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while confessing that he had always been fond ofusing his hands from his earliest years, he remindedthe audience that " a gentle touch comes from theheart rather than from the hands, a touch inspiredby a true sympathy with the patient’s tissue-inthis way only could a man attain the hand of asurgeon." The President then expressed his pleasurein accepting the bronze cast in the name of theLiverpool Medical Institution, and thanked Mr.Jeans most sincerely for his very acceptable gift.All our readers will acknowledge the fitness of theretention in the Liverpool Medical Institution of apermanent memorial of the work of Mr. Paul. Not onlyis he a great as well as a skilful surgeon, but he wasone of the founders of the Liverpool Medical School,and from its earliest days his work has contributedto the building up of the great tradition of thatschool. ____

THE NEEDS OF UNIVERSITY COLLEGEHOSPITAL.

DEVELOPMENT has its embarrassing side for those ’’

who have to find money for the upkeep of their greatpossessions. University College Hospital offers a casein point, and clearly its income must increase to meetexpenditure if the hospital is to make the most of itsnew good fortune. The Rockefeller Foundation’sgrant of Bl,205,000 for the erection of more buildingsand the equipment of research does not affect theordinary income except in so far as it will make foreconomical working, and, unfortunately, the annualdeficit remained at about j611,000 last year. Doubtlessmany subscriptions have been diverted into the fundfor endowing 60 beds in the new maternity block whichthe Prince of Wales is to open on May 28th ; 180,000has been collected for this purpose. The expenses ofthis collection, it is satisfactory to note, were verysmall indeed, and the interest earned on the earliercontributions more than covered the whole cost." We did not advertise for money," says Sir ErnestHatch, the chairman, " we went and fetched it."Besides these maternity wards, now so well pro-vided for, there is a new nurses’ home and medicalofficers’ quarters in Huntley-street, which is alreadycomplete, and the Royal Ear Hospital, which is to beready for use very soon, thanks largely to a gift of65,000 from Mr. Geoffrey Duveen, a member of thecommittee. The hospital’s existing accommodationhad become more and more inadequate, but all theseextensions will furnish 202 additional beds. Mostof them have been furnished indirectly out of theAmerican grant, but the Rockefeller Foundationrightly considers it no part of its work to care for thesick poor, except by research and medical education.London, therefore, must see to it that the fullest usecan be made of what has been provided, and there willbe a ready response to the quiet and inexpensiveappeal which is being launched. Another .615,000a year is needed to bring the ordinary income up toa more satisfactory level, and the fact that a greatfuture is obviously in store for the hospital shouldensure that this sum is found.

CHEWING-GUM AFTER TONSILLECTOMY.

IN a recent number of the Therape1Ûic Gazette(Feb. 15th, 1926), Dr. William H. Spencer, of Phil-adelphia, draws a somewhat lurid picture of the septiccondition of the throat after tonsillectomy, and ofthe systemic absorption of toxins from the " putre-fying mass" which covers the wounds. He is scornfulon the subject of gargles, though he does not mentionthe probability that they do not reach the tonsillarfossse at all, and it would seem that he has noexperience of spraying or syringing the throat in thiscondition. But he is an enthusiastic advocate of the iuse of chewing-gum after operation, and states that" the throats of tonsillectomised individuals usingchewing-gum as an after-treatment do not becomeinfected. Secondary haemorrhage is less frequent."(It is very rare in any case.) " Healing is more rapid.

A full diet being taken, resistance of the individual ismaintained, little or no weight is lost, and no post-tonsillectomy recuperation period is needed." " Chew-ing stimulates the secretion of saliva, which, beingswallowed, laves constantly the wounded surfacesand lubricates the pharyngeal mucosa. The attrition ofswallowing keeps down the membrane formation to aminimum, so that the usual white patches covering thetonsillar fossae, which have often been mistaken fordiphtheric membranes, are in some cases entirelyabsent." Patients might not take so kindly to thismethod here as in a country where they are already usedto it; in the United States, according to Dr. Spencer,"so universal is the habit that it can be chewed inpublic without attracting the slightest attention."Nevertheless, surgeons here who are not satisfied withtheir patients’ convalescence under the usual methods,may like to try this form of after-treatment, which is,at any rate, simple and harmless.

LONDON UNIVERSITY.

