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quickly transferred to half-cream or skimmed-milkmixtures at any sign of intolerance to food the sugarbeing also reduced to some extent. Every infant whois failing to gain weight during the warm weatherought to be louked t)n as a potential victim of summerdiarrhoea. The boiling of all bottles, teats, and cook-ing utensils, and the prevention of contamination of thefood, should be stressed but not placed first. Dr.Ronald Carter’s method of early notification of suchcases with visiting of their homes by trained health-visitors is admirable. At the onset a simple purge withcastor oil, which tends to leave tl infant constipated,and 24 hours—not longer-on half-strength saline orplain boiled water containing a small amount ofsugar, give the stomach and bowel an opportunityto recover. The return to a normal diet should begradual, and a diet low in fat is strongly indicated.Commercially supplied dried butterrnilk is veryuseful in the early days, and skimmed lactic-acidmilk made according to 3 Marriott’s formula is alsovaluable. This formula is as follows ’ to one pintof boiled skimmed milk and half a pint of boiledwater. 130 drops of (B.P.) lactic acid are added dropby drop, the mixture being stirred continuously.This mixture must not be heated above blood tempera-ture or it will curdle. A suitable quantity of sugaris added, and feeds of appropriate size are given.Severe cases of summer diarrhœa must be treated ininstitutions. If summer diarrhoea could be madeuniversally notifiable the mortality wouldundoubtedly be greatly lowered. The prevention,however, lies in further educating the public to thewelfare movement, and in the value of good hygieneand feeding. In this way the proportion of infantsunderweight and ailing should grow less, and itis these cases which are most difficult to deal withmedically. _____

THE MEDICAL DEPARTMENT OF THEU.S. ARMY.

Major-General Merritte Weber Ireland, wlio willbe remembered here as Chief Surgeon of the L:.S.Expeditionary Force in 1918, lias been reappointedSurgeon of the Army of the United States for a, thirdperiod of four years. This presages, it is believed,considerable changes in the Medical Department, ofthat arniv. which in time of war aggregates 20 percent. of all officers mobilised and 10 per cent. of allenlisted men. The Surgeon-General has written 4to the Adjutant-General stating that the acute

shortage of personnel has become well-nigh intoler-able, the staff being over-worked to the limit of humanendurance, in spite of the fact that the MedicalDepartment is an asset rather than a liability, andtherefore should not be unduly limited, for it is anational insurance, saving life, preventing disease,and diminishing claims for pension or compensation.The Surgeon-General proposes that the MedicalDepartment shall consist of six general officers(one major-general, five Brigadier-generals—Three forthe Medical Corps, one dental, one veterinary), andfive sections: (1) the Medical Corps of 1820 officers,from colonel downwards ; (2) the Dental Corps of 560officers; (3) the Veterinary Corps of 250 officers and1500 other ranks; (4) the Nurse Corps of 700, itssuperintendent witli relative rank as colonel, chiefnurses as captains, head nurses as first, and nursesas second lieutenants; (5) the Medical AuxiliaryCorps, 140 officers and 13,500 other ranks, correspond-ing to the orderlies of the R.A.M.C., though separatedfrom the medical oilicers, who are by themselves inthe Medical Corps. The officers of the auxiliarycorps seL’in to be those corresponding to the quarter-naast.ers, R.A.M.C., along with the non-medicalofficers.—surveyors, engineers, chemists.—W ho are

given commissions within the medical department toadvance tlie hygiene of the army, and traders irrmedical supplies, to facilitate the acquirement ofthe necessary medical stores, especially after mobilisa-

3 Amer. Jour. Dis. Child., 1924.4 Military Surgeon, December, 1926, p. 780.

tion. As there is no war at present, only 544 officersand 2050 additional mfn are required at once. Themedical department of the I7.S. Army serves also theAir Corps, " contract physicians " (no longer ’* con-tract surgeons ") being employed as required."

Surgeon " is being employed as a staff title, not asa

mark of professional attainment.

NIELS THORKILD ROVSING.

