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Notes, Comments, and Abstracts.WORLD FEDERATION OF EDUCATIONAL

ASSOCIATIONS.

(FROM A CORRESPONDENT.)

IIITHIS Federation was first projected by the presentPresident, Dr. Augustus Thomas, Education Commissioneifor the State of Maine. It is quite in the Internationalspirit of the time. Its organisation is broadly based amongthe nations, and probably education is the one conceptwhose urgency no nation will dispute. It is certain thatthe nations, both of the East and of the West, have respondedto the idea. The meeting just held in Geneva is the fourth ;the first was at San Francisco in 1923 ; the second at Edin-burgh in 1925 ; the third at Toronto in 1927. There is adesire that consecutive meetings should take place in differentcontinents, but where the next meeting will be has not beenformally announced.

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The Health Section.The Geneva meeting was a success, as was right in

the home of all "internationalisms," as well as of theLeague of Nations. The Federation has been for ten daysthe focal centre for several other conferences and dis-cussions, none of them far from its own central idea, whichis to provide a non-party platform for all forms of educationaltheory, practice, and propaganda. But, from the beginning,the Federation established a Health Section, whose proceed-ings were of practical value at Edinburgh, Toronto, and againat Geneva, for the work of the Section has served to elicitfacts and programmes from over thirty nations, includingChina, Japan, India, Russia, Poland, Latvia, Esthonia,Greece, Roumania, and several others. Western Europe, aswell as Canada and the United States, were well represented.The National Teachers’ Union of England and theEducational Institute of Scotland both sent large contin-gents. Naturally, as the Congress was fundamentallyeducational, the reports presented and discussed at theHealth Section dealt with the health of the school ages, andthe various methods attempted and proposed for educationin health. But in several of the other sections, notably inthe section of Rural Education and Agriculture, and thesection of School and Parent, health always emerged, andwas universally regarded as a necessary condition of allsound school organisation.In the Health Section it had been arranged that delegates

from leading countries should send in advance copies ofbooks, pamphlets, primary official documents of investiga-tions, of administration, of actual and proposed schemes.These many volumes formed a useful reference library ; itwas well consulted by the representatives of the youngernations, thus showing the true use of these internationaldiscussions. The conference was thus able both to learn fromthe various delegates how far their countries had got in schoolhealth administration, to note their readiness to seize onthe views of experience, and to reflect on the numerousquestionings. Such conversations, set going by the Con-gress, will promote the intellectual inter-penetration thatforms one condition of a safe internationalism. Dr. AlfredZimmern, of the League of Nations, head of the GenevaSchool for Intellectual Co-operation, and the author of" The Greek Commonwealth," which is a vital expositionof political ideas and idealisms, made exactly this point ina plenary address, and the Health Section certainly worked inthis spirit.

The Chairman’s Questionaire.Prof. C. E. Turner, of the Massachusetts Institute of

Technology, Cambridge, was Chairman of the HealthSection, which henceforth will cease to be called the " HealthEducation Section." He had issued early in the year anelaborate questionaire, and the replies formed a veryuseful way of obtaining precise information from the variouscountries and of concentrating the discussions. The broadresults were formulated in 16 resolutions. Of the 16,the following were the most important : That healthone of the first aims of education ; that there is need forfurther training of teachers in methods of health education ;that travelling instructors have been found useful to thisend ; that large-type text-books are desirable ; that physio-logy and hygiene should form part of the instruction in thepublic schools of every country; that school medical andnursing service should be provided for schools throughoutthe world, and school-house sanitation (especially hand-washing facilities) should be improved ; that there is needfor permanent representation of the Health Section in eachcountry, in order that information and documents concerning

the progress made in school health may be distributedinternationally ; that there should be further study of thecontinuity and cessation of growth in school-children, as. an indication of health status ; that there is need for greatercontinuity in the health records of children between thepre-school and the school period ; that the teaching of homehygiene, infant and child care should be made universal forgirls of adolescent age ; that there is need for the study anddevelopment of further tests, in addition to weighing andmeasuring, for determining the health status of school-children ; that further study of dental health is necessary ;that every university should provide a student, in addition

t to athletic organisation and health instruction, with a

health service, including preventive medical service,r communicable disease control, financial aid in sickness,

hospital treatment where necessary, and convalescent care.

