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truth in this statement, but the alteration is not asudden change, and from time to time controls bymeans of fresh standards mav be made. I have beenable to improve the sensitiveness of the platinumpoles by passing the current through the apparatusreversed, after which the poles have shown distinctsigns of improved sensitiveness. Lead electrodes arerecommended in place of platinum ones, as they arestated to be more sensitive, and minute traces ofarsenic are more completely converted into arseniu-retted hydrogen. This is true ; but if lead is used,there is a possible risk of the lead containing tracesof arsenic, and consequently platinum is preferable.

I have always found the amount of arsenic to beevenly distributed throughout such an organ as theliver ; thus, by a simple calculation, the amount forthe whole organ is easily ascertained. The intestinesare the only parts of the body in which the contentis liable to variation, which naturally occurs when thedose of arsenic is passing through the alimentary canal.The JJ’larsh, Gutzeit, and Reinsch Methods Compared.The Gutzeit method of estimation and its modifica-

tions are delicate and useful when the source of thehydrogen is obtained by electrical means, but whenzinc is used they are open to the objections citedabove. The Gutzeit method depends on the libera-tion of gaseous arseniuretted hydrogen, which isbrought into contact with filter paper impregnatedeither with silver nitrate, as in the original Gutzeitmethod, or with mercuric chloride, as recommendedby the British Pharmacopoeia ; in both cases a darkstain is formed on the paper (standard stains aremade with known amounts of arsenic). There isprobably little to choose between the sensitivenessof the Marsh and Gutzeit methods, but I preferthe comparison of the mirrors in the Marsh methodto the stains on the paper in the Gutzeit method.In the Gutzeit method the tissues must bebroken up by the nitric and sulphuric acid tech-nique, as given above, and the gases evolved in theapparatus must be passed through lead acetate paperor pumice impregnated with lead acetate, as a certainquantity of hydrogen sulphide is liberated during thepassage of the current, this gas in itself being capableof producing a dark stain on the paper impregnatedwith the silver or mercury salt.A further modification of Gutzeit’s method, useful

except for very minute traces, consists of passing thegases evolved through a known volume of a standardsolution of silver nitrate. The arseniuretted hydrogencombines with the silver nitrate, forming metallicsilver, and the excess of silver nitrate left over isdetermined by titration. I have had no personalexperience of this method, but am favourably dis-posed towards it. The British Pharmacopoeia recom-mends an arsenic limit test by a modified Gutzeitmethod, using zinc, but here it must be recognisedthat any error from this source is in favour of theconsumer of the drug; further, the analyticalmethods given in the Pharmacopoeia are supposed to bewithin the scope, and the apparatus at the command,of the holder of the minor certificate of the Pharma-ceutical Society.The Reinsch test is purely qualitative, but is a

very valuable confirmatory test of the presence ofarsenic, and should never be omitted if there issufficient arsenic present. Its delicacy is inter-mediate between the gravimetric method and theMarsh and Gutzeit methods, and it has the advantageof only requiring two reagents-hydrochloric acidand copper foil. The technique is too well known torequire discussion here.When we are dealing with a substance so widely

used as arsenic, it becomes of paramount importancethat its toxicological phenomena should be studiednot only in the greatest detail, but with the greatestpossible accuracy. Unless the methods of analysiscan be placed absolutely above suspicion, the resultantcontroversy will lead to deductions based on inaccu-rate work, and to a great waste of valuable time.

In conclusion, I would like to thank Mr. JohnWebster for his helpful criticism.

MEDICINE AND THE LAW.

Recovery of a Retaining Fee.IN the Eastbourne County Court recently a medical

practitioner sued a married man under an agreementalleged to have been made by the plaintiff with thedefendant’s wife, whereby he had undertaken at herrequest to attend her in her coming confinement.The patient, in spite of this arrangement, had beeneventually attended by another medical man at herconfinement and during her convalescence, and theplaintiff claimed JE2 2s. for a retaining fee, the defendanthaving repudiated all liability. After argument asto the nature of the contract and as to its effect asbinding the defendant husband, the county court

judge found in favour of the plaintiff for the amountof his claim, ;82 2s., and costs. The fairness of aclaim in these circumstances is obvious. A contractto attend a patient for so definitely expected an eventas the birth of a child naturally involves such arrange-ments on the part of the medical practitioner as willensure his being able to fulfil his part, and he mayhave to alter his plans for a holiday or for othertemporary absence from home in order to carry outhis side of the bargain. It is satisfactory to note that theclaim, if disputed, can be vindicated in a court of law.

