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some of which are quite sharply pointed. The earlyHighland brogue, which was made out of a singlethickness of deer’s or other hide, had the same defect.The loss of the power of voluntary abduction of thehallux is incurred quickly because of the comparativefeebleness of the so-called abductor hallucis and themechanical disadvantage under which it acts, losing,as it does, all power of adduction after the firstphalanx is abducted so that its long axis is a con-tinuation of that of the metatarsal bone. But it is notonly the great toe that has suffered from footgear.As soon as man added a stiff sole to the moreor less sock-like mocassin or brogue, or made thesandal stiff, the muscles began to atrophy and thecomplicated musculature of the foot to lose its raisond’etre. Every normal child appears to be born withactive foot muscles and joints, but in every shoe-wearing adolescent the process of degradation andatrophy is gone through, until the foot becomes nomore than a lever hinged at the ankle and jointed at thetoes. Dr. Adams figures the radiogram of a " footin a properly fitted shoe," but even in this a degreeof hallux valgus is apparent. Such deformity is,we fear, unavoidable in all boots and shoes, anddespite the provision of shoes of which the soles havestraight or incurved inner edges, the halluxnecessarily pressed upon at the metatarsophalangealjoint declines to avail itself of the space provided.We regretfully conclude that unless digitated stockingsand sandals with toe-thongs become our only wear,we must have a more or less abducted great toe.Even the athlete’s running shoe is badly shaped.Those that we have seen do not allow for adductionof the hallux and in so much sacrifice the supportand propulsive leverage of the great toe.

Men’s boots and shoes may be bad, but if so, whatepithet of depreciation is strong enough for theshoes of women ? Now that all females are ladies,the workers among them have aped the fashionswhich were popular with the wealthy idlers of pastgenerations who rode in carriages and did but littlewalking on their high heels and pointed toes. It isastounding that so few complain out of the millionswho now for several years have been defying naturein this way.

SCLEROSIS OF THE RETINAL VESSELS.

SINCE the signs of retinal arterio-sclerosis werefirst pointed out by the late Marcus Gunn, thiscondition has been dealt with by many writers,notably by Foster Moore in 1917.1 The subjecthas been reopened in a series of papers, reprintedfrom the British Journal of Ophthalmology forMarch, April, and May, 1929, by Dr. Noe Pines,a Russian ophthalmologist, now living in London.He distinguishes between general arterio-sclerosisin which the general blood pressure is not necessarilyhigh and essential hyperpiesis in which it is. Thetwo conditions, of course, are often present together,but it is the second and not the first, he argues,to which the retinal changes are due. As to whatthese changes are, he attaches little or no importanceto the loss of transparency in the retinal vesselswhich is extremely common’in elderly people. Thealteration in the reflex which gives rise to the appear-ance known as "silver wire" arteries is more

important but not always easy to determine. Themost important signs of sclerosis he considers to be,first, white lines bordering the vessels-not on thedisc or even in its near neighbourhood, as these may bepurely physiological, but in the retina and especiallyat and near the points where artery and vein cross.These white lines he attributes to perivasculitis inthe sheaths of the vessels. Secondly, signs ofcrushing of the veins at the arterial crossings evidencedby white lines, banking, and deflection of the veins.A number of reproductions of drawings fromHamblin’s collection are given as illustrations, andthis appears to be an excellent way of studying the

1 Quarterly Journal of Medicine, January, 1917.

subject. There is originality in the author’s viewsas to the interpretation of some of the appearances.It is of interest, too, that he finds no connexionbetween this form of retinal disease and nephritis,.and consequently does not consider the changesthat he describes are premonitory of albuminuricretinitis. On the other hand, the connexion between-sclerosis of the retinal vessels and those of the brainis notorious. Both depend on persistently highgeneral blood pressure, and this again on some form oftoxaemia. Once again we see that the ophthalmoscopeis one of the most essential instruments of diagnosison which the general physician has to rely.

TRANSPLANTATION OF AN EPIPHYSIS.

WE do not expect to hear of surgical noveltiesfrom the Sandwich Islands and therefore the reportof a new procedure coming from Honolulu is the morewelcome. Dr. G. F. Straub, of The Clinic, Honolulu,reports1 the successful implantation of a section ofdiaphysis and epiphysis in 1912, as suggested byMurphy. The case was one of osteomyelitis of thetibia with consequent necrosis of the bone includingthe lower epiphysis, and the graft was obtained fromthe sound leg. As the operation was performed as longago as 1912, a definite opinion can be formed on thevalue of the result. The leg, which at the age of 14was 4’5 cm. shorter than its fellow, is now 5-0 cm.shorter, showing that growth has taken place paripassu with the sound limb. The deformity of thefoot, due to unbalanced growth of the fibula beforethe operation, has much diminished, but there isstill some calcaneo-cavus deformity. This paper isillustrated well by photographs and radiograms.

