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This aspect of the problem is the theme for a recentessay by Dr. ARTHUR EASTWOOD, published by theMinistry of Health. 1 In reviewing the existing workhe is considerably attracted by the old hypothesisof BAIL, that in its growth in the body the bacteriumproduces a special form of toxin, named by itsdiscoverer " aggressin," which enables it to establishitself and to successfully overcome the forces ofresistance. The fundamental experiment of BAILconsisted in inoculating a culture of an organisminto one of the serous cavities of an animal. After acertain incubation period the resulting effusion waswithdrawn and freed from organisms ; it was thenfound that the sterile fluid, although in itselfrelatively non-toxic, had the power of so raising thepotency of a culture that a dose of the latter, ordinarilynon-fatal, became easily lethal when mixed with thisfluid. Further, the " aggressin," as the activeprinciple of the fluid was called, had the capacityof exciting immunity when injected alone ; so thatfrom the point of view of these experiments theproblem of immunity became one of reaction between Iaggression and antibody called forth in response to iits presence. The objection to BAIL’S theory has always been that the highly complex materialwhich contained his aggressin contained also bothendo- and exo-toxins from the organisms injected, aswell as protein degradation products, and that theresults, far from being due to a single substance, weredue to a verv varied mixture of substances. Theaggression theory has lain on the shelf, littledisturbed, for a number of years now. Interest hasrecently been revived by an account of somewhatsimilarly acting bodies which ZINSSER has obtainedin vitro. Dr. EASTWOOD thoroughly surveys the workin this field, and although he has an evident likingfor the hypothesis we have discussed, he concludesthat its truth has not been definitely proven. Hegives us a most interesting discourse upon virulence,but at the end we are still left wondering what it isthat makes an organism pathogenic.

THE SPECIAL COURT OF INQUIRY.LAST week, as every one knows, the Panel Con-

ference took the bold and straightforward course of (accepting a Special Court of Inquiry to determinethe amount of the capitation fee to be paid nextyear. The decision to do so, although it was notreached until after a critical debate, was in the endunanimous. During debate it was pointed out withjustice that a voluntary association cannot keep upinterminably a fierce struggle, that a Court of Inquirywould give unlimited opportunity for mud throwingat the panel service, and that an award of less thanthe Minister of Health’s offer would spell irretrievabledisaster. But the argument as put from the chairappealed irresistibly to the Conference : If your caseis really very sound, go for the Court of Inquiry andhave it settled properly. The fact was recognisedby this resolution that no organisation can affordto act illogically. What, indeed, is the purpose oforganisation except to stand out for just rights ?

Criticism of the panel service by friendly societyofficials must be met somewhere, within or withoutParliament, and the campaign of propaganda (it hasbeen called " impropaganda ") has already been setgoing by circulars to insured persons. A SpecialCourt of Inquiry is indeed in another form the arbitra-tion which was repeatedly asked for by the panelexecutive and refused by the Minister-or so it mustbe regarded by the thinking public whose sympathy itis essential for the doctors to retain. This is the

simple train of thought which led to the decision,and it is unnecessary for us to report further thestages by which it was reached.The political situation will not materially affect

1 Reports on Public Health and Medical Subjects, No. 22.Bacteriological Studies: 1. "Factors Determining BacterialVirulence." H.M. Stationery Office.

the Court of Inquiry. As our Parliamentary corre-spondent tells us, the Minister of Health had alreadyissued invitations to possible members of the courtbefore Parliament was prorogued. The court is tobe composed of three or five persons of the type ofthose who arbitrated in 1920, and there is no reasonto doubt their impartiality. The actual terms ofreference have not yet been drafted, but the courtwill be asked what would be the proper capitationfee to be paid to insurance practitioners for theirservices as from Jan. lst next on the basis of theexisting terms of service, with the modificationsresulting from the negotiations of this summer.

The Minister has let it be known that it will be opento all parties to appear before the court, and thatthe approved societies, " who represent to a verylarge extent the insured population," will have thefullest rights to state their views. The court, how-ever, will only be competent to consider such evidenceas will assist it to decide what the service as abovedefined is in fact worth ; wider questions of policywill remain to be dealt with by the Royal Commis-sion. It will be therefore foi the Commission andnot for the Court of Inquiry to consider such ques-tions as those raised by the National Medical Unionin a circular, of which a copy has been sent to us,entitled " The National Health Insurance Act fromthe point of view of the Non-Panel Doctor." TheUnion is of opinion that, as long as human natureremains what it is, contract practice of any kind willbe thoroughly unsafe and bad, for the reason that itinevitably means a maximum of profit for a minimumof work. The Act has, it is stated, actually increasedthe poverty of those who through frequent illnessare reduced to a chronic state of distress, withoutrelieving their ill-health. Anyhow, the loss of