b Some Outstanding Contribictions.Of individual contributions to the Congress, three stand

out clearly ; first, the excellent address on the InternationalAspects of Education, by Prof. Gilbert Murray, whose

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position in relation to the League of Nations and the*’ detailed work of its committees is well known ; second, the’ practical and elegant address by Prof. Leon Bernard, Head

of the Institute of Hygiene in the Paris School of Medicine:on the teaching of hygiene in, by, and through the school,stress being laid on " teaching by example " ; third, thelecture at the final meeting by Prof. Paul Monroe, LL.D.,now Professor of Education in Columbia University, whodrew attention in a masterly way to the great educationalexperiments made, or being made, in China, Japan, thePhilippines, and Russia. To many of the audience who hadheard dissertations of all sorts on education for a generationthis lecture was one of the most striking, forming an effectiveclimax to a week of strenuous work.A fourth contribution deserving of mention was the

address by Dr. Thomas D. Wood, of New York, who spokeas chairman of the united session of the Home and Schooland the Health sections ; this was the mature deliveranceof the veteran author of the well-known height and weightstandards, which are widely used as tests of school-age,growth, and nutrition.

The Wide Range of Work.There were some good contributions to the study of

physical education which is now taking its place as a definitemethod of preventive medicine, and which may becomeprimarily a responsibility upon school medical officers. Com-munications from Hungary and Poland were exactly illus-trative of this point.From both Belgium, through Monsieur de Vuyst of the

Belgian Education Department, and France, throughMonsieur Varrier of the French Department of PublicInstruction, came a survey of the factors in the problemsarising out of the different conditions, as far as education isconcerned, which prevail in the town and in the country.Such problems, and many others like it, were discussedespecially by American representatives and by Americanmembers of the International Parents’ Association, for inAmerica the educational position arising from immigration,with the extraordinary mixture of cultures and races

resulting, requires perpetual and great adjustment.When the transactions of the Congress are published

they will be found to contain illuminating surveys fromwhich educational authorities in many countries will be ableto derive practical information and guidance.

Geneva, August 7th, 1929.

FOCAL SEPSIS IN DISEASES OF THE SKIN.

THE doctrine of focal infection, which has hitherto foundits chief supporters in England and America, is now gainingadherents on the continent, and A. M. Memmesheimer, awell-known dermatologist of the younger school in Germany,has published a paperl in which he seeks to establish ascientific foundation for the now popular hypothesis.

Considering that the claims put forward by such authors asRoberts, Barber, Niord, Semon, and others are based onclinical evidence only, and on material too scanty for satis-factory proof of the alleged association of cause and effect,he set himself to investigate the doctrine in the case of 66patients, of whom half were sufferers from chronic eczema,and the other half included 14 cases of psoriasis, four of lupuserythematosus, seven of herpes zoster, two of rosacea, andone each of erythema nodosum and erythema multiforme.These were utilised as controls. Of the 33 eczematous cases,26 were found to have apical " granulomata " as clearlydemonstrated by X rays. Six of the 14 psoriasis patients,one of the four with lupus erythematosus, and four of theseven with herpes zoster, afforded similar evidence of apical

