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of the testator’s wishes, legal trouble has arisenand much expense has been incurred for legal costs,all of which was a dead loss to one or other orboth parties. On the suggestion of the MedicalInsurance Agency a joint committee has now beenformed comprising three representatives of each

party, and it may be confidently hoped that the Ideliberations of this committee will lead to satis-factory arrangements. The chairman reported tothe committee with great regret the death of oneof their members, Major Betham Robinson, andthe acting secretary of the agency was asked toexpress to Major Robinson’s relatives the sym-pathy and the real sense of loss felt by thecommittee.

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THE MICHELL CLARKE MEMORIAL FUND.

A STRONG Appeal Committee has been formedwith the object of raising a fund to be entitled"The Michell Clarke Memorial Fund," and to beused in behalf of the Medical Library now controlledby the University of Bristol and the Bristol Medico-Chirurgical Society. The late Dr. John MichellClarke was a distinguished native and citizen of

Bristol, who for 30 years worked at the BristolGeneral Hospital as physician, investigator, andteacher; he was Pro-Vice-Chancellor of theUniversity, as well as joint Professor of Medi-cine. His energies were largely devoted tothe cause of medical education, and the AppealCommittee feel that his memory can be best

perpetuated by identifying the Fund withthat cause. One phase of higher medicaleducation-to which, moreover, Michell Clarkeattributed great importance-is the provision ofthe best medical literature for the use of practi-tioners and students. But the Bristol MedicalLibrary, though serving the locality to the top ofits powers, rests upon no specific endowment, andthe provision of such, it is believed, would fulfilMichell Clarke’s wishes. A sum of R2500 will benecessary. Mr. James Rafter, M.A., Registrar ofthe University, is acting as honorary treasurer, andsubscriptions should be forwarded to him at theUniversity, cheques being made payable to the" Michell Clark Memorial Fund."

THE ETIOLOGY OF OVERLAYING.

Dr. F. J. Waldo, coroner for the City of Londonand borough of Southwark, in his annual report tothe corporation of the City, calls attention to theinquests held by him upon the bodies of childrensuffocated while in bed with their parents or

others. These inquests were seven in number,verdicts of accidental death being returned inall cases and the fact of death being due tosuffocation proved by post-mortem examination.Dr. Waldo makes a practice of ordering suchexaminations upon all occasions when suffocationhas apparently taken place owing to the child nothaving been provided with a cot, and it is perfectlyclear that he is right. Without post-mortem exami-nation there can be no certainty that the child didnot die from natural causes ; while, in instanceswhere there is evidence that the adult occupant oroccupants of the bed were intoxicated when thedeath took place, an undeserved charge of man-

slaughter might follow. It is an opinion held by Dr.Waldo that the intoxication of parents is seldom thecause of infants being overlaid, and naturally it is amatter as to which proof is not always forthcoming.In this connexion, however, it may be pointed out

that a post-mortem examination not having takenplace when parents have been committed for trialfor manslaughter, might lead to the acquittalof guilty persons, as counsel for the defence attheir trial would hardly fail to notice the omissionof an inquest and to take full advantage of it. It

is satisfactory to note that the increased use ofcots for their children at night by the humblerclasses has led to a very appreciable diminution inthe inquests held upon deaths ascribed to suffoca-tion in bed. The number of inquests of this classin England and Wales declined from 1660 in 1904and 1098 in 1914 to 585 in 1917.

A RETURN TO WHITE BREAD.

THERE is evidence, at all events from some

quarters, that the bread supplied now is gettingincreasingly white in appearance. If that is so,the decisions of the Cabinet announced by theFood Controller in the House of Commons a weekago as to allowing a reduction in the percentageof flour to be abstracted from wheat are beingacted upon. Mr. Clynes explained that thisstep had been taken as a result of the reliefof the tonnage situation and because it wouldrelease approximately 18,000 tons of offal weeklyfor farmers, pig-keepers, and others to feed theiranimal stock, and a certain amount of barley.An economic necessity appears, therefore, to haveled the Food Controller to revert to the old orderof things in regard to the making of bread fromwheat flour, which was alluded to by the Govern-ment’s own scientific authorities, who, in an officialstatement issued to the public, said :-"We have become accustomed to eat bread made from the

inner two-thirds of the wheat gram, the outer third havingbeen given to animals. But at the present time it is import-ant to use as much as possible of the grain for human food,so that wheat flour is ground to contain four-fifths or moreof the whole grain. This is an advantage, not only becausewe get more food, but because the part of the grain whichwas formerly rejected contains valuable flesh-formingmaterial and salts."

There is a contradiction here in theory or inaction which will need further explanation.

