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feet with 75 square feet of floor space, and 7 feet ofheadroom. In the dayrooms the same boys spent3 hours in summer and from 5 to 7 hours in winterworking and playing at tables in close proximity-most of this time in less than 260 cubic feet, withonly 21-5 square feet floor space, and not 2 feet ofheadroom. An average of 4 hours daily for 6 daysper week was spent in the classrooms with desks inclose proximity in less than 200 cubic feet and with15 to 18 square feet of floor space, and 2-3 feet ofheadroom. Other things being equal, there was

therefore much more likelihood of droplet infectionin the dayroom and classroom than in the dormitory.*

Dr. P. M. MAY said that it diluted his enthusiasmto hear that by giving such assiduous care to reducingthe incidence of zymotic diseases in such specialschools as the one at Greenwich, the best was notbeing done for the health of those boys whose careerwas destined to be in the Royal Navy, seeing thatthe conditions in the Navy were not likely to be asgood as those in the school. It was agreed amongmedical men that the larger the space procurable perboy or girl the better, but those responsible for con-structing and maintaining schools could not alwaysbe persuaded of this, especially when applications forplaces in the school were numerous. There was needfor general enlightenment as to the spread of infectionin school dormitories.The CHAIRMAN said that droplet infection was so

much on the increase, and the facts in regard to it soclear, that nothing should be neglected in the effortto improve conditions. Influenza and the ordinaryfeverish chill-he regarded the latter as the greatdanger of all school life-had doubled in the tenyears 1903-12. Droplet infections should not beallowed to remain such a scourge of school life ; theycaused much more loss of time and were a greaterdanger to life than all the exanthemata combined.He hoped for a good deal from vaccine therapy. Itwas true that amid infective conditions a boy might begradually acquiring immunity, but it was at consider-able risk of breaking down and becoming the victim ofsome permanent damage. He had tried a general vac-cination in his own school, but the number of parentswilling to have this done was a diminishing quantity.

Dr. J. G. FoRBES said this question of the spreadof infection had a very wide bearing ; it was concernedin every closely aggregated community, and especiallyin residential institutions. In class-rooms closecontiguity was unavoidable ; therefore careful atten-tion should be given to ventilation. In influenzaepidemics, ’buses, tubes, and trams were greatfactors in the spread of the infection. Furtherfactors were humidity and barometric pressure. Thegradual development of immunity in the individualas an element of protection to the herd was a largequestion, and the references to it in the paper affordedvaluable food for thought.

Dr. J. A. GLOVER thought the special case of thesailor, to which Surgeon-Commander Dudley haddrawn attention, should not obscure the generalquestion of the reduction of the amount of illnessdue to droplet infection, especially as the risks ofaural disease, pneumonia, &c., were so well known.Surgeon-Commander DUDLEY, in reply, said the

main point was whether it was better to have largebatches of very severe cases separated by considerableintervals of time, or a succession of small groups ofcases, less severe, which occurred in the process ofbuilding up immunity in the herd. He had experience ’of an epidemic of diphtheria in a small place in New

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Zealand of 1500 inhabitants where there had been nocase of the disease for ten years. There were manycases and a number of deaths, and the morbidity infour months equalled that of 30 years in London. Heagreed that the great hope was to carry out efficientvaccination. This certainly had the effect of greatlyincreasing the natural resistance of the recipient.. A Memorandum on the Accommodation for the Sick pro-vided at certain Public Schools for Boys in England, by Capt. W.Dalrymple-Champneys, M.R.C.P.,. has now been issued by theMinistry of Health. (London : H.M. Stationery Office, pp. 35,ls. net.)-ED. L.

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INTERNATIONAL SOCIETY OF MEDICALHYDROLOGY.

ANNUAL MEETING IN ENGLAND.

(Concluded from p. 815.)

THE Society was received at Harrogate on Oct. l2th.Dr. W. EDGECOMBE, Vice-President, welcomed themembers and gave an account of the various types ofwaters, after which parties of various nationalities,with interpreters, viewed the bath establishments..In the evening a banquet was given by the Mayorand Corporation, and the representatives of Franceand Germany proposed the prosperity of Harrogate.The Third Medical Discussion on the

SPA TREATMENT OF CHILDRENtook place at the Royal Mineral Water Hospital thefollowing morning. Dr. ARNiM EELLER (Switzerland),in a paper on the use of brine baths, gave the resultsof 20 years’ experience in the children’s department(114 beds) at the Spa Hospital at Rheinfelden. Upto the end of 1927, 10,107 children, of an average ageof 10 years, had been treated with these baths, usuallywith excellent results. The great majority of thechildren showed " general weakness, lymphatic con-stitution, or scrofulosis," but " surgical " rheumaticand heart cases also did well.

