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caused by removal of the ganglion, it must be con-cluded that this surgical procedure may be dangerousin many cases of angina pectoris. The researches ofthe two Roumanian doctors show that while theexcision of the first thoracic ganglion producesimportant effects on the electrocardiogram, removalof the superior cervical ganglion effects no change.This fact proves that the modifications followingexcision of the first thoracic ganglion are caused bythe blocking of the cardiac motor fibres. Jonnesco’soperation consists in the removal of the stellateganglion along with the cervical sympathetic ; butthe clinical and experimental results of Danielopoluand Marcu, along with operation results alreadyrecorded in medical literature, lead to the conclusionthat the stellate ganglion should not be interferedwith in this condition. The operation proposed is asfollows : excision of the cervical sympathetic, leavingthe superior cervical ganglion and the first thoracicganglion, resection of the vagus and all its brancheswhich supply the thorax, resection of all the ramicommunicantes uniting the inferior cervical ganglionand the first thoracic ganglion to the lowest cervicalnerves and the first dorsal. The advantage of thisoperation is that while a large number of cardio-aortic sensory fibres are resected, the importantafferent fibres which pass through the stellate ganglionremain unimpaired.

Conference on Hereditary Syphilis.Speaking at a dinner held in connexion with the

conference on hereditary syphilis, Mr. Durafour,Minister of Labour, Hygiene, and Social Welfare,stated that every year in France syphilis caused40,000 abortions, 20,000 deaths among infants, and80,000 deaths among adults. Moral progress, however,has taken place, he said, and syphilis is no longerregarded as a disease to be hushed up. As regardstreatment, every day brought forth some new remedy.The campaign was becoming organised, but the Statecould not at present grant more than 4 million francsannually for this purpose, and there were only450 organised centres in France.

An Index of Scientific Jozrnals.Although Paris abounds in large and rich libraries,

it is often a very difficult matter for the research workerto know just where is filed the special scientificjournal he seeks. Thanks, however, to Mr. AlfredLacroix, permanent secretary of the Académie desSciences, this difficulty has been removed. He con-ceived the idea of compiling a general inventory ofthe scientific journals available in the Paris libraries,indicating where each journal could be consulted.The first section of this index appeared last year, andthe second, from M to Z, has just been published.The journals are classified alphabetically according tothe first letter of their titles. With the help of MM.Leon Bullingaire and A. Richard, Mr. Lacroix hascollated more than 17,000 journals, defunct or extant.A third section of the work will be published in a fewmonths, containing geographical and analytical tables,to assist the inquirer who is not sure of the exact titleof the journal he requires. The index is on the samelines as, but of wider scope than, the excellent indexwhich Prof. Leiper has dedicated to those who havemade the weary pilgrimage of your London libraries.

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

Visit of Spanish Medical Men.A PARTY of leading Spanish medical men recently

visited the medical institutions of Germany. Theytravelled from Cologne and Hamburg to Berlin where,notwithstanding the holidays, a special meeting ofthe united medical societies was convened in theirhonour, Prof. Kraus, President of the Berlin MedicalSociety, being in the chair. The Dean of the Berlin

Medical Faculty and President of the PathologicalSociety, Prof. Lubarseli, welcomed the guests in aLatin address ; Prof. Ferran, of Madrid, read a paperon the mutation of the Koch bacillus and the prophy-lactic vaccination of children against tuberculosiswhich had given favourable results. A report on thestudy of medicine and scientific research in Spain wasgiven by the leader of the Spanish medical men,Prof. Rosell, of Barcelona. The party then visitedthe home for tuberculous children, the infants home,the Westend and Virchow Hospitals, and the RobertKoch Institute. Although a great number of medicalmen were away on holidays the meeting was wellattended, as was the dinner at which the Spanishdoctors were entertained before they left Berlinfor Munich.

