811APPOINTMENTS.-VACANCIES.-BIRTHS, MARRIAGES, AND DEATHS.

moneys due to them might expect payment; and whetherhe could do anything to expedite the settlement.-Mr. C. ROBERTS wrote in reply: Figures enabling the finalsettlement for 1915 to be made have been furnished to allinsurance committees in England, and in Scotland and Walesfigures enabling further or final payments to be madehave been, or will shortly be, furnished to insurance com-mittees in these countries. I am unable to give the par-ticulars asked for in the second part of the question withoutobtaining a return from all insurance committees, but if thehonourable Member has in mind any particular case of delayI will make inquiries.

Industrial Disease.Mr. ELLIS DAVIES asked the Under Secretary for the

Home Department whether disease caused by picric acidentitled the workman affected to compensation under theWorkmen’s Compensation Act; and, if not, whether hecould, in view of the number concerned, add the disease tothe Schedule to the Act.-Mr. BRACE replied: The onlydiseases normally attributable to processes in the manu-facture of, or involving the use of, picric acid are eczematousulceration of the skin, or dermatitis, and poisoning bynitrous fumes. Both of them are scheduled under theWorkmen’s Compensation Act.

The Notification of Venereal Disease.Earl WINTERTON asked the Prime Minister whether, in

view of the urgency of the matter, he would introduce legis-lation to make compulsory the notification of venerealdisease in all its forms, and criminal its wilful transmissionby an infected to a healthy person.-Mr. BONAR LAW (onbehalf of Mr. ASQUITH) said : With regard to the first partof the question, I would refer my noble friend to the answersgiven on behalf of the Local Government Board on Thursdaylast. The Home Secretary is considering the suggestioncontained in the last part of the question.

Treatment of Discharged Soldiers.Answering Lord H. CAVENDISH-BENTINCK, Mr. LLOYD

GEORGE (Secretary for War) said : The War Office is chargedwith establishing an organisation for the training andtreatment of the discharged soldier, and this will be doneby means of a civil organisation. The matter is receivingthe most careful consideration.

Body-shields for Troops.Mr. HAZLETON asked the Secretary for War whether there

had been any practical outcome of the investigations andexperiments into the problem of devising body-shields for thetroops at the front; and whether he could say what the pre-sent position with regard to the matter now was.-Mr. LLOYDGEORGE replied : A report on the subject has been receivedfrom Sir Douglas Haig, and steps are being taken to meet hiswishes. It is undesirable to give further details.

WEDNESDAY, NOV. 1ST.Nurses Registration.

Major CHAPPLE asked the Prime Minister whether, in viewof the increasing urgency of enabling those in need of nursesto distinguish those who were fully trained from those whowere not, and in recognition of the national work performedby nurses in the care of the sick and wounded, he wouldbring in a Bill on similar lines to tb e one submitted to himby the Central Committee for the State Registration ofNurses.-Mr. ASQUITH wrote in reply : This is a highly con-troversial proposal, as my honourable friend is aware, and Icannot at the present time undertake to introduce it.

Appointments.Successful applicants for vacancies, Secretaries of Public Institutions,

and others possessing information suitable for this column, areinvited to forward to THE LANCET Office, directed to the Sub-Editor, not later than 9 o’clock on the Thursday morning of eachweek, such information for gratuitous publication.

McKINNEY, B., has been appointed Medical Officer to the ElyDispensary District by the Enniskillen Board of Guardians.

MITCH),;LL, ALEXANDER PHILP, F.R.C.’3. Edin., M.Ch. M.D., InterimSurgeon to the Royal Hospital for Sick Children, Edinburgh.

PRANGNELL, J. T., M.D. Glasg., Medical Officer of Health for theBorough of Falkirk.

SAMARAWARA. L. E., M.R.C.S., L.R.C P. Lond., L.M.S.S.A. Lond.,Medical Officer to the Birmingham General Dispensary.

WILSON, J., Certifying Surgeon under the Factory and Workshop Actsfor the Irvine District of the county of Ayr.

