1555 NOTES, COMMENTS. AND ABSTRACTS WAS SHERLOCK HOLMES A DRUG ADDICT ? (BY AN OCCASIONAL CORRESPONDENT) THE personality of Sherlock Holmes has excited so much interest that for years scholars in England and America have engaged in acute controversy on various points on which the text of the Holmes chronicles is obscure, deficient, or, apparently, contradictory. Was Holmes an Oxford or a Cambridge man ? Was he dependent on his professional earn- ings Did Watson marry one, two, or three wives ? On these and similar questions the most learned authorities are at variance. No attempt has, how- ever, yet been made, so far as I am aware, to examine a more important question : Can we accept Watson’s statements that Holmes was once a victim to the cocaine habit ? It seems that the two men first met late in 1880. We know that Watson joined the army soon after taking his M.D. degree in 1878 ; that he was wounded at the battle of Maiwand, which was fought on July 27th, 1880 ; that he was some months in hospital before going home on sick leave ; and that shortly after returning to London he and Holmes began their joint occupation of the rooms at 221B, Baker-street. At an early stage of their acquaintance he drew up a list of Holmes’s chief characteristics, which, he reminded Holmes some time later, contained the item " self-poisoner by cocaine and tobacco." No wonder that Holmes " grinned " on hearing this remark ; for the list, which is set out in " A Study in Scarlet," contains no such item. This discrepancy, which seems to have passed unnoticed by Holmes scholars, is but one instance of Watson’s inaccuracy in recording events. The alleged addiction is first mentioned in " The Sign of Four," which describes events that took place in July, 1887. Watson states that he saw Holmes give himself a hypodermic injection of what Holmes told him was a 7 per cent. solution of cocaine ; and he adds that this performance had been seen by him " three times a day for many months," and that Holmes said he took cocaine to escape from boredom when not occupied with his cases. Watson records no other administration of the drug ; but he refers to Holmes’s cocaine habit in "The Scandal in Bohemia " I and " The Yellow Face," and, for the last time, in " The Missing Three-quarter," a case, probably investigated in 1897, which, Watson states, followed one of those periods of inaction he had learnt to dread : "For years I had gradually weaned him from that drug mania which had threatened once to check his remarkable career ... but I was well aware that the fiend was not dead but sleeping." He describes his horror when he saw Holmes holding a hypodermic syringe, and his relief on finding that it was to be used to squirt aniseed solution on the hind wheel of a doctor’s car to enable a draghound to trace it to its destination. Though Watson was on intimate terms with Holmes he watched the daily dosing for a long time before making any attempt to check it. Not until " many months " had elapsed did he venture, after a luncheon that included an unspecified quantity of Beaune, upon a mild remonstrance, which was taken in excellent part by the supposed addict. The history of Holmes’s alleged drug addiction is, in short, that it began " many months " before July, .1887, and was gradually discontinued under Watson’s treat- ment, extending over " years," some time before 1897. Now Holmes was not one of those men who are unable to occupy themselves unless some definite task is presented to them. He was a man of immense. mental resource and initiative. He was an expert chemist, an accomplished linguist-with an intimate knowledge of Goethe and Petrarch-an assiduous student of Black Letter texts, a capable performer on the most exacting of all instruments-the violin- a composer, and an authority on the music of the Middle Ages. That a man with such resources should be driven by ennui to seek distraction in cocaine is so improbable that nothing but the strongest evidence could make it credible. Nor was the great detective in other respects of the stuff of which cocaine addicts are made. The victim to cocaine is not, like the opium addict, a solitary self-poisoner ; he is sociable and prefers to take his dope in company. The first effect of the drug upon him is to make him lively and voluble in disconnected talk. He tries to make jokes and shine as a brilliant person. The opium addict may be a man of exceptional powers: Coleridge and De Quincey are examples ; but the victim to cocaine is lacking in mental capacity-incurious, vacuous, needing the gross stimulus of a drug to rouse his interest in life. The continued use of cocaine leads to degeneration-physical, mental, and