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reasonable date for the commencement of an intensivecourse.

May 1st: 10 units ; May 2nd : 20 ; May 3rd : 30 ;May 4th : 45 : May 5th : 60 ; May 6th: 90 (strongishreaction. ∴ 0-25 c.cm. of adrenalin 1/1000); May 7th:50; May Sth: 70; May 9th: 100; May 10th: 140;May Ilth: 200 (slight reaction); May 12th : 200 (verydoubtful reaction); May 13th: 200; May 14th: 250;May 15th : 320 ; May 16th: 400; May 17th: 550;)lay 18th: 700 ; May 19th: 850 (doubtful reaction);May 20th: 900 ; May 21st: 1100; May 22nd: 1300;May 23rd: 1500 units. Here a spell of fine weather issupposed to have started the pollen cloud and so havemade any further prophylactic treatment imprudentfor this very sensitive patient.

Therapeutic Treatment.1. After the commencement of the pollen cloud specific

dcsensitisation may still be practised, but as with otherforms of vaccine therapy the doses must be much smallerthan for prophylaxis ; it may be impossible to give morethan 2 to 5 units, it is seldom necessary or prudent to give emore than 100 units for a dose. As in prophylaxis a

,. reaction" is to be deprecated. The size of dose must beestimated from (a) the sensitiveness of the patient as judgedby his past history or from his skin reaction ; (b) the con-dition of his eyes and mucous membrane at the time ofinoculating; and (c) the reactions, if any, from past doses.The intervals between doses vary with their size from, per-haps, 24 hours with the very smallest up to. say, a week forthe largest. This treatment has, in the writer’s experience,failed dismally with some people, but with others has beenso strikingly successful that they declare they will not bebothered with prophylaxis for the future.

2. Shock doses are as applicable to hay-fever as to anyother of the asthma-urticaria group. If immunity is evolvedin the business it is certainly non-specific for almost every-thing imaginable has been used as antigen : tuberculin,typhoid vaccine, peptone, milk, the patient’s own bloodreinjected intramuscularly, even sulphur emulisfied in oil.The object is to cause a shock with a rigor or two, and inthe writer’s opinion the effect is by suggestion. The methodis not popular and is not advocated here.

3. Polantin is an anti-pollen serum from immunised horses. Applied locally it gives temporary relief to slight symptoms,but seems unable to help the more severe cases. It is lessIISed now than in former years.

4. Avoidance of pollen. This has been spoken of generally *

under prophylaxis. Lotions (e.g.. warm normal saline) 1

wash away pollen grains, and thick ointments protect the i

underlying mucous membrane but cannot be made to coatall the sensitive surf aces. Cauterisation substitutes cicatricialtissue for mucous membrane, and in skilled hands anyspecially sensitive spots can be treated in this way. Carbolicpartly kills and partly anaesthetises the mucous membrane.

5. Anæsthetics will temporarily deaden the intolerablelocal itching, sprays of cocaine, rnorphia, anecsthesin, &c.,may be instanced. but no medical man need be told thedifficulties, dangers, and limitations of such treatment.

6. Adrenalin, to a lesser degree pituitrin, or any proprietarycombination of these gland products, are in a class by them-selves. They have a specific action on all the asthma-itrticaria syndrome, checking the symptoms and affordinginstant though transient relief, whether injected hypo-dermically or applied locally. For hay-fever they can beadministered as a spray of the 1/1000 adrenalin or a lotioncontaining a tenfold dilution of the same. Such applicationsseem to be free of bad after-effects and to lead to no " habit.."

7. Suggestion treatment cannot be eliminated when dealingwith any of the asthma-urticaria syndrome, least of all inhay-fever. It is well in the writer’s mind that single dosesof a pollen vaccine sometimes act miraculously in this way.It is more than probable that cauterisation of the nose,ouce so fashionable, owes much to this factor of suggestion.Anything associated in the patient’s mind with cause or

cure of hay-fever will act accordingly. There seems tobe no evidence that an abnormal mentality plays any partin producing hay-fever.For therapeusis small inoculations, as described

in No. 1 above, are advisable, combined with anypalliative treatments which may help, but in reallyserious cases strong prophylactic measures are

-

.

J. FREEMAN, M.D., B.Ch. Oxf.,Director, Department of Clinical Bacteriology,

St. Mary’s Hospital.

Special Articles.MEDICINE AND THE LAW.