FIRST-AID IN ORDINARY LIFE.

DURING the summer we reported briefly in thesecolumns a series of lectures, delivered at theCollege of Ambulance by representative medicalmen, the purpose of which was to show theadvantage to the community of first-aid on thefarm, in the factory, and, generally, in mitigatingthe results of accidents to life and limb in dailylife. In factories and workshops such provisionis obligatory under the terms of Home Officeregulations, but apart from organised industry, howfew are the facilities provided for emergency treat-ment before the doctor’s arrival, even though delayin their application may well make the differencebetween life and death. We heartily endorse,therefore, the plea of the St. John AmbulanceAssociation that every encouragement should be

given to those who desire to gain a competentknowledge of first-aid, home nursing, and hygiene,the Association expressing its willingness to holdclasses wherever there is a demand for them. Weshould like, too, to emphasise the fact that withthe cessation of hostilities the knowledge of first-aid and elementary nursing acquired by V.A.D.’sand thousands of others should not be cast off asa garment, but rather put to the gentler uses ofpeace.

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IN view of the fact that outbreaks of scurvy have occurredat various times, both in this country, and abroad in HisMajesty’s Forces, and in order to guard against a recurrenceof such outbreaks, especially at places far removed fromsources of supply, the Royal Society Food (War) Committeehave issued the following Memorandum, based chiefly uponinvestigations carried out at the Lister Institute :-

THE CAUSE AND PREVENTION OF SCURVY.1. Scurvy, like beri-beri, is a "deficiency disease," and is due to the

long-continued consumption of food lacking in an accessory foodsubstance or vitamine. The view that scurvy is due to tainted foodmust be abandoned.

2. This vitamine is contained in a number of fresh foods in largestamount in oranges, lemons, and fresh green vegetables ; in considerableamount in roots and tubers, such as swedes, potatoes, &c. ; and insmall quantities in fresh meat and milk. It is deficient in all driedand preserved foods.

3. It is destroyed by prolonged heating. such as takes place duringstewing. Thus, potatoes in stews would be devoid of vitamine, but ifboiled rapidly will still contain some quantity. Alkalies rapidlydestroy antiscorbutic properties. Soda should therefore not be addedto the water in which vegetables are soaked or boiled.

4. Before the onset of definite symptoms of scurvy there is a periodof debility and weakened resistance to disease. The occurrence ofcases of debility in any body of troops without sufficient cause .shouldat once direct the medical officer’s attention to the sufficiency of thediet.

Prevention of Scurvy.5. West Indian lime juice, as ordinarily prepared, is useless for the

prevention of scurvy. Fresh limes have an antiscorbutic action,but their efficiency is only one-fourth that of lemons. The so-called"lime juice," by the regular administration of which scurvy waseliminated from the Navy during the first half of the nineteenthcentury, was really lemon juice obtained from the Mediterranean. Thehistory of Arctic exploration affords numerous examples in whichscurvy was prevented for long periods of time by the agency of lemonjuice regularly taken. Nares’s expedition of 1875, notorious for theserious outbreaks of scurvy encountered, was the first to be provisionedwith " lime juice " prepared from West Indian limes. Orange juice isas effective as lemon juiee.

6. Potatoes and root vegetables have a distinct value in the preventionof scurvy, much less, however, than green vegetables or fresh fruitjuices. A daily ration of 14 oz. of potatoes, boiled rapidly but notstewed, will suffice to prevent scurvy.

7. Pulses, beans, peas, and lentils in the dried condition have no anti-scorbutic properties. If, however, the dried seeds are soaked in waterand are allowed to germinate for a short period, one or two days, theydevelop the antiscorbutic vitamine. At the same time these pulsesare also rich in the vitamine which prevents beri-beri, and are, more-over, valuable foods.The method adopted for germination is as follows. The beans, peas,

or lentils are soaked in water at room temperature (60° F.) for 24 hours.The water is then drained away and, to permit germination, the soakedseeds are spread out in layers, not exceeding 2 to 3 inches in depth, Iand kept moist for a period of about 48 hours at ordinary roomtemperature (60? F.). They should not be allowed to dry after thisoperation, but should be cooked as rapidly as possible (lentils,20 minutes; peas, 40 to 60 minutes).

8. The antiscorbutic value of fresh meat is very low in comparisonwith that of fresh vegetables and fruit. If fresh meat is consumed inlarge quantities, 2 to 4 Ib. a day, scurvy will be prevented. Tinnedand preserved meat possess no antiscorbutic value. Frozen meat.while more valuable than preserved meat, must be considered inferiorto freshly killed meat in this respect.