moral. All this is the antithesis of what we find in Holmes, who was the most unsociable of men : reserved, self-controlled, self-sufficient. There was no falling off in his mental powers, his physical activity, or his character. The effects of his alleged dosings, as described by Watson, are not the manifestations of cocaine poisoning. Moreover, the gradual " weaning " treatment that Watson adopted is unusual in such a case. The sudden discontinuance of cocaine does not give rise to the distressing withdrawal symptoms that follow the sudden discontinuance of morphia. This must have been known to Holmes, who was far more deeply versed in the effects of poisons than his medical friend. Watson was an inexperienced practitioner. There is no evidence that he was in civil practice before he joined the army, and he was invalided out after some two years’ service. For about seven years afterwards he apparently made no attempt to improve his professional proficiency either by post-graduate study or otherwise, but led an idle life, except for the assistance he gave Holmes in the cases in which they collaborated and for his literary work in record- ing a number of cases. It is most unlikely that a man of Holmes’s overpowering personality would be influenced by Watson in a matter so personal as the discontinuance of a drug habit. On the other hand, we have Watson’s statement that he actually saw Holmes inject himself with what he said was a solu- tion of cocaine, and that his forearm and wrist were " all dotted and scarred with innumerable puncture points." How can this statement be explained The explanation is, I suggest, that Holmes was pulling the good Watson’s leg. He had a sense of ironic humour, and when he disguised himself for professional purposes he was delighted at Watson’s failure to penetrate the disguise. He was a con- summate actor, and in " The Adventure of the Dying
Transcript
1555
NOTES, COMMENTS. AND ABSTRACTS
WAS SHERLOCK HOLMES A DRUG
ADDICT ?
(BY AN OCCASIONAL CORRESPONDENT)
THE personality of Sherlock Holmes has excitedso much interest that for years scholars in Englandand America have engaged in acute controversy onvarious points on which the text of the Holmeschronicles is obscure, deficient, or, apparently,contradictory. Was Holmes an Oxford or a Cambridgeman ? Was he dependent on his professional earn-ings Did Watson marry one, two, or three wives ?On these and similar questions the most learnedauthorities are at variance. No attempt has, how-ever, yet been made, so far as I am aware, to examinea more important question : Can we accept Watson’sstatements that Holmes was once a victim to thecocaine habit ?
It seems that the two men first met late in 1880.We know that Watson joined the army soon after
taking his M.D. degree in 1878 ; that he was woundedat the battle of Maiwand, which was fought onJuly 27th, 1880 ; that he was some months in hospitalbefore going home on sick leave ; and that shortlyafter returning to London he and Holmes began theirjoint occupation of the rooms at 221B, Baker-street.At an early stage of their acquaintance he drew upa list of Holmes’s chief characteristics, which, hereminded Holmes some time later, contained the
item " self-poisoner by cocaine and tobacco." Nowonder that Holmes " grinned " on hearing thisremark ; for the list, which is set out in " A Study inScarlet," contains no such item. This discrepancy,which seems to have passed unnoticed by Holmesscholars, is but one instance of Watson’s inaccuracyin recording events.The alleged addiction is first mentioned in " The
Sign of Four," which describes events that took placein July, 1887. Watson states that he saw Holmes
give himself a hypodermic injection of what Holmestold him was a 7 per cent. solution of cocaine ; andhe adds that this performance had been seen by him" three times a day for many months," and thatHolmes said he took cocaine to escape from boredomwhen not occupied with his cases. Watson recordsno other administration of the drug ; but he refers toHolmes’s cocaine habit in "The Scandal in Bohemia " I
and " The Yellow Face," and, for the last time, in " TheMissing Three-quarter," a case, probably investigatedin 1897, which, Watson states, followed one of thoseperiods of inaction he had learnt to dread : "For
years I had gradually weaned him from that drugmania which had threatened once to check hisremarkable career ... but I was well aware thatthe fiend was not dead but sleeping." He describeshis horror when he saw Holmes holding a hypodermicsyringe, and his relief on finding that it was to beused to squirt aniseed solution on the hind wheelof a doctor’s car to enable a draghound to trace itto its destination.