L’riaasicat Procedure in Court of Crirrairaal Appeal.AT its last sitting before the Easter vacation the

Court of Criminal Appeal dealt afresh with the caseof William Knighton who, as previously stated in thiscolumn, had appealed against a conviction for murderat the last Derbyshire Assizes. At the original trialthe defence was insanity arising out of epilepsy.On March 21st the Court of Criminal Appeal wasinvited to substitute for the verdict of " guilty "a verdict of " guilty but insane." The Court declined -to do this, and announced that, as the issue of insanityhad been raised at the original trial, it would notlisten to any fresh evidence of insanity but would leavethat matter to be determined by the Home Secretary.Subsequently the case was reopened, the HomeSecretary referring it back to the Court of CriminalAppeal under Section 19 of the Criminal Appeal Actof 1907. This unusual procedure did not amountto a re-trial of the case, but it gave the appellant achance to produce new evidence. Section 19 of theAct says that nothing in the Act shall affect theRoyal prerogative of mercy ; it then proceeds tomake the machinery of the Act available in two casesfor the purpose of disposing of petitions for theexercise of that prerogative. The Secretary of Stateunder the section may, upon a petition for mercy,do either of two things. First, he may refer thewhole case to the Court of Criminal Appeal to beheard and determined as if it were an appeal underthe Act in the ordinary way. This alternative wasnot possible in Knighton’s case as his appeal hadbeen before the Court of Criminal Appeal already.Secondly, the Secretary of State may refer to theCourt any point on which he desires assistance. Itwas under this latter power that the Home Secretaryacted. The appellant’s new evidence-that of hissister-was produced but was not accepted by theCourt ; the appeal was therefore dismissed a secondtime. Nothing was said to disturb the practice ofthe Court of Criminal Appeal in respect of its refusalto hear any fresh evidence on appeal if that evidencerelates to the defence of insanity and if the issue ofinsanity has been raised by the defence at the originaltrial. The Court of Criminal Appeal is evidentlyunwilling to listen to a succession of mental specialistsin murder appeals ; it leaves the issue of insanityto the Home Office experts. Its practice in thisrespect is, however, open to criticism in that itdiscriminates against the reception in court of a

particular kind of evidence-naniely, evidence ofinsanity-and thus leaves the appellant to take hischance before a departmental rather than a judicialtribunal.

Law Reports and Recent Restrictions.Knighton’s case illustrated the recent restriction

upon the publication of law reports. In the courseof her statement, the appellant’s sister gave certainevidence of a sexual character. The Times, in itsreport, remarked that part of this statement appearedto be within the intention of the recently passedJudicial Proceedings (Regulation of Reports) Act ;this part was, therefore, excluded from the report.It may seem strange that a law report in the Timesshould be affected by the recent Act, seeing that theAct has a saving clause in favour of bona fide lawreports and seeing that the Times reports are allwritten by barristers and are accepted in all Englishcourts as of full and proper legal authority. Butthe Act is so worded as to protect only two classes oflaw reports ; one class includes any publication ofa technical character bona fide intended for circulationamong members of the legal or medical professions ;the other class includes any matter in a separatevolume or part of any. bona fide series of law reports

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which does not form part of any other publication andwhich consists solely of reports of proceedings incourts of law. Thus the law reports in the columnsof a daily newspaper, however carefully, authorita-tively, and unobjectionably prepared and printed,obtain no protection. The omission was not a seriousmatter in the case under discussion, since the Courtfound the evidence unworthy of belief, but cases mayarise where such omissions may be unfair to one ofthe parties as well as destructive of the value of thereport of the proceedings. Admittedly the Actwas imperfectly drafted. It contains, for instance,a list of the sole particulars which may be publishedin reporting a divorce case. The names of the partiesand witnesses may be reported but not, apparently,the names of judge, counsel, or solicitors ; theapparent omission of the judge’s name is the moreremarkable since his summing-up may be given in full.

SCOTLAND.

(FROM OUR OWN CORRESPONDENT.

Clver-prescribenf under the Insurance Acts.WHERE the fund is limited every reasonable care

