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Prof. B. A. MCSWINEY (Leeds University) contri-buted a paper on Physiology in Relation to Psycho-logical Medicine. He said that the paucity ofinformation on cerebral function in the text-books wasdue to absence of methods available to investigate thenormal activity of the higher nerve centres. Theexplanations advanced often took no account of thefunction of the lower nervous system in bringing aboutthe requisite coordination and relationship betweenthe different organs of the body. If knowledge of thephysiological factors controlling mental activity wasto advance, the physiologist must continue to makemeasurements on structures which he was able tocontrol, and carry out investigations in which he wasable to isolate the disturbing factors. He illustratedhis thesis by a number of examples, many of whichwere illuminated by the work of Sherrington andothers.

Dr. IAN S]UTTIE (Fife) read a paper on NeuroticSuperstructures in Certain Psychoses. The paperconsisted of an elaborate justification of the treatmentof early cases by psycho-analysis, and illustrated wellthe degree of concentration and patience required forthe successful pursuit of this method.The PRESIDENT followed with a lantern demonstra-

tion of the stages the egg passed through in thegermination of the chick, bringing out well the finalmechanism which resulted in the emergence of thechick into the outer world.

On Friday, July 13th, Dr. K. C. PADDLE (Wakefield)read a paper on Review of Blood Pressure in theInsane. It was based upon the careful examination of920 male patients, care having been taken not toexcite the patient before or at the time of theexamination. The cases were divided into seven

groups. Summarising his results, Dr. Paddle saidthat in melancholia 51 per cent. of cases had asubnormal blood pressure ; in mania 51 per cent. hada subnormal pressure; in epilepsy 70 per cent. hada subnormal pressure. The average blood pressure inthe insane varied according to the age. The majorityof insane epileptics had a constantly low pressureindependently of the frequency of the fits or thekind of epilepsy.

Dr. F. A. WORTH (Birmingham) contributed apaper on variation in the agglutinin formation in

_

mental hospital patients and its probable relation tofocal sepsis. The main purpose of the communicationwas a consideration of how the system might beinvaded by organisms which demanded a considerableproduction of antibodies to effect their destruction andremoval from the system. The organisms normallypresent in the jejunum evidently migrated to higherlevels, as shown by examination of over 200 cases.The inter-relation between focal sepsis and thevariation in agglutinin formation of the insaneprobably occurred through the medium of a highintestinal sepsis caused by infection with paratyphoidor food-poisoning organisms. ,

]Dr. 3-. F. SMYTH (Wakefield) spoke on the relationof the Spirochceta pallida to the histological changes indementia paralytica. He said that spirochaetes werefound in 75 per cent. of the cases ; they were foundmost frequently in cases which ran a stormy course.The number of cases examined was 52. The mostthat could be hoped for under treatment was an arrestof the damaging process to the cortex.

Dr. JOHN BRANDER (Bexley) discussed generalparalysis of the insane as a clinical and pathologicalentity.

Prof. W. H. MAXWELL TELLING (Leeds University)spoke of the value of psychical research to thephysician. He declared he had received great benefitfrom a study of psychic phenomena, and proceededto review the present state of knowledge and thetendency in the profession concerning this subject.His own attitude was sympathetic towards suchsubjects as telepathy.The concluding item was a demonstration by the

PRESIDENT on cases of sense deprivation and theprimary importance of the aural centres in the cortexcerebri. )

ANNUAL CONGRESS OF THE

ROYAL SANITARY INSTITUTE.

PLYMOUTH, JULY 16TH-21ST.

THE inaugural meeting on Monday has alreadybeen touched upon. During the remainder of theweek the work of the Congress was, as usual, dividedup among many sections. The following notes dealwith some of the points of special medical interestwhich arose in the course of the meetings.

