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amoebic infection exist side’by side, and in such anevent a course of treatment with emetine is of primaryimportance. Wasting is often a marked feature ofchronic dysentery, and may be so extreme that thenourishment of the patient becomes the paramountconsideration. Under these circumstances betterresults may be hoped for if the patient is placed on afairly generous dietary, composed of soft semi-solidarticles of food, from which everything of an irritatingnature is rigidly excluded, than on a strictly fluidrégime. In the management of the bowels constipa-tion may call for the use of sulphates, or in some casesrepeated small doses of calomel (gr. four times inthe day) may be remarkably beneficial. In other casesprofuse and exhausting diarrhoea is a prominentfeature, and may be met by /3-naphthol (gr. 5 incachet four times a day), or bismuth salicylate(gr. 20 four times a day). Lavage of the intestineis more often useful than in acute dysentery ; a longsoft tube should be employed, and the fluid allowedto flow in gently through a funnel by gravitation.Dilute solutions of antiseptics, such as eusol, or ofastringents, such as silver nitrate or copper sulphate(1 in 1000), may be used, but it may be regarded asdoubtful whether these have any real advantage overcleansing injections of warm boric or weak perman-ganate solutions, or even of warm saline. A consider-able number of cases ultimately prove refractory toall forms of medical treatment, and in these thequestion of securing a more efficient degree of lavageby appendicostomy should be considered, or completerest for the lower bowel may be temporarily providedby arranging for the evacuation of the feces throughan opening in the caecum. Vaccine treatment has beenemployed with a certain measure of success. Perfora-tion is a more likely complication of chronic than ofacute dysentery; owing to adhesions the resultingperitonitis is often localised, and ultimately a largecircumscribed abscess may be formed. On accountof the chronic nature of the process the clinicalpicture is often quite indefinite, and the conditionmay exist for some time before it is recognised ; thetreatment is surgical.

ARTHUR G. PHEAR, M.D. Camb., F.R.C.P. Lond.,Physician, Royal Free Hospital, London.

Special Articles.KING EDWARD’S HOSPITAL FUND FOR

LONDON.

THE Prince of Wales presided at a special meetingof the President and General Council of King Edward’s sHospital Fund for London at St. James’s Palace onJuly 25th.Lord Stuart of Wortley, chairman of the Manage-

ment Committee, presented a report on the recoiiinien-dations of the Ambulance Cases Disposal Committeedealing with the need for additional voluntaryhospital accommodation, the inquiry now beingconducted by the Voluntary Hospitals Commission;and the bequests of the late Mr. and Mrs. Wells.Recommendations of the Ambzclance Cases Disposal

Committee.The Management Committee asked the views of

the Distribution Committee on the recommendation-That King Edward’s Hospital Fund, in making its

annual grants, should take into consideration whetherhospitals which deal with cases of accident or sudden illnessoccurring in streets or public places provide (a) a reasonablysufficient number of beds for such cases, (b) a reasonably:sufficient number of observation beds or beds attached tot’ve casualty department, in order to avoid, as far as possible,transfer to another institution of any patient whose con-dition might be likely to be prejudiced by such transfer.

The Distribution Committee have expressed theirwillingness to carry out this recommendation andhave asked the hospitals for particulars of their

available bed accommodation under these heads, andfor their views as to its adequacy. The AmbulanceCases Disposal Committee, in their report, referred tothe fact that most of the cases of alleged unnecessaryor injurious transfer of patients had been reportedfrom Lambeth. They associated this fact with thegeneral shortage of voluntary hospital beds in SouthLondon, where King’s College Hospital has only beenable, since the war, to keep open 226 beds for ordinarypatients out of 388 provided in 1913 for the specificpurpose of reducing that shortage. The opinionexpressed by the Ambulance Cases Disposal Committeein March was strengthened in April by the occurrenceof two further cases of transfer from King’s CollegeHospital for want of beds. The Distribution Com-mittee are accordingly paying special attention to thequestion of the supply of beds for accident cases inSouth London, and particularly at King’s CollegeHospital. The Management Committee invited theobservations of the police and ambulance authoritieson the recommendation-

(a) That it be represented to the police and ambulanceauthorities that no institution which is not equipped for thereception and treatment of serious cases of accident or illnessshould be retained on the list of institutions to whichambulance cases should in the first instance be taken.

