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were psychogenic or physiogenic. The issue betweenthese had been unnecessarily complicated by thepersistence of the old argument of body againstmind. These must not be regarded as separate andopposed, but complemental. He agreed withMcDougall that the dominating partner in thetrinity of cognition, affection, and conation wasconation ; that was the thread of purpose through-out the life-history of the organism which boimd thesuccessive phases of experience together. He insistedthat the psychological description of mental pheno-mena must have a correlation in nervous function.

Basal feoitM’m in ]}f ental Disorders and the Influenceon it of the Diathermic Current.

Dr. JAMES WALKER (Cardiff Mental Hospital)read a paper with this title, paying special attentionto dementia praecox. Mental and nervous symptomsoccurred, he said, as a result of disease of the thyroidgland, but medication with the extract of that glandshould only be employed where thyroid hypo-function was considered to be either a causative ora contributory factor. Several cases of dementiapraecox he had shown to exhibit vagotonia-i.e.,.a subnormal body temperature, a tendency to brady-- cardia, and respiratory arrhythmia. In one or twoof these cases examined during remission he had found- an improvement in the basal metabolism and a

disappearance of the vagotonic symptoms, showingthat the oxidation deficienc y in the cells was not apermanent condition. Psychic excitement profoundlyaffected metabolism, and produced a temporaryincrease in the sugar content of the blood. Themost reliable information was yielded by patientsin the stupor class, though these need not necessarilybe cases of dementia prepcox. He did not think thelowered metabolism was due to a diminution of thethyroid principle or autocoid, but to a decrease in allthe bodily functions. With regard to treatment, theheat produced by the high-frequency current wasendogenous-i.e., produced in the deeper-lying tissues..It produced a slight fall in the systolic blood pressure,an increase in the leucocytes, in the urine, and in theoutput of urea and ammonia nitrogen. The current

produced, in 20 observed cases of mental disorder,an increase of 10 to 15 per cent. in the basal meta-bolism, 2 to 3 degrees increase in body temperature,and 20 to 30 beats per minute increase in the pulse.His conclusion was that diathermy was a usefultherapeutic measure and one likely to play a definitepart in furthering recovery. During remission indementia prsecox the basal metabolism approachedthat of the normal person.

Diagnosis of Dysenteric Infections in Mental Hospitals.This subject was dealt with in an able paper by

Dr. A. A. W. PETRIE, of the Maudsley Hospital. Hesaid the diagnosis of acute cases was comparativelyeasy ; the difficulty lay in the recognition of verymild chronic and latent cases. He first alluded to thecauses of non-dysenteric diarrhoea, including tuber-culous and nervous mucous colitis, and ulcerativecolitis. With regard to the true dysenteries, thetropical dysentery due to the Balantidium coli couldbe excluded as it practically never occurred in mentalhospitals. An investigation of asylum subjects ’’,showed 9-7 per cent. to be infected with the Enta,mceba

’

histolytica, compared with 4 per cent. to 8 per cent.in the general population. He entered minutely intothe differential characters, remarking that the principalbacilli occurring in bacillary dysentery were the Shigabacillus and the Flexner bacillus, the former usuallycausing the more severe types of the disease, but theFlexner being the more common organism in asylumdysentery. In the chronic disease, help could beobtained from the agglutinins occurring in the blood.

The Ranchi E1trOpean Mental Hospital, India.The PRESIDENT read to the meeting a paper

descriptive of the Ranchi Mental Hospital, contributedby Major OwEN’ BERKELEY-HILL, its medical officer-in-charge. This is the only mental hospital in India

intended solely for the treatment of persons of eitherEuropean or American parentage. The hospital isbuilt on-the " pavilion " system, and covers 85 acres,with ten wards, which will accommodate 92 male and88 female patients. There is a nurse to every two orthree patients and the general health is very good.The methods of life and treatment are detailed in thepaper in a very interesting fashion.

In addition to other excursions, members visitedthe Maudsley Hospital, where Dr. EDWARD MAPOTHERexplained the work being done there and gave somedemonstrations in the laboratory.