must be taken to get full value for the money spent.This is all that the " checking bureau " means. Ithas worked in Scotland with much success from anearly stage in the organisation of National HealthInsurance. But there has been, from time to time,much heart-burning. It is not an agreeable duty fora practitioner to sit in judgment on his fellowpractitioner’s prescriptions, and I have never heardthat any local panel committee enjoyed the job.Yet there is no doubt whatever that the general effectof the checking system and the frequent inquiries bythe doctors and officials concerned in the administra-tion of medical benefit has been to improve the levelof prescribing. Probably over-prescribing-whichsimply means the use of expensive drugs when equallygood but cheaper drugs are available-is largely dueto defective teaching. It must be embarrassing whena professor charged with the scrutiny of prescriptionsfinds that some of his own fav ourite prescriptions areamong those pilloried as " excessive " by the checkingbureau. But the explanation is simple. Whilst theexpense of a drug bears no relation to its therapeuticeffect, nevertheless, if " panel " work is an integralpart of our domiciliary medical service, the questionof expense is very relevant to practice. Recentlyefforts have been made to bring before the medicalprofession the methods of avoiding expense by selectionof drugs, and by careful attention to quantitiesdispensed, but obviously there is a recurrent irritationamong the insurance practitioners. It is reportedthat appeals " against fines amounting to .6370 areto be made by eight of 13 Glasgow panel doctors whowere surcharged following allegations of over-pre-scribing." It is sometimes said that insurancepatients get one quality of drugs and private patientsanother; no such distinction is involved in anyregulations under the Insurance Acts. Whether themachinery for investigating so-called over-prescribingis the best for its purpose is another question. Theoriginal intention was to enable the medical menthemselves to act as checkers of each other’sprescribing.

Nursing at a Maternity Hospital.Although an amalgamation of the Simpson Memorial

with the Royal Infirmary has been arranged, the newaccommodation cannot be ready for some seven years.Meanwhile the work must be carried on and there isan acute financial difficulty, the main immediatecause of which is a. change in the period of training formidwives. This has caused a marked falling off inthe supply of pupil nurses, and in order to maintainthe nursing staff even at a minimum standard it hasbecome necessary to offer free training to pupil nurseswho have had their general training. Hithertopupil nurses have paid fees and the giving of free train-

ing to the majority of its pupils will mean an actualand immediate loss to the -Edinburgh MaternityHospital of £2000.

Prof. George Robertson. President of the RoyalCollege of Physicians of Edinburgh, at the recent meet-ing of the hospital dealt with some fundamental point.of hospital administration. Everyone, he said.would approve of the directors’ decision to give freetraining to all pupil nurses who had already had theirgeneral training. He wished to bring home to thepublic the fact that the great voluntary hospitalsdid not pay probationer nurses adequately for theservices they rendered. It was true that they werebeing trained, but they were also working hard aUday and all night long to keep the hospital running.The whole machinery would stop if the probationernurse did not work, and for those services she wasentitled to payment, and to more adequate payment,than she got at present.

Prof. Robertson’s speech has aroused great interest.

The Aberdeen Royal Infirmary.The Aberdeen Joint Hospitals Scheme has advanced

another stage. Last week, at a meeting presidedover by the Lord Provost, a motion was carriedunanimously authorising the board of directors ofthe Royal Infirmary’to acquire forthwith the partof the Forresterhill site allocated under the scheme.and to take all necessary steps towards the erection ofa new infirmary upon it. The Lord Provost said thatthey were appealing for the sum of £400,000, and alreadyhe had received before the appeal had been issued£212,000. He had gone into the cost of the infirmarypart of the scheme with Mr. William Kelly, whoassured him he would be able to carry out the workat a cost of about 2500 per bed, fully equipped, andthat would mean that the total cost of the infirmarysection would be £257,000.

Mr. Kelly was the architect who, 36 or 37 yearsago, planned the expansions of the present RoyalInfirmary. He is known as one of the most dis-tinguished of Scottish architects, and it is recognisedthat the people of Aberdeen reach their objectiveswithout wasteful expenditure ; but I cannot helpthinking that £500 a bed is a very sanguine estimatein view of experiences elsewhere, even allowing forthe fact that the conditions as to site are exceptional.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

Prof. Michael Grossmann.THE medical teaching staff of Vienna University

has lost one of its most esteemed members in Prof.Michael Grossmann, who has died at the age of78. Professor for diseases of the throat and nose,and one of the leading specialists in his time, hewas at first a surgeon, being assistant to thefamous Billroth, and later to Sc.hrotter, who in the’eighties made his clinic famous for the develop-ment of laryngology. Here Dr. Grossmann investi-gated a large series of pathological conditionsand published reports and papers on emphysema,on blood pressure in the lungs, on " nasal asthma,"and on the laryngeal nervous system : further, hewas active in organising the medical service on

railways, for which he wrote a very instructivebook, since translated into many European languages.He withdrew from public life some eight years ago.

The Liver-Fluke in Austria.Liver-rot is not a common disease among the

livestock of this country, but is now prevalent inthe eastern provinces of the Republic. It is causedby the liver-fluke (Distomum hepaticum or Fasciolahepatica) which is about one inch long, a quarterof an inch broad, and has two " mouths," the secondone on the ventral side of the body, and both acting = -

as suction organs. The infection of the cattle takes