(b) That it be suggested to the authorities that in drawingup the list of such institutions the cooperation of theMinistry of Health be sought in the case of infirmaries, andof King Edward’s Hospital Fund in the case of hospitals.

It will be noticed that this recommendation dealsprimarily with the provision of emergency treatmentin the first instance, as distinct from the provision ofbeds, which is dealt with in the previous recommenda-tion. The London County Council has concurred inboth parts of the latter recommendation and hasgiven directions for them to be carried into effect bythe London Ambulance Service.The Management Committee also considered a

recommendation-That it be represented to the Ministry of Health that in

the case of street accidents or sudden illness brought toPoor-law institutions (including " removals " from thecasualty department of a voluntary hospital) : (a) noquestion of residence of the patient, or site of the accident,or site of the transferring hospital, should be raised priorto reception and treatment ; (b) no such cases should betransferred to another institution if their condition might belikely to be prejudiced by such transfer ; (c) the charge fortreatment of such cases should be a common metropolitanone, and not fall on the union receiving and treating suchpatients ; (d) such patients should not be subject to anydisability arising out of technical pauperisation as theresult of their reception and treatment.

These changes would remove certain difficultieswhich now sometimes prevent an accident case frombeing taken to the infirmary which lies nearest.The Management Committee addressed a letter to

the Ministry of Health, urging upon his considerationtheir view that these proposals should be the subjectof early legislation or administrative action. In doingso, they drew the Minister’s attention to a resolutionpassed on May 29th by a conference of representativesof Metropolitan Poor-law Boards of Guardians,endorsing generally the conclusions and recommenda-tions of the Ambulance Cases Disposal Committee.11 eed for Addit’ional V ol1.mtary Hospital Accommoda-

tion and the 7’Hq’M hy the VoluntaryHospitals Commission.

The Voluntary Hospitals Commission have beenasked by the Minister of Health to make an inquiryinto the extent of the additional voluntary hospitalaccommodation required in England and Wales andthe best means of providing and maintaining it.The Commission have requested the King’s Fund, asVoluntary Hospitals Committee for London, to issuea questionnaire to the hospitals of London, and totransmit the replies to the Commission with a generalcovering report. The report will be prepared by theManagement Committee with the assistance of theDistribution and Hospital Economy Committees. Itwas already known to the King’s Fund that numerous

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schemes of extension or improvement, unavoidablypostponed during the war and the subsequent financialcrisis, had been and were being taken up by thehospitals themselves. Several have been completed,others are in hand, and others again have been passedby the King’s Fund with a view to early action. Thenumber of beds available at the hospitals on the booksof the King’s Fund has increased from 11,800 in 1913to 13,400 in 1924, and the schemes now in hand orproposed would add another 1000 beds. During thelast three years the hospitals of London, besidesincreasing their income from 2,4=30,000 to z2,850,000,adding jS991,000 to their endowments, and obtainingmore than 2100,000 through the combined appeal,have received about z1,100,000 for extensions andimprovements. A large sum is, however, still requiredto meet the capital expenditure on these schemes.The grants from the King’s Fund in aid of such schemeswere reduced to a minimum in 1921, and, althoughthey have been again increased in subsequent years,they do not yet amount to the same proportion of thecapital cost of the schemes, or of the total distributionby the Fund, as they did before the war. Additionalincome will also be required for the maintenance ofthe increased number of beds.

