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court. The chairman of quarter sessions agreed.In giving final judgment on the appeal he said thatthe offences were flagrant, and serious breaches of theDangerous Drugs Regulations which could not bepunished in any other way than by imprisonment.The court, however, thought the period of 12 monthsexcessive, and reduced it from 12 to 5 months in thesecond division.

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

Deficiency of Beds in Municipal Hospitals.IT was stated at the Berlin Society for Public

Health that during the epidemic of influenza lastspring nearly 3000 patients who needed hospitaltreatment could not be received in the municipalhospitals owing to lack of available beds. About15 per cent. of the patients in municipal hospitals areincurable or suffer from chronic diseases which donot require the lavish outfit and expensive manage-ment of a great general hospital. It was suggested,therefore, that for those patients the city should setup sanatoriums without operating theatres or labora-tories, where a relatively small number of nurseswould be able to do the work. The establishment ofspecial hospitals for cancer and tuberculosis wouldfree the general hospitals from patients with thesediseases. It would be a further relief to the hospitalsif indigent patients and those with chronic diseasescould be dismissed after the acute stage of theirillness and nursed at home on the expense of themunicipal authorities. In one of the Berlin districtsthe local authorities have already appointed municipalnurses, the result being that about 600 patients whootherwise would have been taken to hospital wereattended at home. The appointment of 60 municipalnurses would save the provision of 200 beds and inthis way a considerable amount of money would bespared for other purposes.

A Sexual Hormone in Crystalline Form.It is reported in the Naturwissenschaft that Dr.

Butenandt, of Gottingen, an assistant of Prof.Windaus, has succeeded in isolating the ovarianhormone in a crystalline state. This hormone wasshown by Prof. Zondek and Dr. Aschheim and othersto be present in the urine during pregnancy in largeamounts, a fact which has several times been referredto in your columns.1 The activity of the hormone isassayed by injecting into castrated mice. Butenandtworked with an oily material which was obtainedfrom the urine of pregnant women, and containedabout 30,000 mouse-units per gramme. By repeateddistribution between two solvents (aqueous alcoholand petroleum ether) inactive substances were

removed in the petroleum ether fraction, and thematerial then had 500,000 mouse-units per gramme.This substance was further purified by the use ofother solvents (ether, benzene, and ethyl acetate)and by adding alkali in increasing strength to theacid solution. An alkali-soluble fraction was obtainedwhich had a mouse-unit of only 1.5 to 2 millionthsof a gramme. Further purification was effected bydistilling this oil in a vacuum of 0-20-0-03 mm. Hgand at a temperature of 130-150° C*., and the materialthen contained 5,000,000 units per gramme. Sublima-tion in a high vacuum or treatment with solventsyields a crystalline product of which one grammecontains 8,000,000 mouse-units. The author hasnamed this substance progynon ; it is soluble inacetone, chloroform, benzene, and ethyl acetate.Further chemical examination has shown that thesubstance is not albuminous but belongs to the sterolgroup. The new work appears to be highly importantin adding to our knowledge of the nature of hormones.

1 See THE LANCET, 1928, ii., 834, 876 ; 1929, ii., 1108. The possible clinical applications are reviewed on pages 36 and 39 of this issue.

Gauze Visible to X Rays.It happens sometimes that pieces of gauze are left

in the abdominal cavity after laparotomy, and thoughthis usually causes no reaction there are occasionallycomplications. Gauze swabs may eventually bedischarged through the intestines or the bladder, butoften they have to be removed at a second laparotomy,when the mortality is somewhat high. Difficulty indiagnosis arises because the ordinary gauze swabcannot be detected by radiography, and Dr. Cahnhas therefore devised a special gauze which is notimpermeable to X rays. The feature of this gauzeis that some of the threads are impregnated bythorium hydroxide which gives a distinct shadow onthe Rontgen plate. A surgeon suspecting that a pieceof gauze is still in the abdomen can thus settle thequestion by radiography before closing the abdominalwound. Experiments with the gauze have shown thatit is harmless, being neither poisonous nor irritant;Cahn even suggests that the radio-activity of thoriummay have a bactericidal action. The gauze is a littlestiffer than ordinary gauze but may nevertheless befolded as usual.

