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medical history of the war. A proper statistical

investigation dealing with the sick and wounded,even among the British soldiers only, in this giganticstruggle will furnish lessons for the future of thehighest importance. The circumstances of the war

have been and are in many respects unprecedented,and we may receive specially significant informa-tion from the statistical analysis of the casualtyand sickness lists; apart from which our previouswars have been so badly chronicled from the medical

point of view that much general instruction to begathered from the figures will be new to us.

Similarly the assistance which the Medical

Research Committee have been able to offer to

military hospitals in respect of their pathologicaldepartments has not only been of great practicalservice in the care of our sick and wounded, butis likely to have far-reaching results. In some

of the places where medical officers, havingcommissions, have been appointed to pathologicalposts, the Medical Research Committee havemade grants for the supply of apparatus such aswould not necessarily be found in the ordinaryequipment of a hospital; to other military hospitalsgrants have been made for the appointment of part-time pathologists, not having commissions, whosework can in some cases be carried out in an

adjacent laboratory belonging to a university or amunicipal authority. ’In some cases the MedicalResearch Committee have equipped laboratorieswithin military hospitals for the purpose of routinework or special inquiry. The work here done in

collaboration with the Royal Army Medical Corps,whose scientific status is now so good, and whoseachievements throughout the war have been re-cognised as a feature in our military successes, isbound to throw light upon many difficult problemsin preventive medicine and therapeutics.Among the special inquiries which the Medical

Research Committee are employed upon may bementioned the study of epidemic cerebro-spinalmeningitis, which is being undertaken under thedirection of Dr. M. H. GORDON, who has receiveda commission as a major in the Royal ArmyMedical Corps, and who has a central laboratoryat the Army Medical College, Millbank, where theCommittee provide him with two assistants.

Research in the same direction in many provinciallaboratories is also being subsidised. The services ofthe* bacteriological department of the Committee,which is under the direction of Sir ALMROTH WRIGHT,have been applied to purposes of military signifi-cance, while it is well known that at the outbreakof the war Sir ALMROTH WRIGHT and his staff gavethe whole of their time to the preparation ofvaccines for the army in the inoculation departmentof St. Mary’s Hospital. We publish elsewhere in fullthe interim report of the Medical Research Com-mittee, which tells its own story of multifarious

industry, and feel sure that no medical man canread it without seeing how fitting an adjunct tothe labours of the Royal Army Medical Corps theCommittee are proving themselves to be.

Annotations.

THE LATE MADAME DEPAGE.

"Ne quid nimis."

IT is felt that the tragic death of Madame Depage,to which reference was made in our columns lastweek, should not be allowed to pass without somedemonstration of the admiration that is felt for hercharacter and of sorrow for her tragic fate whileengaged on an errand of mercy. Madame Depagehad many friends who were deeply attached to herboth here and in the United States, and it isthought that they might like to give expression totheir feelings by subscribing to a small bronzememorial to be placed in the Depage Hospital atBrussels after the war. The memorial might beexecuted by some of the distressed Belgian artmetal-workers who are now in exile. Subscrip-tions will be gladly received by Mr. Robert Jones,11, Nelson-street, Liverpool; by Mr. D’Arcy Power,10A, Chandos-street, Cavendish-square, London; orby Professor Sinclair White, Ranmoor, Sheffield.

THE TREATMENT OF THE ATONIC WOUNDSOF WAR.

AT a recent meeting of the Societe Médicale desHopitaux of Paris M. François Debat describeda simple and effective method of treating thewounds of war which resist ordinary methodsand remain atonic or even degenerate into ulcers.Our Paris correspondent has already referredbriefly to the treatment as being satisfactory.The wounds in which it was employed were usuallynot deep. At first they showed nothing par-ticular and then the following obstinate con-

dition gradually developed. The wound becameviolaceous and its surface smooth or mam-

millated with soft granulations, the borderspunched out or nodular. There was an abundantserous or purulent discharge. Sometimes a thinviolaceous cicatrix formed at certain points withlittle power of resistance. In other cases the ulcerincreased in depth and extent. This complicationusually occurred in soldiers who were debilitated,fatigued, or addicted to alcohol, but sometimes wasobserved in young, robust, and sober men withoutspecific or tuberculous history. Atonic woundsshowed a predilection for certain situations-the backs of the hands and feet, the innersurface of the arm, and the antero-internalsurface of varicose legs. They were never