Though Watson was on intimate terms with Holmeshe watched the daily dosing for a long time beforemaking any attempt to check it. Not until " manymonths " had elapsed did he venture, after a luncheonthat included an unspecified quantity of Beaune,upon a mild remonstrance, which was taken inexcellent part by the supposed addict. The history
of Holmes’s alleged drug addiction is, in short, thatit began " many months " before July, .1887, andwas gradually discontinued under Watson’s treat-
ment, extending over " years," some time before1897.Now Holmes was not one of those men who are
unable to occupy themselves unless some definitetask is presented to them. He was a man of immense.mental resource and initiative. He was an expertchemist, an accomplished linguist-with an intimateknowledge of Goethe and Petrarch-an assiduousstudent of Black Letter texts, a capable performeron the most exacting of all instruments-the violin-a composer, and an authority on the music of theMiddle Ages. That a man with such resources shouldbe driven by ennui to seek distraction in cocaine isso improbable that nothing but the strongest evidencecould make it credible.Nor was the great detective in other respects of
the stuff of which cocaine addicts are made. Thevictim to cocaine is not, like the opium addict, asolitary self-poisoner ; he is sociable and prefers totake his dope in company. The first effect of the
drug upon him is to make him lively and voluble indisconnected talk. He tries to make jokes and shineas a brilliant person. The opium addict may be aman of exceptional powers: Coleridge and De
Quincey are examples ; but the victim to cocaine is
lacking in mental capacity-incurious, vacuous,needing the gross stimulus of a drug to rouse hisinterest in life. The continued use of cocaine leads to
degeneration-physical, mental, and moral. All thisis the antithesis of what we find in Holmes, who wasthe most unsociable of men : reserved, self-controlled,self-sufficient. There was no falling off in his mentalpowers, his physical activity, or his character. Theeffects of his alleged dosings, as described by Watson,are not the manifestations of cocaine poisoning.
Moreover, the gradual " weaning " treatment thatWatson adopted is unusual in such a case. The suddendiscontinuance of cocaine does not give rise to thedistressing withdrawal symptoms that follow thesudden discontinuance of morphia. This must havebeen known to Holmes, who was far more deeplyversed in the effects of poisons than his medicalfriend. Watson was an inexperienced practitioner.There is no evidence that he was in civil practicebefore he joined the army, and he was invalided outafter some two years’ service. For about seven yearsafterwards he apparently made no attempt to improvehis professional proficiency either by post-graduatestudy or otherwise, but led an idle life, except forthe assistance he gave Holmes in the cases in whichthey collaborated and for his literary work in record-ing a number of cases. It is most unlikely that aman of Holmes’s overpowering personality would beinfluenced by Watson in a matter so personal as thediscontinuance of a drug habit. On the other hand,we have Watson’s statement that he actually sawHolmes inject himself with what he said was a solu-tion of cocaine, and that his forearm and wrist were" all dotted and scarred with innumerable puncturepoints." How can this statement be explained The explanation is, I suggest, that Holmes was
pulling the good Watson’s leg. He had a sense ofironic humour, and when he disguised himself forprofessional purposes he was delighted at Watson’sfailure to penetrate the disguise. He was a con-
summate actor, and in " The Adventure of the Dying
1556
Detective " he shammed a severe illness with such skillthat Watson, completely deceived, was preventedonly by extreme measures from rushing out forassistance from Harley-street. The puncture markscould easily be counterfeited by a man so proficientin make-up as Holmes ; and we have no evidencebeyond Holmes’s own statement that the bottleWatson called the " cocaine bottle" ever containedcocaine. It was like Holmes to enjoy mystifyingWatson and watching his attempts to screw up hiscourage to protest against his friend’s self-poisoning.What happened when Watson, emboldened byBeaune, did protest is consistent with the hypothesisof a leg-pull : " He did not seem offended. On the
contrary, he put his finger-tips together, and leanedhis elbows on the arms of his chair, like one who hasa relish for conversation."The hypothesis explains also Watson’s account of
his " weaning " treatment. Holmes, who had a
genuine affection for his Boswell, was doubtless
intensely amused at the " weaning " efforts, whichprobably began when Watson after his marriagepurchased a small practice in Paddington. Holmesnaturally wished to encourage his friend in his newrole of general medical practitioner by allowing himto think he was successfully treating a difficult caseof drug addiction.
