46 BRISTOL AND THE WESTERN COUNTIES. -

MEDICAL INSPECTION OF SCHOOLS INSCOTLAND: THE POSITION OF

FEMALE ASSISTANTINSPECTORS.

:2o the -Editor of THE LANCET.

SiR,&mdash;As several Scottish councils are at present seekingassistant medical inspectors and offering lower terms forwomen than for men, I ask your permission to draw specialattention to the fact. Edinburgh City, Fife, and Forfar-shire, which have all accepted the recognised minimum of.SZ50 per annum for male assistants, offer .g200 and.E150 respectively for the corresponding female appoint-ments. Several reasons, the ingenuousness of which isdoubtful, have been publicly given, such as that thework of the female inspector is to be less important,or that if the female medical inspectors are remuneratedat the same scale as males the female teachers willdemand like treatment. The fact is that the councillorsbelieve the supply of women to be cheaper than that of men.From the point of view of the profession the services per-formed by the men and women are equally incumbent on thecouncils, and as the prospect of advancement before theassista,nt is even less for women than for men it is desirablethat every woman should loyally support the contention thatfor women as for men a whole time appointment in a servicewhich is almost a drawback for any other department ofmedical work requires a minimum salary of <E250, and thatthe councils should be made to realise this by receiving noapplications for the female assistant inspectorship until theterms are adequate.-I am, Sir, yours faithfully,Dundee, June 30th, 1909. R. COCHRANE BUIST, M.D. Edin.

A SYSTEM OF DIET AND DIETETICS.To the Editor of THE LANCET.

Sm,-In your interesting review of the above work inTHE LANCET of to-day I am somewhat surprised to findthat you had no adverse criticism to offer regarding Dr.Edmund Cautley’s account of the Salisbury diet, which,despite the editor’s assurance that the book is written ’’ bymen who have had special experience of the subjects onwhich they write," can only be described as incomplete anderroneous. The vital error in Dr. Cautley’s article has refer-ence to quantity. Dr. Cautley says that the diet consists of twoto four pounds of meat daily and three to five pints of hot water.Does Dr. Cautley mean that certain types of cases are

allowed two pounds a day, others four pounds, while othersagain have intermediate quantities ? Or does he mean that alltypes of cases are placed indiscriminately upon a minimumof two pounds and that this amount is gradually increasedto four pounds ? Whichever way it may be, a minimum oftwo pounds a day, divided between three meals (Dr. Cautleydoes not mention the number of meals), means nearly11 M.naes at eaah meal. As an initial quantity this will inthe majority of cases greatly overtax the digestive capacityof the patient and cause disaster. The largest quantityprescribed by Salisbury at the commencement of treatmentwas eight ounces a meal, and often it was much less. Thus,in chronic rheumatism he commenced with a minimum oftwo ounces a meal and stopped at a maximum of eight ounces.I am aware that in certain cases-obesity, for example-hegradually increased the diet to a relatively large amount, butonly after assuring himself by analyses of the urine and faecesthat the patient could take it with advantage. Personally,in cases in which I have prescribed the diet I have found thatthree to four ounces is usually the most suitable quantityto begin with, and that it is seldom necessary or advisable toincrease it beyond eight to ten ounces. I think I am right insaying that this represents the experience of the majority ofphysicians who have had occasion to prescribe the treat-ment. Some cases do much better on beef-mince (which Dr.Cautley does not mention) than on beef patties, his recipefor which, by the way, is not the one described in Salisbury’slatest work.

I hold no brief for the Salisbury diet, which, in commonwith all restricted systems of diet, is liable to abuse andshould only be prescribed with caution. On the other hand,when limited to carefully selected cases, and suitablymodified both with regard to the disease and the individual,

it will frequently prove a valuable therapeutic weapon whereless drastic measures have failed. Therefore it is to be

regretted, inasmuch as Dr. Cautley has written what wiUundoubtedly be regarded as an authoritative article on thesubject, that he has not given a more correct and detailedaccount of its rationale.

I am, Sir, yours faithfully,Wimpole-street, W., June 26th, 1909. ERNEST YOUNG.

THE DETERMINATION OF SEX.To the Edito’J’ of THE LANCET.

SiR,-In the review published on May 22nd of my book onthe Oausation of Sex " you advocate the accumulation ofdata of proved scientific accuracy." Towards this collectionof data I send you this fact. The birth of a princess to theQueen of Spain on Tuesday, June 22nd, not only entirelyconfirms my theory, but was correctly foretold by means ofthe data given on pp. 182, 183 of my book. As the Queenof Spain was delivered on May 10th, 1907, of a boy andexpected to be delivered again in June, 1908, it was clear bymy theory that her second child would be of the same sexas the first, and so on June 23rd, 1908, the boy PrinceJaime was born ; becoming again pregnant and again expect-ing in June, 1909, it was evident the child would be of theopposite sex to the last, and so a princess was duly born onJune 22nd, 1909. So that, as was the case with the Empressof Russia’s children, my theory is fully confirmed.

