very littleprogress has taken place in the creation of centreswhere adults of small means can obtain efficient

1 L’Influence des Bruits Industriels, Bull. du Service Médicaledu Travail, No. 1, p. 30.

dentistry at moderate fees. In some districts thisproblem has been solved by the creation of a publicdental service, Brighton, Reading, and Bournemouthhaving been first in the field,’ and the experiment has,we believe, worked with satisfactory results. At thepresent time one of the difficulties in forming thesecentres lies in the huge demands that are beingmade upon the public purse and the great increase inlocal taxation; where authorities admit that publicdental service should be given it is incumbent uponthem to equip such centres at the least possiblecost. A centre has recently been created in Folkestone,and here it is satisfactory to note that use isbeing made of the offices occupied during the day by .

the school dental clinic. The adult dental elinic isopened for the treatment of patients from the hours of4 to 6 P.M. daily, with the exception of Saturdays andSundays, and arrangements have been made for thesame dental practitioner to be in attendance duringvisiting hours, thereby ensuring that patients whorequire to pay more than one visit will always betreated by the same dentist. The general arrangementsof the clinic are to be under the control of the towncouncil, and the installation of surgical and mechanicalappliances has been made possible by the liberality ofSir Philip Sassoon. -

THROAT OPERATIONS ON OUT-PATIENTS.

IN commenting upon the death of a child who diedafter operation for tonsils and adenoids the City coronersaid that the child ought to have been detained inhospital for a day or two. Dr. Waldo was right to

point out the ideals, but, alas, many institutions have todo the best they can with the means at their disposal.At all our large hospitals many operations are performedfor the removal of tonsils and adenoids in children.The little patients are brought up having been pre-pared according to instructions given to their parents.They are operated on and taken away again withina few hours unless there is anything to show dangerin this course. If, as Dr. Waldo suggests, everypatient who has undergone this operation were keptin hospital for a day or two only very few of theseoperations could be done ; there would not be the bedsavailable to permit of more. Consequently numbers ofchildren would have to keep their peccant tonsils andtheir adenoids and the accompanying poor health.Taking the line of the greatest benefit for the greatestnumber, the hospitals are bound to act as they now do.They run the risk of accidents such as that which ledto this particular inquiry. The risk is fortunately slight.Death from post-anaesthetic toxaemia, of which this childapparently afforded an example, is uncommon. More-over, the condition, when severe, is often unaffected bytreatment, so that even under observation in hospitalthe course of events might have been the same. Withregard to the anaesthetic that had been chosen in thiscase, and to the administration of sugar before anves-thesia, we are here on highly controversial matters,even among experts. Such a situation is one in whichwe feel that every judge, magistrate, or coroner shouldavoid saying anything which might direct censure inthe minds of friends and relatives of the deceasedupon those who have exerted their knowledge and skillin behalf of the deceased, for the censure might beunjustified. -

A PROPOSED SUBSTITUTE FOR ERGOT.

IN view of the difficulties under which so many hos-

pitals are now labouring, the cost of drugs assumes a.

special importance. The present high price of ergot,for example, largely due to the absence of Russian

supplies, has stimulated inquiries as to the possibilityof finding a new source or a substitute. It would

probably be possible to cultivate the fungus in thiscountry by inoculating fields of rye, but any possibleadvantages would be outweighed by the danger attach-ing to the introduction in quantity of an organismwhich for centuries caused outbreaks of disease on

1 See THE LANCET, 1917, i, 505.

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the continent, and to a lesser extent in these islands,reaching at times the dimensions of a plague. Accord-ing to a statement recently published in Germany,linfusions and macerations of shepherd’s purse, Capsella- BMTsa-p(tsoWs, exert on the isolated guinea-pig’suterus an action which is very similar to that of ergot,and it is suggested that it may be found possible to usethis plant, which is one of our commonest weeds, inplace of the expensive drug now so widely employed.Although very great variability in the potency of thesamples of plants and preparations examined wasobserved-some were, in fact, found to be inactive-atleast it may be said that the pharmacological actionand chemical composition of the plant are worthy ofthe fullest investigation. Other lines of attack are,however, available in addition; the three principalphysiologically active constituents of ergot-ergotoxine,ergamine, and tyramine-are obtainable commercially,and by a proper use of one or more of them, it may beadded, the variability in composition and action of theentire drug can be obviated. Of these constituents thetwo latter can be artificially prepared and it is possiblethat by devising comparatively inexpensive processesof manufacture synthetic chemistry will in timefurnish at least a partial solution of this problem.

DR. H. SCURFIELD’S RETIREMENT.

THE announcement of Dr. Harold Scurfield’s resigna-tion of the post of medical officer of health of Shefdeld,which he has held for the last 17 years, was a surpriseand something of a blow to his medical colleagues.During his life in Sheffield Dr. Scurfield has wonthe respect and esteem of all with whom he has- come in contact. His wide knowledge of all subjectsconnected with public health, his deep and particularinterest in the problems of tuberculosis, infantwelfare, and school hygiene, combined with the deter-mined championship of any cause which he has taken up,have made him a power for good which it will bedifficult to replace. In addition to his ordinary publicduties Dr. Scurfield has for many years renderedvaluable services to the University of Sheffield as

professor of public health. In retiring from officialwork whilst still active and vigorous, he carries withhim the best wishes of his medical colleagues. Wemay hope that his ripe judgment and wide experiencewill still be available in connexion with the importantsubjects upon which he is a recognised authority.