All we know of Holmes’s alleged addiction can beexplained if we assume that he did not actuallytake the drug, but mystified Watson into believingthat he did. The facts can be explained on no otherhypothesis. This conclusion reflects unfavourablyon the professional competence of Dr. Watson ; butthe interests of truth are paramount, and this contri-bution to the literature that has gathered roundHolmes is offered in justice to the most famouscharacter that has appeared in English fiction sincethe great days of Dickens.
TYPHUS FEVER
THE July-September issue of the EpidemiologicalReport of the Health Section of the League of Nationscontains the second and concluding part of thearticle by Dr. Yves Biraud and Dr. S. Deutschmanon typhus and typhus-like rickettsia infections, ofwhich the first was summarised in these columnsearlier in the year (1936, i., 1250). In dealing withthe distribution of these diseases in Africa they statethat lice-borne typhus remains endemo-sporadic inNorth Africa, is endemo-epidemic in Egypt,among the Bantu population in Basutoland and theUnion of South Africa and South-West Africa, andhas recently invaded the mountainous area of South-West Uganda and Urmndi. Murine typhus has beenfound both in rats and men in the ports and inlandtowns of North, West, and South Africa. Tick-borne diseases are present throughout North Africain the form of boutonneuse fever and in CentralAfrica (Kenya) and South Africa as tick-bite fever.In North America Canada is almost free from allforms of typhus. In the United States louse-bornetyphus, though repeatedly imported from Europeand Mexico, has never become endemic, whereasthe mild form known as Brill’s disease is still endemicin New York City, Massachusetts, and Connecticut.For some years murine typhus has become increas-ingly frequent in the cities of the eastern and south-eastern States, especially Alabama, Georgia, andFlorida, and in towns on the Mexican Gulf and alongthe Rio Grande valley, where the fatality is about5 per cent. On the other hand lice-borne typhus hasbeen endemic for centuries in Mexico, where it iscalled tabardillo and has a fatality of about 40 percent. In Central America typhus is almost confinedto the higher regions of Guatemala. In South
America the distribution of lice-borne typhus extendsfrom Venezuela to the Argentine and the plain ofSouthern Chile. Murine typhus is also found inNorthern Chile, on the coast of Peru, and in theArgentine. In Asia louse-borne typhus is prevalentfrom the northern half of the continent southwardsto the mountainous parts of Iran, Afghanistan,British India, North Indo-China, and South-WesternChina. Three main forms of typhus are also metwith in India : (1) a form clinically and serologicallyidentical with the tropical scrub typhus of Malaya;(2) a more severe form prevalent in the southerndistricts; and (3) a form closely allied to murineflea-borne typhus. In Malaya three types of diseasesare described-scrub typhus or rural typhus, shopor urban typhus, and Japan river fever or Tsutsuga-mushi. In Australia since the disappearance oflouse-borne typhus in 1869 two distinct forms haveexisted-coastal fever, pseudo-typhus or sugar-canetyphus on the eastern coast of tropical Queensland,and another form in the non-tropical part ofQueensland.