observed on the face or the plantar or palmarregions. Ordinary treatment was of no use. Anti-septics only irritated and destroyed the tissues.Moist dressings macerated the surrounding integu-ment and provoked dermatitis and folliculitis. Drydressings adhered to the wound and formed a crustunder which suppuration spread downwards. In

many cases, after two or three months’ treatment,the condition was worse than ever. The localisa-tion of the wounds gave the key to their patho-genesis. As stated, palmar and plantar woundshealed well. Three reasons may be given for this.1. The thickness of the integuments, particularly ofthe generating Malpighian layer. 2. The activityof the circulation. 3. The frequency of contractionof the subjacent muscles. In the regions where theatonic wounds occur there are, on the contrary, athin epidermis, a circulation of little activity, and

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feeble and infrequent muscular contractions, as thewounded man tends to immobilise the affected limb.The treatment follows. Irritation of tissues withlittle power of resistance must be avoided. Their

activity must be increased by movements and

massage. M. Debat eliminates all antiseptics. He

applies a light dressing of gauze soaked in salinesolution of the strength of 9 per 1000 covered withcotton wool. To prevent maceration he exposesthe wound every day to the air and increases theduration of the exposure as the dischargediminishes. The time of exposure is two hourson the first day, and this is increased by an hourdaily. When the discharge ceases the saline solu-tion is replaced by a thick paste of oxide of zinc orinnotyol. Every hour the muscles subjacent to thewound are moved for five minutes, while the limbis maintained in an elevated position. Every dayeffieurage of the limb with pinching of the skinaround the wound is performed. If the wound’

‘

is in the lower limb the patient should remain inbed; if in the upper limb he should wear a sling.This simple method had an immediate effect. The

following is an example. On Oct. 28th, 1914, a robustsoldier, aged 21 years, addicted to alcohol, sustaineda superficial wound on the antero-internal surfaceof the arm in consequence of a shell explosion. Thewound was painted with iodine and moist dressingswere applied. After a fortnight the wound suppu-rated abundantly and tended to enlarge. Peroxideof hydrogen, nitrate of silver, iodine, permanganateof potassium, carron oil, and dry dressings were

tried in turn. After two months there was no

improvement. On Jan. 8th, 1915, the treatmentdescribed above was adopted. The movementsconsisted in pronation, supination, shutting thehand, and flexion of the forearm. After three daysthe wound was red instead of violaceous, and wasgranulating, particularly at the borders and lowerend. On Jan. 26th healing was complete.

HOW PLAGUE MAY BE CARRIED FROM PLACETO PLACE.

IT is now generally recognised that plague maybe conveyed from port to port or from one continentto another by infected rats which may travel onboard vessels, concealed like stowaways among thecargo. Modern preventive measures, therefore,require a careful examination of sacks, crates,boxes, or other packages before they are carried onboard ships at the port of departure and againbefore landing at the place of destination to dis-cover if any rats are concealed in them. OurAmerican contemporary, Public Health Reports ofMarch 26th, calls attention to what appears to bean illustrative example of this possible danger.Recently at Seattle, a seaport town situated onPuget Sound, in the State of Washington, on thePacific coast, a large box of plants arrived fromJapan, and on being opened by the State horti-culturist a rat was discovered concealed in the soilat the bottom of the box. The animal was at oncekilled with a stick and the body was handed overto the medical officer of the Public Health Servicestationed at Seattle for examination, with theresult that it was found to have been sufferingfrom a form of plague. There were two possibilities-namely, that either the rat had entered the boxat Yokohama before it was carried on boardthe ship, or that it had managed to enter the

package at Seattle when it was opened by theofficial appraiser for customs purposes. The

experts who inquired into the case came tothe conclusion that the affected rat musthave entered the box at Yokohama and travelledin it to Seattle. For some time the local ratsat Yokohama are known to have been infectedby plague, but on the other hand it is equally truethat since 1913 plague-infected rats have beenfound from time to time at Seattle up to the