Prof. GROEDEL (Bad Nauheim) spoke of the valueof CO baths in children after rheumatic endocarditis,as well as in the circulatory disorders associated withmalnutrition and anaemia. In congenital cardiac cases-compensation was often improved by these baths. -

Dr. SIGMUND WASSERMANN (Franzensbad andVienna) contributed an interesting paper on the actionof ferruginous waters. Recent work had shown thatonly the unstable ferrous salts, such as those thatoccurred in absolutely fresh chalybeate waters, weretherapeutically active. Such waters, as well as mudbaths, had a definite use for delicate, anaemic, andcatarrhal children. Prof. J. D. STANLEY (Birmingham)reported on the use of hot packs or baths in chorea.In many cases good results were obtained. The sub-normal temperature observed was probably due toderangement of heat control by rheumatic infection.

Dr. ANGLADA (la Bourboule), in a paper presentedby Dr. Ferryrolles, held that the muriated arsenicalwaters which are extensively employed for childrenare of benefit in three types of disorders : (1) ofmucous membranes, (2) cutaneous, (3) arthritic.A paper was also communicated by Dr. CATTANEO

(Salso Maggiore) on the use of " dry pulverisation "of chloride-iodide waters. In an atmosphere so chargedthe dry particles find their way into the pulmonaryalveoli and favourably affect both local catarrhs andthe general want of resistance so commonly met with.This form of treatment may be used with muchadvantage in the first two years of life.

,

In the subsequent discussion it was remarked thatmost of the methods of treatment described wererecommended for similar types of patients, and itwas suggested that a more precise differentiation ofmethods, with corresponding indications, should bestudied at the next annual meeting in Hungary.

After the meeting the members enjoyed a

clinical demonstration of various forms of arthritisgiven by the hospital staff. Dr. J. A. THOMSON showedseries of radiographs of osteo-arthritis, and describedin joints so affected small areas of rarefaction, orcavities, surrounded by an osteo-sclerotic wall,suggesting that simultaneous bone destruction andbone defence was characteristic of this disease.

In the evening the party was entertained by theHarrogate Medical -Society. ;The final discussion of this meeting took place at

the Devonshire Hospital, Buxton, on Oct. 15th.Dr. C; ,W. BUCKLEY presided in the absence of LordDawson. The aspect of -

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RHEUMATISM AS A NATIONAL PROBLEM. Jwas dealt with in a series of reports from seven

870

different countries. Dr. HENRI FORESTIER (Aix-les-Bains) spoke for the Association which has been Iformed in France to deal with the question. Prof.PRUSIK (Prague) said that in Czecho-Slovakia a I

widespread scientific and public propaganda was inprogress. Dr. ZOLTAN DALMADY (Budapest) men-tioned that rheumatism was rarer in Hungary thanin many other European countries. The use of mineralbaths was habitual and popular in Hungary. Dr. MAXHIRSCH (Berlin) stated that they had come to theconclusion in his country that it would be better toform a society to combat rheumatism, in order thatthey could be registered and have the support of theState. He had collected statistics of the incidence ofrheumatism in Germany, and found that the figureswere similar to those for England. They in Germanyhad also formed the opinion that the influence ofrheumatic diseases upon industry was more seriousthan that of tuberculosis. " The German Societyis much impressed by the possibilities of internationalcooperation," he added. Dr. Zimmer, secretary ofthe German Society, gave an outline of its programme(see Arch. of Med. Hydr., August, 1928).

Appreciative references to the work of the Inter-national Society were made by Dr. J. vAN BREEMEN(Amsterdam). " Good organisation is essential," hestated, " but actually it is nothing but a shell, andif no flesh and blood be added, the organisation soonshrivels up to a skeleton. It is, therefore, a mostimportant fact that in the course of the two years theInternational Committee has existed the firm founda-tions have already been laid for a grand edifice, thecompletion of which will take years yet, but whichbears the unmistakable signs of solid construction."

Dr. R. FORTESCUE Fox (London) said that inEngland they had been very fortunate in that theyhad had the assistance of representatives from theMinistry of Health, the London County Council, theBritish Medical Association, and, equally important,the great industrial organisations.

" I think theresultant cooperation of industrial and medical menhas already been invaluable in our country," headded. In some other countries they had not hadthat cooperation. Referring to the efforts which hadbeen made to widen the scope of spa treatment, Dr.Fox said they could not dream that the whole of thepopulation could be treated at the spas, so theywere bound to consider the provision of centres fortreatment of rheumatic diseases in the towns, as insome other countries.