SOVIET SCIENCE
Mr. J. G. Crowther has paid seven visits to theSoviet Union in the last seven years, in one ofwhich he had the privilege of being the guest ofinstitutes for a considerable period, and he is thusqualified to write an account 1 of Soviet science fromfirst-hand observation. The author’s aim in a little bookentitled " Soviet Science " is mainly to give informa-tion about the sort and conditions of research inSoviet scientific institutes. The book is divided intosix parts entitled respectively, Theory and Organisa-tion, Physics, Chemistry, Applied Science, Biology,and History of Science. Part I. opens with a chapteron dialectical materialism and then proceeds todescribe the organisation of physical research, theacademy of sciences, and so forth. When theauthor proceeds to describe the actual work beingcarried out he gives the impression of anxiety-doubtless associated with the kindness of his hosts-not to omit mention of any worker or any pieceof research that he came across ; the result is that theuninformed reader would gather a very muchexaggerated idea of the importance of both theworkers and the work. We have no wish to belittlethe commendable energy which is being displayedby the authorities of the U.S.S.R. to foster research.The results in their proper perspective show that thequest of science is not being neglected in the SovietUnion.
ANIMALS AS POSSIBLE VECTORS OF
POLIOMYELITIS
IN the October number of the Annales d’hygiènepublique there is a paper by Prof. Tanon and Dr. H.Cambessedes on the r6le of animals in the trans-mission of poliomyelitis. What has impressed themabout the incidence of the disease in Paris of recentyears has been its sporadic behaviour, no one casebeing traceable to another in the same town. Some-times an inquiry would reveal the sole significantfact that the patient had lately been in some otherlocality known to be infected with poliomyelitis.Tanon has instructed his medical inspectors engagedon the recording of cases of poliomyelitis to keepin mind the possibility of the transmission to manof poliomyelitis from animals, notably poultry.With this slant given to the investigations nowproceeding, he has succeeded in collecting somecurious cases. One of them was that of a child of 4,suffering from typical poliomyelitis, who lived withher parents in a small detached house in the suburbs,isolated from all other buildings. She never wentbeyond the confines of the property, not going toschool or playing with any other children. Whenever
1 Soviet Science. By J. G. Crowther. London: Kegan Paul,Trench, Trübner and Co., Ltd. 1936. Pp. 342. 12s. 6d.
1557
she left the house, it was only to play in a poultryyard that had recently been evacuated because anepidemic among the fowls had killed several of them,and the remainder had been removed by their owner.In another case two brothers, aged respectively 3 and4, developed poliomyelitis. They hardly ever wentout of doors, but played on a large balcony thatcommunicated .with the room of an old woman whohad recently been given a young cat. Its ill healthwas construed by its owner as a sequel to the profusionof fleas it harboured, so she set to work, with theassistance of the two children, to rid the cat of theseparasites. Now the cat had been given to the oldwoman by her son who had recently been in more orless direct contact with a fatal case of poliomyelitis.In another case of this disease there was no poultryyard to connect it with, but in the same householdfive or six cats had recently died after a long illnesscharacterised by progressive difficulty in walking.Though Prof. Tanon is interested in these observa-tions, he warns his readers that " la coincidenceest 1’ennemi des conclusions scientifiques."
BRIGHTON’S WATER-SUPPLY
BRIGHTON and the neighbouring districts thatshare its water-supply are still growing rapidly, andthe Brighton corporation has been obliged fromtime to time to extend its watershed areas on thedownlands near the border of the town. A fewyears ago it bought nearly 800 acres of downlandat Balsdean, at the extreme eastern end of theborough, to the north of R.ottingdean. Graduallythis estate has been developed, water rights havebeen secured, and this one watershed now covers nofewer than 1330 acres. A month ago the pumpingstation was officially opened, and the two bell-shapedpumps were set in motion. They have a capacityof 4,500,000 gallons per day, which is a very consider-able contribution towards the 10,000,000 to 11,000,000gallons per day which the whole area of the under-taking requires. The machinery at Balsdean consistsof two centrifugal borehole pumps. Electricitysupplies the power, and the pumping station is saidto be the largest electrically driven station in England.The Brighton undertaking, including the district itserves-now one of 46i square miles-has neverseriously suffered, even in the recent years ofdrought ; warning notices in the past have alwayssufficed. Now that the undertaking claims to beable to meet twice the requirements of the presentpopulation, there should be no fear of a watershortage, or even of curtailment.