THE long expected report! of the DepartmentalCommittee of the University of London appears bya curious coincidence a few days before the surrenderof the promised Bloomsbury site. For it seems

certain that next week the conditional offer of thissite to the University for its central buildings willlapse definitely and its value be claimed by theChancellor of the Exchequer. The event mighthave passed unnoticed had it not been for a demon-stration of students who last week beat the boundsof what was to have been their home on the same dayas a petition signed by over 4400 students and teacherswas handed to the Prime Minister, asking the Govern-ment that all should not be surrendered and thatpart of the site should be reserved for residentialquarters and a students’ Union. Even if no promisehas actually been broken, the students may be rightin claiming that the engagement ring should not bereturned ; and they may take comfort f om the wordsof the Departmental Committee, which states that,wherever the central offices of the University are tobe located, the creation of a strong University Unionis eminently desirable and is a proper charge on thefunds of the University. The report of the Depart-mental Committee differs from the Final Report ofthe Royal Commission of 1910, issued in 1913, andof the Haldane Commission of 1909, in being a readabledocument of 52 pages with 5 pages summarising itsrecommendations. The report makes no attempt topresent a record of the development of the University,nor to discuss in detail its aims or constitution.The Committee frankly regards it as impracticableto give effect to some of the major recommendationsof the Haldane Commission. It has been concernedto devise an immediately practicable scheme forbetter government and organisation, evolutionaryrather than revolutionary, and yet embodying theessentials of a university in a great centre of popula-tion. The fear raised by the Haldane Report of anattack on the system of degree examinations forexternal students is found to be groundless. In theevidence laid before the Committee no responsiblebody claimed the abolition of these degrees andnone of the Committee’s recommendations is designedto restrict the present facilities available for ex-ternal students. The Committee refuses to emphasisethe distinction between external and internal sidesof the work of the University, provided that theauthority of the teachers and of the teaching institu-tions on the academic side is safeguarded. As timegoes on it assumes that internal graduate memberswill gradually outnumber the external graduatemembers, so that the organisation of the externalside will become increasingly dependent upon thesupport of internal graduates. The Committeerecommends no further extension of incorporation

1 Board of Education: Report of the Departmental Com-mittee of the University of London. Cmd. 2612. 1926.H.M. Stationery Office. 1s. 3d.

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which is now not regarded as an effective instrumentfor securing financial and educational control. Ithas been influenced largely by the difficulties whichhave had to be surmounted in the case of the medicalschools and of the Impeiial College at SouthKensington. No plan of separating the schools fromtheir parent hospitals or of selecting from among the12 general medical schools three which should qualifyfor incorporation has been evolved satisfactorily.Nevertheless, in the meantime the closer inter-relationof these schools, along with the aid of the UniversityGrants Committee, has enabled six of them to organiseunits and to qualify for University chairs in clinicalsubjects. Some of the advantages to be hoped forfrom incorporation have thus been achieved withoutit. But the system of direct Government grants fromthe Treasury to unincorporated schools is condemnedby the Committee, which regards such a course asindefensible and inconsistent with any form ofUniversity government ; and one of its main proposalsis to set up a University Council to determine theallocation of funds for the execution of Universitypolicy. The proposed constitution of this Council andof a reorganised Senate and of the five standingcommittees of the Senate are set out clearly in thesummary of recommendations. No one who reads Ithe report can fail to appreciate the spirit in which Ithe Committee, under the chairmanship of Mr. E.

I

Hilton Young, which included in its number Dr.H. L. Eason, has done its work, and all those who feelstrongly the dangers of interfering with the delicateworks of a going concern may breathe more freely.

CONGENITAL DEFECT OF ARMS.

THE wonderful results which may be achieved withvery small means are in no cases more striking thanin those of congenital defect of the limbs. In the caseof the lower extremity, persons suffering from defectof the legs have ridden on horseback across country,and of this A. M. Kavanagh, the well-known sports-man and politician, who had neither hands nor feet,was a striking example. Numerous cases of con-

genital defect, or very early loss of the upper limbs,are on record in which the sufferers have made theirfeet do duty for hands with an astonishing degreeof success. The celebrated Miss Biffen earned a nichein the temple of fame of the Dictionary of NationalBiography, and there have been painters on thecontinent who defied the disadvantages of theirbirth and achieved a large measure of technicalsuccess. Only two years ago a young man namedElroy, whose arms had both been amputated at theshoulder-joints in infancy, exhibited the wonderfuladaptation of his feet, with which he achieved variousdifficult tasks, as well as performing nearly all theoffices of daily life for which the hands are normallyused. He used no artificial help, yet he possessedno muscle and carried out no coordinated movementsof which the normal infant does not possess thepotentiality. In cases of congenital defect of the armit is generally found that, however small the rudimentsof the upper extremity may be, its owner can domore with the bare stump or stumps than he coulddo with the most ingenious and well-fitting prosthesis.Hitherto surgery has been able to do little for suchcases which it has seemed best to leave to their ownwits and persevering energy and to the education ofexperience.

