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handle about 25 in. high. At lower heights thestrength of pull diminished rapidly.

B’s height to the middle finger-tip is 27 in., andW’s 24 in. The heights to the upper border of thepatella, are 21i in. and 20i in. respectively. These

heights are marked by arrows below the curves oflumbar pull. In both subjects the maximum pullwas achieved with the handle approximately at theheight of the middle finger-tip-the height adoptedby Cathcart and his colleagues.The upper curves in the accompanying Figure

show the strength of pull with knees bent and trunkerect. For this method of pulling the most favour-able height was the same as that for the lumbar pull,but whereas with the lumbar pull a departure of aninch or so from the optimum height made littledifference, with the knees bent and trunk erect achange of 1 in. on either side of the best heightcaused a considerable diminution in the strength ofpull (about 7 to 10 per cent.). With the trunk erectand knees bent a much more powerful maximum pullcan be exerted than with the back bent and knees

straight. In the two subjects the difference amountedto 105 and 110 pounds, or 26 to 28 per cent. of themaximum lumbar pull.Some observations were made of the strength of

pull when, instead of maintaining one of the positionsdescribed, the subject bent both his knees and hisback. It was found difficult to repeat such a posturewith accuracy, as with the handle at a given heightthe knees would be bent more and the trunk less onone occasion than on another. Consequently thepulls made were very variable.

It is clear from our data that in dynamometertests such as have been described the handle of theinstrument should be adjusted to a standard height,and that if the maximum pull is to be measured thatheight should be the level of the subject’s middlefinger-tips. Any appreciable deviation from thatheight is likely to cause a considerable reduction inthe pull recorded. When, as is generally the case,the lumbar pull is being measured care should betaken that the knees are kept quite straight.

SUMMARY

1. In an increasing number of studies of physiquethe maximum lumbar pull, as measured on a spring-balance dynamometer, is being used as an index ofgeneral muscular strength.

2. The pull which can be exerted is greatly influencedby the height of the dynamometer handle, the pullbeing at a maximum when the handle is at the heightof the subject’s middle finger-tip. This is the heightto which the handle should be adjusted.

3. In measuring the lumbar pull care should betaken that the knees are kept quite straight.

REFERENCES

Cathcart, E. P., Bedale, E. M., Blair, C., Macleod, K., andWeatherhead, E. (1927) Rep. industr. Fatigue Res. Bd,Lond. No. 44.

— Hughes, D. E. R., and Chalmers, J. G. (1935) Rep.industr. Hlth Res. Bd, Lond. No. 71.

Hill, A. B., Magee, H. E., and Major, E. (1937) Lancet,August 21st, p. 441.

Sargent, D. A. (1897) J. Boston Soc. med. Sci. 1, No. 13.Vernon, H. M. (1924) Rep. industr. Fatigue Res. Bd, Lond.

No. 29.

GENERAL MEDICAL COUNCIL

WINTER SESSION, NOV. 23RD-26TH, 1937

Penal Cases Referred by the Dental Board

THE following dental cases were heard, and ineach case the name of the dentist was deleted fromthe Register in accordance with the recommendationof the Dental Board after its inquiry : Robert WhittonGoldie, registered as of 6, East-road, Elgin, " DentistsAct, 1921," who had been convicted in the SheriffCourt of Aberdeen, Kincardine and Banff of lewdand libidinous behaviour towards three little girls ;Mihran Haroutune Chirinian, registered as of 57,Fasset-road, Kingston-on-Thames," Dentists Act,1921 /’ who had been convicted at the Central CriminalCourt of conspiring to procure miscarriage ; JohnDonaldson, registered as of Orwell Cottage, Dunoon,Argyllshire, L.D.S.R.F.P.S. Glasg., 1928, who hadbeen convicted in Scottish courts of a number ofoffences connected with drunkenness and assault ;Albert Stanworth, registered as of 26, High-street,Towyn, Merioneth, " Dentists Act, 1921," and DavidMinton, registered as of High-street, Blaina, Mon.,"Dentists Act, 1921," both charged with false certi-fication and improperly obtaining or attempting toobtain money from approved societies for work notdone.

The sixth dental case was that of Leon Shaw,registered as of Midland Bank Chambers, 221,Edgware-road, London, W.2, "Dentists Act, 1921."This case was heard in camera, Mr. Shaw beingpresent and defended by Mr. R. F. Levy, K.C., andMr. John Stephenson, counsel, instructed by Mr.P. V. Stallon, solicitor. The Council did not see fitto order the erasure of Mr. Shaw’s name.

