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excluded, such as tuberculosis, syphilis, rheumatism,gout, diabetes, heart disease, haemophilia, and lead

poisoning. Out of 38 cases collected by Mackee in 1915,31 occurred in the male sex. Auto-intoxication is

regarded by most authorities as the causative agent,but until this is definitely established the treatmentcan be only symptomatic. Rest and an elevatedposition of the limb, with the use of embrocationsof Burow’s solution, will prove useful. Calcium lactatemay be given to increase the viscosity of the blood,and later strychnine and arsenic should be admin’is-tered. The use of a porous bandage without rubber, toexert an even pressure, has also been recommended.

THE HOS PITAL S URVEY.

Sir Napier Burnett has now presented to the Red ) Cross Joint Council a survey of the financial position of the voluntary hospitals throughout Great Britain and (

Ireland for the five-year period 1914-19. His inquiry rwas directed to ascertaining the total amount of

ordinary income and expenditure for each of these iyears, along with the total value of legacies not ear- I

marked for specific purposes. The conclusions to iwhich he comes, stated baldly, are that the voluntary thospitals in this country, taken as a whole, are solvent; ithat there is a deficit on the five years running of about (a quarter of a million pounds for the provincial hospitals (and a similar. sum in London); and that a further sum of three-quarters of a million is required to meet theaccumulated cost of repairs and necessary alterations 1in both metropolitan and provincial hospitals. A 1covering letter from Sir Arthur Stanley states that if the voluntary system is to continue, five things are Inecessary:-

(1) Payment of war debts, preferably by existing voluntary corganisations, or, failing that, by a grant from theExchequer.

(2) The extension of the almoners’ system, under whicha contribution towards their maintenance is requested from those patients who can afford to make it. (

(3) The organisation of systematic collections from work- ipeople and employers of labour.

(4) The establishment of a competent authority to exam ine ]hospital accounts and consolidate appeals.

(5) Closer cooperation with the Poor-law infirmaries inwhich there is a large number of vacant beds that mightbe utilised to relieve the pressure on existing voluntary 1hospitals. ]

We shall take an early opportunity of commenting on 1the figures from which these important conclusions are 1drawn.

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IMMEDIATE SELF-DISINFECTION AND THE MINISTRY OF HEALTH.

AN influential deputation from the Society for the aPrevention of Venereal Disease was received by Dr. aAddison, Minister of Health, on July 2nd, when Lord Willoughby de Broke submitted the following resolution :- rThat inasmuch as the Ministry of Health has failed, and public

bodies, including the London County Council, have declined, toprovide the means of delayed disinfection against venereal disease a

at ablution centres, this meeting calls upon the Ministry of Health and upon local authorities to instruet all qualified chemists to sell tsuch means of immediate self-disinfection against venereal disease as may be approved from time to time by the Ministry of Health or xby medical officers of health. r

He added that while everybody was agreed that all the tinfluence of research and administration ought to a

be applied to the prevention and cure of venereal r

disease, and that all means of moral prevention a

ought to be constantly employed, especially with Iregard to the youth of the nation, the society which he r

represented was addressing itself to the efficacy of simmediate self-disinfection, and the policy it recom- e

mended was that the Ministry of Health should take -x

such steps as would educate the public in the whole r

hygiene of this important subject. Captain W. E. Elliot, s

speaking as a medical Member of Parliament, said that the House of Commons was intensely interested in the tprevention of venereal disease, and felt that unless 1

stronger arguments could be brought against it than r

had hitherto been the case, it could not continue to Jaccept the responsibility of prohibiting the sale of dis- a

infectants which had the approval of the medical t

profession. Dr. J. H. Sequeira stated that the numberof new male patients, mostly ex-soldiers, sufferingfrom syphilis, admitted for treatment at his clinic atthe London Hospital in 1919 was 90 per cent. above thenumber attending in 1918, and that there was an increaseof 15 per cent. in the total of female patients. Theincrease in cases of ophthalmia neonatorum and lipchancres proved that there was a deflnite increasein venereal disease, and that increased attendanceat clinics was not merely the result of the spreadof knowledge of these diseases amongst the people.Sir Archdall Reid stated that about 40,000 men passedthrough his hands during the war, and up to 1917 therewas a vast amount of syphilis. In the beginning ofJanuary, 1917, a policy of immediate self-disinfectionwas advocated among the troops under his command,with the result that venereal disease practically dis-appeared. Mr. Wansey Bayly said that 14 boroughcouncils, including West Ham and Holborn, in the