DAIRY REFORM IN THE IRISH FREE STATE
OUR DUBLIN CORRESPONDENT writes : It is justeighteen months since the Milk and Dairies Act, 1935,received the Royal Assent, but its operation wasdelayed pending the framing of regulations requiredin some of the sections. Regulations in relation todairies and milk, and in relation to inspection ofanimals, were to be made by the Minister for LocalGovernment and Public Health with the con-
currence of the Minister for Agriculture. Thesehave now been framed and were issued last week.Stringent conditions are imposed as to the cleanli-ness required both in cowsheds and in dairies. Theremust be adequate washing apparatus and equipmentfor the use of those handling cows or milk. Thefloors of cowsheds and dairies must be so constructedas to be easily cleansed, and there must be no creviceor cavity in which liquid matter could lodge andremain. The floors of cowsheds must be providedwith channels for conveyance of all liquid materialfrom the sheds and the floors must be so slopedthat liquid material will flow into such channels.The cowsheds must be adequately lighted and properlyventilated. The lighting must be such that a personwith ordinarily good sight milking a cow and seatedin any normal milking position could distinguishdirt on the udder or teats, or abnormalities in thecolour of the milk. Provisions are made that the
interior surface of the walls and the ceiling of everycowshed shall be cleansed as often as may be necessary,either by washing with " potable water " or, if thematerial of the walls and ceiling be not of washablematerial, by other thorough methods followed bylime-washing or spraying with lime, or otherwisedisinfected. The floor shall be flushed with water atleast once in each day. Strict conditions are laiddown as to the procedure to be followed in order toensure cleanliness and protect the milk from con-tamination during the act of milking. As regardsinspection, it is provided that every dairy and thevessels and machines in such dairy shall be inspectedat least once in every three months, and the animalsshall be inspected at least once in every six months.The regulations, viewed generally, appear to have
been made with considerable care. It is just possiblethat in some particulars they may have taken toolittle consideration of practical difficulties. In fewIrish farmyards, except where the dairying industryhas been extensively developed, is there a supply ofwater adequate to flush the floors of a cowshed.Again, it is barely necessary to require that the wallsof the cowshed and the hands and arms of the milkershould be washed with " potable " water. There isa danger in attempting to impose conditions whichappear unreasonable or impracticable, for the localauthorities, in whose hands lies the responsibility foradministering the Act, may refuse to stir themselvesin the matter if they think the conditions harsh.
ENCEPHALITIS AFTER VACCINATION
POST-VACCINAL encephalitis, according to van denBranden and. N61is (Bruxelles-méd., 1936, xvii., 1)is rare in Belgium compared with England andHolland, though the figures are scarcely comparablesince it is not compulsorily notifiable. Their opinionis based on the records of the State Vaccination Officein Brussels to which only 11 cases were reportedbetween June, 1932, and June, 1936-an incidenceof one case for every 150,000 vaccinations or
revaccinations. The age-distribution was as follows :one case at 7 t months, six between 2 and 7 years,two in children whose ages were not given, one withoutany mention of age whatever, and one in an adult.Three of the patients completely recovered, five died,and in three the issue was not stated. It is furthernoteworthy that not a single case of post-vaccinalencephalitis has been reported from the BelgianCongo, where in some years half a million vaccina-tions and revaccinations are performed and threelarge insertions are regularly made. van den Brandenand Nelis adopt the now conventional view that firstvaccinations should if possible be performed ininfancy, and they suggest the age of six months toone year as the most suitable time.