Preventoriums.Prof. Lazarus has drawn attention to the fact that

while the mortality from infectious diseases, includingtuberculosis, has fallen of late years, the death-ratefrom senile and pre-senile diseases has considerablyincreased. In 1927 more people died from diseasesof the heart and vessels than from all the infectiousdiseases put together, and twice as many as fromtuberculosis. Prophylaxis against these diseases ispossible only if people who are still in apparentlygood health are thoroughly examined at least twicea year. The family doctor is not in a position todiscover early disease-though he may know thepatient’s constitution-because he does not own themodern apparatus required for the diagnosis ofinitial symptoms. Public hospitals and universityclinics deal only with patients who are already ill.Prof. Lazarus therefore proposes the establishment ofspecial diagnostic centres with every modern facilityfor diagnosis. These establishments, which he calls"preventoriums," should have no connexion withsick clubs or other State institutions, and should beset up by the medical profession itself, the specialistsbeing appointed by representatives of the profession.He believes that examination of the whole populationtwice a year would do much to prevent senile diseasesand his idea is certainly a good one, though probablytoo expensive for execution.

Damage from Irradiated Ergosterol.An infant whose birth was retarded two weeks

and whose initial weight was 4500 g. became weaksoon after being born. He had vomiting, a certainrigidity of the skin, and a subfebrile evening tempera-ture ; the Pirquet reaction was negative. Thoughno symptoms of rickets were present, 6 drops ofirradiated ergosterol (vigantol) were administereddaily, beginning in the tenth week, and this dose wascontinued for 96 days. Seventy days after thebeginning of the treatment leucocytes and albuminwere found in the urine but were ascribed to cystitis.The child died when 5 months old and the post-mortem examination, as reported by Dr. Puschler,in the Zesc /M eMde, showed severein the Zeitschrift für Kinderheilkunde, showed severecalcification of the tubules and interstitial tissue ofthe kidneys. The administration of irradiatedergosterol seems to have caused this condition, whichcorresponds with what is found in animals fed in thesame way. The case suggests that this substance isby no means harmless if given to infants not sufferingfrom rickets.

Since the war a considerable increase has beenobserved in the incidence of thrombosis and embolismafter delivery and abdominal operations. The causeof the increase is not yet fully clear, but Prof. Sellheim,of Leipzig, the well-known gynaecologist, is of opinionthat it is due to cardiac weakness. During and after

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the war, he says, the hearts of many women were somuch injured by exertion, hunger, and grief thatthey are unable to stand the strain of delivery orabdominal operation. Not only those who werealready adult during the war but also those of theyounger generation which was then developing areespecially liable to thrombosis in consequence.

Dr. Louis Lewin, late professor of pharmacology inthe University of Berlin, has died at the age of 80.His special branch was the study of poisons and hisstandard work on toxicology ran into several editions,and was translated into French. The doyen of Germanpharmacologists, he was busy until recently, andonly last year wrote an essay on banisterin whicharoused general interest. Apart from his scientificwork he often acted as expert of the law courts indifficult criminal cases connected with poisoning.

Dr. Kino, writing in the Medizinische Welt, drawsattention to paresis of the ulnar nerve in cyclistsand motor-drivers. The paresis may be producedby pressure of the hand on the steering wheel or thehandle-bar. The condition becomes manifest byweakness and tickling in the fourth and fifth fingers ;in severe cases a typical motor and sensory paresisof the fourth and fifth fingers and sometimes muscularatrophy, may develop. The prognosis is favourableprovided the patient abstains from work for severalmonths. It is possible that the paresis is not onlyproduced by a direct pressure of the nerve but alsoby the perpetual shaking in driving.

IRELAND .

(FROM OUR OWN CORRESPONDENT.)