Vacancies.For further inforination regal-ding each vacancy reference should be ’,

made to the advertisement (see Index).Whm the applicxticn of a Belgian medical man would be considered

the advertisers are requested to communicate with the Editor.BIRMINGHAM CITY EDUCATION COMMITTEE.-Temporary Assistant

School Alelical Odieer. Salary R300 per annum.

BRIGHTON, ROYAL SUSSEX COUNTY HOSPITAL.-Junior House Surgeon,unmarried. Salary B80 per annum, with board.

BRISTOL GENERAL HOSPITAL.-Casualty House Surgeon. Salary atrate of B175 per annum, with board, &c.

BRISTOL ROYAL INFIRMARY.-House Physician. Salary at rate of£120 per annum, with board, &c.

BURY INFIRMARY.-Senior House Surgeon. Salary £250 per annum,with board, &c.

ILFORD COUNCIL EDUCATION COMMITTEE.-School Oculist. Salary1 guineas for each session of two and a half hours.

GLOUCESTER, GLOUCESTERSHIRE ROYAL INFIRMARY AND EYEINSTITUTION.-Surgeon.

HOSPITAL FOR CONSUMPTION AND DISEASES OF THE CHEST, Brompton.-Assistant Resident Medical Officer. Salary .8103 per annum,withboard, &c.

LEICESTER ROYAL INFIRMARY.-Pathologist. Salary £500 per annum.MANCHESTER COUNTY ASYLUM, Prestwich.-Locum Tenens. Salary

B7 7s. per week, with board, &c.NETLEY, SOUTHAMPTON, WELSH HOSPITAL.-Medical Officer, Salary

JMOO per annum, with board, &c.NEw HOSPITAL FOR WoMEN, Euston-road.-Temporary Female

Assistant Surgeon for six months. Also Female House Physician,Two House Surgeons, and Obstetric Assistant for six months.Salaries at rate of 250 per annum, with board, &c. Also Anaesthetist.Salary 210 lCs. Also Clinical Assistant for Ophthalmic Department.

ROYAL FREE HOSPITAL,-Gray’s Inn-road, W.C.-Dental Surgeon.SALFORD UNION INFIRMARY, Hope, Pendleton, near Manchester.-

Female Assistant Resident Medical Officer. Salary ,c250 per annum,with board, &c.

SHEFFIELD, ROYAL INFIRMARY,-Two House Surgeons. Salary £100. per annum, with board, &c.VENTNOR, ISLE OF WIGHT, ROYAL NATIONAL HOSPITAL FOR CON-

SUMPTION AND DISEASES OF THE CHEST ON THE SEPARATEPRINCIPLE.-Assistant Resident Medical Officer.

VICTORIA HOSPITAL FOR CHILDREN, Tite-street, Chelsea, S.W.-House’ Physieian. Salary .e200 per annum, with board, &c.WAISALL AND DISTRICT HOSPITAL.-Assistant House Surgeon and

Anaesthetist. Salary £175 per annum, with board, &c.

THE Chief Inspector of Factories, Home Office, London, S.W., givesnotice of vacancies for Certifying Surgeons under the Factoryand Workshop Acts at Crossgar. in the county of Down, and atLytham, in the county of Lancaster.

Births, Marriages, and Deaths.BIRTHS.

BARNES.-On Oct. 24th, at Hill House, Eye, Suffolk, the wife of Lieu-tenant H. E. Barnes, M.D., R.A.M.C., of a son.

RANKIN.-On Oct. 24th, at Fitzroy-place, Glasgow, Ivy (née Taunton),the wife of Temporary Captain W. Rankin, R.A.M.C., of a son.

ROSE-HUTCHINSON.-On Oct. 28th, at Malabar-hill, Bombay, the wife ofMajor L. T. Rose-Hutchinson, I.M.S.-a son.

MARRIAGES.PEARCE GOULD-JACKSON.-On Oct 25tb. at St. Mary’s, Betteshanger.