HOSPITAL MATERNITY WORK IN GLASGOW,

THE Glasgow Royal Maternity and Women’s Hos-pital contains 114 beds, 25 of which are reserved forthe antenatal department. The report of the hospitalfor the year 1927, which has reached us, covers thetreatment of nearly 4000 in-patients and 3500 districtcases, its general arrangement being based on thatrecommended by the Committee of the Royal Societyof Medicine, in which cases which have attended theantenatal clinic and emergency cases are recordedseparately. In Glasgow, however, a large numberof patients apply for admission without havingattended a clinic, or having been seen by a doctoror midwife, and for these it has been necessary toform a third section, numbering 700 in all. For thewhole hospital a 2 per cent. decrease is recorded onthe morbidity of the previous year. Comparisonof the results obtained in the antenatal and emergencysections goes far to prove the value of antenatalwork, particularly in centres where pelvic contractionis common. This is the case in Glasgow, for 288cases of contracted pelvis were treated by triallabour, Csesarean section, or forceps. Labour seemsto have been induced only in six cases, in three ofwhich no measurements are recorded, one of themresulting in the delivery of a 10 lb. baby at term inless than three hours. In two of the other threecases the pelvis is described as generally contractedalthough the diagonal conjugate measured 4 inches.Csesarean section was performed in 112 cases, mostlyfor contracted pelvis, eight of the operations beingof the "lower segment" type. The mortality-rateswere: maternal 11-6, foetal 16-0 per cent. Thereport has been compiled for the second year insuccession with great care by the registrar, Dr. J. N.Cruickshank, who remarks that the method ofrecording the cases has involved the omission ofcertain details. The reader would have liked moreinformation, for instance, as to whether or not foetalheart sounds were heard when the patient was

1 Surg., Gyn., and Obst., May, 1929, p. 687.

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admitted, especially in the series of " emergencybreech extractions " where of 13 multiparae admitted8 children were stillborn and the remaining 5 died.The section of the report devoted to cardiac casesis of special interest and here the results obtainedwere excellent.

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MINERAL WATER METABOLISM.

THE natural mineral waters of our own andContinental spas vary widely in their active con-

stituents and recent investigation has perhaps tendedto concentrate too much on the presence and possibleeffects of their radium, thorium, and actinium contents.Much work has been done in France and Germany onthis basis and efforts have been made to show thatthe therapeutic action of these waters is similar to,if not identical with, that obtainable from puresolutions of these rare elements similarly used. Thelarger subject of the general pharmacology of thesenatural therapeutic agents, due in the main to theirdissolved saline constituents, has thus been thrustsomewhat into the background. The work of Dr.David Brown and Mr. A. Woodmansey, of which adigest appears in our present issue, is an attempt toremedy this omission. The fresh water from certainContinental and American springs has been shown topossess distinct and measurable catalytic propertieswhich can be demonstrated in vitro. The Harrogatenatural sulphur water has similar activities.R. McCarrison has shown the remarkable effect onrats of adding minute quantities of manganese to adiet deficient in certain essential accessory substances.Brown and Woodmansey have inquired whether thisobservation has a possible bearing on the mode ofaction of mineral waters. In their paper they attributethe general increase in tissue change, and the stimula-tion of special body ferments which they haveobserved, to the presence of manganese and itscatalytic agency. Other measured effects are theretention in the body of large percentages of mineralconstituents, notably sodium and barium, whoseretention may be responsible in part for the metabolicchanges observed. Knowledge must come slowlyin a field in which the relation of cause and effect isso hard to assess : it is, however, work of this detailedand exact nature which is needed to increase ourunderstanding of the mode or modes of action ofthese naturally occurring compound drugs and togive us a clue to their application in the treatmenof disease.

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INTRAVENOUS INJECTION OF ALCOHOL.