beginning of the present year along the waterfront. After consideration of the facts we are dis.posed to agree with the view taken by the Seattleexperts that the infected rat was conveyed fromYokohama in the box of plants, and that it wasextremely unlikely that it could have managed tofind its way into the package during the shortexamination made by the official appraiser atSeattle. If this view be correct the importanceof the case can hardly be over-estimated, forif the box had been consigned to some inlandtown in the United States where the publichealth officials were not on the alert, it is morethan probable that the infected rat would haveescaped to mingle with the local rats, and mighthave established a fresh focus of plague infection.We understand that the medical officers of theUnited States Public Health Service have nowinstituted a systematic examination of all packagescoming from infected ports in order to ascertainthe relative frequency of such occurrences, so

that suitable steps may be taken at Seattle andother ports to prevent any danger that mightarise from this cause in future.

THE ASSAY AND PHYSIOLOGICAL VALUE OFMEAT EXTRACTS.

AN interesting discussion on the methods adoptedin the estimation of the nitrogenous constituentsof extracts derived from albuminous substances,such as meat extracts and similar products, withspecial reference to the physiological significanceof the results, was opened by the chairman, Mr.A. C. Chapman, at a joint meeting of the Society ofPublic Analysts and other Analytical Chemists andthe Bio-chemical Society, held at the ChemicalSociety’s rooms on May 5th. The chairman drew asketch of the analytical methods in vogue whichaimed at separating and estimating such productsas gelatine, gelatin-peptone, syntonin, albumosesand peptones, creatin and other meat bases. Dr.F. Gowland Hopkins, in the course of some

interesting remarks on the work that was beingdone on the subject at Cambridge, said-The animal body dealt not with the intact proteins or

even with the albumoses and peptones, but with the freeamino-acids which were the individual constituents of theprotein molecule. The actual way in which the differentamino-acids were grouped in the protein molecule was not ofmuch consequence, but the effects produced by the indi-vidual amino-acids were of extreme importance. He de-scribed physiological experiments which he had madeshowing that when rats were given a diet including a com-plete amino-acid mixture corresponding to the proteins of anordinary diet the growth was almost exactly normal, whilewhen arginine and hisidine were removed from the amino-acid mixture the growth ceased immediately, being resumedwhen arginine and histidine were again added. The re-

moval of tryptophane from the amino-acid mixture also pro-duced similar results, and Osborn and Mendel in Americahad shown cystine to be similarly essential. It did notfollow that this was the case with every amino-acid, and thequestion as to which of the amino-acids were essential inthat way offered a large field for investigation. Recentwork at Cambridge indicated that certain acids could beremoved from the amino-acid mixture without affecting the

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rate of growth. With regard to the minimum quantity ofany amino-acid required for nutrition, experiment had shownthat, in the case of rats, at any rate, the critical minimumfor arginine lay somewhere between 2½ and 1 per cent.

It appeared that the functions of the individual amino-acids were not confined merely to flesh formation. The effectof feeding animals on zein, which was deficient in bothtryptophane and lysine, was not only to restrict growth butalso to shorten the survival, and the same was observed withzein plus lysine ; but with zein plus tryptophane the animalwas able to maintain its weight for a long period, although itdid not grow. It was clear from this that trytophaneexercised some other function than the mere supply ofmaterial for growth.

Mr. A. R. Tankard thought that it was important in somecases to estimate separately the meat fibre and coagulablealbuminoids, with a view to the detection of extraneousmatters which were sometimes added. For some time pasthe had adopted the method of centrifugalising the bromineprotein precipitate, mixing the residue with water, and

centrifugalising again. He made a practice of separatingthe albumoses and peptones, but agreed that in most

ordinary cases this was of little value. There were, how-ever, on the market certain so-called fortified" meatextracts which contained albumoses and peptones in verymuch larger proportion than occurred in ordinary meatextracts.