ANNUAL DINNER OF THE MEDICO-PSYCHOLOGICALASSOCIATION.-The annual dinner was held at the HotelMetropole, London, on July llth, Dr. Edwin Goodallpresiding. Dr. Percy Smith, who proposed " The Legis-lature," gave an interesting sketch of the history of legalrestraint in relation to the safety of person and property.The Bill now before Parliament for the admission of patientsto county and borough mental hospitals without the for-mality of certification had, he said, the bulk of professionalopinion in its favour. He expressed the hope that itsadministration would not prove so harsh as to be anotherform of certification or so exacting as to be another doseof red tape. Lord Onslow, in replying, forecasted thepassing of this Bill before the end of the year. The provi-sions it contained for after-care should often avoid thenecessity for further institutional treatment, and facilitieswere also given for research in mental disease. LordRiddell and Sir Sydney Russell-Wells also briefly replied.Dr. Goodall, proposing in humorous vein the " SisterMedical Societies," dwelt on the elevating influence of anassociation of medical men and women. There was, hesaid, something wrong with the medical fraternity of anycommunity which had no medical society. Sir HumphryRolleston, Mr. H. J. Waring, Sir William Hale-White, andDr. Henry Cotton, of New Jersey, replied. Dr. C. HubertBond proposed " The Visitors," and Sir Eric Geddes " TheAssociation." Sir Eric Geddes spoke with great sympathyof the vast field for research and investigation openingbefore mental medicine. Quite apart from hopeful lines ofphysical treatment, the aid of psychiatry seemed to him,as a layman, almost unexplored. If the case were putbefore the public clearly and definitely he believed thesupport obtained for the aims and objects of the Associationwould be overwhelming. In spite of the tropical heat thedinner was well attended and most successful.

NATIONAL ASSOCIATION FOR THEPREVENTION OF TUBERCULOSIS.

THE ninth annual conference of this Associationwas held in the University, Edmund-street, Bir-

mingham, on July 12th, 13th, and 14th.THURSDAY, JULY 12TH.

The conference was opened by the Right Hon.the Lord Mayor of Birmingham (Sir David Davis),who welcomed all members of the Association to theconference. Sir ARTHUR STANLEY presided over themeeting.The LORD MAYOR in his opening speech referred

to the work done in Birmingham in connexion withtuberculosis, and mentioned the fact that in thistown, as in a large number of other towns, the cam-paign against tuberculosis had resulted in a verydefinite diminution in the number of new cases ofthe disease. For some three years before the warthere was an average of 4000 new cases of pulmonarytuberculosis reported per annum ; last year therewere about 1700. The fall in the mortalitv had notbeen proportionately so great because it related tocases which commenced years ago, but at the sametime there had been a decided drop, the rate forthose three years being 0-9 per 1000 of the popu-lation. That was a reduction of 60 per cent. inmortality compared with the figure of 50 years ago.Fighting consumption was costing Birminghamnearly ,S90,000 per annum, but if the reduction inthe prevalence of the disease be continued then thecity was willing to spend the money.

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The subject for the morning session wasCare of Advanced Cases of Tuberculosis, especially as

regards Prevention of Infection.A paper on this subject was read by Prof. J.

ROBERTSON (medical officer of health for Birmingham),prepared by the medical officer of health for Edin-burgh (Dr. William Robertson), who was unableto be present. The opening paragraph of this paperwas the cause of much discussion-namely : " It hasyet to be realised by sanitary authorities that thesegregation of the advanced case of pulmonary tuber-culosis is quite as important as is the isolation ofsmall-pox. From some points of view it is more so,because the spread of small-pox can be arrested inan effectual way by definite measures, while thespread of tuberculosis can only be controlled, as faras we know at present, by preventing the diffusionof the infecting micro-organisms." He further statedthat there were far too many sufferers from pulmonarytuberculosis, not a few in an advanced stage of illness,wandering about our streets, resorting to places ofpublic amusement, travelling in trains and trams,and freely scattering infection about them. Hecondemned home treatment when patients were

living in overcrowded and insanitary homes totallyunsuitable for the isolation of such a dangerousdisease. The housing question, he says, is the Alphaof the tuberculosis problem, but when we discuss theadvanced case of tuberculosis we reach the Omegaof the subject. " A disease that can levy an annualtoll of nearly 40,000 persons every year in our countryprovides an enemy that must be defeated by methodsthat are at our hands if we waste less time in discus-sion and get to business. We know that tuber-culosis is preventable, and we have seen how betterhouses will prevent it." Dr. Robertson consideredthat warrants for the forcible removal to sanatoriumof those who cannot with safety be looked after intheir own homes, is a measure that will have to beenforced in the near future. "

Surely," he added," we can afford to be drastic when grappling withsuch a death-dealing malady." Enforced removal ofadvanced cases also caused much discussion.