HIGH BLOOD PRESSURE
ACCORDING to R. S. Palmer, interest in the surgicaltreatment of essential hypertension is becominggeneral in the United States, and in reporting on agroup of 169 cases treated medically and watchedfor six years or more, he suggests that it may serveas a control (New Eng. Jour. Med., Sept. 24th,1936, p. 569). His results, as might be expected,are good ; he noted a substantial fall in the systolicblood pressure in half the mild and moderate casesand in a third of the severe cases. (No mention ismade of the diastolic blood pressure.) Symptomaticrelief was observed in 90 per cent. of the mild, 75 percent. of the moderate, and 46 per cent. of the severecases. Palmer states that he was at pains to excludecases of hypertension due to other causes-notablychronic glomerulonephritis, but he does not say howhe achieved this. He thinks that a proportion ofpatients in the mild and moderate group, especiallyyoung adults, with signs of rapid progress towardsthe severe form, might benefit by surgery. Buthe regards reduction of blood pressure as the solecriterion of the effectiveness of surgical treatment,
1558
and it is open to question how far the subjects ofessential hypertension are benefited by sudden anddrastic reduction of this kind.
WORK ON TUBERCULOSIS IN WALES
The twenty-fourth annual report of the KingEdward VII. Welsh National Memorial Associationcontains a number of valuable clinical articles onsuch subjects as effusions in pneumothorax, pul-monary abscess, empyema, and problems of dif-ferential diagnosis in dispensary practice. As directorof research, Prof. Lyle Cummins refers to work nowbeing done on silico-anthracosis. Recent evidencepoints to the power of fine dust particles of adsorbingtuberculin and thus reducing the constitutional mani-festations of the disease. Experiments with auro-etu-chloride are also mentioned ; this salt, havingproved bacterio-inhibitory power in vitro, has nowreached the stage of clinical trial where it has provedto be well tolerated in patients and sufficientlyencouraging in results to justify a more extended trial
A PUBLISHING CENTENARY.-On Jan. lst, 1937,the firm of Ferdinand Enke in Stuttgart celebratesthe hundredth anniversary of its foundation. Thispublishing house has for a long time past specialisedin works on medicine and natural science, issuing alsoa number of periodicals on these subjects.
AppointmentsD’OFFAY,T.M.J.,M.B.Edin., F.R.C.S. Eng., has been appointed
Clinical Assistant to the Surgical Department of the RoyalInfirmary, Sheffield.
MAY, G. W., M.B. Lond., Hon. Assistant Ophthalmic Surgeonto the Hertford County Hospital.
PATTERSON, W. H., M.D. Belf., D.C.H., Medical Superintendentat the Booth Hall Hospital, Manchester.
PURCE, AGNES M., M.B. Belf., D.P.H., Assistant Medical Officerfor Bethnal Green.
QuiN, B. 0., M.B. N.Z., Resident Medical Officer at the PrincessElizabeth of York Hospital for Children, Shadwell.
Royal Free Hospital.-The following appointments are
announced :-
CoNSTANTINE, MARY C. E., M.D. Lond., Senior Assistant’tothe Obstetric and Gynaecological Unit;
SmPPnn2, EvERELL M., M.D. Lond., Second Assistant to theObstetric and Gynaecological Unit; and
KEEVIL, NORA L., M.B. Lond., Third Assistant to the Obste-tric and Gynxcological Unit.
VacanciesFor further information refer to the advertisement columns
Bangor, Caernarvonshire and Anglesey Infrmarr.-Hon. Surgeonand Hon. Physician.
’
Barnsley County Borough.-M.O.H. and School M.O., £900.Battersea General Hosp., Battersea Park, S.TV.-H.S. and H.P.,
at rate of B130 and £120 respectively. Also Cas. 0., atrate of .850.
Bedfordshire County Council.-Asst, County M.O.H., &c., 9800.Bexley U.D.C.-Asst. M.O.H., .6550.Birmingham City Mental Hosp.-Jun. Asst. M.O., £350.Brighton County Borough Mental Hosp., Haywards Heath.-Jun.
Asst. M.O., 350.Bury County Borough.-Deputy M.O.H., ,1;650.Canterbury, Kent and Canterbury Hosp.-Hon. Anaesthetist to
Ear, Nose, and Throat Dept.Cardiff City Mental Hosp., Whitchurch.-Med. Supt., £1000.Chelsea Hosp. for Women, Arthur-street, S.W.—Anæsthetist,
£21.
Cheshire, Cleaver Sanatorium for Children, Heswall.-Res. Asst.M.0., £300.