Charges against Medical PractitionersThe Council then considered seven charges of

drunkenness and its consequences adjourned fromprevious sessions, and five new charges of drunkenness,without directing the erasure of any name from theRegister.

ERASURES FOLLOWING CONVICTIONS

.

The Case of Samuel Grahame Connor, registered asof 75, Bedford Court Mansions, London, W.C.1,NT.B., C.M. 1889, U. Edin. Dr. Connor had been sum-moned to appear on the charge of having been con-victed at the Central Criminal Court in June, 1937,of using an instrument with intent to procure themiscarriage of seven women, for which crime he hadbeen sentenced to twelve months’ imprisonment inthe second division. He did not appear, and theCouncil’s solicitor said that he was ill and in hospital.His name was erased.

The Case of Patrick Joseph O’Shaughnessy, regis-tered as of Ballitore House, Ballitore, co. Kildare,M.B., B.Ch. 1926, N.U. Irel. Dr. O’Shaughnessy wassummoned because of his conviction twice for drunken-ness in the autumn of 1936, and at Liverpool CityQuarter Sessions on July 29th, 1937, for indecentlyassaulting a married woman, for which offence hewas sentenced to three months’ imprisonment in thesecond division. He appeared, accompanied by Mr.Oswald Hempson, who made a statement in mitiga-tion and produced testimonials. The Council directedthe erasure of respondent’s name.

, A CHARGE OF ADULTERY

The Case of Frederick Henry Nixey, reaistered as of2, Ospringe-road, London, N.W.5, --NT.B., Ch.B. 1915,U. Edin., who had been summoned to appear beforethe Council on the following charge.

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That being a registered medical practitioner (1) youcommitted adultery with Mrs. Phyllis May Salzer in orabout August, 1934, and on numerous occasions there-after until August, 1936 ; (2) you stood in professionalrelationship from February, 1934, until August, 1936,with the said Phyllis May Salzer, and with her husbandHenry Conrad Salzer from March, 1934, until May, 1935.And that in relation to the facts so alleged you have beenguilty of infamous conduct in a professional respect.The complainant was Mr. Henry Conrad Salzer,

who was accompanied by Mr. Charles A. Davis,solicitor.

Dr. Nixey was not present, nor was he represented.Mr. Davis read a statement from Dr. Nixey deny-

ing the charges and stating that the relationshiphad been merely that of landlord and tenant. Hesaid that in February, 1934, his clients had takenrooms over respondent’s surgery and had bothbecome his patients, Mr. Salzer going on his panel.Dr. Nixey had first approached Mrs. Salzer one daywhen he was massaging her in the surgery, suggestingthat she was wasted on her husband. Later, he hadleft the surgery but had continued the relationshipwith her, sending for her to his rooms and takingher out in his car. The husband had eventuallylearned of the adultery ; Mrs. Salzer and the doctorhad both at first denied and later admitted it. Lettershad been addressed to Miss Cooke at the address ofa friend, Mrs. Cook, and had been passed on to Mrs.Salzer ; one of these letters was available. It con-tained expressions which indicated attachment.

Mr. James Charles Gilbert, clerk to the LondonInsurance Committee, testified that Mr. Salzer hadbeen on Dr. Nixey’s panel from June 30th, 1934,until September, 1935, when Dr. Nixey had resignedfrom the list.

Mrs. Phyllis May Salzer related the history of heracquaintance with respondent. She had consultedhim professionally for rheumatism at the end of

February, 1934, and had seen him almost daily. InJune, 1934, he had suggested intercourse ; at thetime he had been massaging her neck and back.She had repulsed him, and had said she would nottell her husband because she did not want to have tomove out of the fiat. Ultimately intercourse hadtaken place in the surgery and had been frequentlyrepeated, and continued at the various places whererespondent had subsequently lived. Dr. Nixey hadtried to poison her mind against her husband. Thelast date of intercourse and of professional attendancehad been in August, 1936. She produced an undatedprescription for indigestion. She had not, she said,been attended by any other doctor during the materialtimes.

Mr. Salzer confirmed the story told by his counseland his wife. Dr. Nixey had, he said, treated himfor itching of the legs and produced two prescriptions.He and the doctor had gone dog-racing togetheralmost every night, and had maintained friendshipup to August, 1936. Anonymous letters had informedhim of the adultery with his wife. He had not seenrespondent after this until a fortnight ago, when hehad visited him. The police had been sent for.Witness had told him to keep away from his wifeand respondent had not made any reply. Witnesshad not paid any fees to the doctor ; he had neverhad a bill. The doctor had attended him as a friendat least a year after leaving his practice. The lastattendance had been for the shock produced by ahalf-confession. He knew nothing of any panelrecords.