Recently, however, Dr. Harry E. Mock, of Chicago,has reported in the Journal of the Amer’1.can kledicalAssociation (Feb. 20th, 1926) a case of congenitaldefect of both arms and talipes equino-varus anddefect of toes in both feet, upon which he operatedin 1920. Before operation the patient, who was mani-fest,ly very intelligent and had the will to persevere,had been able to do a number of things for himself,by using his feet, despite the absence of all digits,except a short great toe on the one foot and a longone on the other. It may here be noted that thedeformity of varus of a moderate degree is rather anadvantage than a drawback when the foot is to be

used in lieu of a hand. Moreover, this boy was ableto do a surprising number of things by opposition ofhis right shoulder and cheek. Between them he couldgrasp and use a pencil and even a small saw, andwith them he learnt to seize and turn a door handle.The boy at the age of 12 could draw, write, carvewood, and weave rugs, besides washing himself andcleaning his teeth with the help of his feet. Yet hewas not content to remain so unlike other boys andearnestly desired to be able to wear artificial arms.and hands, if it were only for the sake of appearances.Finding from the inspection of radiographs that therewas a rudimentary stump of each humerus concealedbeneath the skin of the chest, although there were naaxillae, Dr. Mock decided to make use of these. Byexcellently planned and skilfully carried out operations.he succeeded in freeing the rudimentary humeri andclothing them in muscle and skin, despite the factthat there was grave muscular defect. The boygradually learned to move the stumps, and the resultfive years later is interesting as showing the connexion , sbetween function and development. The upper endsof the humeri and the glenoid fossee, which beforeoperation were only rudimentary, have now developedgreatly after five years of exercise, and the boy isable to wear artificial arms and hands which he finds.of considerable use.The lessons to be learnt from this case are : first,

that no matter how unpromising the condition, thereis always a chance of benefit following well-thought-out and skilful surgical interference ; secondly, thatthere is no knowing what development of the growing-organism may follow on restored or new functions;and thirdly-and this is the most important of all-that as in war so in prosthetics the moral is to thephysical as at least three to one. Dr. Mock does notspecify the kind of artificial arm which was providedfor his patient, and information on this part ofthe subject would be of considerable interest. Theexperience of those who had to do with the provisionof arm prostheses during and after the war was mostdisappointing. It was found that in their daily lifepensioners used even the.most ingenious arms verylittle, if at all, and that only in the case of doubleamputation were they really useful except for roughwork. Some of the most striking successes in the use-of artificial arms have been achieved with very simpleappliances. It is to be remembered, however, that.the possibilities of usefulness of stumps are far less.for the adult who finds himself suddenly mutilatedthan for the congenital case, whose growing organismdevelops in adaptation to its environment. In allcases, however, intelligence, the will to succeed, andwhat is colloquially known as grit, are the mostvaluable compensations to the congenital arm-cripple.

THE Rt. Hon. T. R. Ferens, of Hull, who recentlygave 2d0,000 to the University of Hull, has now given.220,000 to found an institute for diseases of the ear,nose, and throat in connexion with the MiddlesexHospital. ____

’

THE Home Secretary gives notice that it is proposedto apply for an Order of the King in Council in pur-suance of Section 8 (2) of the Dangerous Drugs Act,1920, declaring that Part III. of that Act shall applyto veronal and the other drugs of the barbitone groupin the same manner as it applies to the drugs-mentioned in Subsection (1) of Section 8 (morphine,cocaine, &c.), and in pursuance of Section 7 of theAct to make regulations limiting the supply of thedrugs to authorised persons or institutions or to

persons for whom the drugs have been prescribed bya duly qualified medical practitioner.

THE Oxford University Press will shortly publishan illustrated monograph by Dr. Jamieson B. Hurry,entitled " Imhotep. the Vizier and Physician to King Zoserand afterwards the Egyptian God of Medicine." Imhotepor I-em-Hete was one of the earliest of known physicians’and was recently the subject of an annotation in our columnsTHE LANCET, 1925, ii., 821). 4,