Eric Lush Peane Gould, F.R.C.S., Temporary Surgeon, R.N., toAudrey Mitchell, daughter of the late Mr. Lawrence Jackson,K.C., and of Mrs. Jackson, of Updown, Eastry, Kent.

PLATT-TURNEY.-On Oct. 27(h, at Marylebone Parish Church, HarryPlatt, M.S., F.R.C.S., Capt. R.A.M.C., to Gertrude S., seconddaughter of Mr. R. Turney, late of Linslade, Bucks.

THACKER-NEVILLE-TRESHAM.-On Oct. 25th, at St. Paul’s, Onslow-square, William Stewart, M.D. (T.C.D.), F.R.C.S. Edin., of theChurch of England Mission, and Union Medical College. Peking,Temporary Captain, R.A.M.C., to Maud, youngest daughter of thelate Mr. D. H. Tresham, Beylah Indigo Concern, Benares, India,and of Mrs. Tresham, Purston, Eastbourne, England.

DEATHS.HUDSON.-On Oct. 14th, at Allahabad, India, Lieutenant-Colonel

Ernest Hudson, F.R.C.S., I.M.S., youngest son of Henry LombardHudson, late of Harleston, Norfolk.

NICOL.-On Oct. 23rd, died of wounds, Captain C. M. Nicol, M.B.,R.A.M.C., D.A.D.M.S., aged 28.

VALUGHAN-HUGHES.-On Oct. 25th, at Cemmaes Court, Hemel Hemp-stead, James Vaughan-Hughes, M.D., L.R.C.P. Lond., aged 95.

WILKINS.-On Oct. 27th, at Stayer House, Eye, Colonel James Suther-land Wilkins, I.M.S., D.S.O., aged 65.

N.B.-Afee of5s. is charged for the insertion ofnotices of Births,Marriages, and Deaths.

BOOKS, ETC., RECEIVED.

CHURCHILL. J. AND A.. London.Moore’s Manual of Family Medicine and Hygiene for India. Pub-

lished under the authority of the Government of India. Eighthedition. By C. A. Sprawson, Major. I.M.S. With Foreword by SirC. Pardey Lukis, Director-General, I.M.S. Price 6s. net.

HEINEMANN, WILLIAM, London.Student’s .Text-book of Surgery. By H. Norman Barnett, F.R.C.S.,Major and Officer Commanding 3/2nd South-Western MountedBrigade Field Ambulance. Price 21s. net.

LEWIS, H. K., AND Co., London.Sexual Disabilities of Man and their Prevention and Treatment. ByArthur Cooper, Consulting Surgeon to the Westminster GeneralDispensary. Third edition, revised and enlarged. Price 6s. net.

LONGMANS, GREEN, AND Co., LondonEssentials of Chemical Physiology for the Use of Students. By W. D.Hallibuiton, M.D., LL.D., F.R.S. Ninth edition. Price 6s. net.

Right Hon. Sir Henry Entielrl Roscoe, P.C.. D.C.L., F.R.S. : ABiographical Sketch. By Sir Edward Thorpe, C.B., F.R.S. Price7s. 6r1. net.

812 NOTES, SHORT COMMENTS, AND ANSWERS TO CORRESPONDENTS.

Notes, Short Comments, and Answersto Correspondents.

.ANGIO-NEUROTIC œDEMA.To the Editor of THE LANCET.

SIR,-In answer to the very interesting and typical accountof a case of this complaint by Major, R.A.M.C. (T.F.), inTHE LANCET of Oct. 7th, and my appreciation of the difficultyin finding just the information one needs in a text-book, Imay be forgiven if I go over ground in my reply with WhICbhe as a sufferer is more conversant than I am. Whilethe exact pathology has not been made out, it is generallyconsidered to be a vaso-motor neurosis with increasedpermeability of the blood-vessels and probably a deficiencyof calcium salts in the blood, and while it often occursin persons with a family history of the same complaintor allied complaints, such as erythema, purpura. Raynaud’sdisease and chilblains, mucous colitis, and neurasthenia ;this family history is certainly not always the case. I havefound by careful observation that from time to time inthese cases a slight mitral or tricuspid murmur can bedetected and that the blood pressure is almost always verylow up to about 110 mm. of Hg for ages up to 45 or more, andthat slight traces of albumin occur in the urine with fairregularity, and that at least 50 to 65 per cent. of the caseshave gastro-intestinal disturbances. The following is an