In the succeeding discussion Dr. F. N. KAY MENZIES(principal assistant medical officer of health, LondonCounty Council) stated that he considered the infec-tivity of tuberculosis had been greatly exaggerated,and this tended to have a detrimental effect on thework of professional men and to discourage voluntaryeffort. It also made it difficult for the great organisa-tions in dealing with cases, because it carried with ita stigma on the patient which was hard on him in Ifollowing his occupation in life. He did not agreethat the segregation of tuberculosis was as importantas that of small-pox. He further stated that 25 localauthorities in this country, Birmingham being oneof them, had been given the power compulsorily toremove highly infective cases of tuberculosis for somany months. He had asked these 25 authoritieshow many compulsory removals they had enforced,and the answer in nearly all instances was not morethan one or two. The public would never put upwith compulsory removal. He did not agree thathousing was the Alpha of the tuberculosis problem.If one factor was to be concentrated upon, the mostimportant was food.

Colonel S. LYLE CUMMINS (David Davies Professorof Tuberculosis, South Wales and Monmouth) saidit would be ridiculous to compare the infectivity oftuberculosis with small-pox, and yet the infectivityof tuberculosis was a terribly real and dangerousthing, and it would not do to discard the importanceof infection. He considered that the hope for thefuture lay in the discovery of a specific remedy, aprophylactic vaccine or both. A few months agosuch a hope seemed remote. One variety of tuberculinafter another had been tried, and the measure ofsuccess had not been very great. The last few weekshave opened up for us new vistas of investigation andeffort; and once more, as so often in the past, thenew light has come from laboratory research. Itwould be unwise, as yet, to claim that Prof. Dreyer’s

It antigen " is the long-sought remedy for which wehave waited, but it can be stated with certainty thatDreyer has broken fresh ground and that the resultsalready obtained were decidedly in advance of thoseof any previous worker, and that they are full of hopefor the future.

Dr. W. H. DAvisON (assistant medical officer ofhealth, Birmingham) considered compulsory removala broken reed, and thought segregation in the homeshould be encouraged. It was the most humanemethod. There was a good scheme working in Birming-ham at present whereby a patient can purchase abed by the hire-system or have a bed lent to himfree of charge. There were about 700 beds in useunder this scheme, which was doing wonderful workin preventing the spread of infection. He consideredit better to spend money on the proper methods ofpreventing the spread of the disease at home than onthe cost of maintenance of an advanced case in aninstitution.

Dr. A. FERGUS HEWAT (assistant physician, RoyalInfirmary, Edinburgh) considered early cases oftuberculosis might be as infective as the so-calledadvanced case with an old cavity. Patients who werebedridden and were living in small houses in contactwith children he advocated should be removed, asalso the cases who were disobedient in their preventivetraining.

Dr. MARCUS PATERSON (medical superintendent,Colindale Hospital, Hendon) did not agree with corn"pulsory removal except in the case of the " rotter’1-i.e., the man who was disobedient and who made noattempt to control infection. He mentioned thedifficulty of removing the prejudice of the publicagainst the sputum flask. He has proved this preju-dice by travelling to Birmingham with a third-classticket and a sputum flask instead of indulging in afirst-class ticket in order to secure a comfortablejourney. He stated that it had been necessary forhim to spit into the flask 16 times, but it had enabledhim to have a carriage to himself all the way. Hethought the conference would do invaluable work ifit helped to overcome this prejudice.’ Dr. ERNEST WATT (medical officer, Scottish Boardof Health) gave some interesting statistical data

showing the necessity for the removal of advancedinfective cases.