I am, Sir, yours faithfully,Broadstairs, June 26th, 1909. E. RUMLEY DAWSON.

THE DIAGNOSIS IN PARALYSIS OF THEEXTRINSIC MUSCLES OF THE EYE.

To the Editor of THE LANCET.

SIR,-In THE LANCET of June 19th I read with much

appreciation Mr. Angus Macnab’s interesting and clever paperon "A Simple Method of Diagnosis in Paralysis of theExtrinsic Muscles of the Eye." I quite agree with him whenhe says ordinary methods require ’’ a very efficient memoryor a severe mental effort." A few years ago I readan article by Mr. Priestley Smith of Birmingham, inwhich he laid down the following rules for the diagnosisof paralysis of ocular muscles :-1. Ascertain in whichdirection the images lie farthest apart : the inefficientmuscle is one of those which normally turns the eyes in thatdirection. 2. Ascertain which image belongs to which eye:the inefficient muscle belongs to the eye whose image liesfarthest in the said direction. I have carried these rules in

my memory and found them of great assistance. I thoughtthey might interest Mr. Macnab.

I am, Sir, yours faithfully,G. VICTOR MILLER, M.D. Edin.,

Ophthalmic Surgeon, Stockton and MiddlesbroughHospitals.June 30th, 1909.

BRISTOL AND THE WESTERN COUNTIES.(FROM OUR OWN CORRESPONDENTS.)

The Tlnivt’J’sity. ’THE Bill to dissolve University College, Bristol, and to

transfer all the property and liabilities of that College to theUniversity of Bristol, came before the Committee on Un-opposed Bills in the House of Commons last week. Aftersome slight discussion the Bill passed and was ordered forthird reading. On Thursday, June 24th, the new buildings ofthe Merchant Venturers’ Technical College, which havearisen on the site of those consumed by fire a year or so back,were dedicated by the Bishop of Bristol and formally openedby Lord Reay ; and on Friday evening a conversazione washeld within the new buildings themselves. They form ahandsome and imposing block and occupy a centralsituation. They are, unfortunately,. separated by nearlyhalf a mile from the main block of the buildingsof the University, with which . trhe’ College is now

incorporated. The Faculty of Engineering in the Uni-

versity of Bristol will be greatly strengthened by thisaddition both in teaching staff and in premises. One of the

47BRISTOL AND THE WESTERN COUNTIES.-BIRMINGHAM.

difficulties which the University has to face is the distanceof several of its centres of work from the main buildings ;the General Hospital and the Royal Infirmary are some

minutes’ walk from the medical school. This is not, how-ever, so great a drawback as it might seem, for by a judiciousarrangement of the curriculum it can be overcome.

The &Aacute;natomwal Society of Great Britain and Ireland.This society held its annual meeting in Bristol for the

first time on June 25th and 26th. Scientific proceedingswere limited to the morning and afternoon of the first day,and were held in the anatomical theatre of the University.On Friday afternoon there was a reception at the house ofMr. P. J. Worsley in Clifton, and in the evening the societyand its guests dined at the Queen’s Hotel. Professor A. M.Paterson of Liverpool was in the chair, and among thosepresent was Professor Ramstrom of Upsala. Several of the

speakers made apt and graceful allusion to the new Univer-sity ; and all who knew the history of the later stages of itsdevelopment were glad to find in these speeches somerecognition of the untiring efforts of Dr. E. Fawcett, theprofessor of anatomy and dean of the Faculty of Medicine.

The Recent Epidemic of Scarlet Feve’J’ at Sidmouth.Dr. R. J. Reece, Local Government Board inspector, has

issued his report on the inquiry which he recently held inreference to an outbreak of scarlet fever at Sidmouth

(Devon) and the sanitary administration of the urbandistrict. Dr. Reece states that from October, 1908, to

February, 1909, 52 cases of scarlet fever were notified inSidmouth ; none of the cases proved fatal, and the epidemicwas mild and of comparatively small dimensions. Dr. Reecestates that the dwellings of the poor are for the most partclean, but in certain localities cottages are crowded together,without any means of thorough ventilation, and adds thatthere is no systematic inspection of meat and foodstuffs.Dr. Reece says that the town council of Exeter has agreed,since 1905, to receive infectious cases from Sidmouth in its.isolation hospital. Dr. Reece suggests that Sidmouth andfive adjoining sanitary districts should unite in building anisolation hospital, and in appointing a medical officer whoshould give his whole time to public health work.

The Local Goeerrament Board and the &Aacute;aeminsteq’ (Devon)Rural District Cmcncil.