Beq’l.Ú:st8 of the late Jfr. and 1Ylr8. Wells.The Management Committee have had before them

for some time the question whether the Iiing’s Fundcould take definite action to help the hospitals to meetthese needs. It so happened that in February last,just when the Ambulance Cases Disposal Committeewas considering the connexion between the lack ofsufficient accident beds and the general question of theshortage of hospital beds, particularly in SouthLondon, the King’s Fund was notified that a large sum,estimated at more than .6200,000, would shortly bereceived under the wills of the late Mr. and Mrs. Wells.The custom of the General Council, in dealing withlegacies which it has power to spend, has usually beento invest part and distribute part. It would thus beconsistent with previous policy if the King’s Fund,having recently invested more than .61,100,000 fromthe bequests of Lord Mount-Stephen and Sir ThomasSutherland, were to include the Wells legacies ofjB200,000 in the estimates of the amount available fordistribution if required. This is specially the casewhen, as at present, the hospitals are faced with variousexceptional needs, such as those mentioned above.The Management Committee accordingly consultedthe Distribution Committee as to the best method inwhich, should the General Council approve, the Wellslegacies could be used for this purpose, and havereceived from them the following statement :-

(i.) The Distribution Committee cordially support thesuggestion that the Wells legacies should be used to assistthe hospitals to meet special needs.

(ii.) The Distribution Committee are of opinion that thefollowing method of applying the legacies, in whole or inpart, could usefully be considered : (a) Assistance in theprovision of additional hospital accommodation, includingaccommodation for accident cases, by grants towardscapital expenditure on schemes of extension, or towards thereduction of deficits on schemes that have been completed,or towards the opening of beds in extensions that havealready been provided but are not yet available for thepatients for whom they were intended ; (b) assistancetowards schemes of improvement as distinct from schemesof extension ; (c) increased grants to maintenance, includingthe maintenance of additional beds.

(iii.) In connexion with the provision of additionalaccommodation, including accommodation for accidentcases, the Distribution Committee consider that there is

urgent need for a further step towards the completion ofthe full service of King’s College Hospital, where 162 of the388 beds provided in 1913 by the removal to DenmarkHill are still not available to meet the shortage of bedsin South London.

(iv.) The Distribution Committee think that, when theyare preparing proposals for the application of these excep-tional legacies, they will sometimes find it desirable thatdefinite conditions should be attached to the grants-e.g.,a condition that beds should be opened, or that beds shouldbe reserved for accident cases, or that a scheme should beput in hand at once. or that the balance required, or a

specified part thereof, should be raised. In some instancesit would be an advantage that the Committee should be ina position to make a definite arrangement in advance withthe hospital concerned. In suitable cases the exceptionalgrants might be used in this way to stimulate fresh activityon the part of hospitals.

(v.) Under the scheme outlined above, the whole amountwould not be distributed at once. For example, grants forthe opening of beds would be spread over a period of years ;grants in aid of extensions and improvements need not bewholly confined to schemes already submitted ; and partof the sum received from the legacies might be retained forthe present in case new needs should arise.

In conclusion, the Management Committee approvegenerally of the proposals contained in the report.Lord Stuart, in moving the adoption of the recom-

mendations, said that the replies to the interrogationsissued at the request of the Hospitals Commissiongave evidence of the care which the hospitals weregiving to the answers. Lord Revelstoke, honorarytreasurer and chairman of the Finance Committee,seconded the proposal and was supported by SirCooper Perry, chairman of the Distribution Committee,and Sir William Collins, chairman of the AmbulanceDisposal Committee. The motion was carriedunanimously.The Prince of Wales, after reading a letter from the

King in which His Majesty endorsed the action of theManagement Committee and expressed his gratificationthat the Fund should be in a position to afford atthe present time special assistance to the voluntaryhospitals, continued :-

" I wonder if there is anyone who still thinks the voluntaryhospital system is dead, or dying. If so, let him look at thefacts and figures before us to-day. Even in 1920, when thecrisis was at its worst, the hospitals of London had anincome of or2,400,000 as against z1,500,000 before the war.Since 1920 their income has increased to z2,850,000,without counting any of the z6400,000 raised by the CombinedAppeal ; jB990,000 has been added to their endowments ;and .81,100,000 has been received for extensions and improve-ments. This means that, over and above their annual income,which last year was nearly twice what it was before thewar, the voluntary hospitals, in London alone, have receivedin three years two and a half millions for special purposes.And this does not include the additions, during this sameperiod, to the investments of the King’s Fund itself. Then,again, there are 1600 more beds than there were before thewar, and the extension schemes now in hand, or proposed,would add another 1000. This is not decay or death.It is life-and very vigorous life. More than that, it isgrowth. The hospitals are not satisfied with merely makingboth ends meet-difficult as that seemed a short while ago.They are constantly expanding in response to the ever-