A Plea for Modern Dress.The modern fashion in dress has been the subject

of many and severe criticisms in this country bymoralists, women’s associations, and the clergy of everyreligious denomination because of its alleged indecency.Prof. Fried berger, of Greifswald, however, has takenup the cudgels on behalf of the modern girl, for,speaking as a hygienist, he has recently stated thatmodern fashions for women are almost ideal and inevery respect preferable to male attire. The modernfashion not only allows free access of air and lightto the body, but it has an educational influence bycompelling women of every class to extend theirablutions beyond the hands and face. The advantageof the modern shoe, which only covers the heel andthe toes, leaving the other parts of the foot free, isthat the perspiration evaporates easily. Short frocksand very thin stockings of porous material exposethe legs to the salutary influence of the sun and the air,while arms, neck, and shoulders, which have no coverat all, benefit in proportion. The "bobbed" or" shingled " coiffure, which has replaced the formerfashion of wearing great masses of hair and artificialtresses, together with the light modern hat made ofthin straw or felt, leads to good ventilation of the head.With the disappearance of the corset chlorosis hasbecome almost unknown among the rising generation.Chills are less frequent in women than in men. Thedress of men, notwithstanding the increased amountof physical exercise now taken, has not undergonesuch a radical revolution as that of the female sex.It is true. that the high collar and the starched shirthave disappeared except for evening dress and thatshoes have taken the place of boots, but the highwaistcoat still exists. Prof. Friedberger makes pro-posals for reform which, however, will probably notmeet with the approval of fashionable circles. Insteadof long trousers, breeches should be generally wornin summer, as is already the mode for sportingpurposes. A combination of shirt and pants similarto that worn by ladies should become the rule. Acollar, even a soft one, Prof. Friedberger holds, is

highly unhygienic and should be replaced by a sortof decollete. Sporting dress should be generally wornin offices and for visits. Prof. Friedberger found thatthe dress of his assistant weighed 3229 g., while hiswife’s clothes weighed only 741 g. There is no reasonwhy in an office the clerks should wear dress which isfive times heavier and 20 times less hygienic than thatof their lady colleagues.

A Penholder in the A bdominal Cavity.Before the Surgical and Gynaecological Society of

Hamburg Dr. König showed the case of a woman,42 years of age, who had had several normal birthsand miscarriages. The last normal birth had happenedone year ago. In the spring of this year a miscarriagehad occurred and a putrid foetus was removed by amedical man. She was conveyed with high fever tothe Hamburg General Hospital where, besides thesymptoms of abortion, a tumour of the uterus wasfound. It was believed that a myoma of the uterusinfected by the septic abortion was present and theuterus accordingly removed. In the course of theoperation, however, a piece of vulcanite penholder,

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4 cm. in length, was found between the bladder andthe uterus. The woman admitted that she had intro-duced the penholder into the uterus four years agoto produce abortion. The penholder had obviouslypenetrated the wall of the uterus into the peritonealcavity. It is remarkable that a foreign body remainedwithin the peritoneum for four years without pro-ducing any symptoms and without preventing sub-sequent normal births until it was detected in thecourse of an operation.

A Curious Verdict.

A well-known alienist had been asked by the familyof a patient to give a certificate of insanity for thepurpose of a divorce. He did so and charged a feeof M.1000 (£50), which was paid. As the certificateMas eventually not required in the suit, the familyasked the medical man to refund part of the fee, whichhe, of course, declined to do. The family accordinglyprosecuted the medical man before the specialAnti-Usury Court, alleging that the sum chargedwas too high. The defendant pleaded that the casehad been a specially complicated one, that he had toexamine the patient on three occasions for severalhours at a time, and that his certificate was basedon scientific deductions. In spite of these facts thecourt gave a verdict against the defendant becausethe fee was held to be not in accordance with theservice rendered, and that the case thus fell underthe Anti-Usury Act. The medical man was con-demned to refund M.700, and moreover, in additiona fine of M.150 (£7 6s.) for usury was imposed.This verdict has aroused much interest because theprovisions of the Anti-Usury Act are directed againstovercharging for food, clothes, and other necessaries,and therefore according to this ruling a medicalcertificate falls into a category that appears a

little stiange.

PUBLIC HEALTH ADMINISTRATION.

ADMINISTRATIVE MACHINERY.*

(Continued from p. 773.)

IX. JAPAN.THE Empire of Japan covers an area of 236,000

square miles and has a population of 80 million(339 persons to the square mile). There are fourlarge islands and over 4000 small ones.

