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conducted for profit, or for other specific reasons cannotbe included in Class B. One college, which refused tohave inspections carried out, is listed as " unclassi-fied," with a note to the effect that, from informationobtained, no rating higher than C should be given toit. Of the total of 81 medical schools thus classified,74 are described as non-sectarian, 3 as homoeopathic,1 as eclectic, and 3 as nondescript. The decline ofhomoeopathic and eclectic schools is shown by the factthat in 1901 they numbered 22 and 10 respectively.The American student is urged, before choosing amedical school, to obtain information of its require-ments of preliminary education, of its teaching,classification, and fees, and of the extent of recog-nition of its diplomas. At present 38 (73 per cent.) ofthe State licensing boards require that before beginningthe study of medicine a student must have completedtwo years of work in an approved college of liberalarts, in addition to a four-year high school education.All the better medical colleges now require thisstandard of preliminary education, and the studentis warned that requirement of any lower standard isan indication that the medical education given will becorrespondingly low. Adequate instruction can begiven only in the Class A medical schools. Althougha favourite bait offered by the inferior medical schoolsis that of low fees, the fees charged by some of the best(Class A) schools-particularly the medical departmentsof some State universities-are lower than thosecharged by several of the poorly-equipped Class Cinstitutions. The better schools which charge higherfees spend several times the amount of the fee peryear on each student, being enabled to do so byendowments or State aid. There are now more than300 free scholarships available for deserving studentsin the better medical schools. The student is warnedagainst accepting without confirmation the statementsmade in the extensive newspaper and magazineadvertisement carried on by some schools. A seriouspitfall to the student in the United States appears tobe the number of institutions representing variousunscientific or pseudo-scientific cults (osteopathy, chiro-practic, &c.) which profess to train those who desireto cure diseases ; the necessity of a thorough trainingin all the fundamentals of medicine is thereforeemphasised. The essentials of an acceptable medicalcollege are detailed, both as regards its educationalrequirements in the student himself, and in itsorganisation, clinical and other facilities, instruction,and financial basis. A list of classified medical schoolsis given, and the reader is left wondering-supposingthe Educational Number of the J ouma of the American3ledical Association to have the circulation it deserves-how any but the Class A medical schools can

continue to exist. ____

DENTAL BENEFIT.

REFERENCES recently made in the daily press to theacceptance by the Incorporated Dental Society onAugust 31st of a scheme similar to that alreadyadopted by the British Dental Association for thesupply of dental benefits to members of approvedsocieties show that there exists a widespread beliefthat such benefits are only about to be establishedand constitute an innovation. The fact is, of course,that dental panels have now been in pa,rtial operationfor about a year. In August, 1921, a series of panelswas formed in the nine central counties, the panelsconsisting of dental practitioners who were alreadyon the register before the passing of the DentistsAct of last year. In April of the present year it wasdecided to organise a system of panels of registereddentists throughout the country. Executive com-mittees elected from the panels in each area are nowselecting representatives to a central panel committee ;when this selection is completed a meeting will beheld in London (probably during October) to formulatea general scheme for the carrying out of dental benefitsin conjunction with approved societies. With regard tothe work already done in this direction, the X ational1 ostcrmuee Gazette for August 12th pointed out that

in the experience of many societies dental benefit isthe most popular and at the same time the mostcostly of the additional benefits offered by the largerinsurance societies which found themselves enabledby accumulation of funds to extend their scope beyondthe ordinary sickness, disablement, and maternitybenefits. It was found that even where generousamounts were set aside for purposes of dental benefit,they were barely enough to meet the demands. Thus,a society with a membership of 20,000

"

good lives "made provision for 21000 per annum dental benefit,to cover the full cost of dental treatment and halfcost of dentures ; this sum barely sufficed for thepurpose. It may be argued, as the Gazette points out,that the first year of such benefit was bound to showexceptionally heavy claims, the whole membershipbeing entitled to claim at one time, and that lighterdemands may be anticipated in following years; onthe other hand, a large percentage of the insuredpopulation were sceptical as to their title to additionalbenefit, and the claims of succeeding years maytherefore be as heavy as in the first year. TheGazette goes on to emphasise the fact that the popu-larity of dental benefit should be welcomed by thoseresponsible for the working of the National InsuranceActs, since digestive upsets account for a considerableproportion of the cost of sickness benefit, and preven-tion of these disorders will materially strengthen theposition of any benefit society.

PROF. SPITZKA AND HIS PATIENTS.