independence and self-respect, alleged to be inducedby the Act among both insured people and thedoctors who attend them, more than counterbalancesthe relief afforded. Furthermore, the Act providesmen of inferior ability and qualifications with a

comparatively quick method of obtaining a liveli-hood, and until the medical benefit portion of theAct is remodelled or erased, the quality of medicalpractice will continue to deteriorate and the healthof the people will suffer. This is the consideredopinion of a responsible group of general practitioners,and it would surely be impossible even for approvedsociety officials to state a case with more vigour.But the Union is not against the principle of nationalinsurance as such, and believes that a solution maybe found in a system of unfettered private practiceunder a contributory scheme by which the insurancepool would be used for payment of medical bills.The work of the Court of Inquiry will be done whenthe total amount of money to be distributed amongthe doctors engaged in insurance practice has beendetermined. It will remain as heretofore largely forthe doctors themselves to determine the method ofdistributing the pool. Those, however, who are bestqualified to judge see little evidence during the lastten years in support of the assumption that contractmedical practice has deteriorated, while vital statisticsrefute the suggestion that the health of the peopleduring that period has suffered.

MEDICINE AND LITERATURE.AT the Royal College of Physicians of London on

Nov. 20th Mr. EDMUND GOSSE, LL.D., delivered thefirst David Lloyd Roberts Lecture, taking as hissubject Personal Relations Between Medicine andLiterature. Sir HUMPHRY ROLLESTON, who presided,referred to the occasion as unique not only becausethat was the first lecture under the David LloydRoberts Bequest, but also because the College hadnever before had the honour of sharing a lecturein common with the Medical Society of London andthe Royal Society of Medicine. He recalled thecircumstances of the founding of the lectureship, andclaimed credit for the choice of the first lecturer.

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Mr. GOSSE described himself as not personallyacquainted with Dr. LLOYD ROBERTS, and thereforeas dependent for his impressions of the latter on thereports of others, chief among whom were Dr. W. E.FOTHERGILL and Dr. HERBERT SPENCER. He under-stood that Dr. LLOYD ROBERTS, although reticent asto his exact age, was at least 85 when he died in 1920.He was a self-made man, who, like KEATS and IBSEN,received his first impressions among the gallipots ofan apothecary; he retained throughout his life a

certain roughness of temper. Mr. GossE went onto say that they were met not because Dr. ROBERTSwas a great gynaecologist, but because he frequentedbookshops as a collector in the best sense of theword. He himself was anxious to approach hissubject in the spirit which Dr. ROBERTS would havewished ; in his own first youth he had had theambition to be a surgeon, and although constitutionallyunfitted for the career had proceeded a little way init. Passing to what history offered in testimony ofthe relation between the professions of medicine and literature, Mr. GossE said he wished to separate thetwo groups, usually joined, of men who had givenliterary form to their medical writings, and of menwho had written prose and poetry apart from theirprofession. The greatest of ancient physicians wereconscious of literary form ; AMBROISE PARE hadnoticed that HIPPOCRATES took care to write simplyand clearly, apparently that women and girls shouldbe able to understand his meaning. Phoebus Apollo,destroyer and healer, was god of medicine as well aspresident of Parnassus. There was no need to recallthe fact that the author of the " Religio Medici "was a man of letters. Salerno, celebrated for itssalubrity of climate, had formed the nucleus of medicaleducation in the early Middle Ages. Little though weknew of this school, it was a shining lamp amid thedarkness of the ninth century; when all othereducation was crushed into ecclesiastical form,the school of Salerno held to sanity amid priest-ridden superstition and ignorance. The professors ofSalerno wrote in clear language, using no inflatedjargon of the other schools ; he liked to think that some-thing of the Greek spirit remained with them-thatthey cared for the humanities as well as for humanity.