THE death is announced from Copenhagen of Dr.Tliorkild Rovsing, professor of clinical surgeryand sometime Rector of the University, at the earlyage of 64 years. He died in his own private hospitalafter operation for cancer of the throat. Prof.Rovsing was born in 1862 at Flensborg, was educatedat Copenhagen, and entering the surgical service ofthe Royal Frederick Hospital, soon became its leadingspirit on the surgical side, and finally chairman ofthe board of management. He was for a long whilePresident of the Danish Surgical Society and a

corresponding member of medical societies in the-iieighbouring countries. His first important publica-tion dealt with inflammations of the urinary bladder,and between 1895 and 1910 appeared the three volumesof his standard work on the surgical diseases of theurinary organs. Later he published a volume onabdominal surgery. His work on appendicitis attachedhis name to a diagnostic symptom, about the valueof which there was a sharp discussion 20 yearsago. More recently his interest centred on the gall-bladder, and lie collected material wherewith to refuteNaunyn’s teaching that stones only arise in an infectedbladder ; analysis of his own 530 cases all went toshow that there is a small nucleus of pigment at thecore of every stone, while in more than half thecases the contents of the gall-bladder were sterile.,Bs a result of this work he remained a stalwartopponent of cholecysteetomy. In some other direc-tions his surgical methods attracted notice, as in histreatment of arthritis bv injections of vaseline andan ingenious method uf gastropexy. His literaryactivities were many-sided, for lie edited with greatsuccess the Hospitalstidende, a iveekly Journal con-taining original papers and reviews of medicalliterature. Latterly lie took a prominent part in thecampaign against cancer in Denmark and was for atime a member of the short-lived (Government of 1920,although. happily for surgery, his political career

lasted only a few days. Dr. Rovsing’s two sons are inthe medical profession. His death removes one of theprincipal attractions of the Copenhagen MedicalSchool to visitors from abroad.

DENTAL BENEFIT.

THE position of dental treatment as an additionalbenefit under the National Itealth Insurance Actsseems to have become remarkably stable, if it maybe judged from the various circulars issued bythe Ministry of Health and the Board of Healthfor Scotland. Circular A.S.259, the most recent ofthese documents, sets forth the latest decisions arrivedat by the Dental Benefit Joint Committee, andit appears from them that the system evolved foradministration of voluntary benefit bears a fairlyclose resemblance to that which governs statutorymedical benefit. The dental societies have apparentlybeen able to set up a representative committee tolook after the interests of deritists. and this willwork in much the same way as the panel committeeworks under the medical scheme. The Dental BenefitJoint Committee has functions generally analogousto those of local insurance committees, and hasa subcommittee whose duties reseluble those of the-

medical services subcommittee. Lastly come the-regional dental oflicers, whose posts are, of coursemodelled on those of regional medical oilicers ; sevenof them are now being selected, and will act in areaswhose centres will probably be London, Manchester.Birmingham, Leeds, Cardiff, and Ulasgow. Except --

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for a couple of lines in the fourth schedule thereis no mention of dental treatment in the NationalHealth Insurance Acts, and the new dental organisa-tion has at present no statutory sanction, but is basedon an agreement between representatives of the dentalprofession and the approved societies. The fact thatthe Ministry of Health, on the invitation of the DentalBenefit Joint Committee, has actually assumed

responsibility for the appointment and control ofthe regional dental officers seems to indicate thatopposition to the new scale of fees shown by certainapproved societies is not taken very seriously. Figuresavailable for December of last year show thatapproved societies representing 73 per cent. of memberseligible for dental benefit at once accepted the feesand conditions of service agreed upon by the DentalBenefit Joint Committee. The societies whichdefinitely refused to accept the scale represented onlya per cent. of eligible insured persons, and the generalrefusal of the dental profession to give dental treat-ment on any lower scale, and other considerations,have since resulted in the great majority of thedoubtful societies coming into the agreement. Itmay be taken, therefore, that the initial difficultiesof the scheme have been practically overcome, andthat a four years’ experiment in dental treatmenthas been launched. Whether a scheme involving theannual expenditure of over £2,000,000 and theprofessional treatment of over 10,000,000 insuredpersons ought to be left without some statutorycontrol, by regulations which will have the force oflaw, is a matter for serious consideration.

DIET AND CANCER.

THE idea that diet is an important ætiologicalfactor in cancer seems to make a strong appeal tothe imagination of many writers. We cannot callit an appeal to the scientific imagination becausethere is little scientific about it. It is not basedeither on considerations of the pathology of thedisease or on trustworthy clinical, experimental orstatistical evidence. The argument begins as a rulewith the assertion that cancer is rare in some

particular community. The native races of CentralAfrica or the Esquimaux are most frequently quotedin support of the contention. Since there are novital statistics available in communities such as

these, the statement at once puts out of court thoseinconvenient fellows, the statisticians, and makes itdiflicult to find anybody who from personal experiencemight be able to contradict the statement. So theperson who makes a statement of that kind isfairly sure of getting a good innings as a "cancerexpert" until the statement is investigated and foundto be either untrustworthy or incorrect. Even if itwere found to be true that certain races have alow incidence of cancer it would not necessarily-follow that this is due to dietetic factors, sinceobservations on animals have shown that racialdifferences are responsible for differences in thesusceptibility to malignancy.