ALTHOUGH the method of anaesthesia, devised byDr. Miguel Garcia Marin, described on p. 1247, is notthe novelty which it has been hailed as in variousquarters, there are, nevertheless, details in it whichare new -and which may prove of value. Intravenousanaesthesia has. of course, been extensively practisedwith ether, with hedonal, and also, though less exten-sively, with ethyl alcohol. There are certain obviousadvantages in this method, which are pointed outin the paper by Dr. J. D. Constantin, and there arecounterbalancing disadvantages. These have hithertooutweighed the advantages to such an extent thatintravenous anaesthesia has never established itselfas a method of choice for routine work. It remainsto be seen whether the improvements introducedby Dr. Marin will alter this state of affairs. Themost important innovation is the use of isotonicglucose solution as the conveying medium for theanaesthetic. This may free the use of alcohol fromone of the objections which largely led to its dis-continuance-viz., the fear of damaging the redcells of the blood which are cremated by strongalcoholic solution. We notice the mention of haemo-globinuria in Dr. Constantin’s paper, which suggeststhat this danger is still not to be disregarded. A repre-sentative of THE LANCET was given the opportunityof seeing Dr. Marin’s method employed and certainlyas far as the two patients concerned are a test, theresult was eminently satisfactory. But the operations

were not a severe trial of anaesthesia. The inductionof unconsciousness was quiet, but took longer thanwith most modern inhalation methods. The conditionof respiration and circulation was excellent through-out and recovery was unattended by vomiting. Onedisadvantage of intravenous anaesthesia has alwaysbeen the large amount of fluid added to the circulationwhich resulted sometimes in pulmonary oedema. Wewonder whether a similar objection or others willarise to the instillation of large amounts of glucosesolution. So far as the comparatively slender directevidence now available goes, Dr. ’V7.arin’s methodappears to deserve further trial, which doubtless itwill get from anaesthetists in this country.

THE ENEMIES OF RESEARCH.

MOST of us are inclined to treat the activities of theantivivisectionist with a certain detachment, forthey do not interfere with the work of the ordinarypractitioner. The research worker who has suffereddirectly from these attacks has no such philosophicattitude, and Prof. A. V. Hill seized the opportunityof his Stephen Paget Lecture to the Research DefenceSociety on June 10th to return a Roland for theirOliver, and to attack the whole spirit which informsopposition to man’s painful progress. Too few, hesaid, realise fully the facts of man’s gradual evolution ;most people still think that Adam arrived full growna few thousand years ago, with a complete universityeducation and a degree in zoology. He drew a vividpicture of Nature’s age-long experiment in livingthings by expressing them in the scale of a singlelifetime. Tn that notation it had needed 49 years forman to learn to settle down in villages. Halfwaythrough his fiftieth year he had learned to write ;Christianity had been his religion since the middle ofApril of that year ; printing had been invented afortnight ago, steam less than a week, cars about aday, and wireless for a few hours. We are yet farfrom Utopia, said Prof. Hill, but the gradual progressof knowledge has improved men’s lot and characterand outlook in the last half-million years and mayreasonably be expected to continue to improve themin the next 50 million. To the scientist, as tomost reasonable men, that heritage of painfullyacquired knowledge is a sacred thing. In Prof. Hill’swords, " The capacity for knowledge, for under-standing himself and his environment, is man’sessential characteristic and his alone ; to deny himthe exercise of this fundamental gift would be anunpardonable, an almost unthinkable offence." ToProf. Hill antivivisection is " only a passing phase inthe varying follies of mankind, while the fanaticaldesire to obstruct the advance of knowledge for oneor other cause is a permanent factor in man’s mentalconstitution, a mild form of mental disorder whichhas expressed itself from time to time in varioushideous forms, in cruelty and persecution, in hatredand malice, in the perpetual treachery of hinderingmankind in his slow and pathetic efforts to climb theladder of civilisation. He instanced an " Anti-Rail-Road Journal " published in 1835, supported by themost worthy institutions and claiming to " fight onlyon the side of truth for the exposure of the railwaysystem." Prof. Hill illustrated his lecture with aselection from a hundred letters he had receivedfrom aritiviviseeti-onists ; most of them were

incredible and many unprintable. " I know a

gentleman living in Compton-street that has had twoof his pussies stolen by your bloodhounds," ran one,and another : " From personal observation I havenoticed that a vivisector becomes a seducer, an

abortionist, and a potential murderer " ; while a

gentleman in E.12 wrote : " In my particular circleof friends we are doing all in our power to preventany further subscription being sent to any hospital."On May 24th last the Parish Paper of St. Jude’s-on-the-Hill, Hampstead Garden Suburb, contained anappeal from the Rev. B. G. Bourchier to intelligentpeople to take the opportunity of the general electionto put an end to the waste of public money involved