growing need for better equipment and more beds. Evenduring the crisis they never quite stopped doing this.Extensions and improvements, like so many other goodthings, were delayed by the war, but they still went on hereand there. After the war new schemes came with a rush;so much so that the King’s Fund had sometimes to act,much against its will, as a restraining force ; taking theview that, except in specially urgent cases, the maintenanceof the hospitals, as a whole, must have precedence overappeals for capital expenditure in any particular instance.The distribution of the surplus funds of the Red CrossSociety and the Order of St. John, through the King’s Fund,helped a large number of schemes. Nevertheless, a goodmany had still to be postponed.But gradually the position has changed. With the aid

of the temporary Government grants and the CombinedAppeal, most of the deficits are paid off. Income of allkinds, voluntary contributions, patients’ payments andworkmen’s collections, the ordinary distribution of theKing’s Fund, all are increasing. There are, unfortunately,some institutions still in grave financial difficulties. Andthe hospitals are all faced with the increased expenseinvolved in new methods of medical diagnosis and treatment.But, taken as a whole, they have been able to turn theirattention more and more to extension. The King’s Fundlast December increased its grants in aid of schemes. Thepublic, which by its gifts helped to save the hospitals in 1922,is now, with equal generosity, supporting their new ventures.More than one large appeal for special objects, such asendowment, reconstruction or extension, has in recentmonths been conspicuously successful."

Continuing, the Prince said now that the Councilhad approved the general principle, the DistributionCommittee could prepare plans for the actual use ofthe money. They had already collected a good deal of

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information about the most urgent needs of the 1hospitals. One of these, the need for additional Iaccident beds, especially in South London, had beenbrought before the public more than once in recentmonths, and it was gratifying to hear from Sir CooperPerry that the decision of the King’s Fund wouldenable immediate action to be taken to meet that need.The Distribution Committee had also before them along list of schemes of extension and improvement,and there were other special needs. The King’s Fundwas making its special contribution to the forwardmovement, but it could not be, and did not want tobe, a substitute for that individual interest andindividual effort which, under the voluntary system,was the source of life to the individual hospital. TheKing’s Fund had its own particular function. It wasconcerned with the needs of London as a whole, andwith the relative needs of the different districts. Ithad exceptional means of comparing the circumstancesof the various hospitals. And where a donor ora testator was not specially interested in any oneinstitution, but desired to benefit the hospitals ofLondon generally, or to have his gift distributed inproportion to needs, he could, if he so wished, availhimself of the facilities of the King’s Fund.The meeting closed by a vote of thanks to the Prince

of Wales, moved by Lady Ampthill and seconded bythe Chief Rabbi, which His Royal Highness brieflyacknowledged.

THE NUTRITION OF MINERS AND THEIRFAMILIES.

IN the autumn of 1922 considerable public attentionwas directed to the state of affairs in the coal-miningindustry. For various reasons of economic sort theprosperity of persons employed in this industry wasgreatly depressed, and it was freely stated that theavailable income of families dependent upon the minesfor subsistence was insufficient to provide the baremeans of life. Questions were asked in the House ofCommons, but no detailed evidence as to the precisedomestic circumstances of the miners’ families wasavailable. The Committee on Quantitative Problemsof Human Nutrition appointed by the MedicalResearch Council decided, with the financial supportof the Department of Mines, to investigate the matter,and the result of this investigation has now beenpublished. 1The food requirements of man are first set out and a

provisional assessment is made of the needs of thecoal-miner. The study of family budgets forms thenext section of the report, with an account of themethod of inquiry pursued by the Committee. Acritical discussion follows, and then a tabular state-ment of the height and weights of the children ofminers. Finally, certain general conclusions are reachedwhich are set out below in the words of the Conxmittee:

Gencral Conclusions.The material upon which this report is based is too scanty

to authorise any sweeping conclusions, but is, in our opinion,so accurately compiled that a high degree of probabilityattaches to some inferences, but before noting them thefollowing points must be borne in mind and any conclusionsmust be interpreted in their light.