It would be a reasonable argument to suggestthat dietetic errors may be responsible for cancerof the digestive tract. It is quite feasible that sucherrors might produce a type of chronic irritationcorresponding to that produced by tar, which leadsto cancer of the skin to which it is applied. Thereis at present no evidence in support of a view ofthis kind. A recent statistical inquiry by Dr. M.Young on the incidence of cancer in men of differentsocial classes has brought to light the interestingfact that cancer of the bowel is more prevalent inmen of the best social classes, while cancer of theœsophagus and stomach is higher in men of thelowest social classes. If we assurne for the sake ufargument that dietetic errors are responsible forcancer of the digestive tract, we would have toconclude that the dietetic errors committed by men

1 Journal of Hygiene, 1926, xxv., 209.

of the highest social classes must be debited with theinduction of cancer in the bowel and credited withan increased resistance to cancer of the stomach, andvice versa for the dietetic errors committed by menof the lowest social classes. Dr. Young’s analysis,therefore, yields no evidence in support of the viewthat the general susceptibility to cancer of the digestivetract is affected by such dietetic differences as existbetween men of the highest and the lowest socialclasses.But those who are trying to establish a relation

between diet and cancer do not restrict their con-

tentions to argument of this kind ; they hold that acarcinoma of the stomach, of the breast, a sarcomaof the bone, and a glioma of the brain may allfind their origin in diet. The report on Dietand Cancer by Dr. S. Monckton Copeman andProf. Major Greenwood just published by the Ministryof Health, which we review in detail in anothercolumn, contributes further evidence against theview of an essential relationship between the genesisof cancer and diet. In this case the incidenceof cancer in enclosed monastic orders living on

a vegetarian diet shows no significant differencefrom the incidence in the general population, althougha very definite assertion to the contrary had beenmade. The name of Prof. Greenwood is a guaranteeof the soundness of the statistical argumentation.For many years Dr. Copeman has been before thepublic as an out-spoken believer in the importance ofdiet in cancer. At a meeting of the British Associationfour years ago he created a sensation in the dailypress-if not among the scientific public-by suggest-ing that a definite relationship existed betweendiet (especially its content in vitamin A) and cancer.lie has treated patients suffering from cancer witha special diet. It is therefore of real significance tofind under his signature the following statementwhich occurs in the tinal paragraph of the conclusions :" We think a perusal of our report will convince mostimpartial persons that no scientific value whateverattaches to assertions supported merely by thevague pseudo-statistical evidence customarily citedrespecting the rôles of certain articles of commonconsumption in the genesis of cancer." The authors.however, propose to investigate further the apparentdiscrepancy noted by the late Dr. Charles Cioringbetween the incidence of cancer in the prison and

the general population.

COD-LIVER OIL AND VITAMIN B.

Two papers recently published,l by Erik Agduhrand Axel IIojer, have again brought into proniinence.the ill-effects of an excess of cod-liver oil in the diet.These authors find that, besides other changes, theheart is chiefly affected and that it shows brownatrophy and vacuolar degeneration of the muscle-cells. Agduhr concludes that these changes are

caused by some injurious substance in the cod-liveroil, but Hojer records experiments on rats provingthat they are produced, not by a poison in the oil,but by giving it in overdose without simultaneouslyincreasing the amount of vitamin B in the food.The ill-effect of.large doses of cod-liver oil was firstobserved in 1922 by R. H. A. Plimmer and Rosedale 2during experiments with chicks, when it was found thatthe harmful action was removed bv an increase ofmarmite (which contains vitamin B) in the food.The same workers 3 have since studied in detail therelation of vitamin B to the quantity of food andhave indicated that the quantity of vitamin B inthe food must bear a constant ratio to the quantityof carbohydrate, fat, and protein in the diet. Theyconsider it impossible to speak of the requirement ofvitamin B in terms of a daily dose as is usuallysupposed. It has also been pointed out by Plimmerand Rosedale -1 that deficiency of vitamin B must

1 Acta Pædiatrica, vol. vi., Fasc. 2.2 Biochem. Journal, xvi., 11.

3 Proc. Roy. Soc. Med., 1926, vol. xix., Sec. Comp. Med., p. 21.4 Ibid.