metropolitan area, had adopted the policy of the

society, and that the National Birth-rate Commissionin its last report had expressed the opinion that themethods for the prevention of venereal infection byimmediate self-disinfection should not be withheld fromthe public. Dr. A. Mearns Fraser reported his successin inducing the public at Portsmouth to accept the prin-ciple of immediate self-disinfection. Dr. C. W. Saleeby,Lady Askwith, Sir William Arbuthnot Lane, and SirJames Crichton-Browne also spoke.Dr. Addison, in reply, said that they did not really

know whether venereal disease was increasing or not,because they had no data supplied of a properly ascer-tained scientific kind. They knew that there was agreat increase of people attending centres or clinics.The propaganda of the society represented by thedeputation and the general public enlightenment wereperhaps bringing people to realise that they must beproperly treated. At all events, they had not got a basisof ascertained fact on which it was quite safe to

dogmatise. It was suggested that the Ministry shouldissue certain instructions to local authorities and tothe public, and he pointed out that it would benecessary to have an overwhelming case to justifysuch action and to avoid the conflict of opinion.They would have to contend with a great wave of

public feeling which would suggest that the Govern-ment was really encouraging vice. It had been urgedby the deputation that their suggested policy wouldbe successful if scientifically and thoroughly done.That might be a true statement. They could nothowever, deal with a population of 40 millions on thesame basis as Sir Archdall Reid, with iron discipline athis command, could deal with 2000 soldiers at one

time. That was quite different from placing somethingat the disposal of any citizen with certain instructionsas to use. They had to have a very strong case thatwould meet the intense and vehement oppositionwhich such a proposal would arouse, and if they werenot successful it would put the whole movement backa generation. There would be great objection raised,and he thought they must admit that a great deal of itwould be well founded. To adopt such a proposaltowards the population as a whole-boys and girls,men and women-would be held, and he thought withmaterial ground, as doing something which would tendto encourage people to run risks. Last year heappointed a very strong body of men, who hadreported to him that certain drugs, if properlyapplied, were efficacious, but if these drugs were notproperly or scientifically applied their efficacy couldnot be relied upon. They also reported that the use ofsuch drugs gave rise to a falsesense of security andencouraged the taking of risks, and that, in spite of the .

most careful instructions, the issue of packets to soldiersresulted in men who used them for self-disinfectionstill having infection. Could they rely, he asked, on thegeneral public properly and scientifically using thosethings? Two experimental centres had been estab-lished under the Manchester corporation, and so far theresults were encouraging. Those experiments inManchester were being watched with anxiety. Heassured the deputation that the Ministry was anxiousto take any practical measures they could thoroughly

84

recommend for the prevention and treatment of thedisease, and they were quite prepared, if they werecertain of good results, to face novel methods. ICHARLES MAYO AND THE AMERICAN HOSPITAL

IN LONDON.A DINNER was held at Claridge’s Hotel, London, on

Tuesday evening last, with the double object of payinga high compliment to Dr. Charles H. Mayo, the famousAmerican surgeon, of Rochester, Minnesota, and of

introducing to public notice the movement, rapidlyadvancing from theory to realisation, for founding anAmerican Hospital in London. The hosts at the dinnerwere the President, Lord Reading, and Governors ofthe projected American Hospital, and the two toastsof the occasion were the health of Dr. Mayo, whichwas proposed by the Chairman, the Lord ChiefJustice of England, and " Prosperity to the AmericanHospital in London," which was proposed by Mr.Balfour. Lord Reading disclaimed any ability to describe ’to an audience, comprising so many medical men, Dr.Mayo’s professional position or the performances bywhich he had attained thereto, but dwelt on the factthat between the two great English-speaking peoplesthe inevitable links of race and language must beenormously strengthened by the interchange of scientificknowledge. Dr. Mayo gave a sympathetic sketch ofwhat true intellectual union between England andAmerica might achieve, and concluded a blood-curdlingforecast of what war in the future would mean bystating that medical preparation to combat wholesalescientific destruction ought now to be made. Mr.Balfour, in wishing all good fortune to the AmericanHospital in London, concentrated upon the value ofmutual understanding between America and this countryon questions of medical science. He claimed, amidprotests, to be the oldest man in the room, and havingshown what enormous progress in medicine his span ofyears had witnessed, prophesied that this rate of pro-gress would be accelerated in the future. He asked whatcould more surely assist to this desirable end than apractical exchange of their experiences between pro-fessors, teachers, practitioners, and even students of thetwo countries, such as could only be got by personalconference, and could never be supplied by any writtenmedium. The toast was responded to by theAmerican Ambassador and Sir Arbuthnot Lane. TheAmerican Ambassador rejoiced to know that Londonwould soon possess an outward and visible sign of thegraces of friendship and hospitality invariably ex-