Dr. Percival Hartley described his experience of VanSlyk’s method of determining amino-nitrogen, which wasbased on the fact that when protein and protein degradationproducts were treated with nitrous acid nitrogen gas wasgiven off. The results of complete analysis of various proteinsshowed that the constitution of serum albumin was quitedifferent to that of the globulins, the former containing a muchlarger proportion of lysine and of cystine than the latter.Another interesting result was that the globulins exhibitedno difference in chemical composition-eu-globulin and

pseudo-globulin apparently being closely related. Another

point brought out was that the free amino nitrogen of nativeproteins appeared to be approximately one-half of the lysinecontent which, if substantiated, would appear to afford asimple method of estimating lysine without hydrolysis ofthe protein. Furthermore, the proportion of free amino

nitrogen indicated to what extent the protein had beendigested or peptonised.On the whole the discussion did not throw muchfresh light upon the actual value of meat extractsas nutrients. The general impression was derivedthat there might be activators present in suchextracts which were of value in encouraging theassimilation of actual food substances, and so theclassical conclusion that meat extracts served asadjuvants or stimulants rather than direct nutri-tives would appear still to hold the field.

THE REGISTRATION OF PLUMBERS.

THE protracted efforts of the Worshipful Companyof Plumbers, no less on behalf of the public healththan for the honour of the trade they represent, areslowly bearing fruit. Recently the corporationwaterworks of the county borough of St. Helensissued a regulation to the effect that for the pro-tection of the water-supply, and in the interests ofthe consumers, it is essential that all plumbingwork should be well and soundly executed ; and inorder to ensure the employment of none but goodworkmen a register of plumbers will be kept in theoffice of the water department of the corporation,on which may be enrolled any plumber carrying onbusiness within the limits of the water-supply whoshall satisfy the water committee and the engineerin all respects as to his competency, and who shallsign an agreement to conform to and comply withthe by-laws relating to water-supply. No otherperson will be recognised as an authorisedemployee. Still more recently, on April 24th, theannual general meeting of the Incorporated Joint

Committee on Water Regulations was held at theLondon Guildhall, at which was passed a resolutionapproving the principle of

"

raising the qualificationof plumbers employed on water fittings, and call.ing on water authorities to recognise and requireas far as possible the employment of plumbersqualified and responsible for the efficiency of theirwork by having passed a theoretical and practicalexamination, such as that conducted by the GeneralCouncil for the National Registration of Plumbers,which is constituted of representatives of masterplumbers, operative plumbers, and authorities con-nected with public health." It was further recom-mended that where there was not a sufficient supplyof plumbers possessing the necessary qualificationthe water authorities should obtain information fromthe plumbers of the locality as to the reason forthe apparent insufficiency and the possibility ofincreasing the number of properly qualified men.It is hoped that regulations such as the above willinfluence all plumbers to bestir themselves with aview to obtaining some certificate as to their com-petency. Hitherto the majority of plumbers, weregret to say, have abstained from registration,finding themselves able to obtain employmentwithout payment of the annual 5s. fee necessary forregistration. While this narrow attitude continuesthe public are left without any guarantee of theworkman’s ability to execute properly the workwhich he undertakes, and bad results to thepublic health follow. --

THE PHYSIOLOGICAL SIGNIFICANCE OF REFLEXPHENOMENA IN SPASTIC PARALYSIS OF THE

LOWER LIMBS.

THE elaborate observations reported by Dr. R.Walshe in Brain (1914, Vol. XXXVII., p. 269) is ofmuch more than passing interest. They are ofhigh clinical and diagnostic importance; theyinstance, too, a striking example of the value toclinical medicine which apparently purely physio-logical data can afford. Professor C. S. Sherrington’sresearches upon the

"

spinal" and the " decerebrate "

animal form the starting-point. It has been shownby him that there are two separable systemsof motor innervation which control two setsof musculature. One system exhibits thosetransient phases of heightened reaction whichconstitute reflex movements, well exemplified inthe protective reflex of flexion following a nocuousstimulus to the sole of the foot; the othermaintains that steady tonic response which suppliesthe muscular tension necessary to attitude, andwhich is mainly evidenced in the extensor group ofmuscles. These two systems, moreover, cooperate,exerting influences complemental to each other.Does this system of innervation apply in man? 2Dr. Walshe brings forward what appears to us to beconvincing evidence that it does. He recognises,with Babinski, two forms of spastic paraplegia: one"in flexion" when the limb or limbs becomeflexed, and the other " in extension " with the limbextended. In paraplegia with flexion one hasmuscular rigidity in flexion, profound loss of

voluntary power, diminished or absent tendon-jerks, and exaggeration of the defence reflexes andextensor response (the Babinski sign, which Dr.Walshe argues is a definite part of the flexionreflex). Such a form of paraplegia is met withespecially when there is local and extensivecord damage, when, it is suggested, not only thepyramidal tract but the lateral columns also areaffected. In a pure pyramidal lesion, such, for

