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pernicious. Quinine prophylaxis requires, says SignoraCelli, Leal, determination, and personal attention.The Italian Marine Corps controlled administrationby urine examination. The Italian Artillery wasnotably free from malaria owing to the closeness withwhich men and officers were thrown together and theinterest taken by the officers in seeing that their mentook their little daily dcse.

THE OSLER MEDAL.

THE photograph which we publish shows theobverse and reverse of the bronze medal which hasbeen designed for the Committee of the Osler MemorialFund by Mr. F. Bowcher. The Osler Memorial Fund

THE OSLER MEDAL : OBVERSE AND REVERSE.

was accepted by the University of Oxford last yeartogether with a plaque by Mr. Vernon, of Paris.An account of the unveiling of the plaque by theVice-Chancellor in the University museum on

June 10th, 1925, was published in THE LANCET.The Osler memorial bronze medal is to be awarded

once in every five years to the Oxford medical graduatewho shall, in the opinion of the Board of Awarders,have made the most valuable contribution to thescience, art, or literature of medicine, and who hasnot previously received the medal. The residue ofthe income of the fund, after payment of all expensesin connexion with the medal, may be used at thediscretion of the members of the Board of Awardersresident in Oxford, in making grants from time totime to teachers in the Oxford Medical School, toenable them to pursue some special study connectedwith medicine outside the University. The first awardof the medal was made on June 10th, 1925; the nextwill therefore be made in 1930.

MENSTRUATION AND PAIN.

WHEN the Victorian young lady took to her roomand left word that she was " unwell," she was nottaking refuge in an empty euphemism. The monthlyperiods seem to have been a much more severe ordealto her than they are to her grand-daughters, and sheaccepted malaise. headache, and more or less severepain in the hypogastrium and back as part of the orderof Nature. It is true that some gynaecologists still teach that pain is the normal accompaniment of Imenstruation, but statistics show that only about 70 per cent. of healthy modern women, such as public Ischool girls and Civil Service candidates, experience it;

and certainly if women suffered as a sex what they are-supposed to have suffered 50 years ago they could nothave taken the large part they have in business andprofessional life. Nevertheless a fair number stillfind their periods a real handicap, and their sufferingshave provoked the question, " Why does a normalfunction cause pain ? " The first reply is, of course,the counter-question, " Is it a normal function ? "

Prof. A. Pinard and others have maintained that the-normal woman would never menstruate ; Natureintended that from her first period onwards her sexuallife should be a continuous series of pregnancies andlactations. The subject is discussed fully and with anexhaustive bibliography in the able monograph whichProf. V. Wallich has written for Prof. Ch. Richet’s

monumental " Dictionnaire de la Physiologic," now

in the press. This monograph has been printed andcirculated separately, from the dictionary’s formes.l

Prof. Wallich points out that although thehaemorrhage has naturally drawn both social andscientific attention to itself, to understand the realsignificance of the monthly cycle it is essential tofollow its variations through the whole mammalianspecies and to study the complex of symptoms, ofwhich bleeding is only one and not an invariable oneat that. The main fact is a periodical congestion ofthe female genital organs which marks the crest oftheir rhythmical activity and ceases when they takeup their proper work of reproduction. Anatomicalobservation shows a profound modification of themucosa uterina, the whole of which undergoestumefaction and hyperplasia in order to fit it to receiveand nourish the fertilised ovum. Simultaneouslythere is a psychic awakening that induces the femaleto seek the company of the male. This phenomenonof congestion occurs in all mammals and is moreintense in some than in others ; there is always somedegree of haemorrhage, but this may take place onlyin the interstices and may never show itself in theuterine cavity or at the vulva at all. Prof. Wallichstates that the bleeding is probably more profuse inthe higher primates because their heavily-muscled andplexiform uterine wall locks the capillaries of themucosa and prevents them from expanding properlyat the time of congestion. They are fragile and ruptureeasily. In the horned uteri of the lower mammalsthe vessels have a bed of cellular tissue in which toexpand, and any hæmorrhage there may take thesimple form of infiltration into the submucous layer.

1 Librairie Félix Alcan, Paris.

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It has been demonstrated beyond question thatmenstruation depends on ovarian function. It ceasesaltogether when the ovaries are removed, but theslightest trace of ovarian tissue left behind or ingraftedwill cause the phenomenon to persist or return. Prof.Wallich concludes that every part of the ovary isconcerned in producing the reaction and that no onepart preponderates over the rest. Blood examinationhas shown that secretions are present at the menstrualcrisis that are not found at any other time, and it isalmost certain that, even in mammals subject toheamorrhage, the flow is not the only way in whichthese substances are excreted. The intensity of themenstrual changes varies with latitude and season ;the most favourable time for conception in our

latitudes is the month of May. This probably corre-sponds with the general biological quickening-up thatall creatures experience at the end of winter, and hasbeen shown to depend to some extent on the loweringof the lecithin content of the blood, which is raised inwinter and which counteracts the secretion of theinterstitial tissue of the ovaries.On this view menstruation is the compromise with

Nature allowed to females who are not fertilised whenthey come on heat, and just so far is menstruation a" natural " process. The lives of many women showthat the price is no very heavy one, and the psycho- ’,logical factor in dysmenorrhoea may prove, when moreis known about it, to play a major part. It is permissible to conjecture that the woman with painful Iperiods is paying not only for her failure to conformto Nature’s law that she should conceive every timeshe menstruates, but also for her lack of adaptation toenvironment-physical, moral, and mental. TheVictorian spinster suffered, not only because she didnot have children, but also because she took no exerciseand because she failed to make psychological termswith her sex. Modern women are more closely adaptedto realities ; they are better ventilated, both in bodyand mind.