tended by London to American visitors, and SirArbuthnot Lane then gave a rapid sketch of theactivities which have culminated in the foundation ofthe American Hospital in London. The original ideaof the institution he attributed to Mr. Philip Franklin,and he showed how on both sides of the Atlantic thatidea had quickly taken root and had been developed bythe energies of prominent citizens, medical and lay,until now a great institution was arriving, certain toachieve much in the future, alike in the promotion of agood understanding between the two English-speakingcountries and in the facilities for research afforded.Sir Arbuthnot Lane, like all the preceding speakers,paid tribute to the great career, so sadly cut short, ofSurgeon-General Gorgas, whose life-work formed a

perfect example of what internationalism in medicinecan achieve.

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Sir Thomas Clifford Allbutt is to be sworn a Memberof the Privy Council. The honour is the more signalwhen it is noted how few of the present PrivyCouncillors have become such on the ground of scientificattainment, while, as far as we know, no doctor hasever before attained to this distinction in recognition ofpathological and professional work.

INDEX TO " THE LANCET," VOL. I., 1920.

THE Index and Title-page to Vol. 1., 1920,which was completed with the issue of June 26th,are given in this number of THE LANCET, and willnot be issued separately.

THE

BRITISH MEDICAL ASSOCIATION.EIGHTY-EIGHTH ANNUAL MEETING AT

CAMBRIDGE.

THE 88th Annual Meeting of the British MedicalAssociation was concluded last week, and on all sidesthose who assisted in the session have had reason tobe satisfied with the work achieved, as well as withthe facilities provided so generously by the Universityand city of Cambridge. And Cambridge was arrayedby nature for the occasion, the noble colleges and ancientstreets being radiantly beautiful in the perfect summerweather.The final ceremonies included a dinner party in

Gonville and Caius College given by the President ofthe Association, Sir Clifford Allbutt, who is a Fellowof the College ; a reception at Emmanuel College byDr. Peter Giles, the Master of the College and Vice-Chancellor of the University ; a reception by the Mayorof Cambridge at Christ’s College; a reception by theMaster and Fellows of Trinity College ; and the AnnualDinner of the Association, held by permission of theMaster in the Hall of St. John’s College.The last item on the scientific programme was the

Popular Lecture, and this was delivered by Dr. G. S.Graham-Smith, who took as his subject*" Flies," andonce again emphasised for public information theprimary part played by fiies in the dissemination ofdisease.

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SECTION OF MEDICAL EDUCATION.

THURSDAY, JULY 1ST.This section opened with five papers on

The Place of Preliminary Science in the MedicalCurriculum.

The papers were an address on the subject generallyby Sir GEORGE NEWMAN, President of the section;addresses with reference to particular sciences by Pro-fessor Arthur Smithells (Chemistry), Professor SydneyHickson (Biology), Professor Arthur Keith (Anatomy),and Professor Sir Ernest Rutherford (Physics), and apaper by Professor Lorrain Smith on the connexionbetween the teaching of preliminary science and patho-logy. Professor Lorrain Smith’s paper is publishedelsewhere. The discourses were taken as read, theauthors merely outlining the essentials in brief speechesfor the purposes of debate.The PRESIDENT commenced by calling the attention

of the section to the distinction of the men who werecontributing to its work and hoping that somethingpractical, perhaps in the way of resolutions, wouldemerge from the debate. Passing to the - considerationof the subject of medical education in general, hesaid that the purpose of a medical education is theequipment of the practitioner in knowledge and skill.The curriculum must incorporate the principles ofmedicine as interpreted in current knowledge. It mustalso comprehend its practice in relation to the needs ofthe time and the art of the practitioner. Sir CliffordAllbutt had explained thàt the new birth of medicineits nothing less than its enlargement from an art ofobservation and empiricism to an applied sciencefounded upon research; from a craft of tradition andsagacity to an applied science of analysis and law; from

.

a descriptive code of surface phenomena to the dis-L covery of deeper affinities; from a set of rules and.

axioms of quality to measurements of quantity." Nor: were the signs of expansion limited to practical medi-I cine ; there was the new work on the cell-in physics,in chemistry, and in biology. The cell theory-cell

basis, cell division, the nucleus, the nucleolus-isyielding its secrets, and something of the hidden

powers of the chromosome of the germ cell and theinternal secretion of chemical substances, whether

’ they be hormone, toxin, or antitoxin, is now revealed., It would seem impossible to exaggerate the effect on thel science of medicine of the new knowledge of the

chemical and electrical changes going on in the cells of