Methods of Cooking. 9. The destruction of the antiscorbutic properties depends rather

upon the time than the temperature employed. All foods, especiallyvegetable, should be cooked for as short a time as possible at boiling-point. Slow methods of cooking, such as stewing with meat orsimmering below boiling-point, should be avoided. Potatoes should beplunged into boiling water and the boiling continued for 20 to 30minutes after the boiling-point has again been reached. Frozen meatshould be roasted when practicable,The Memorandum closes with a summary of measures

recommended for the prevention of scurvy when fresh

vegetables are unobtainable: (a) The lime-juice rationshould be replaced by lemon juice ; the ration should be1 oz. daily served with sugar. (b) Cooked germinated peas,beans, or lentils should form part of the regular daily ration.(0) Attention should be paid to the methods of cookingemployed, as set forth under 9.

THE PARLIAMENTARY REPRESENTATION OF THESCOTTISH UNIVERSITIES.—Professor William R. Smithrequests us to intimate that he will address the graduatesof the Scottish Universities at the Royal Institute of PublicHealth, London, to-day (Saturday) at 4 P.M.

Correspondence.DISPENSARY SUPERVISION IN PULMONARY

TUBERCULOSIS.

" Audi alteram partem."

To the Editor of THE LANCIET.

SIR,-I can cordially endorse everything written in thearticle under this heading by Dr. G. Jessel published inyour columns on Oct. 26th. This may possibly be the morevaluable as the experience which endorses it is obtained inthe county borough of Middlesbrough with a population of126,000 in an area of 6 square miles against Wigan’s 40 squaremiles. The same method of home treatment with dispensaryattendance and constant nursing supervision has been inoperation here for the last four years, and the nursingelement is continually growing and still insufficient, althoughwe have three dispensary nurses employed. Recently wehave instituted monthly nursing reports on all insured cases,however well they are, with most valuable results. This hasbeen specially demonstrated in controlling the tendency todeteriorating health in the two influenza epidemics. Wehave also recently added three weeks’ holiday in a suitablelocality, when needed, paid for by after-care scheme, whichis really an essential in those stabilised, if home treatment isto be efficiently carried out. The result of this experiment wasvery interesting; at first it seemed rather a failure, but areview of the cases two months after demonstrated its

unexpected value. The disappointment was due to the factthat only 50 per cent. of the cases sent away were imme-diately benefited ; the unexpected and gratifying result wasthat in the two months’ revision subsequent to their return75 per cent. were benefited, and this in spite of the fact thatwe went through the first I I flu " epidemic during the holidayperiod. As this result is rather opposed to sanatoriumresults the suggestions are very interesting.There is one other matter suggested by Dr. Jessel’s article.

During the reconstruction period after the war, with its largehousebuilding schemes, it would be worth while consideringwhether it would not be advisable, when so many of thehouses in which the tuberculous live are so unsuitable fortheir residence, for the local authorities who are rebuildingto reserve certain houses in each area, to be let at a lowerrental if necessary to those tuberculous families in need ofother quarters, as one of the most economic expenditures inthe control of tuberculosis. It is not suggested that thesehouses should be segregated, unless the local bodies wereprepared to spend an extra sum on the beautifying of thearea to overcome the natural tendency there would be to

consider it a leper area, and so defeat its own ends. May Isay that home treatment, to be properly carried out, needsa home, not a hovel, and tuberculosis does not require thismore than other diseases.For home treatment to be successful there must be constant

supervision according to the requirements of the case, reason-able freedom from anxiety, and a possibility of removal toa sanatorium, when the extra rest there obtained is anessential consideration. In Middlesbrough the results arefully justifying the idea that the only real way in whichtuberculosis can be controlled is by making home treatmentand supervision the foundation-stone of the whole structure.Sanatoria, hospitals, and farm colonies should be onlyseparate rooms in the structure for special use ; home treat-ment and supervision must be the foundation of the whole.

I am. Sir, vours faithfullv.

Middlesbrough, Nov. 16the, 1918. H. A. ELLIS,Tuberculosis Medical Officer.

PS.-Since writing the above I have read Dr. F. E.Wynne’s letter in your issue of Nov. 16th. Surely hehardly makes out a case. While admitting the failure inpresent methods of dealing with tuberculosis, as "vitalstatistics show no decline whatever, either in the incidenceof tuberculosis or the mortality from this cause," he

depreciates a method which has at least demonstrated thatit has attained the supervision of 1615 cases where before. only 1164 were supervised, or that a third of the cases were

previously not supervised. At least home supervisiondoes away with many present extravagant and irksome

methods, which apparently, in Dr. Wynne’s belief, are

entirely useless. Whether home supervision and treatment