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example, as hemiplegia, there is, on the contrary,always paraplegia in extension, not in flexion. Now,flexion paraplegia, on account of the loss of knee-jerk, which represents the degree of extensor

tonus, indicates interruption of those motorchannels concerning such tonus, and since thisinterruption never occurs in pure pyramidallesions it is argued that such channels pursue anextra-pyramidal course. Flexion paraplegia in factcorresponds to Sherrington’s

"

spinal " animal, inwhich the cord is definitely interrupted. Extensionparaplegia presents a different condition. Thereis here the exaggerated knee-jerk; there is, thatis to say, evidence of heightened extensor tonus,and such a condition corresponds to Sherrington’sdecerebrate rigidity. Now, the same conditionfollows, experimentally, section of the brain-stemabove the level of the pons, but not so far forwardsas the forebrain. The centre controlling this extensorreflex lies probably near the paracerebellar nuclei.In animals, therefore, it is suggested that ofthe two reflex centres controlling flexor responsesand extension tonus respectively that subservingflexion rests in the cord, and that preserving tonusin the extensors rests in the brain at the sitesuggested. A pure spinal lesion generally causesflexion paraplegia, for here the tracts for extensortonus are usually involved as well as the flexion"

spinal centre. A cortical lesion, such as hemi-plegia, representing a pure pyramidal lesion,always causes extension paraplegia, for here thepaths for extensor tonus are not interfered with;the tonus is, indeed, heightened. This increasedtonus may modify the character of the reflexesof its antagonistic muscles, the flexors, wherethe crossed extensor response is only obtainedin such conditions. Disturbance of sensationappears to influence hardly appreciably the

. form of these reflexes. The investigationshave been followed in some cases by means ofgraphic records of the tendon-jerks. The analogybetween events as seen in the experimental animaland those furnished by pathological conditions inman is thus of striking significance, and the powerof diagnosis is materially aided by this lift up"

"

from the physiological laboratory.

INSANITY CLAIMED TO BE DUE TO MINERS’NYSTAGMUS.

THE causation of insanity is a wide subject,which it would be impracticable to endeavour toreduce to fixed or specific limits by the definiteinclusion of certain factors and the rigid exclusionof others. At the same time, if attention is devotedto what may appear the most prominent incidentin the previous history of a case, and a proportionedestimate of the action of less obvious but at leastequally potent factors is not made, there is graverisk of misconception and of erroneous judgment.Nothing is more clear in discussing the incidenceof insanity than the fact that the soil from whichmental disease springs is prepared by the inherit-ance of the individual, and the task of assigningrelative importance to the various elements thatmust be regarded in any particular case of insanityis one demanding careful and mature consideration.In a recent case under the Workmen’s Compensa-tion Act nystagmus was claimed to be the cause ofthe insanity of the individual whose case was underadjudication. The Navigation Coal Company wassued by the widow of Walter Jones, a coal miner,for compensation in respect of the death of herhusband as being due to nystagmus contracted

when in the company’s employment. The facts"arebriefly as follows. The deceased contracted miners’nystagmus and received compensation for a time.He subsequently took the position of steward tothe Merthyr Vale Hibernian Club, and performedhis duties to the satisfaction of the club. Later,however, he became obsessed with the idea thathe was not doing his work satisfactorily, and heresigned. The club persuaded him to withdraw hisresignation, but he resigned again, and this time hisresignation was accepted. Before his notice expiredhe .committed suicide on the railway, the coroner’sjury returning a verdict of " Temporary in.

sanity." In order to establish her claim for’compensation the widow had to show that herhusband’s death was caused by nystagmus, whichit will be remembered, is a disease included inSchedule III. of the Act of 1906. Evidence was,called to establish the claim that his depressionand suicide were the consequences of the diseasewhich he had contracted. Judge Bryn Roberts,however, regarded the chain of causation as in.sufficiently demonstrated, and the widow’s applica-tion was refused. Time and custom have sanctionedthe division of etiological factors into "predis-posing" " and