. interesting case or set of cases :-The brother of two patients of mine was invalided home from the

East with ’’dysentery" attacks of haemorrhage of the bowels. I hadmet him at a social function, and he had conversed freely with me abouthis complaint, but did not see him to speak to again, but heard of hisprogress. After being treated in a nursing home in London for somemonths for dysentery, he went to Bath, where a diagnosis of appen-dicitis was made and the appendix removed. Still he got no better andeventually he gave up treatment and took a holiday and went fishing.This did him a lot of good. and the last I heard of him was he was stillmuch better. Personally, from his history I doubted both diagnoses andtold the relatives so, on their asking me what I thought ; and thebacteriologist who examined his faeces, on my saying I did not thinkhe had found either amcebic or bacillary dysentery said : "That was so."This was while the attacks were on.Both his relations, my patients, had very low blood pressures, suffered

from chilblains very badly, and one had been the subject of very severeattacks of angio-neurotic oedema for over 14 years before I treated thecase. Had attacks of diarrhoea from time to time, and severe facialattacks coming on occasionally in the latter half of the nights, andlooking as if "just out of the ring from prize-fighting," the featuresbeing entirely obliterated.

Sargent and Russell, in their excellent work, mentionthis complaint and its allied forms as a possibility thatmust never be lost sight of when investigating a case of acuteabdominal symptoms. Most sufferers, I find, are anaamic,but some are ruddy and gouty. Apart from the constitu-tional tendency to it, consisting of low blood pressureand want of coagulability of the blood, anything whichtends to produce neurasthenic conditions tends to bringthis on, and therefore one should try to live under thebest possible hygienic conditions, avoiding excesses ofany kind, errors in dietary, and giving strict attention tothe state of the bowels. An entire change often does good,as in the first case mentioned. Those foods which bring onurticaria certainly bring this on, and over-brewed tea is one,and a patient in whom I traced this and who took such teadaily was not discomforted by weak, fresnly made, China tea.Again, tobacco is a very common source of trouble, and onepatient I had who "never smoked more than three cigarettesa day" got great relief by abolishing smoking altogether.Apart from gastro-intestinal irritants and alcohol, gout,malaria, and syphilis certainly have been at the root of thetrouble. One dose of salvarsan has completely stopped it ina case of the latter, and colchicum and quinine gave benefitin the former two sources of trouble.In uncomplicated cases almost all the remedies used aim

at the vaso-motor system, and it is interesting to note thatboth vaso-dilators and vaso-constrictors are prescribed, suchas thyroidin, nitroglycerine, pituitrin, adrenalin, the lasttwo being specially useful in the attacks. As with every-thing else, if the cause can be found the treatment becomeseasy, but I do not think any one irritant or article of diet canbe said to be the sole cause of attacks. Nuts certainly act insome persons as a gastric irritant, and the fact of its "comingon three days after eating nuts," reminds me, some yearsago when attending boys in a large private boarding schooland when called in to attend cases of catarrhal jaundice, Ialways counted three days bacK in my mind and thenmentioning the day of the week to the boy, said: " See, youhad nuts on - day." After a little reflection, " cocoanuts "were mostly to blame, other times smaller nuts were ownedup to. Strawberries, shell-fish, salmon, all in turn affectsome. So far as my experience goes, I have found treating thepatients for their anaemia with iron and arsenic ; for the low

blood pressure, with tincture of strophanthus and nux vomicawith either alkalies or acids (as indicated by the case underconsideration) for three weeks to six weeks at a time, onesuch course at least every three months, alternately with acourse of calcium chloride gr. x. to xx. t.d.s. (or calciumlactate gr. xx. to xxx. t.d.s.) give the best results. Ironglycerophosphate and its calcium salt are excellent for achange.It is interesting to note with regard to " Major’s " experi-