Prof. CAWADIAS (of the University of Athens)told how the disease had been spread in villages inGreece by the return of emigrants. He consideredsegregation was the course to which reason prompted,but sentiment would not allow them to be too severe.

Prof. J. ROBERTSON (medical officer of health forBirmingham) said that Dr. W. Robertson’s statementthat tuberculosis was spread as easily as small-poxhe felt was not quite correct. He thought, however,that it was very nearly correct, as there was not muchdifference when they looked at the fact that verynearly the whole of the community was infected withtuberculosis at one time or another.

Dr. BOLTON THOMSON (Hastings), Dr. S. B,wzs(M.O.H. for Derbyshire), Dr. G. C. TROTTER (M.O.H.Islington), Dr. F. L. MOORE (tuberculosis officer forNorthumberland), and Dr. ALEX. COLLINS (tuber-culosis officer for West Ham) also took part in thediscussion, the majority of them disagreeing withcompulsory removal.The subject for the afternoon session was :-

Extent and Nature of Damage Done by TuhermÛosisderived.from I n.fected JJf ilk: Methods of Prevention.

The discussion was opened by Mr. JOHN D. WATSON(Birmingham). He explained the work done by theBirmingham Drainage Board to eliminate tuber-culosis from the cattle on their farms. The firsttuberculin test applied to cows in 1908 showed that60 per cent. of the milk cows and 12 per cent. of theheifers were tuberculous. Recurring tests gaveencouragement to proceed, and they appeared to

prove that by the maintenance of consistent procedureit was possible (within four years of its initiation andat trifling expense) to eliminate tuberculosis from aherd of short-horned cows, which on the first test

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showed 60 per cent. suffering from the disease. Tofree a herd from tuberculosis, he said, was not enough ;you must be in a position to maintain the herd ina. healthv state. He concluded by saying that,important as the attitude of the farmer towards thisq iestion may be, the lamentable indifference of thepublic is the ruling factor. If only milk were a clearfluid like water, and if the public could only see whatis so frequently offered to them as clean milk-quite apart from the pathogenic character of the fluidwhich is offered-they would realise the importanceof what the hygienist is trying to do for them.

Sir GILBERT BARLING (Vice-Chancellor of Birming-ham University) said that tuberculosis derived fromalimentation was especially prone to attack children,especially in glands of the neck and abdomen andbone and joint diseases. He was happy to say,however, that these diseases were distinctly fewer Ithan when he commenced practice 40 years ago. IHe recommended the appointment of a commission Ion the question of the pasteurisation of milk, andsuggested that something could be done in thisdirection by the conference.

Mr. JOHN FRASER (surgeon, Royal Hospital forSick Children, Edinburgh) stated that he had analysedfigures for the past ten years and regretted to saythat he saw no signs of diminution of surgical tuber-culosis amongst children. He considered that theincreasing incidence of the present day was mostlikely due to the widespread unemployment andpoverty among our hospital classes. He stated thathe was a believer in the overwhelming importance ofthe bovine infection, and claimed that future investiga-tion would show that it is of even greater importancethan we now suspect. The elimination of the bovineinfection resolves itself into the preservation of milkfrom infection, and to secure this the proper meansis to arrange for the production and the preparationof the milk that the possibilities of contamination bereduced to a minimum. The first essential of a puremilk production, he stated, is a herd of healthy cows,and this could be guaranteed by the institution ofperiodical tuberculin tests and the immediate elimina-tion of any animals which react.

Sir HENRY GAUVAmT (medical superintendent, LordMayor Treloar Cripples’ Hospital, Alton and HaylingIsland) exhibited some extremely interesting andinstructive lantern slides showing what air therapyand heliotherapy had done towards cures of surgicaltuberculosis. He believed that 50 per cent. of the casesof spinal caries, lupus, and infected glands were dueto bovine tuberculosis, and no form of food-supplyhad caused more deaths than the milk-supply of thiscountry.

Mr. BRENNAN DE VINE (chief veterinary officer forBirmingham) stated that during the past 15 years56 herds of cows had been tested, under the Birming-ham scheme, and 37-8 per cent. of the animals hadbeen affected with tuberculosis. He stated that inattempting to eradicate a widespread disease such asbovine tuberculosis in this country, assistance shouldbe offered by the State in order to relieve the burdenwhich falls upon the owner of live stock to the benefitof the general community.