"

exciting," and no physician willemphasise one at the expense of the other, for theoperation of each is of significance. Of the pre-disposing factors in the case under consideration,no information seems to be- forthcoming, butassuredly they cannot be ignored, and whetherpredisposing factors are matters for compensationis too debatable a subject to be decided by mereex cathedrâ statements. On the other hand, it canbe understood that, where the soil is alreadyprepared, the existence of such a physical defectas miners’ nystagmus might become a veritableobsession in a particular case, and originatea train of morbid mental processes whichmight end in the commission of suicide. Ina sense, therefore, it can be regarded as an excitingcause. Whether it was the only exciting cause inthe present case is quite another matter, and, asalready remarked, the part played by predisposingfactors may be of equal, if not greater, importance.To assign compensation by singling out one onlyof a number of pre-existing morbid agencies atthe expense of the others would be unjustifiablefrom the medical point of view, and equallyunwise. The judge’s decision that the chain ofcausation in this particular case was incompleteis one which we think expert opinion in regard tothe causation of insanity will uphold.

THE VALUE OF ATOPHAN IN GOUT.

SOME observations on the use of this drug, whichis a diphenyl-chinolin-tetracarbonic acid, havebeen recently published by Dr. P. Biffis in Il Poli-czinico. He administered it to five healthy andtwo gouty subjects in half-gramme doses two toeight times daily, the latter being on a rigorouspurin-free diet. In the healthy subjects therewas a definite increase in the uric acid eliminatedby the urine, which generally reached its maximumin the first six hours, after which it diminishedeven though the dose was trebled or quad-rupled. The increase was not in proportion tothe amount of drug given after the first day,even if the experiment were made in thesame individual at different times, and whenthe administration was suspended there was a

diminution, sometimes very marked, in the quantity

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of eliminated uric acid which continued for two tothree days. There was no change in the quantityof urine passed, but it became slightly turbid andhigh coloured and gave a sediment of urates anduric acid, and a trace of albumin was frequentlyobserved. In large doses it was not well tolerated,causing pyrosis, which was not relieved even byfull doses of bicarbonate of soda; this digestivedisturbance was not nearly so frequent when

novatophan was substituted for atophan. In thetwo gouty cases the drug was not given in the acutestages, and, taken in conjunction with other observa-tions previously made by him, the author cameto the conclusion that the drug was much less activewith regard to the elimination of uric acid in goutysubjects than in healthy. It had hardly any actionin doses of 1-2 grammes, and this may be whysome observers have reported unfavourably of thedrug. The inertia can perhaps be explained by thefact that atophan acts rather upon the eliminationof exogenous uric acid and is therefore less activein.gouty subjects on a diet free from uricogenoussubstances. With regard to the quantity of urine,the tolerance, and the albuminuria, the same

phenomena were observed as in the healthysubjects. The action of atophan is little under-stood, but it probably consists in the decom-position of a larger quantity of nucleoproteidsor in some alteration in those fermentative.processes which regulate the oxidation of thepurin bases. ____

PAINLESS LABOUR.

IN a recent issue of La Clinica Ostetrica Dr. E.Curti gives his experiences of 25 cases of labour inwhich he used amodificationof scopolamine narcosis.Instead of the morphine with which this drug isusually associated and which has been blamed forsome of the untoward results following its use, hehad the idea of combining it with narcophine,a substance which is a synthetic double salt of

morphine and narcotine having the chemical formulaCiH407, C17H19N03, C22H23NO7 + 4H20. This substanceis a white powder, soluble in water, and possessesthe narcotic efficacy of opium without its toxicity.Its action is slower but more lasting thanthat of morphine, while its use is not followedby nausea. The technique employed by Dr.Curti was to give half-hourly injections com-

mencing with scopolamine gm. 0’00045 (about1/150th grain), with narcophine gm. 0’03 (aboutt grain). The second dose consists of scopol-amine 1/200th grain alone, the third of the samequantity with the above dose of narcophine, thefourth of scopolamine alone, and so on alternately.The first injection was given as soon as the cervixwas nearly fully dilated. Dr. Curti never foundthat the injections were followed by either nauseaor vomiting, headache or giddiness. The patientsfelt well and were not fatigued, neither were