THE death, reported from New York last week,of Dr. Edward Anthony Spitzka, sometime professorof anatomy in Jefferson Medical College and directorof the Daniel Baugh Institute of Anatomy inPhiladelphia, recalls the remarkable opportunitywhich he possessed of verifying his clinical diagnosesby immediate post-mortem examination. He it waswho performed the autopsy on and examined thebrain of Leon F. Czolgosz, the assassin of PresidentMcKinley, and he had many opportunities of observingthe changes found in other criminals after electrocution.In regard to Czolgosz, the character of mental diseasefrom which he was suffering was not determined.There was no evidence of insane delusion or hallucina-tion ; he had no morbid mental exaltation or

expansiveness of ideas suggesting mania, none of themental gloom of melancholia, none of the conjointmental and motor symptoms eharacteristic of generalparesis, nor was there anything in his manner orconduct to suggest persecutory ideas or transformationof personality. Nothing beyond the absurdity of hisstatements and acts gave ground for any assumptionof mental unsoundness. Prof. Carlos F. Macdonald,ex-President of the New York State Commission inLunacy, recorded his unqualified opinion thatCzolgosz, when he assassinated the President, wassane legally and medically and responsible for his act.It was therefore to be expected that the post-mortemexamination should reveal nothing in the brain toaccount for intrinsic cerebral defect ; Prof. Spitzkanoted, however, that -the brain did not exhibit thatespecial kind of asymmetry of gyral structure in thecerebral halves which he held to be characteristic ofthe brains of highly endowed individuals. The fewpeculiarities noted in the arrangement of the cerebralfissures were insignificant, the slight asymmetry ofthe skull being well within the normal range ofvariation. The examination was conducted withespecial care in view of the attempt in those days tofound a " school of degeneracy " to explain crimeand social wickedness in terms of accidental per-sistence of lower types of human organisation.Spitzka was unable to confirm any such correlationof structural anomaly with criminal delinquency.His opinion on Czolgosz was that he was " sociallydiseased and perverted," but not mentally diseased." The wild beast slumbers in us all " was the con-cluding sentence in his report. Ten years laterSpitzka published an account of the changes whichhe found in the brains of five other electrocuted

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criminals, removed and fixed within 15 minutes ofdeath. In each case a number of perivascular lesions,25-300 iL in diameter, were found scattered throughthe lower parts of the brain, the vessels showingbeading, with an area of condensation surroundingthem. The lesions suggested sudden liberation of gasfrom electrolysis, and might have an obvious bearingin medico-legal cases where death from electric currentwas alleged. Spitzka made a study of the brains notmerely of criminals but of many eminent men ofvarious races, and he found time to edit the eighteenthAmerican edition of Gray’s Anatomy. He was

46 years old at the time of his death.

GRASS DISEASE AND BOTULISM.

SOME allusion has been made during the last fewweeks in the daily press to the possible relationbetween botulism and a disease of horses in Scotlandwhich goes by the name of

"

grass disease " or "

grasssickness." It is not generally known that the ScottishGrass Disease Committee has been working on thismatter for the last four years, and that Dr. J. F.Tocher, of Aberdeen, a member of this committee,was concerned in the earliest detection of the Bacillusbotulinus in this country in 1919. The limitations ofour present knowledge were set out in a paper byMr. J. B. Buxton, F.R.C.V.S., read before theSection of Pathology of the Royal Society of Medicinein January last. The grass sickness of NorthernBritain appears to be identical with the forage poison-ing of horses and cattle described in America, andan organism indistinguishable morphologically fromB. botulinus was recovered bv Dr. Tocher from theintestine and spleen of horses dead of this disease.An attempt was made last year to devise some meansof controlling the incidence of the disease, and abotulinus-antitoxin prepared by the Wellcome Physio-logical Research Laboratories was employed, chieflyat first for curative purposes, although it was realisedthat, with the precedent of tetanus, its preventiveapplication was more likely to command success.