Dr. Nixey’s name was erased.

UNPROVEN CHARGE OF DRUNKENNESS

Alexander Ronald Black, registered as of105, London-road, Neath, Glam., M.B., Ch.B. 1922,U. Glasg., was charged as follows :That being a registered medical practitioner, and whilst

acting as locum tenens for Mr. Manik Ghosh, M.B., aregistered medical practitioner, you on Jan. llth and12th, 1937, were so far under the influence of drink thatyou were unfit to attend or treat patients ; and that thisconstituted infamous conduct in a professional respect.

Mr. Black appeared, accompanied by Mr. 0.Hempson on behalf of the Medical and Dental DefenceUnion of Scotland, members of which withdrew andtook no part in the hearing. The complainant, Mr.Ghosh, was represented by Mr. R. W. Skinner.He said in evidence that he had employed Mr. Blackas a locum tenent in January, 1937, in order that hemight go to a nursing-home for operation, Whilethere he had received a telephonic complaint fromthe clerk to the insurance committee that Mr. Blackwas unfit to attend the insured patients, and hadauthorised the clerk to make other arrangements.Mr. Black had left the next day and had not com-municated with him. He admitted that he had madeno attempt to ask Mr. Black for an explanation,but had lodged his complaint on the word of hisservants and two patients. On cross-examination,he said that he would prefer their estimate of thedoctor’s condition to that of a medical man or mentalexpert. Two of his maids and two patients testifiedthat Mr. Black had been in a " very peculiar " con-dition ; one of the maids, aged seventeen, and awoman patient said the doctor had been drunk.Mr. Hempson in defence said that Mr. Black had,shortly before the material time, seriously fracturedhis jaw and had been suffering from extreme physicaland nervous exhaustion.

Dr. John Stanley, police surgeon, and Dr. R.Snowie testified that they had examined the respon-dent on the evening of which complaint had beenmade and had found him overwrought and over-

worked, but with no signs whatever of drink. Two. other doctors sent statutory declarations to the sameeffect. The Council found that the charge had notbeen proved.

The PharmacopoeiaProf. DAviD CAMPBELL, in introducing the report

of the Pharmacopoeia Committee, said that thenumber of copies of the British Pharmacopoeia,1932, sold during the last six months had been 1596,and that of the 1936 Addendum 3743 copies had beensold. The totals sold since publication had been44,872 and 9300 respectively. The work of theB.P. Commission, he reported, was proceeding actively.Much detailed investigation upon individual sub-stances had been carried out and the results hadmade it possible for the Commission to revise andapprove provisionally 322 monographs. These wouldbe further reviewed before they were included inthe Pharmacopoeia. The Commission proposed toinvite criticisms and suggestions for improvementin the more important of the proposed changes frommedical practitioners, pharmacists, and othersinterested. The list of proposed improvements andadditions which had been sent to medical authoritiesat home and overseas had elicited many valuablecriticisms and suggestions. When all availablecomments had been collected the Commission pro-posed to define the scope of the next Pharmacopœia.Close cooperation with the committee of revision

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of the U.S. Pharmacopoeia continued. The changeseffected by the first supplement to the eleventhU.S.P. were being carefully considered by the

Commission.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

EDINBURGH UNIVERSITY CHANCELLORSHIP

Edinburgh University is perhaps best knownoutside Edinburgh for its medical school. It istherefore not surprising that many members of themedical faculty thought it inappropriate that LordLothian, who is well known to be a christian scientistand an antivivisectionist, should be elected chancellor.Lord Lothian was nominated by a committee

appointed by the General Council of University,but at a meeting of the General Council last weekLord Tweedsmuir gained a large majority in the voteof members present. Dr. Edwin Bramwell supportedhis nomination and said that " we feel so stronglythat Lord Tweedsmuir is an ideal candidate for thepost that we are prepared to wait the two or threeyears until he retires from his present position.Sheriff Neil A. MacLean, K.C., proposed Lord Lothianand said that it was true that Lord Lothian was achristian scientist, but that he had said that he couldwith a clear conscience, in spite of his views, cap ayoung graduate with the degree of bachelor ofmedicine. The voting for the chancellorship willnow be carried out by post.