there any haemorrhages or other complications ineither mother or child. The narcosis obtainedis not complete, the mental faculties not beingsuppressed, but sensation is blunted and it ispossible to administer food and medicine. Labourwas never retarded and instrumental delivery,when it occurred, would have been necessary evenwithout this narcosis, which is a great boon toa practitioner when single-handed. The durationof the narcosis after delivery varied, and dependedpartly on the number of injections and partly onthe amount of blood lost during labour. Replying

to the query whether the narcosis is due to thescopolamine or the narcophine, Dr. Curti’s experi-ence is that narcophine alone causes drowsinessbut that large doses are required to overcome thelabour pains, and with such doses probably uterinecontractions would be diminished in intensity. Thecombination, however, with scopolamine enablessmaller doses of narcophine to be used and producessleep of short duration, together with almost com-plete cessation of the pain and abolition of full con-sciousness of what is taking place. -

HOSPITALS AND RATES.

THERE is no encouragement to hospital governorsto enlarge or even modernise their institutions ifthe case of the Royal West Sussex Hospital atChichester. can be taken as a test. Although noextra accommodation has been provided in bring-ing the institution thoroughly up to date, the localassessment committee has so increased the ratablevalue that the governors are called upon to payannually on account of rates ;S80 more thanhitherto. There may be strong arguments infavour of the increased assessment, but it seemsunreasonable treatment of an institution which isdoing thoroughly good work among the sick poorand has readily opened its doors for the receptionand treatment of our wounded soldiers. The greaterthe work of the hospitals generally the lessshould be the taxes upon them: this would seemto be the more equitable way of regarding theposition. Their whole purpose and tendency isto save expense to the community, and whatis perhaps more important to improve the race.A very strong point against the increased assess-ment is that comparing the accounts of the institutionat the Sussex cathedral city with hospitals in othercomparable towns in no case is it found that such aheavy sum is being paid in rates in proportion to thenumber of beds. For example, the Royal SussexCounty Hospital at Brighton, with nearly 200 beds,is assessed at only JE104; the Royal West SussexHospital’at Chichester, with 60 beds, C280 ; whilethe Portsmouth Hospital is not assessed at all, butreceives £ 250 annually from the corporation.Further, two-thirds of the income of the Chichesterinstitution are subscribed by those living outsidethe city borders; of an annual expenditure of £4661,no less than £ 3496 are spent in the city itself ; andof the £16,000 raised to pay for the reconstructionthe city subscribed ;E325, which sum included thebishop’s subscription of .;1;:100. The complaint ofthe governors can well be understood, and in theevent of relief not being granted there seem to beample grounds upon which a friendly action mightbe cited.

____

THE next session of the General Medical Councilwill begin on Tuesday, June lst, when the Presi-dent, Sir Donald MacAlister, will take the chairat 2 P.M.

____

THE library and offices of the Royal Society ofMedicine will be closed for the Whitsuntide holidaysfrom Saturday, May 22nd, to Tuesday, May 25th,both days inclusive. ____

Mr. J. B. Lawford, we understand, will offerhimself again as a candidate for the Council of theRoyal College of Surgeons of England, by the desireof his colleagues, as a representative of ophthal-mology.

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THE London Gazette announces that the King hassanctioned the appointment of the King of the

Belgians as an Honorary Knight of Justice and ofthe Queen of the Belgians as an Honorary Ladyof Justice of the Order of St. John of Jerusalemin England, and also the promotion of AdelineDuchess of Bedford from a Lady of Grace to a Ladyof Justice of the Order.

Lieutenant-Colonel Hugh Jones Roberts, T.D., ofLlywenarth, Penygroes, Carnarvonshire, has beenappointed a Deputy Lieutenant of the County of,Carnarvon.

NOTES FROM INDIA.

(FROM OUR OWN CORRESPONDENTS.)