(a) Many of the families investigated were burdened bydebt, the aftermath of the strike, and therefore a wage, which Imight have been sufficient to provide an adequate supplyof food, was so reduced as to make living difficult.

(b) In some of the families, at least, the amount of moneyallowed to the wife, for the purchase of food and the house-hold expenses generally, bore no relation to the wage earned,and it is not known in these cases exactly how much wasactually earned.

(c) It must again be emphasised that, when comparisonsare made between the physical condition of the miners’children and those of the general average for the county

1 Reports of the Committee upon Quantitative Problems inHuman Nutrition. Report on the Nutrition of Miners and theirFamilies. Special Report Series, No. 87, Medical ResearchCouncil. London : H.M. Stationery Office. 1924. Pp. 59.1s. 3d.

area, the numbers of miners’ children studied were very small.In some groups the numbers for comparison were as lowas two. Another point in this connexion on which we haveno direct evidence is whether or not there is any hereditarydifference as regards physical condition between the averagemining class and the average population of the areas

investigated.Subject, then, to these limitations we conclude :—

1. That during the period of observation (December, 1922,to March,1923) the average consumption of food in one district,Derbyshire, was sufficient to maintain healthy existence,and, in that district, the children of the miners whose familydiets were studied differed in respect of height and weightin no significant way from the average of the whole county.

2. That the diets of the four other districts, and in particularof the Durham area, if the energy requirements in theseareas be comparable with those of Derbyshire, fell somewhatbelow the standard generally accepted as satisfactory. InDurham the children measured were in respect of weightslightly below the county average.

3. That quite apart from differences of income there arevariations of diet from district to district and within eachdistrict which suggest that housewives could be helpedto secure a more adequate return for their expenditure bya better dissemination of knowledge both of the economicand hygienic aspects of diet. There is evidence that in thedistricts where bread is baked at home the diets are moresatisfactory.

4. The absence of a definite correlation between theweights of the children and the calorie intake seems to indicatethat factors other than diet, so far as examined in this report,influence the state of nutrition of these children.

5. That there is evidence which would suggest that thediets of families of which the mother had had training indomestic service are better than the average, but the evidenceis not conclusive.

The personnel of the Committee upon QuantitativeProblems in Human Nutrition responsible for thisreport is as follows : Prof. E. P. Cathcart, M.D., F.R.S.(chairman), Dr. Major Greenwood, Dr. LeonardHill, F.R.S., Dr. A. W. J. MacFadden, Sir ThomasMiddleton, Prof. D. Noel Paton, M.D., F.R.S., andProf. T. B. Wood, F.R.S.

In tending their report, the Committee expresscordial thanks to various medical officers of healthwho collaborated with them in this inquiry, and alsohigh appreciation of the work of the field investigators.It is evident that there has been a close and harmoniouscooperation between these workers and the staffs ofpublic health departments, which is of happy auguryfor the success of other investigations which it maybe found desirable to undertake in the future.

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

The Medical Register and the Irish Free State.THE Government of the Irish Free State has taken

an important step to avoid the difficulties which hadarisen in regard to the admission to the MedicalRegister of licentiates and graduates educated in theFree State. A Bill has been introduced, and rapidlypassed through the Dail, authorising the GeneralCouncil established under the Medical Acts tocontinue temporarily to exercise jurisdiction andauthority under those Acts in respect of medicalpractitioners in the Free State. The Bill sets out thatthe General Council and the Branch Council are tohave the same authority, and medical practitionersin the Free State the same rights, privileges, andimmunities, and be subject to the same obligations asprior to the establishment of the Free State. TheGeneral Council and the Branch Council are tocontinue to be nominated, chosen, and elected in thesame manner as heretofore. The Medical Acts areto continue to have effect in the Free State. Theduration of the Act is one year from the date of itspassing. The Bill passed rapidly through the Dailand has passed its second reading in the Senatewithout serious opposition. It is understood that,during the year’s grace which this Bill will allow, thewhole question will be thoroughly studied, and thatthe Government will then, after consultation with themedical profession, promote considered legislation.