CHADWICK’S MESSAGE FOR TO-DAY.

IN his Chadwick public lecture delivered at Man--chester on Dec. 7th Sir Malcolm Morris explained thathis object was to discuss some urgent public healthquestions of the moment in the light of the teachingsof Edwin Chadwick, whose ideal was the prevention ofdisease by the creation of a wholesome environmentand the avoidance of modes of life detrimental to healthand well-being. The prevention of disease, not themere staying of its course, but the sweeping awayof the conditions that bring it into being, was stillthe ultimate aim of all enlightened sanitary effort.The public health movement would never come to fullfruition until the individual citizen recognised, in thefirst place, that it was his duty to take as much care ofhis health as of his property ; and, in the second place,that if he contracted disease, it was equally his duty tokeep it to himself. Talk to John Smith of his rights.and he would turn a ready ear. What we had to dowas to bring him to a sense of his privileges. We mustpersevere until we had made him feel that the medical-officer of health was his best friend and that the preser-vation of health was a much more important matterthan the acquisition of wealth. During 50 years in themedical profession, Sir Malcolm Morris said that he hadoften asked himself how much of the sickness that stillabounded was avoidable, gratuitous, self-incurred? Itwas his deliberate opinion, after much pondering, that

1 H. Kochmann : Münchener medizinische Wochenschrift, 1920,No. 45.

at least 75 per cent. of it was the penalty inflicted bythe nature of things for violations of the elementarylaws of health, violations which consisted in careless-ness, in neglect, in folly, in excess of all kinds. SirMalcolm Morris might have had in his mind a sentencefrom the first number of a new American journal, entitledNational Living, which runs :-Possibly you will find the root of the evil yourself. If you

have corrected all your corrigible transgressions and after areasonable length of time you are still suffering from yourold symptoms, see a physician.But our contemporary has overlooked the fact that it isthe physician himself who has shown the way to correctthe corrigible transgressions.

PRIMARY GASTRIC SARCOMA: A SERIESOF CASES.

ACCORDING to Dr. William D. Haggard,’ professor ofsurgery in Vanderbilt University, primary gastricsarcoma is one of the rarest surgical diseases. In27,250 abdominal sections at the Mayo Clinic in fiveyears there were only 8 saroomata of the stomach,and of 2067 malignant tumours at this clinic between1908 and 1920 only 13 proved to be sarcomata, so thatthere was one sarcoma to 159 carcinomata of thestomach. The condition may occur at any age, theyoungest case being in a boy of 3 years (Finlayson),and the oldest in a man of 85 (Gosset), and is mostfrequent after the age of 40. Of 66 cases in which thesexes were stated 33 were males and 33 females. Thesize of the tumour varies from that of a bird’s eggto that of the case reported by Baldy, in whichthe tumour filled the whole abdomen. Histologicallythe tumour may be round cell, spindle cell, mixedcell, lymphosarcoma, myosarcoma, fibrosarcoma, angio-sarcoma, or endothelioma. The round-cell variety,which is the most malignant, is apt to be mistaken forcancer. It usually infiltrates and most often involvesthe pyloric end of the stomach, but rarely producesstenosis. The spindle-cell sarcoma is apt to be circum-scribed and is frequently pedunculated. The diagnosisbefore operation is often impossible, especially as

there may be no gastric symptoms whatever. Hsemor-

rhage from the stomach and blood in the stools arefrequent, especially in the round-cell variety, thoughnot so frequent as in carcinoma. But in sarcoma,unlike ulcer or carcinoma, there is not a long history ofdyspepsia, and there are less likely to be signs ofobstruction. On the other hand, there is more likely tobe a palpable mass in sarcoma. Rapid development ofanaemia and debility, with loss of weight and cachexia.accompanied by early, rather severe, and more or lesspersistent pain in the epigastrium, and the absence ofany long-standing history of dyspepsia and pyloricobstruction, are also suggestive of sarcoma. In additionto his own case of fibro-sarcoma in a girl of 17, in whichcomplete recovery followed operation, Dr. Haggardgives a resume of 13 cases operated on at the MayoClinic between 1908 and 1920.

POST-ANÆSTHETIC MUTISM.THE interesting case of loss of speech after an

anaesthetic, which we publish on p. 1198, directs atten-tion to other mental effects which are occasionallyobserved after the taking of these drugs. With rareexceptions, these are much more often functional in all .probability than due to any organic lesions. Cerebralhaemorrhage or thrombosis resulting in definite hemi-plegia has certainly occurred more than once duringthe inhalation of and the recovery from anaesthetics,but such an event is rarer than the appearanceof emotional or mental alterations, which also maylast for some time. It is difficult to ascribe these toorganic lesions. It happens not very infrequently thatfollowing an anaethesia, and starting soon after recoveryor sometimes days later, a patient’s mental conditionbecomes abnormal. There may be actual mania or

there may be melancholic symptoms. An attack of this

1 Surgery, Gynecology, Obstetrics, London, 1920.