Further reference to rheumatism clinics was made ina paper by Dr. A. R. NEUGAN, read in the compiler’sabsence by Dr. W. S. C. COPEMAN, one of the honorarysecretaries. The English spas, he said, are good, wellstaffed, and well equipped, and their more general useshould be urged. On the continent going to a spa isregarded much in the same light as going to a phar-macy in England, but the spa does not solve the wholeproblem of chronic rheumatism even on the con-

tinent. There had been set up, therefore, in the largecities a system of clinics for the treatment of rheu-matism. In New York and other cities of Americaarthritis clinics were becoming common. Such clinicsshould be centres of research in rheumatic diseases,of diagnosis and special treatment, in full cooperationwith hospitals and health resorts.

Following brief reports from Swedish, Portuguese,and Danish representatives, Mr. W. A. ApPLETON(General Federation of Trade Unions), speaking onbehalf of the friendly societies, agreed that rheumatismwas a national problem. It divided itself automaticallyinto a medical side and an economic side-he wouldconfine his remarks to the latter. First mentioningthat in the friendly societies’ membership there wasrequired 18,000 weeks’ treatment per year, Mr.Appleton stated that there was a great deal of mis-understanding regarding the money held by theinsurance societies.

Doctors refer to it as surplus, he said, but we speakof it as reserve built up against contingent liabilities.

He urged the medical men to be sympathetic if thesocieties appeared to go slowly with regard to thetreatment of rheumatism. It is due entirely to finan-cial doubt, he explained. Mr. Appleton prophesiedthat within a comparatively short period, perhapstwo or three years, some rational scheme would bein operation.

Discussion,Dr. G. L. KERR PRINGLE (Harrogate) suggested

that if clinics were established the cases treated theremight become chronic, and that chronic cases wouldbe sent to the spas.

" The places to treat rheumatic diseases are thespas," was the view of Dr. JOHN MURRAY (Llandrindod).It was important, he added, that our working classeswere kept sound and well. If we, as a nation, couldnot afford two or three millions a year to do this,and yet could spend 800 millions on other things,then it was time the government of the country wasaltered. Every county should have its rheumatismofficer, just as it had its tuberculosis officer. Thefriendly societies should not be saddled with theburden alone. It was a national problem, not onlyinvolving people who work with their hands, but alsothose who work with their heads.

In summing up, Dr. BUCKLEY made reference toeach report which had been given. Speaking of theGerman report, he remarked that Dr. Zimmer hadsaid they in that country had the moral and financialsupport of their Ministry. Already we in Englandhave our Ministry’s moral support, he added, andwe trust that in the future, as the result of the forceof public opinion, we also shall have the financialsupport. Dealing with Mr. Appleton’s comments onthe question of the friendly societies’ finance, Dr.Bucklev suggested that surely rheumatism could beregarded as one of their most serious " contingentliabilities." So long as the insurance companiesallowed so many weeks of labour to be lost throughthis disease, they must expect a heavy drain upon theirresources.

At a meeting of the members of the former Inter-national Committee on Rheumatism, held in theDevonshire Hospital, at Buxton, on Oct. 15th, anInternational League against Rheumatism was dulyconstituted. Representatives were present of thenational committees and associations for combatingrheumatism in Germany, France, Czecho-Slovakia,Hungary, Holland, Sweden, Switzerland, and England.Other delegates of the committees in Russia, Austria,and Belgium sent their adhesion in writing. Thefollowing officers were appointed : Chairman, Dr.Fortescue Fox (pro tem) ; vice-chairman, Prof.Dietrich ; hon. secretary, Dr. van Breemen. Thecentral office is : 489 Keizersgracht, Amsterdam.The functions of the League, as of the former Inter-national Committee, will be mainly advisory andcoordinative.

At Droitwich Spa the Society was warmly receivedand entertained to lunch and tea by the CorbettTrustees, and under the guidance of local medicalmen, members were given an opportunity of seeingone of the strongest brines in the world. The possi-bilities of Droitwich as an international spa, especiallyfor children, were referred to by several authoritiespresent.The annual meeting tour ended with a visit to

Bath, where the various baths and springs were

studied, and where members had the opportunity ofclinical demonstrations by the local physicians ofrheumatic cases at the Royal Mineral Water Hospital,besides inspection of the Roman baths and town.

Throughout the tour the Society was received withthe utmost hospitality and kindness, the Mayor andCorporations, the local medical societies, and bathscommittees vying with each other in providingbanquets, civic lunches, and interesting excursions.Next year’s meeting will he held in Hungary early

in October.