URINARY REACTIONS IN DISEASE

In health the urinary reaction, acid or neutral,is determined by the proportion of acid and basicelements present, which are derived from the food.Prof. D. M. Lyon, delivering in Edinburgh the sixthHonyman Gillespie lecture, spoke on the reactionin disease and on treatment. Diet has an importanteffect on the urine and abnormal products are

excreted if metabolism is upset. Urinary reactionvaries during the process of digestion, the well-known " alkaline tide " accompanying the out-

pouring of hydrochloric acid in -the stomach. Highlyacid urine is excreted in acidosis resulting fromsevere starvation, diabetes or liver damage, and inpregnancy. Alkalosis is very uncommon but is seenin hysterical hyperpnoea, and rarely in massivealkaline therapy. Prof. Lyon pointed out that theestimation of the acidity or alkalinity of the urineby titration, used until recently, is fallacious, sinceit does not distinguish strong acids from weak.Accurate estimation is now performed by dyeindicators, which give the pH of the urine.When food is burnt in the-body, as in a calorimeter,

" ash " remains which is passed in the urine. The

acidity or alkalinity of the ash determines thereaction of the urine. Oils and sugars give a neutralash : animal and vegetable foods produce respectivelyacid and alkaline ash. An alkaline-ash diet has beenused experimentally in the treatment of nephritisand has been shown to cause a definite improvement.A similar diet has proved useful in the treatment ofhyperpiesia by relieving the symptoms and Sansonclaims that it lowers the pressure.

After discussing the value of a ketogenic diet inthe treatment of epilepsy, Prof. Lyon said that inthe urine of patients with ketosis, ammoniacaldecomposition is delayed; ketogenic diets were

therefore tried in urinary infections. This treat-

ment, however, is unpleasant, and the ketone bodiesthemselves cannot be given by the mouth. He thenreferred to mandelic acid treatment. It is generallygiven as sodium mandelate which is converted intothe acid in a strongly acid urine, the pH of whichmust be between 5’0 and 5’5. The older urinaryacidifiers were found to be incapable of producingsuch a degree of acidity, but ammonium chloride iseffective. This treatment clears up infection withgreater certainty than the older methods, butrecurrence unfortunately is just as liable to takeplace.

IRELAND

(FROM OUR OWN CORRESPONDENT)

A RADIOTHERAPEUTIC INSTITUTE FOR IRELAND

THE Minister for Local Government and PublicHealth of the Irish Free State has accepted in

principle the recommendation of the Hospitals Com-mission to establish a radiotherapeutic institute forthe treatment of malignant disease. It is proposedthat the institute should be in or near Dublin, andthat the training of a suitable personnel should beundertaken. It will be under the control of a

national representative body to be known as theCancer Council. In the first instance a provisionalcancer council will be formed for the purpose of

submitting proposals to the Minister for the pro-vision, staffing, equipment, and administration of aradiotherapeutic institute having regard to existingfacilities, and in general to report on such aspectsof the problem as the council thinks fit. It is intendedthat the provisional council should consist of fifteenpersons-namely, five representatives of the voluntaryhospitals to be nominated by the Associated Hospitals(Sweepstakes) Committee, representatives from thefollowing institutions-University of Dublin, theUniversity Colleges of Dublin, Cork, and Galway,the Royal Colleges of Physicians and of Surgeons,and the Royal Dublin Society, and four persons,including the chairman, to be nominated by the

"

Minister.For some years past the Irish Radium Committee,

which worked in association with the Royal DublinSociety, has been pressing on the Minister and on theHospitals Commission some such development as isnow foreshadowed. From 1920 to the present thecontrol of radium for purposes of research and treat-ment in Ireland has been in the hands of the IrishRadium Committee, a joint committee of the RoyalDublin Society and of the (now extinct) Irish PublicHealth Council. The original stock of radium wasthe property of the Royal Dublin Society to which,at the time the committee was formed, was added aloan from the Medical Research Council. The com-mittee has added to this stock from time to time bypurchase and by gift. Most radiotherapeutic work inIreland has been done with radon rather than withradium itself. It may be worth recalling that thehollow needle method of applying radon, now widelyused, was first developed in Dublin by the late Prof.John Joly and the late Mr. Walter Stevenson.

TYPHOID IN A MENTAL HOSPITAL

A serious outbreak of typhoid fever has occurredin the Co. Donegal Mental Hospital at Letterkenny.The outbreak has now lasted for some three weeks.Seventy-one persons have been infected, includingthree members of the staff, and there have been four