Hygiene in Industry.Mr. Ramsay MacDonald, in his presidential address

to this Section, compared the worker with a delicatescientific instrument; the old fashion of putting himto do a job just as it came was now abandoned byeveryone who had any common sense. Public healthhad the individual as its aim, but the community asits medium, and included both self-help and mutualaid. The work of bodies such as the NationalInstitute of Industrial Psychology, the MedicalResearch Council, and the Industrial Fatigue Board,was putting industrial hygiene in its proper placeas one of the most vital concerns of our country. Wewere still in the transition stage and did not whole-heartedly accept the doctrine that the conduct ofindustry is a national concern. The latest attemptsby the General Council of the Trade Union Congress -

to explore the conditions of industrial peace were anessential contribution to the practical success ofrecent scientific investigations. In industry strains,fatigues, and worries were as poisonous to life as weredisease germs. A close and detailed study of theuse to which the human body is put in industry wasneeded. Mr. MacDonald gave many convincingillustrations from the experience of Dr. C. S. Myers,of unnecessary fatigue and waste of muscular effort infactories, which had been easily remedied with alittle study. The temperature and ventilation ofworkshops affected not only physical condition butthe nerves, as shown by temper, general ease, andhappiness. It had been found, also, that men variedin their suitability for working with machines runningat different speeds ; of two men working side by sideat similar machines one might be brought to the vergeof nervous breakdown by inability to keep up, whilethe other might complain of boredom from theslowness of the pace. The hygienist was handicappedby the fear of the worker that industrial economymeant intensification of labour for him. The solutionof all such problems was of immense importance toindustry both as regards its economic working and itsinternal harmonies, and this department of researchwas essential for moulding our organisation of indus-brial and sociological relations into a cooperativesoncord.

International Preventive Medicine.Dr. L. Rajchman, Medical Director and Secretary of

the League of Nations Health Committee, in hispresidential address to the Preventive MedicineSection, outlined the policy and methods which hadbeen evolved by seven years’ work on the part ofleading men of many countries of all continents. Hereferred to the services of epidemiological intelligenceand public health statistics, of technical publications,and of permanent liaison work with national sanitaryadministrations ; to commissions at work and organ-isations in progress in many countries ; and to investi-gations of many problems, including those of sleepingsickness in Equatorial Africa, small-pox and encephal-itis in Northern Europe, leprosy in South America andthe East, malaria throughout the world. Otherhopeful enterprises included the practice of pre-ventive methods by health insurance organisations,the adoption of common standards for sera andvaccines, and common lists of causes of death,and the study of preventable causes of infantmortality.

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The Present Position of the Tuberculosis Problem.

Dr. F. J. H. Coutts (Ministry of Health), in openingthis discussion, pointed out that the conspicuous fallin the mortality-rate from 1851 to 1910 was at theage-period 20-25 years. Since 1910 the greaterdecline had been at later age-periods, while at age-periods 15-20 and 20-25 there had been little reductionamong males and an actual increase in the female

mortality. This disquieting feature of the break-down of young adults from tuberculosis neededelucidation and investigation in each district. Muchfurther investigation was also needed of the supposedimmunity acquired by children who suffered fromperi-bronchial or other mild forms of tuberculosis.He thought that direct measures had played theirpart in the decline of tuberculosis and quoted intensiveexperiments in Sweden and the U.S.A. in confirmation.As regards treatment, good results were being obtainedfrom the induction of artificial pneumothorax andthoracoplasty, and the greatest sphere of usefulnessot artificial light treatment was in the treatment oflupus.

Dr. Marcus Paterson said that we taught theinfectious consumptive how to avoid infecting hisown family and how to lead a healthy life, but wedid not educate the public in the fact that the use ofa pocket spittoon by the consumptive was a pro-tection for them. Medical students, except inEdinburgh, did not receive adequate instruction inthe management and treatment of tuberculosis.

Shell-fish.The cultivation and marketing of shell-fish in

good condition was dealt with from the point of viewof the trade, of the Fishmongers Company, and of themedical officer of health. There appeared to begeneral agreement as to the great value of the bacterio-logical tests originated by the Fishmongers Company,coupled with inspection of the beds and an intimateknowledge of the topographical conditions.Mr. James Y. Johnston (Prime Warden of the

Company) described the action taken by hisCompanyto organise an influential deputation to the Govern-ment, which had resulted in the appointment of

special committees, one for investigation of the wholequestion of pollution of rivers and estuaries, and theother for instituting research as to sewage effluents.Many medical officers of health spoke of the ready

help afforded them by the Fishmongers Companyin the case of doubtful shell-fish, and it was pointedout by Prof. J. W. H. Eyre that the Companyreceives samples for testing from all parts of thecountry, and that the information in its possessionas to samples and beds is freely available both forthe trade and for medical officers of health.