A Conference on Public Health.THE Minister for Local Government and Public

Health has taken an important step in issuing invita-tions to the local health authorities to hold a Confer-ence in Dublin for various discussions. He points outthat in recent years much has been done to improvethe organisation of public hygiene and the servicesfor the care of the sick and the poor, and it is feltthat a stage has now been reached when an exchangeof opinion and experience and a discussion of diffi-culties would be of value in supplementing ordinaryofficial methods, and in promoting a closer under-standing between the agencies concerned in theseservices. He suggests several topics suitable fordiscussion-namely, the despatch of business atmeetings of boards of health and public assistance ; Ithe county medical officer of health and his func- ’,tions ; the economy of preventive measures in healthadministration ; health of the school child ; improve- Iment of county homes ; rural health problems;welfare of children in the care of public assistanceauthority ; health education and methods by whichit can be promoted ; and administration of home assist-ance. He invites local authorities to suggest othersubjects for discussion, but thinks it desirable thatthe attention of the Conference should be directedto matters of practical importance and to improve-ments within existing resources, rather than to idealsolutions of problems. It is further suggested that,together with two delegates from within their ownbody, each local authority should send its secretaryand its medical officer to attend the Conference.Such a Conference as the Minister has summonedcan hardly fail to have a high educative value. Thelocal authorities lag behind the central authorityboth in interest in and in knowledge of health pro-blems, and it is necessary that their interest shouldbe aroused and their knowledge increased if properprogress is to be made. In the counties in whichcounty medical officers of health have been appointedthere is already evidence of an increased interest inhealth.

Appointment of Medical Superintendents ofMental Hospitals.

Differences have arisen between the committeesof management of two mental hospitals in the IrishFree State and the Minister of Local Governmentand Public Health as to the mode of appointmentto the vacant posts of medical superintendents. Ineach case-Clonmel and Sligo-the committees wishedto promote the assistant medical officer, who hadgiven several years of good service in the subordinatepost. The committees relied on the right apparentlyreserved to them in the Local Government (Employees)Act of 1926, to make an appointment by promotionof an officer already in the service without referringthe matter to the Appointments’ Commissioners. Toact in this way, however, the local authority hasfirst to obtain the approval of the Minister, and ineach of the present cases the Minister has withheldhis approval, and ordered the vacancy to be referredto the Appointments’ Commissioners. A deputationfrom the Clonmel committee interviewed the Ministerlast week, and put forward strong reasons in favourof allowing the committee to appoint the medicalofficer who was known to it and was familiar withthe working of the hospital. In reply the Ministerstressed the importance of the office of residentmedical superintendent of a mental hospital, as onhis efficiency depended largely the welfare of thepatients, the discipline of the staff, and the economicadministration of the hospital. It was essential thatnothing should be omitted that would ensure theappointment of the best candidate available. Experi-ence and local knowledge should count, but there wereother factors of importance which should be con-sidered. The Poor Law Commission had recom-mended that these appointments should be filled onthe advice of the Appointments’ Commissioners, andhe was now being asked to ignore that recommenda-tion. He added that it was clearly in the interestsof the whole medical service of the mental hospitalsthat there should be a selection free from all localinfluences. While he sympathised with the wish ofthe committees to promote its own officer, he regardedit as essential that the whole medical service shouldknow beyond doubt that the department stood forthe free flow of promotion, and that appointmentswould only be made after impartial selection. Somediscussion also took place on the question of salaryand emoluments, and the Minister expressed theopinion that it was not wise, as a matter of policy,to reduce the emoluments to a point at which theseposts would cease to be attractive. They must offeran inducement to young men of talent to enter theservice.

I Presentation to Dr. Campbell Hall.I Dr. J. Campbell Hall, who had been medical officerof the Monaghan County Hospital for some 40 years,has recently retired from that office. His retirementfurnished the occasion for a remarkable exhibition ofthe affection and esteem in which he is held by thepeople of County Monaghan. He was presented withan album containing the names of 654 subscribers,together with a purse of gold, and a massive silvercentre-piece. A tablet has been placed in the hospitalto commemorate his services. The presentation wasrecently made at a public meeting by the Bishop ofClogher.

HOSPl’1’AL CHANGES IN BIRMINGHAM.——Variouschanges are being contemplated in relation to the hospitalsand homes under the jurisdiction of the Birmingham PublicHealth Committee and the Asylums Committee. Lodge-road Hospital, which is now used for babies suffering fromwasting diseases, is to be taken over by the Asylums Com-mittee for mental cases, and the babies are to be transferredto Canwell Hall, near Sutton Coldfield. The treatment ofinfectious diseases is to be concentrated at Little BromwichHospital, which is to be enlarged at a cost of jE70,000.Male mental convalescents are to go to Uffculme Park,King’s Heath.