Surgeon and Coroner.An inquest was held at Scarborough recently upon

the body of a domestic servant, 28 years of age, whowas being treated for Graves’s disease and had diedin Scarborough Hospital as the result of an operation.The coroner found a verdict to the effect that deathwas due to Graves’s disease, cardiac asthenia, and tooperation. In doing this he is reported to have addedthat the operation was a mistake, and ought not tohave been performed without consultation withspecialists. We submit that the coroner was notjustified in thus censuring the medical practitionerwho was responsible for operating. The practitionerhimself had deposed that death was not due in anyway to the anaesthetic, but to cardiac weakness.aggravated by the operation. He had franklyacknowledged that there was a risk, but he hadexplained to the patient that without operation shemust have died in two or three years, and had obtainedher consent. The coroner’s comment upon this wasthat in three years’ time surgical science might haveadvanced, and that it would have been different ifit had been a case of days. In his judgment it was" a pity and a mistake " to operate. The rejoinder

of the medical witness, Dr. L. S. Debenham, to thiswas : " Then I was to let the girl drift to her deathwithin three years, when the span of life is three scoreyears and ten." It is to be noted that the coronerdoes not appear to have relied himself upon theevidence of any specialist to the effect that theoperation should not have been performed in thecondition in which the patient was at the time. Shewas of full age, and if it was clearly put to her thatsome risk to her life would be involved, it can easilybe understood that she accepted it, in lieu of thecertainty of continued illness and death, perhaps, ifshe was friendless, in a Poor-law infirmary. In suchcases responsibility must inevitably continue to beshouldered by surgeons. It is a hardship, alsoapparently inevitable and therefore to be cheerfullyborne, that they should have to submit to criticismat the hands of persons less qualified to judge thanthemselves.

3ogics Doctor as Locum Tenens.The Medical Defence Union were successful recently

in prosecuting at W’imbledon police court TamesAllport, an unregistered person, described as a" pathologist," who, among other fraudulent proceed-ings, had obtained the post of locum tenens for a weekto a medical practitioner at a fee of nine guineas,with board and lodging. He had also obtainedunlawfully a kit-bag and surgical instruments fromMessrs. Arnold and Sons, and a microscope fromthe City Sale and Exchange Company. To a memberof Messrs. Arnold’s staff he had described himself as.

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L.R.C.P. Considering the serious results to life andhealth that may arise from an unqualified personpassing himself off as a doctor, the sentences imposedon Allport seem hardly adequate. He was fined onone charge £20, with three months’ imprisonment as analternative, and ordered to undergo imprisonment forthree months on the other, a possible total of sixmcnths’ removal from the scene of his activities.

NOTES FROM INDIA(FROM OUR OWN CORRESPONDENT.)

Medical Inspection of Schools.No comprehensive scheme for the medical inspection

of school-children in the Madras Presidency has beenbrought into working order, although tentativeproposals have been under consideration for someyears past. For various reasons the work involved ’in such a -scheme has been shelved to a great extent, Ibut individual schools here and there have had thebenefit of medical inspection. From the report for1921 of the Director of Public Instruction it appearsthat 143 schools appointed medical inspectors duringthe year, and 11,786 pupils were examined (the totalnumber of pupils attending school is nearly two million).Sixty-three reports from medical inspectors werereceived. Government in 1920 sanctioned the depu-tation for a period of two years of three specialassistant surgeons, with headquarters at Madras,Rajahmundry, and Coimbatore respectively, to workunder the orders of the Director of Public Instruction;their chief duties will be to inspect pupils in Govern-ment secondary schools and secondary schools z,attached to Government colleges, to supplement the ’,work of local medical practitioners employed in aidedinstitutions, and to correlate the inspection of schoolsby local medical practitioners. These assistantsurgeons have not yet been appointed ; on theirappointment the department intends to publish aseparate report on the results of the medical inspectionof schools, based on the work of the assistant surgeonsand on an examination by them of the reports receivedfrom medical inspectors. The appointment of a

permanent medical inspector is under consideration.The financial position has prevented any furtheradvance being made in this important branch ofpublic health work, but the few inspections alreadymade will probably prove conclusively that a greatextension of the work is urgently called for.