’The Military Medical Students’ Strike at Lahore.SOME time last year the military students of the

Inhere Medical School complained that the uniformworn was unsuitable. This complaint was endorsedby the Principal, considered by the Military Depart-ment at Army Headquarters, and certain altera-tions sanctioned; but owing to the demands of thewar the materials necessary to carry them outcould not be supplied. The students were alsodissatisfied about the rates of scholarship allow-- lances in these times of scarcity. During the visitto the school of Sir Pardey Lukis, the Director-General of the Indian Medical Service, on Feb. 20th,the Principal drew his attention to this matter,and Sir Pardey Lukis gave the representationsympathetic consideration; but on Feb. 22nd thesecond, third, and fourth year military studentsdecided at a meeting to appear in plain clothesinstead of uniform at the classes, contrary to thestanding orders. Next day a body of these studentswere seen by the Principal leaving the hostelin mufti for their classes. They were orderedto appear in uniform before him at 9 A,lBf., and ondoing so were given extra drills for their breachof discipline. The students went back to theirboarding house, absented themselves from theclasses, and subsequently held a meeting, at whichthey decided to go on strike. A part of the dutyof these military students was the care inhospital of the wounded sepoy patients fromthe front, and they were also responsible for theunloading of the batches of wounded sepoys as

they arrived at the hospital, so that they left the-wounded soldiers unattended to, and but for the’college students and the civil students of the

school, who volunteered for the extra duty, notonly must these patients have remained entirelyneglected, but it would have been impossible to Ireceive any more. On Feb. 23rd the Principalcalled on the students for an explanation of theirabsence from classes. The students stood silent,and they were then asked to take their beddingand leave the hostel for the night. They weretold that the matter had been reported to the IDirector-General of the Indian Medical Service, Iand that they must await his orders beforereturning to their classes. They themselves Iwired to the Director-General and were orderedby him to return to duty, and to submit theirgrievances through the proper channel. Thenumbers concerned up to this time were 75 out 3of 117 military students; the remainder of the 352 Istudents in the school had taken no part in the ]

strike. On Feb. 24th 28 out of the 33 first-yearmilitary students joined the strikers, making 103 inall. On Feb. 27th the students on strike were in-formed by the Principal that the names of all themilitary medical students who did not return totheir classes before 12 noon on March 3rd wouldbe struck off the school rolls, that their scholar-ships in hand would be forfeited, and that allbondholders would be asked to make good theirsureties. Practically none of the students re-

turned by March 3rd, and the orders mentionedabove were all carried into effect. In the mean-time the Director-General had asked Colonel C. J.Bamber, Inspector-General of Civil Hospitals, toconduct an inquiry into the causes of the strike.After consideration of Colonel Bamber’s report theDirector-General issued orders that the studentsmust return to duty unconditionally and submit towhatever punishment the Principal might considerit his duty to recommend, otherwise the ordersalready issued by the Principal, directing theremoval of their names from the school rolls forgrave misconduct, must hold good and theirsureties would be called upon to discharge theirbonds and pay up the amounts due. In compliancewith these orders 13 students applied for re-

admission and were again taken into the militaryclass. The remaining 90 remained out on strike.The Principal then asked permission from theDirector-General, I.M.S., to readmit suitablestudents who might even then apply, and underthe orders of the Director-General March 27th wasfixed as the latest date for receiving such applica-tions for readmission. As none of the remaining90 students availed themselves of this further

period of grace offered to them by the Director-General they have ceased to have much chance ofgaining readmission to the Lahore Medical School.The students apparently contend that they havenever been on strike, but have always been readyto return to duty if they were taken back uncon-ditionally and a consideration of their grievancespromised. These contentions indicate a funda-mental ignorance of the proper relation betweenpupil and an instructor, and of the requirements ofmilitary discipline, to which these students are

subject. What else but a strike is persistent refusalto attend classes and carry out allotted duties ? So

long as the idea persists that in case of a differenceof opinion between a professor and his students itis the right of the student to indicate terms to hisinstructor, such regrettable incidents as this strikeare bound to recur.

Town Planning and Sanitation in Bombay.Professor Geddes, lecturing in connexion with

the town-planning exhibition, discussed in somedetail the report of the recent Bombay Develop-ment Commission. The housing of the people inBombay, he said, merited the most urgent con-

sideration of the city, and he pointed out theinadequacy of the present rate of progress in regardalike to the decrease of the death-rate and increaseof the population. A strenuous and organised civilendeavour was the prime desideratum of the townplanning of Bombay. He characterised the planningof chawls of the present common type as ware-housing the people and not housing them, andinsisted that it was not impossible to make a largeprovision of respectable homes with sufficient play-grounds and not yet exceeding two storeys. ProfessorGeddes addressed an interested audience, for thepublic health of Bombay is much discussed just now.