ence that it has recently been pointed out that there is at deficiency of lime salts in the food supplied to troops in war1 time and that this accounts for the prevalence of entericT and dysentery; and certainly I believe one finds a deficiency[ of lime salts in all cases of abnormal permeability of the

vessels, and the benefit of calcium is shown in cases of chil-, blains and" bleeders." The value of a course of high-frequency; in these cases has been testified to by several writers, and

during an attack I know of nothing that stops the pain so, quickly as the high-frequency effluve, vacuum or brush, the

former for face chiefly. During an attack brisk salines, hot; alkaline baths, calcium lactate 3i., repeated in two hours if

necessary, adrenalin, and pituitrin are the most useful.Specially useful as articles of diet are peas, beans, eggs,butter, and milk, all containing lime salts. ,

.

I am, Sir, yours faithfully,! Bournemouth, Oct. 14th, 1916. G. HERBERT RUTTER.

THE REPATRIATION OF GERMAN CIVILIANS.Lord Robert Cecil stated last week in the House ofCommons that an arrangement had been made wherebyall civilians over the age of 45 interned in Germany or theBritish Empire would be repatriated subject to the rightof either Power to detain for military reasons not morethan 20 persons. Doubtless the great majority of internedBritish subjects will desire to avail themselves of thisopportunity. With regard to interned German subjects,where, as in many instances, they have resided for years inthis country and have British-born wives, the case isdifferent. We understand that the repatriation is notcompulsory and that any interned civilian has the rightof appeal against it, and if the appeal is allowed heremains interned. Political refugees are not forciblyrepatriated. An appeal to remain from a German civilianwith a British-born wife is readily granted. If the mangoes and his wife remains behind she loses the Govern-ment grant. This now amounts to 11s. 6d. weekly inLondon and 9s. 3d. in the country, with Is. 9d. extra foreach child, which may be raised to 2s. 6d. at the discretionof the guardians.

A GOLD COAST DRUG.THE Blue-book of the Gold Coast Colony for 1915 containsthe following reference to a sample of bark of colonialgrowth sent to the Imperial Institute for investigation inthe Scientific and Tecnnical Research Department :-‘° Asample of bark "was identified as probably that ofZaiiihoxylzi?n senegalense, D.C. The bark, which hasstimulant properties and is employed locally in rheumaticaffections, intestinal troubles, and other diseases, has been ’previously examined by various investigators and foundto contain a fixed oil, a neutral body, and two alkaloids,one of which (artirine) was found to be present to theextent of 0-4 per cent. This drug is described as producingmuscular irritation and physiological disturbances similarto those induced by veratrine. The root bark of

, Zanthoxylum senegaletise also yields a fixed oil which(probably on account of the artarine dissolved in it) tendsto produce paralysis of the nervous system." Althoughthere is not any regular demand for this bark in Europe,it is possible that if the alkaloid artarine could be shownto be clearly analogous to veratrine in physiologicalactivity it might replace the latter in medicine. It wastherefore wisely suggested that a quantity of the barkshould be sent to the Imperial Institute for investigation.

THE PROLIFICITY OF OPPOSITE TWINS.To the Editor of THE LANCET.

SIR,-In England it is a popular and widely-known beliefthat in the case of twins of opposite sexes the girl is invariablysterile. In fact, I was asked to consider my own marriagein this direction. However, my wife, though such a twin,has presented me with five healthy children.

I am, Sir, yours faithfully,Ziirich, Oct. 25th, 1916. M.D.

X RAY APPARATUS AND ACCESSORIES.WE have received an interesting catalogue (B) of X ravapparatus, tubes, and accessories from Messrs. R. Butt andCo., Ltd., of 147, Wardour-street, London, W. There aresome admirable illustrations made from the actual X raytubes and apparatus kept in stock. As improvements aremade they are adopted, this firm being their own manu-facturers. The descriptive matter is well written andcontains some useful practical information.