Housing.The discussion on housing was opened by Councillor

Albert Webb, chairman of the Plymouth HousingCommittee, who dealt chiefly with methods of house-purchase, the renovation of existing privately ownedhouses, and the clearance of congested areas. Hefirmly believed in occupier-owners and, during thelast three years, the Corporation had advancedM50,000 to enable tenants of limited means tobecome owners. The Corporation borrowed at4 per cent., and lent at 5 per cent., and the percent. paid management expenses, so that this schemewas self-supporting.The Corporation had also provided for the sale of

municipal houses to existing tenants on easy terms.The only initial outlay for the tenant was a depositof £10 and the cost of transfer and mortgage deed.For example, a

" non-parlour " house, rented at8s. 9d. per week, could be purchased by the paymentof 9s. 6d. per week for 30 years.The Corporation had renovated 147 properties

under Section 3 of the 1925 Act, at a cost to theowners of .825,000, to be recovered from them inrepayments spread over ten years. Most of thiswork was done by agreement with the owners.

They had a new scheme, which was provisionally

approved by the Ministry of Health, for reconditioningcertain houses in a congested area and demolishingthe remainder. Such a scheme might to some

extent cater for the casual worker. An experimentin providing small houses for special cases was beingconsidered.

Several speakers congratulated Councillor Webbon the housing activities of Plymouth. From allquarters came the admission that up to now nothinghad been possible in the provision of houses for thepoorest class and the low-paid worker with a largefamily.

Dr. C. Lander (Devonport) thought they shouldrecognise that economic rents were frankly impossible,and that housing should be regarded as a State socialservice. There must be a subsidy and it should comefrom the National Exchequer. A valuable contri-bution came from Miss J. M. Upcott, housing managerto the Chesterfield Town Council, on the managementof municipal housing estates on " Octavia Hill "lines. She advocated a gradual preparation andeducation of slum tenants for their removal tobetter quarters, with perhaps a transition periodspent in reconditioned houses.

Milk.Dr. W. G. Savage opened this discussion with a

paper on Milk and Tuberculosis. He regarded thegrading of milk as a " magnificent educationalgesture." The Tuberculosis Order, as at presentworked, was of no value whatever. It would be acontinuing expense, with no reduction of bovinetuberculosis and no protection to the public fromtuberculous milk. Before the country was com-

mitted to the expense of routine veterinary inspectionof milk herds, they should be quite clear in theirminds as to what they expected this inspection toaccomplish and draw up a carefully thought-outscheme, including the cooperation of the dairyfarmers.

In the discussion the case for dried milk was putby Mr. F. 0. Morris, the case for pasteurisation by Dr.S. G. Moore, and there was a general admission thatthe eradication of tubercle was so remote that somemethod of rendering raw milk safe must be adoptedin the meantime. ,

Immunity Methods in Scarlet Fever and Measles.Dr. R. A. O’Brien showed that the Dick test, the

Schultz-Charlton test, active immunisation, and theuse of antitoxin have been firmly established in thecase of scarlet fever. There was still lacking anantiserum to combat septic conditions which hadalready appeared, and the problem of the convalescentcarrier or return case was unsolved. Convalescentswere discharged with haemolytic streptococci in theirthroats indistinguishable by any available test fromscarlet fever streptococci, but it was not as yetpracticable to ask for negative cultures before release,and the medical officer could only adhere to the ruleof sending out cases after the restoration of normalhealth with an absence of discharges from mucousmembranes. As regards measles, the utility of theserum of convalescents for conferring either temporarycomplete protection or for giving active lastingimmunity, according to the date after exposure toinfection on which the dose was given, was nowaccepted. The problem for sanitary authorities wasto provide and maintain a supply of this serum andto make appeals for volunteer donors.