Colchester, Essex County Hosp.-Asst. H.S., £120.Doncaster Royal Infirmary and Dispensary.-Res. Anaesthetist,
at rate of £175.East Ham Memorial Hosp., Shrewsbury-road, E.-Res. M.O., at
rate of £200.
Godalming, County Sanatorium, Milford.-Jun. Asst. Res. M.O.,at rate of £350.
Guildford, Royal Surrey County Hosp.-H.S., at rate of £150.
Hosp. for Consumption and Diseases of the Chest, Brompton,S.W.—H.P. for Out-patient Dept., at rate of £50.
Hosp. for Sick Children, Great Ormond-street, W.C.-Three Clin’.Assts. for Out-patient Dept.
Hosp. for Tropical Diseases, Gordon-street, W.C.—Res. Med.Supt., £400.
Hosp. of St. John and St. Elizabeth, 60, Grove End-road, N.W.-Surg. Reg., at rate of £100.
Hull Royal Infirmary.—Second Cas. 0., at rate of £150.Laboratories of Pathology and Public Health.-Jun. Patho-
logists, £500.Leeds Public Dispensary and Hosp.—Research Worker in
Arthritis, £500.Leicester Royal Infirmary.—Hon. Dental Surgeon. Also two
Hon. Asst. Dental Surgeons.London Hosp., E.-Hon. Asst. Surgeon to Dept. of Neuro-
surgery.London University.—University Chair of Pathology, 92000.Manchester, Crumpsall Hosp.-Res. Asst. Obstet. Officer, at
rate of .6250.
Manchester, Royal Children’s Hosp.-Res. M.O. and Res. H.S.,at rate of zgl 50 and £100 respectively.
Manchester, Withington Hosp.-Res. Asst. M.O., at rate of.8200.
Medical DiaryInformation to be included in this column should reach us
in proper form on Tuesday, and cannot appear if it reachesus later than the first post on Wednesday morning.
LECTURES, ADDRESSES, DEMONSTRATIONS, &cCENTRAL LONDON THROAT, NOSE, AND EAR HOS-PITAL, Gray’s Inn-road, W.C.,
FRIDAY, Jan. 1st.—4 P.M., Mr. Archer Ryland: Cine-matograph Film Illustrating the Radical Mastoid.Operation.
FELLOWSHIP OF MEDICINE AND POST-GRADUATEMEDICAL ASSOCIATION, 1, Wimpole-street, W.
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MONDAY, Dec. 28th, to SATURDAY, Jan. 2nd.—BROMPTONHOSPITAL, S.W., M.R.C.P. course in chest diseases(twice weekly, 5 P.M.)—CITY OF LONDON HOSPITAL,Victoria Park, E., Wed. and Fri., 6 P.M., M.R.C.P.course in chest and heart diseases.-PRESTON HALL,near Maidstone, Kent. Sat., special demonstrationson pulmonary tuberculosis.
WEST LONDON HOSPITAL POST-GRADUATE COLLEGE,Hammersmith, W.TUESDAY, Dec. 29th.—10 A.M., medical wards. 11 A.M.,
WEDNESDAY.—10 A.M., children’s ward and clinic. 11 A.M.,medical wards. 2 P.M., gynaecological operations,medical, surgical, and eye clinics.
THURSDAY.-10 A.M., neurological and gynaecological clinics,Noon, fracture clinic. 2 P.M., operations, medical,surgical, genito-urinary, and eye clinics. 4.15 P.M.,venereal diseases.
FRIDAY.-Jan. 1st, 10 A.M., medical wards, skin clinic.Noon, lecture on treatment. 2 P.M., operations,medical, surgical, and throat clinics.
SATURDAY.-10 A.M., children’s and surgical clinics. 11 A.M.,medical wards.
REDUCED CHARGES AT BATH.—A new tariffsystem has been introduced at this spa, with a reducedfixed charge for all methods of treatment. There isa further reduction of a third during certain hours,and during the winter and summer months. Particularsmay be obtained from the spa director, Bath.