1 Arch. f. Derm. u. Syph., 1928, clvii., 183.

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infection. The proportion of dental infections in thetwo groups worked out at 79 per cent. to 51 per cent.Memmesheimer here raises the important question whether

we should regard the preponderating percentage of dentalinfections in the eczematous group as evidence of a causalfactor, or whether people with the cutaneous idiosyncrasymay not have an associated weakness or lack of resistancein their dental tissues. It might further be argued thatdental toxins can sensitise the body to some other exogenousor endogenous poison which would not be capable of pro-ducing cutaneous symptoms in their absence. In the hopeof showing some of these problems, he examined the electiveor specific action of the streptococci from dental foci, andendeavoured to elicit some evidence of their presence, orthat of their toxins, in the patient’s own blood and tissues.Injections into rabbits and mice were tried, both with singlelarge doses and small repeated doses, designed to imitatetoxic absorption in human beings. Mice were found to berelatively immune, but of 27 rabbits inoculated with themassive single dose 15 died, and in 9 of them the strepto-cocci were recovered in cultures from the blood. In nosingle instance were skin lesions produced, nor did suchlesions make their appearance in a similar series (27)injected from day to day.

Complement-fixation tests, both of the blood serum andtissue cells, in 14 patients tested to their own strain ofstreptococci and to foreign strains, were positive in twocases, and that in a restricted sense only. But removal ofthe infective foci-i.e., the apical granulomata- cleared upthe eczema in 5 out of 15 cases, and Memmesheimer holdsthat the low percentage of positive findings is by no meansconclusive evidence against the doctrine of focal sepsis.Further research on the same lines is, he thinks, desirable.

HEALTH CONDITIONS IN THE FALKLANDISLANDS.

A REPORT prepared by Mr. J. M. Ellis, Colonial Secretary,has recently been issued by H.M. Stationery Office, dealingwith the affairs of the Crown Colony of the Falkland Islandsand its Dependencies. Geographically the Falkland Islands liein the South Atlantic Ocean. In addition to the two mainislands, known as the East and the West Falkland, thegroup comprises about 200 small islands clustered aroundthem, within a space of 120 by 60 miles. The Dependenciesare divided into two main groups, the one consisting ofSouth Georgia with the South Orkneys and the SouthSandwich Islands, and the other of the South Shetlands withGraham’s Land. The area of these Dependencies covers3,100,000 square miles, or approximately one-fifth of thetotal area of the British Empire. The population of thecolony, which at the end of 1927 was 2286, is European, andchiefly of British descent. The birth-rate during that yearwas 22’31 per 1000, and death-rate 9’26 per 1000. As inprevious years, general diseases were rare, with the exceptionof tuberculosis, which is common. Its prevalence seems tobe aggravated by close inter-marriage and by inadequatehousing conditions. Steps are being taken to improve thelatter ; and it is hoped in the near future to organise a schemeto examine sputums, in the hope of discovering the diseaseat earlier stages. Chronic appendicitis is also prevalentamong the inhabitants of the colony. Communicablediseases, mosquito or insect borne, were entirely absent, andno acute infectious condition was reported during the year.Septic throat and cervical adenitis were troublesome.

Particular care is being devoted to the dental treatmentof the school-children, who all receive free attendance. Anoutbreak of bad colds occurred some time ago, and treat-ment with stock vaccine did not meet with much success.The colony is devoted solely to sheep farming, and all itsinterests are subordinate to the production of wool.The Falkland Islands are bleak and the climate is rigorous

but healthy. It is trying to people from the United King-dom on account of the continuous cold, the lack of sun, andthe constant high winds, and also because few opportunitiesare afforded for outdoor exercise.

INTENSIFYING SCREENS.

WE have received a booklet from Philips Lamps Ltd.,entitled Intensifying and Fluorescent Screens, which isdevoted mainly to a description of intensifying screens

manufactured by this firm. The Philips screen is coatedon a celluloid base which, it is claimed, is not easily scratchedor damaged, and moreover may be washed with water,petrol, or methylated spirit. From a perusal of the pamphletit is clear that the manufacturer is alive to those qualitieswhich a fluorescent screen must possess if it is to be efficient.The use of an intensifying screen for reducing the exposure

required to produce a radiogram dates back to 1897.Experience has shown that the yellow green fluorescenceemitted by irradiated barium-platino cyanide, thoughadmirable for fluorescent screens, is relatively ineffectiveon a photographic emulsion, which, unless specially prepared,

is only particularly sensitive to violet and ultra-violetradiations. Fluorescence of this character is excited incalcium tungstate by X rays which in consequence formsthe active layer of modern intensifying screens. Theproduction of calcium tungstate of high photographic activityfree from phosphorescence and in a fine state of subdivision,has, however, necessitated a considerable amount of experi-mental work. The fine detail of many of the earlier radio-grams was confused by the impression of the crystallinestructure of the screen, and the afterglow from the latteroften destroyed the sharpness of the image ; but it may befairly claimed that the modern intensifying screen is freefrom these defects.