Dr. W. A. Lethem (Ministry of Health) pointed outthat though last year measles killed five times asmany children as scarlet fever, the public was stillnot convinced of its dangers. Schemes for the supplyof the serum of convalescents were in operation inseveral towns in France, Germany, and the U.S.A.Dr. Lethem outlined a scheme for districts in thiscountry. The serum was effective from the eighthto the fourteenth day after the temperature fell. Itwas preferable to obtain it from adults who couldeasily spare enough to immunise some 30 children.Adults were usually treated at home by general

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practitioners. The medical officer of health shouldhold a meeting with practitioners to explain thescheme and seek their coöperation in obtainingdonors. He should select a laboratory and arrangefor an expert from the laboratory to collect theblood. The serum remained potent for many months,if kept at a low temperature. He thought donorswould be readily obtained when they understood thegreat benefit they were conferring on the communitywithout harm to themselves. If the supply waslimited, its use should be restricted to children forwhom an attack of measles might be a matter ofextreme gravity : if more ample, it might be used forall very young children who had been exposed toinfection.

Dr. W. T. Benson (Edinburgh), Dr. J. ParlaneKinloch (Aberdeen), and Dr. E. H. R. Harries (Bir-mingham) confirmed from their experience the viewsexpressed by Dr. O’Brien and Dr. Lethem.

Nursery Schools.Miss Margaret McMillan described, with the aid of

lantern slides, the wonderful changes effected in thepre-school children from the congested areas of Dept-ford and Greenwich by attendance at the RachelMcMillan open-air garden school. She explainedthe methods adopted and claimed that by economicalmanagement and simple buildings the cost is lessthan that of an ordinary infant school. The parentscontribute, but in return the children get three goodmeals a day. Nursery schools may be a confessionof failure-of failure under existing conditions tosecure a good home for each child with reasonableaccess to playground or garden-but the practicalsanitarian acknowledges that congested areas in ourindustrial towns will hardly be removed in one

generation and that there is, in the meantime, aclamant need for many more " Rachel McMillan

"

schools run by enthusiasts like Margaret McMillan.It is not surprising, therefore, that the resolution, infavour of more open-air nursery schools, and callingupon local authorities to make the nursery classesin the Fisher Act of 1918 operative without delay,met with general acceptance by the Section. Prof.Winifred Cullis, in seconding, emphasised the factthat during these years the foundations of health,character, and education were laid, and that childrenwho had been under the supervision of welfarecentres showed fewer defects when they reached theschool-entrance age.-Dr. Mabel G. Brodie alsotestified to the value of such nursery schools ;and Dr. E. G. Annis (M.O.H., Greenwich) confessedthat Miss McMillan’s work for the children of hisborough had converted him from a sceptic into afirm believer. The open-air régime and care takenquite prevented outbreaks of infectious disease in the.school.

Light Treatment.Dr. Albert Eidinow described the biological actions

of light, while Dr. H. Stanley Banks (Leicester) andDr. W. Allen Daley (Hull) dealt with the practicalapplication of light treatment to public health work.

Dr. F. G. Bushnell (Devon) spoke on uses and abusesof light treatment, and all the three last-mentionedspeakers sounded a note of warning as to exaggeratedstatements and commercial exploitation of thistreatment.

Dr. Daley pointed out, from his experience, thedanger of this treatment being added to the list ofso-called medical baths and employed without propermedical supervision. He summed up by expressingthe opinion that light treatment was a permanentaddition to the disease-preventing and disease-curingmethods which should be provided by a local authority,particularly for the sun-starved denizens of our

towns, that the use of irradiated foodstuffs was nota substitute for light clinics; and that the provision oflight treatment by baths committees should bewatched with great care.-A resolution was adoptedrecommending the establishment of public sun andair bathing- facilities by local authorities especially I.for children.