Dr. HAROLD SCURFIELD thought that bovineinfection of the human being could be stopped ifmilk were sufficiently heated. The diminution of themortality rate of non-pulmonary tuberculosis was

largely due to the fact that mothers have been givingtheir children milk which had been rendered safe byheating.

Mr. WILFRED BUCKLEY (of the National CleanMilk Society) Dr. W. T. MUNRO (medical super-intendent, Glenlomond Sanatorium), and Dr. J.WHEATLEY (Shropshire) also took part in the dis-cussion, the latter stating that he did not agree withDr. Fraser’s statement that surgical tuberculosis wason the increase, statistics showed otherwise.

Prof. J. ROBERTSON advocated the pasteurisation ofmilk and stated there had been an enormous reductionin the mortality from non-pulmonary tuberculosisdue to better supervision of the infective consumptive

and to the strenuous efforts to free herds from tubercu-losis. He stated that Birmingham figures show thatnon-pulmonary tuberculosis was now a little morethan one-third as prevalent as it was 20 years ago..

The annual meeting of the Association and con-ference of branches was held at the University at5 P.M., and was presided over by Sir ARTHURSTANLEY. After the usual business of the meetingwas over a discussion took place on

Work of T1,tberculosis Care Committees ; and How theBranches of the Associaf.ion and Other

Kindred Societies can Assist.

Dr. FRANCIS J. H. COUTTS (senior medical officer,Ministry of Health) opened the discussion, and wasfollowed by Miss McGAW (member of the CouncilN.A.P.T.) and Mr. G. W. ALLEN (Director, Tuber-.culous Ex-service Men’s Society). They emphasisedthe necessity of after-care societies to help patientsafter discharge from sanatoriums. Temporary financialhelp was not what Care Committees should give. Itwas the function of a Care Committee to look upon thefamily of a consumptive as a unit, the whole income ofthe family should be considered, and the best meansfound to assist that family in order to enable the patientto live and work under the most satisfactory condi-tions possible. The necessity for choosing the righttype of women for visitors was emphasised ; theyshould be women with plenty of tact to whom patientscould feel they could go as a friend and Lnot as anofficial.A reception given by the Lord Mayor and Lady

Mayoress was held at the City Art Gallery in theevening. (To be concluded.)

Reviews and Notices of Books.THE BLOOD-SUPPLY TO THE HEART.

In its Anatomical and Clinical Aspects. By LoUIsGROoss, M.D., C.M., Douglas Fellow in Pathology,McGill University, and Research Associate, RoyalVictoria Hospital, Montreal. London : HenryFrowde and Hodder and Stoughton. Pp. 171.25s.

Dr. Louis Gross’s monograph on the " Blood-Supplyto the Heart " gives an account of the results of hisresearches on this subject and the special techniquewhich he has employed. Each chapter also containsa short summary of the work of previous investi-gators and a sketch of the present state of ourknowledge in that particular branch of the subjectwith which it deals. The material was investigated bymeans of X ray examination after injection withsuitable material, and the hearts were finally clearedin oil and sectioned. In the opening chapter theactua,l technique employed is described in sufficientdetail to enable other workers to carry out the methodfor themselves.The most striking feature of the book is an

interesting series of photographs, which have beenvery beautifully reproduced, showing the alterationin the relative richness of the blood-supply to the twosides of the heart at different age-periods. At birththe vascularity of the right and left ventricles isapproximately equal, but as age advances a markedleft-sided preponderance develops, corresponding tothe muscular preponderance which has been studiedby Muller and other observers. The relative ansemiaof the right ventricle is considered to be a potentfactor in the aetiology of those diseases which are mostliable to prove fatal in old age. In discussing theblood-supply to the valves of the heart, the authorputs forward the suggestive hypothesis that the siteof election of valvular endocarditis is largely dependenton the vascularity of the different valves at differentage-periods. In foetal life it is the right heart whichis most frequently involved. In adults, on the otherhand, although relatively few normal valves show a