It is common practice to place intensifying screens onboth sides of a film, which leads to a considerable reductionin the time necessary to produce a radiogram. From thephotographic point of view there is, moreover, the addedadvantage that the value of the screen is greatest in the lowerdensities where it is most required, and hence forinstantaneous radiography they are invaluable., Much of the success obtained with intensifying screensdepends not only upon the mechanical qualities of thematerials used as the foundation for the fluorescent layer,but also on the casette for holding it close to the photographicfilm. Experience has shown that both must be such thatthe screen is held in perfect contact with the film at allpoints during exposure, otherwise blurring of the imagemay occur and the screen becomes inefficient. How farimprovements in these directions have been made may bestbe judged by the fact that the intensifying screen is nowregarded as an essential part of modern radiographicequipment.

VESALIUS AND THE INQUISITION MYTH.. To the Editor of THE LANCET.

SIR,—Some stories seem to be endowed with immortalityIt is of no consequence that they have no basis in fact ;it is enough that they are tinged with some colour ofromance, or that their tragic denouement excites pity, orthat they can be used to make a point in controversy.Truth limps painfully behind and never makes up to them.A recent illustration of this is to be found in Prof. A. V.Hill’s lecture on the Enemies of Knowledge. As it isreported in your columns (June 29th, 1929, p. 1389), hespoke as follows : " Vesalius was inspecting with the consentof his kinsman the body of a Spanish nobleman recentlydead ; the heart gave a feeble palpitation when divided bythe knife. Vesalius was denounced to the Inquisition anddriven from Italy." No doubt Prof. Hill believed he wasmerely stating facts, and yet there is not a single phrasein this description which will bear examination. It is over30 years since I first published the proof of its falsity, andI went into the matter with greater detail in the EdinburghMedical Journal in 1914. More recently a short summaryof the genesis of the myth appeared in THE LANCET(Jan. llth, 1928, p, 105). The statements I have madehave not been controverted. Indeed I do not know anyauthority on Vesalius who credits the story. All I can claimto have done is to have examined most closely all the con-temporary documents relating to that period of theanatomist’s life. If, then, Prof. Hill has discovered freshdocumentary evidence, he would confer a boon on studentsof medical history by publishing it.

I am. Sir. vours faithfullv,G. MATHESON CULLEN.

NITRATE POISONING: AN EPITAPH.

WE are informed that the following appears on a tombat Cross Kirk in Eshaness, Shetland.Donald Robertson, born Jan., 1783, died June 4th, 1848,

aged 65. He was a peaceable quiet man, and to all appearance asincere Christian and his death was very much regretted and was.caused by the stupidity of Lawrence Tulloch in Closeheston (?)who sold him nitre instead of Epsom salts, by which he waskilled in the space of five hours after taking a dose of it.

ENLARGEMENT OF HARROW HOSPITAL.-The districtserved by Harrow Hospital is increasing so rapidly inpopulation that it has become urgently necessary to enlargethe institution. An extension to cost £22,500 has beenprepared as part of a larger scheme which it is hopedeventually to carry out. There are at present 40 beds, butthe enlargement will comprise wards for 18 additional bedsand for 12 paying patients, an X ray department, a newoperating block, and quarters for a resident medical officer.Nurses’ quarters will be erected in the garden of the hospital.The extension is to be known as " The Stuart Memorial,"in honour of the former president, the late Mr. J. N..Stuart.