District Health Staffs. ,

In connexion with the formation of a districthealth staff for each district in the Madras Presidency,the Government have issued an order regardingdeputy inspectors of vaccination and sanitary inspec-tors of cholera parties, who will together form themajority of the members of these staffs. All deputyinspectors of vaccination are trained sanitary inspec-tors, and there are no obvious advantages in main-taining two distinct classes of officers with more orless the same qualifications for dealing with twodifferent diseases. They have therefore decided toamalgamate the two services, and pay them accordingto a uniform scale which is shown below : (1) Generalscale : Rs.60-5-120 ; (2) selection grade : Rs.125-5-150. The number of appointments in the selectiongrade will be fixed at 15 per cent. of the total strengthof the service. Deputy inspectors of vaccination willhereafter be designated sanitary inspectors. Asservice in cholera parties involves a certain amount ofrisk, members of the amalgamated service who workin such parties will be granted a special pay of Rs.10per mensem in addition to their regular pay.

The General Hospital, J.1I adras.In spite of financial stringency the hospital require-

ments of the headquarters of the Presidency are notbeing overlooked ; a recent report in the ltlactras Alailgives details of an inspection of the Madras GeneralHospital by the Hon. the Rajah of Panagal, Ministerfor Local Self-Government, in charge of the medicalportfolio. The Minister was received by Col. W. R. J.

Scroggie, I.M.S., superintendent of the hospital, andwent through the building noting its work and equip-ment in detail. In speaking of his impressions of thehospital, the Minister owned to having been at onetime sceptical of the wisdom of erecting a new generalhospital for Madras on the Spur Tank site ; but, hesaid, after seeing the antiquated condition of thepresent hospital buildings, and realising the adversecircumstances under which the staff have to work init, he had changed his ideas and realised the greatneed for a new general hospital, in every way worthyof the reputation which Madras has achieved for theefficiency of her medical institutions. It was quiteunreasonable to expect the present building-builtmore than a century and a half ago, in the days of theEast India Company-to serve the needs of an up-to-date hospital in the midst of a progressive community.Accommodation for the growing numbers of both in-and out-patients was, in his opinion, not only inade-quate, but even unsuited in several respects. Thecooking and latrine arrangements in the several wardswere miserable ; the ground floor was covered withbricks of very old fashion, subject to the action oftinctures and acids, and impossible to keep clean.The operation theatres were far inferior to the theatresin some of the hospitals in mofussil districts. Theout-patient department seemed to be very poorlyequipped ; and the absence of a casualty department,essential in a hospital of the high reputation of theMadras General Hospital, was very much to bedeplored. Residential quarters for the nurses in thehospital seemed to him another urgent want. Nursesare now accommodated on the second floor of thehospital ; if they were given separate accommodation,the second floor might be used as special or generalwards. An electric lift to replace the one now workedby manual power, he felt, was also necessary if thehospital equipment was to be brought up to date.

Danish :Ilissioo Hospital.The foundation-stone of the new extensions to the

Danish Mission Hospital at Tirukoilur, in South Arcotdistrict, was laid last week by the Rev. Mr. Hoff, inthe presence of a large gathering of officials, non-officials, and mission workers. Before the ceremonywas performed, Dr. S. Dalmar, medical officer incharge, read a brief report on the working of thehospital since its opening in 1913. The hospital, shesaid, owed its existence to the spirit and self-sacrificeshown by nurses in Denmark, who had collected thenecessary money for a woman’s hospital in India.A new operation theatre, a laboratory, and newisolation rooms and wards were needed ; she hopedthat the people of South Arcot would come forwardwith liberal donations and help the mission authoritiesto complete the work.

ROUMANIA.(FROM OUR OWN CORRESPONDENT.)

A Public Health Campaign in the Vujdascig.THE Vajdasag is a large district in the southern part

of old Hungary, now belonging to Jugo-Slavia, andlying between Hungary and Roumania, to the northof the old Serbia. The population consists mainly ofrich and intelligent agriculturists, who are able toappreciate the importance of sanitary reform. Thesanitary board of the Vajdasag—an independent bodyappointed by the Ministry of Public Hygiene inBelgrade-led by the physician and medical authorDr. Lazar Markovics, established in 1920 at threecities in the district-Szabadka (population 160,000),Ujvidek (100,000), and Nagybecskerek (70,000)-freedispensaries where all are admitted without distinc-tion of nationality or financial condition, free medicaltreatment and medicines being provided. ’ There arespecially equipped dispensaries for the tuberculous, forvenereal diseases, for child welfare, and for trachoma-this disease being very common in the district. Atthe venereal disease dispensaries salvarsan is givenin any quantity required ; this type of dispensary isequipped with a blood-testing laboratory, patients