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MENTAL DEFICIENCY AND IMPRISONMENT.

FOR the third time in little more than a year publicattention has been invited to the fact that the fullvalue of the Mental Deficiency Act is lost, the com-munity is injured, and the prison establishment isunfairly burdened because the Act contains theunfortunate requirement that the condition of mentaldefect must be shown to have existed from birth orearly age. Twelve months ago the Prison Com-missioners pointed out this flaw in the working ofthe Act 1; some months later the Committee onSexual Offences recommended an amendment toremedy it 2; and now the Prison Commissioners intheir recently issued report for the year 1924-25

3

have emphasised the same point again. The requisiteproof of mental deficiency from birth or early age,they say, frequently cannot be given ; if a parent orguardian chooses to make mis-statements on thesubject when asked for information, it is difficult tocontrovert them. Medical officers can bring forwardcases of unmistakable mental defect, yet they find itimpossible to give a certificate in the absence of therequired particulars of the patient’s early history.As in the case of insanity, so in the case of mentaldeficiency, it should be the patient’s present con-

dition which should determine the issue of certification.Dr. G. B. Griffiths, the Medical Commissioner, in hiscontribution to the recent report, explains the signifi- cance of the wording of the Act as it now stands. IIn the past four years 985 mental defectives whohad come in conflict with the law have been dealtwith under Sections 8 and 9 of the 1913 Act and,instead of being sentenced to imprisonment, havebeen either certified and removed to institutions whileundergoing sentence or else have been sent to a

’’ place of safety " pending the presentation of apetition on their discharge from prison. Thus nearlya thousand persons have been withdrawn from the

1 THE LANCET, 1925, i., 196.2 THE LANCET, Jan. 2nd, 1926, p. 45.

3 Cmd. 2597. H.M. Stationery Office. 1s. 3d.

army of habitual offenders, and the gradual decreasein the numbers of our prison population and thegeneral diminution in crime may be attributed inpart to the segregation of these persons in institutions.But clearly there are still many mental defectiveswhom, because of the flaw in the Act, it is impossibleto certify. Prison, says Dr. Griffiths, is no place forthem since they are unfit for prison discipline, anda few weeks or months of imprisonment has no curativeand possibly no deterrent effect upon them.The Commissioners’ report (as in previous years)

makes the further suggestion that the MentalDeficiency Act might, with advantage to society, beextended to provide proper care and control forcases of subnormal mentality and mental instability.The medical officer of Brixton prison points out thatcases of mild senile or other dementia are unprovidedfor ; persons of this type commit trifling offencesoften because they are unable to earn a living. Theyare not certifiable as insane. yet are no longer ableto look after themselves in our complicated socialsystem. The medical officer at Holloway similarlymentions (as last year) the type of debilitated womenwho have become defective either through senility,alcohol, or their mode of life. They are not at presentcovered by the Act, yet are unfitted for employment,and on release from prison drift into the workhouseor else return to prison again. Two other interestingpoints from the medical officers’ reports may bementioned. One is the reference to post-encephaliticdelinquents at Brixton, cases resembling congenitaldefectives in their mental characteristics, apparentlyhopeless and likely to increase in number unlessand until some sure method of curing or protectingagainst encephalitis lethargica is discovered. Theother point is made by the medical officer ofBirmingham prison, who boldly says that thewhole question of the correct treatment of offendersis a purely psychological matter. No prison punish-ment, he remarks, can be inflicted without themedical officer’s concurrence. " It is but a shortand logical step to the position that no sentence ofimprisonment should be awarded, or any order ofcourt made, without due attention being paid tothe findings of an adequate medical examination."Judicial comments upon this perfectly rationalproposition would be entertaining. Mr. JusticeShearman has just been telling a jury in a criminalcase that it is not for " Harley-street " to decidequestions of insanity. What will he say tothe suggestion that " ITarley-street " should passsentence ?

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THE COUNTRY DOCTOR IN FRANCE.

IN the Petit Journal Illustré (Paris) of March 7th M.Jean Lecoq has written an interesting article entitledLe Medecin de Campagne. After citing Balzac andthe good Dr. Benassis, the friend of the poor who wasalways remembered by them in their morning andevening prayers and who accepted money from therich only to buy with it medicaments for the poor,the author next quotes Flotow in the old and favouritecomic opera,

" L’Ombre," where the jolly médecinde campagne always seasons his treatment with ahappy couplet, so that as soon as the sound of theneck-bell of his mare is heard, " le malade sourit, etbien souvent guerit," which agrees with the opinionof Moliere that " lorsque le médecin fait rire le malade,c’est le meilleur signe du monde." He then citesHumbert de Romans, an authority in his time, andthe rules he laid down for his disciples to follow intheir medical treatment, but which dealt more withtheir habits, deportment, table manners, and lightconversation. His counsel was that " as you probablywon’t be able to diagnose the complaint, tell the patientthat he has obstruction of the liver, and when hereplies ’ No, master, it is in the head that I suffer,’reply quickly,’ Ah, that comes from the liver.’ " Also,he suggested, "make good use of the word obstruction’as they won’t know what it means and they shouldn’tknow." France to-day, says M. Lecoq, containsabout 21,000 doctors, a figure which is a little surprising,