Central Health Organi.satiation.The first body created in Japan for sanitary

administration on a scientific basis was the medicalbureau which was established at the Departmentof Education in 1873. Before this time there werehardly any health regulations ; the " Medical Code,"which was drafted in the following year, was the firstunified medical statute. In 1875 the bureau wastransferred to the Home Department, and since thenthe Ministry of Home Affairs has been responsible ’’

for the health services. The Sanitary Bureau, as it isnow called, manages all the general sanitary adminis-tration except industrial hygiene, which comes intothe sphere of the Bureau of Social Work. It isdivided into a public health section, a medical section,and sections for the prevention of chronic and of acuteinfectious diseases. There are 19 members of thestaff of the bureau under a director, and there areanother 19 officers who act in a temporary capacityas experts. These figures include clerks. Schoolhygiene is in charge of the Ministry of Education ;the Navy and War Departments also have medicalbureaux, whilst railway and prison sanitation comeunder the control of the Ministries of Railways andJustice. Besides these administrative bodies thereare three advisory councils-namely, the Central. Board of Health, the Council for the Investigation

* Based on a Series of Reports on National Health Organisationto the Health Section of the League of Nations. Obtainable inGreat Britain from Constable and Co.

of the Japanese Pharmacopoeia, and the Board forthe Investigation of National Hygiene. The principalfunction of these bodies is to frame advice in responseto inquiries made by the administrative departments,but they may put forward their views without beingconsulted. The Board for the Investigation of NationalHygiene, which is under the chairmanship of theMinister for Home Affairs, is not a duplicate of theCentral Board of Health, but is occupied in con-

sidering new measures which may be required by theunsatisfactory state of the public health. The CentralLaboratories include the Infectious Diseases Investiga-tion Institute, attached to the Imperial University,which manufactures sera, vaccines, and the like ;the Hygienic Laboratories at Tokio and Osaka,which are responsible, amongst other things, for theexamination of drugs; and the Research Institute ofNutrition. All of these are under the supervision ofthe Home Department.

Local Health Organisation.The provincial bodies for sanitary administration

are the local governors, chiefs of police stations, andchiefs of cities, towns, and villages, in addition tocustom house and port quarantine authorities.In provinces the governors are the highest officials,and under them are the police departments in whichare established sanitary sections to take charge ofhealth affairs. To each of these sanitary sectionsexperts of various kinds and a laboratory are attached.In the Tokio prefecture responsibility for sanitaryadministration is divided between the Governor andthe Inspector-General of the Metropolitan Police,but it devolves mainly on the latter, and there isa sanitary department in the Metropolitan PoliceBoard. The intermediate provincial authorities inJapan are the heads of subprefectures and the chiefsof police stations. As a rule, however, sanitary affairsare supervised by the chiefs of police stations, whogenerally have jurisdiction over subprefecturesand cities, and look after health conditions therein.Cities, towns, villages and their heads have alsopublic health responsibilities of their own, in accord-ance with the laws and regulations. Most cities andtowns have a sanitary department and a hygieniclaboratory, but in villages certain officials representthe whole health organisation. There are six portswith peimanent health quarantine organisations,and the customs authorities take charge of theprocedure. If temporary quarantine is neededprovisional quarantine stations may be set up,and these come under the supervision of the localgovernor and the immediate charge of the chiefof the police department of the prefecture concerned.Rural sanitation has been very elementary, andmeasures are being devised for its improvement onthe basis of elaborate investigations which have beenundertaken ; but these are still incomplete. In largecities there are municipal disinfecting stations, whichdespatch sanitary squads for domestic disinfection.In the villages the work is undertaken by the localsanitary official, and there are lecture courses forsuch persons to instruct them in the work. There are

regular factory inspectors attached to the staff oflocal governors, and a great many private organisa-tions are interested in improving industrial conditions.

Hospitals, Schools, and Training.Hospitals are at present controlled by the regula-

tions of the local prefectures rather than those of theMinister. At the end of 1913 the available beds wereaccounted for as follows : general hospitals-public7628, private 48,884 ; hospitals for infectious diseases,25,037 ; isolation wards, 74,910 ; and hospitals forlicensed prostitutes, 5000 beds. (In Japan therewere over 50,000 licensed prostitutes in 1923.) Thetotal number of beds available for tuberculosis wasabout 3000 in 1923, and for leprosy about 5000.The care of schools is in charge of the Section of SchoolHygiene in the Ministry of Education, and there arespecialists attached to each prefectural local govern-ment. Public schools appoint school physicians,