But even in cases which did not recover the acutesymptoms of disease appeared to be checked tem-porarily by intravenous administration of the anti-toxin. Further investigation revealed the presencein the blood of several chronic cases of an appreciableamount of antitoxin, type A. One of these animalshad, it is true, received injections of high valuebotulinus-antitoxin some weeks previous to the bloodexamination. As, however, in a control experiment,antitoxin even to the extent of 25 c.cm. of high valuewas eliminated from the blood within 10 days, it wasdeemed at all events highly probable that chroniccases of grass disease do develop a certain degree ofactive immunity, as shown by the presence of anti-toxin. Complement-binding antibodies were alsofound, although it was not possible clearly to indicatethe presence of agglutinins. The Wellcome Labora-tory has, we understand, been preparing botulinus-antitoxin of both types A and B during the last twoyears, and has, in conjunction with the Scottish Com-mittee, recently initiated an experiment in preven-tive inoculation. Further work in this direction isproceeding. ____

CONTROL OF CONCEPTION BY IRRADIATION.MOST of the methods which have been devised for

the control of conception, ingenious though many ofthem are, have been found to possess drawbacks forone or other of the consenting parties. In a recentnumber of the Deutsche rnedizinische WochenschriftDr. Emmerich Markovitz sets out a method whichemanates from the Central X Ray Laboratory of theVienna General Hospital. He submits that recentinvestigations have shown that the parenchymatousconstituents of the genital glands are affected byX rays to the point of actual degeneration, while theinterstitial tissue more or less escapes change. Heproposes in cases where temporary cessation ofconception is desirable to obtain it by alternately

1 Since published in the Veterinary Journal, April, 1922.

dosing the husband and the wife. In the earlyexperiments of Gauss, of ten women about the age of30 years, nine were rendered temporarily sterile byX ray radiation, whereas before the treatment theywere bearing children at an average of one in 18months. Weber went on to show that sterility set inwithin six months of irradiation, and M. Frankelobserved the return of menstruation and normalpregnancy a few months after stopping the X rays.More recently Seitz and Wintz have set out the exactdosage of X rays required to attain sterility withminimal damage to other than the immediatelyripening follicles. In regard to the male, analogousresults have been obtained, and Markovitz quotesespecially the experience of Kriser, who at theVienna Central X Ray Laboratory producedazoospermia in a patient by means of minimal doses,giving in fact only thrice at two-month intervals1 H through 0-3 mm. brass filter on the skin. Mar-kovitz’s programme would consist in irradiating theman before the ability to conceive returns in thewoman, as indicated by the recommencement ofmenstruation. Since the duration of the sterilisationin the man is as yet unknown, he admits that periodicalexaminations of the spermatic fluid will be necessary.The morbid conditions for which the treatmentis suggested are slight tuberculosis of goodprognosis, Graves’s disease after successful operativeor X ray treatment, diabetes of slight grade, mor-phinism when not too pronounced, and such like.The treatment has the merit of avoiding finality.Prof. Holzknecht, under whom it is being carried out,lays down the principle that the doctor has no right todestroy more tissue than is necessary in the individualcase ; a partial exovulation not affecting more than6 to 12 ovula should meet the case. The methodimplies agreement on the side of both parties. Dr.Markovitz appends a limited but useful bibliographyto his paper. ____

MALARIA IN THE MALAY STATES.

FROM the annual report for 1921 of the ChiefSecretary to the Government (Mr. W. G. Maxwell,C.M.G.) it appears that, as usual, malaria heads thelist of fatal diseases in the Federated States. Theactual number of deaths from malaria was 17,168, aconsiderable decrease from the 20,595 recorded in1920, but still nearly half the total for all diseases,giving a rate of 13-16 per mille as compared with15-24 in 1920 ; but the disease is, of course, a

contributory factor in many deaths attributed toother causes, and when the malaria sick-rate anddeath-rate are reduced, the total death-rate of thecountry will fall in proportion.The Malaria Advisory Board meets every month,

and almost every district has its mosquito destructionboard. Any estate that requires an anopheline surveycan obtain one, free from cost, together with a reportand the health officer’s recommendations, but to beeffectual, anti-malarial measures must be carried outunder the direct supervision of the estate medicalofficer, and constitute a duty of the owners of estates.The district mosquito destruction boards function inthe town areas, villages, and kampongs. The (central)Malaria Advisory Board merely advises, controls, andcoordinates the work of the district boards. Theadvisory board is endeavouring to achieve a policy ofcombined anti-malarial action by contiguous estates ;where anti-malarial work is carried out under expertsupervision upon an estate, and neighbouring Stateland or small holdings also requires to be treated, theGovernment considers applications for a fair con-

tribution in order to render the operation effective.The anti-malarial works at Kuala Lumpur cover6600 acres, and were maintained during the year at acost of$22,126 ; the sum of$105,000 was expendedon the erection of new works. The Port Swettenhamanti-malarial area of 3100 acres was maintained at acost of$4623 ; at Seremban a drained area of 1500acres was maintained at a cost of$8283. Surveys atTaiping, Kuala Lumpur, Gemas, and Raub werecar ied out over an area of 2600 acres. At the