Tracing the apparent influence of the Salernianson later medical literature, Mr. GossE expressedhimself as unable in the short time at his disposalto deal with RABELAIS and MONTAIGNE, but hopedthat some successor would expatiate in those direc-tions. PARE first dared to address the ordinaryreader in the latter’s own language, although hisfellow physicians tried to suppress his works onthe ground that their terms were intelligible outsidethe profession. Early in the seventeenth century thewritings of PARE were translated into English ; SirTHOMAS BROWNE then began to compose the " ReligioMedici "-the earliest work in which the harmonybetween the physician and the man of letters wasapparent. In 1659 THOMAS SPRATT, afterwards Bishopof Rochester, published a poem which nominally dealtwith the plague at Athens described by THUCYDIDES,but really referred to the outbreak which had latelyoccurred at Naples. Such an extended work entirelyon medical themes was not repeated until GARTHpublished his poem 40 years later. Continuing, Mr.GossE referred to Sir THOMAS BROWNE, to LOCKE,the friend of SYDENHAM, and to Sir RICHARDBLACKMORE, whom he described as a reputable Iphysician misrepresented by the hostility of DRYDEN.BLACKMORE, who became a Fellow of the Royal Collegeof Physicians in 1657, produced two long and vapidpoems, Prince Arthur and King Arthur, which werewidely read and savagely attacked, the writer alsobeing asked why he did not treat of some useful medicalsubject. After that time the question was no moreraised in England ; the barrier between imaginativeliterature and medical science was finally broken down Iwhen Sir SAMUEL GARTH’S long mock-heroic poem,The Dispensary, dealing with the quarrel between I

physicians and apothecaries over the furnishing offree drugs to the poor of London, appeared in 1699.

GARTH’S poetry was only half-poetry, and his scienceonly half-science, but he drew the subjects togetheras they had never been drawn before. Before GARTHdied the connexion between medicine and literaturehad become not the exception but the rule ; a warm

comradeship was established between doctors andauthors in the greatly improved civilisation of the reignof ANNE. Pre-eminent among the lettered physiciansof those days was Dr. JOHN ARBUTHNOT, who took upthe mantle of GARTH, and was always most at home inthe company of authors. POPE and SWIFT wereinvalids, neurotic to excess, made difficult of access byintense nervous irritability ; the cheerful humour ofARBUTHNOT was their constant bromide. Also amonghis friends were GAY, PARNELL, ATTERBURY, STEELE.and CONGREVE. An Aberdonian, ARBUTHNOT gainedslow recognition in London, until PRINCE GEORGEwas taken suddenly ill at Epsom when ARBUTHNOThappened to be present-an illustration, remarkedDr. GossE, of the fact that talent and industry wereinsufficient for success without the sovereign elementof good luck. ARBUTHNOT became a Fellow of theCollege in 1723 ; he remained a planet in the constella-tion of wits for a quarter of a century. He was stillremembered for the irony of his " History of JohnBull"; of his medical writings the most famousdealt with the nature of " animates "-what would nowbe spoken of as vitamins. Of medical men who madenames in literature during the eighteenth century,OLIVER GOLDSMITH and others never received recog-nition from the College ; but MARK AKENSIDE, poetand anatomist, enjoyed every distinction the Collegehad to bestow. Coming to the present day, Mr. GossErecalled the fact that the Poet Laureate was a medicalman, and expressed his belief that if Dr. ROBERTShad chosen to perpetuate his subject in sculpture,instead of by oratory, he would have selected a statueof ARBUTHNOT, together with busts of POPE, SWIFT,STEELE, and GAY, to crown the monument.

Annotations.

DENTAL BOARD OF THE UNITED KINGDOM.

" Ne quid nimis."

THE autumn session of the Board was opened onNov. 13th at 44, Hallam-street, W., when thechairman, Mr. F. Dyke Acland, delivered an address.Only within the last few months, he said, had theBoard been able to begin to deal with the manyimportant duties which would normally devolve uponthem, the first 18 months of their time having beenoccupied with the machinery of registration. Theday seemed to draw nearer when by the process ofordered evolution the Board might, much to the regretof its other members, lose the representatives fromSouthern Ireland. The passing of the Dentists Act of1923, which became law in July, necessitated anamendment of the Regulations ; an opportunitywould be taken to amend the table of fees, and toobtain authority for their remission in certain cases,in order to carry out the wishes of the Board andprevent hardship for those who would have qualifiedprior to the passing of the Dentists Act, 1921, hadit not been for the war.

It was, Mr. Acland said, of the utmost import-ance, if sufficient dentists were to be obtained tomeet the requirements of the population in future,that the number of students should be increased.The Board had already taken steps to this end ;large sums of money had been expended in helpingthose who found that the Government grants werenot sufficient to enable them to complete thecurriculum ; a beginning had also been made in thegranting of bursaries to persons who, for want of

means, would have been unable to enter upon theprofession of their choice. It would be necessary tospread these over as large a number of students aspossible, and, though the grants hitherto had beenon a liberal scale, the Board might not be able to