At a meeting of the Axminster rural district council,held on June 25th, it was stated that the Local GovernmentBoard had written saying that it would sanction the appoint- iment of the medical officer of health (Mr. W. Langran) for

I

another year, but acting upon the advice of Dr. R. DeaneSweeting, who had recently inspected the district, theBoard recommended the district council to combine with

neighbouring authorities with a view to the appointment of a Ijoint medical officer of health, possessed of special qualifica-tions in public health, who would devote his whole timeto public work.

-TI-ealth of Cornwall in 1908.Health of Cornrval! irt 1908. IThe annual report of the sanitary committee of the Com-

wall county council for 1908, which has just been issued,shows that the birth-rate during the year was at the rate of22’ 44 per 1000, compared with an average of 21 - 97 for thelast five years. The death-rate was 14’ 75, against 15’ 08 in1907. Of the 4763 deaths, 748 were of children under oneyear, against 678 in the previous year. 187 deaths occurredfrom zymotic diseases; 133 of these were due to measles,whooping-cough, and diarrhoea. 440 deaths were due toI consumption." The report shows an increased birth-rate,a decreased general death-rate, a decreased zymotic death-’rate, a decreased infectious diseases rate, a decreasedphthisical death-rate, and a decreased percentage of thecombined diseases of consumption, bronchitis, pneumonia,and pleurisy.

The Royal Glozceester Infirmary.The King visited the Royal Agricultural Show at Gloucester

on June 23rd, and in his reply to the civic address said : "I Iam happy to take this opportunity to inform you that I givemy permission for the title Royal to be prefixed henceforwardto the name of the Gloucester General Infirmary in recogni-tion of the admirable work done by those responsible for itsmanagement, and the continued and successful efforts of its.staff in the prevention and alleviation of human suffering."

Testimonial to Mr. E. M. (}’I’Me.The Testimonial Fund to Mr. E. M. Grace has now reached

about &530.

The IZenzcncrcctiot of Pcblie Yaccinators.At a meeting of the South Molton (Devon) board of

guardians held last week Mr. A. H. Brown tendered his resig-nation as public vaccinator for the Witheridge District,stating that it was quite impossible for him to carry out theduties for the small fees he received. The guardians decidedto ask Mr. Brown to accept a fee of 5s. per case, this beingthe old fee before the recent reduction was made.

Y7<C B’J’itish Dental Association.The annual meeting of the Western branch of the British

Dental Association will be held at the University of Bristolon July 16th.June 29th.

_________________

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

The University.THE summer term is practically at an end. The examina-

tions are either completed or are in their final stages, and thedepartments of chemistry and physics are preparing to moveto their new quarters at Bournbrook. The entries for theexaminations show a very definite increase, most marked inthe departments of the Faculty of Science and in the Facultyof Commerce, whilst the other faculties practically retainthe good positions they previously held.

The Hospital Sattwday Fund.Saturday, June 19th, was Hospital Saturday in Birmingham,

and the thirty-seventh annual collection made on that dayreached the sum of 13,739 Os. 3d., or about R1121 less thanthe amount collected on the corresponding day last year.The Fund will not close for several days yet, and in spite ofthe bad times, it is still hoped that even if the record sumof .E20,632 9s. 10d. collected last year is not attained thisyear, the final total will still be over E20,000. On Friday,June 25th, the total amount had risen to .E17,554 lls. 9d.,which is rather more than <E1ZOO less than the total on thesame day last year, and if the hope of .620,000 is to berealised the contributions still to come in will have to belarger or more numerous than has usually been the case

during the later days of the collection.The Feeble-Minded.

The truth about the feeble-minded is gradually being putin plain words before the public, and at a recent meeting ofthe Birmingham education committee Mrs. Pinsent, who hastaken so active a part in work associated with the care andcontrol of defectives, spoke very forcibly regarding thenecessity for legislation giving legal control over those unableto take care of themselves. In moving the adoption of thereport of the special schools after-care committee, Mrs. Pinsentstated that whilst the children improved very much while theyremained in school it was found that when they were turned outinto the world only 5 per cent. proved capable of earning 10s.a week, and many who as soon as they left school becamewage-earners fell back into the class of unemployed. The

experience of the after-care committee has led Mrs. Pinsentto the conclusion that the mentally defective are persons whorequire life-long control, some to a greater and some to a lessextent, but such control must be provided unless the workspent on them during their earlier years is to be entirelywasted.

l’J’erdment Assoeiected with Medical Inspection.Worcestershire has initiated a scheme for the purpose of

dealing with the cases of children who have been shown bymedical inspection to be in need of care and treatment. The

draft scheme has been adopted as a basis and a committeehas been appointed to draw up a plan based on the schemeand to present it at a subsequent meeting. The schemesuggests a central committee consisting of members of theeducation committee and sanitary sub-committee, such com-mittee to act as a centre for organisation, to obtain funds, andto consider the best means of obtaining cooperation betweenmedical practitioners and institutions. In addition, localcommittees are suggested, the duties of which will be to follow