Health of Seamen.Fleet-Surgeon W. E. Home said that during

this year, for the first time, fairly accurate statisticsof the mortality of seamen, occupied and retired,had been published by the Registrar-General. Theirmortality from disease was 75 per cent., and frominjury five times greater than those of

" all males."The cubic space of British seamen had been increasedfrom 72 cub. ft. to 120 cub. ft., while that of thelascars had remained at 72 cub. ft. Coincidently, thephthisis death-rate of British seamen had declinedby 40 per cent., and that of the lascars only by15 per cent. The seaman lived in his ship for 24hours in the day, and his living accommodationshould be passed by a health authority. Some of theseaman’s needs were : care of water-supply, wash-places, good galleys, good w.c.’s, drying-rooms, andaccommodation aft.-At a conference of portsanitary authorities, held on Thursday, July 19th,the following resolution was unanimously adopted :-That the Council of the Institute be recommended to

direct the attention of the Government to the desirabilityof the care of the health of the men of the Merchant Servicebeing placed in the charge of the Ministry of Health.

The motion was proposed by Fleet-Surgeon Home,and seconded by Alderman F. Askew, chairman, Hulland Goole Port Sanitary Authority, who togethersent the motion up to the Council of the Institute,to get it on the agenda of the Conference. Themotion was supported by Commissioner H. Miller, ofthe St. 3-ohn’s Ambulance Brigade, in an excellentspeech, and its unanimous acceptance was ensuredfrom the first.

National Health Insurance Service.On the last day of the Conference Mr. Henry Lesser,

in a presidential address, showed how financial con-siderations were retarding the proper developmentof the Service, and Mr. W’. Gill Hodgson, clerk tothe Liverpool Insurance Committee, expressed theopinion that the present scheme should be perfectedby the addition of specialist and consultant serviceswith laboratory aids and of dental treatment beforeany further classes of persons, such as dependantsof insured persons, were brought in.

DONATIONS AND BEQUESTS.—Sir Henry Samman,Bart., of the Manor House, Willerby, Yorks, shipowner,left ;f;23,OOO for charity, including £10,000 to the HullInfirmary, £5000 each to the Seamen’s Mission, Hull,and the Henry Samman Chamber of Commerce Endow-ment, Hull, £1000 each to the Port of Hull Society Sailors’Orphan Homes, and to Hull Seamen’s and GeneralOrphanage, and B500 to Victoria Hospital for Children, Hull.-The Right Hon. Satyendra Prasanna, Baron Sinha ofRaipur, of Delhi, India, and of London, left Rs.10,000 eachto the hospital attached to the Belgatchia Medical College,the trustees of the Sadharan Brahmo Samaj of Cornwallis-street, Calcutta, the trustees of the Bhowanipur SanmilaniBrahmo Samaj, the Sambhunath Hospital, Bhowanipur,and the Calcutta Orphanage of Bulloram, Deys-street,Calcutta. And if he had not already made provision (ashe had intended to do in his lifetime) for the maintenanceof the Middle English School and Charitable Dispensarywhich he had built and for many years maintained at Raipur,then Rs.50,000 upon trust for investment and the incomeapplied for such purpose.—Mrs. Emily Crossley, of High-gate, left 22000 to the Ancoats Hospital, Manchester. as to£1500 for the general maintenance of that hospital and£500 towards the general maintenance of the ConvalescentHospital at Warford, Cheshire, in connexion with theAncoats Hospital.—Mr. Samuel Palmer Cooper, of Moseley,Birmingham, left £1000 each to the General Hospital,Birmingham, Queen’s Hospital, Birmingham, the Birming-ham and Midland Free Hospital for Sick Children, and toDr. Barnardo’s Homes : £500 each to the Birmingham andMidland Eye Hospital, the Birmingham and MidlandHomoeopcathic Hospital, the Birmingham Royal Institutefor the Blind, the National Institution for the Blind, andthe Children’s Hospital, at Cold Ash, Newbury, if his niece,Mary Katherine Cooper, is matron there. After otherbequests the ultimate residue of the property is left betweenthe General Hospital. Birmingham. Queen’s Hospital,Birmingham, the Birmingham and Midland Free Hospitalfor Children, and Dr. Barnardo’s Homes.