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sions. The poor-law hospitals would be removedentirely from the immediate sphere of poor-lawrelief. The danger of bureaucracy was real, but notinsurmountable. The general medical hospitals mustbe left free from red tape, but their requirements werequite different from those of an institution for chroniccases, and if the nucleus of their staffs were appointedfrom the voluntary hospitals the evil should be averted.The poor-law hospitals were not unworthy to take partin an organisation on these lines ; they had alreadyassumed a large part of the burden of the voluntaryhospitals, in spite of many handicaps like lack of Itreatment facilities, the fear of the ratepayers, andthe almost complete apathy on medical matters of thepoor-law section of the Ministry of Health. It was thefashion to decry these institutions and say that patientswould not go into them ; the fact was that they had tocater for the patients refused by the voluntaryhospitals. Dr. Little’s figures about empty beds didnot apply to London, and patients, so far from beingreluctant, often asked to be sent to the infirmary. Itwas true that the poor-law hospitals were inadequatelystaffed, but this fault, with others, was being removed.In Lewisham and Eltham, with their huge new popula-tions, the guardians had stepped into the breach,which would otherwise have remained empty, againstmuch opposition and with no help from higherauthorities. A new voluntary hospital was beingerected at Shooter’s Hill, and would run without anyconnexion with the new poor-law provision ; thiswas almost a public scandal. The example was anextreme one, but showed the present state of hospitalorganisation.

Discussion.

Miss E. FULFORD, chairman of the Fulhamguardians, strongly defended the poor-law systemfrom the criticisms made by Dr. Graham Little.There were no empty beds in Fulham Hospital.The atmosphere of free service was equal to that ofthe voluntary hospitals, the legal disqualification hadbeen removed in 1918, and guardians put theirpatients’ needs before those of the ratepayers.Moreover, the central authority and the Ministry ofHealth were most helpful.

Mr. B. METIVIEB, of the Edmonton guardians,exposed the fallacy that a consultant was con-

taminated by being paid for hospital service.

Lord RIDDIELL wondered whether subscribers wouldcontinue to support the voluntary hospitals when theysaw public institutions doing just as good work andbeing as well run. Public bodies, however, lacked thespirit of research, and a teaching hospital could notsucceed on the cast-iron lines of a rate-supportedorganisation. To preserve the voluntary systemmeant preserving the voluntary subscriber, and manypersons were opposed nowadays to the principle ofhaving the voluntary hospitals supported by a limitedclass and would prefer an increase of, say, a penny onthe rates.

Mr. E. A. H. JAY, the propaganda secretary of KingEdward’s Fund, agreed that people would onlysubscribe to a thing which could not otherwise beobtained. Endowments, which up to 1914 had beenlargely adequate, had now dropped in value to19 per cent. of the required revenue ; 32 per cent. waspaid by public authorities, and the remainder had tobe got from subscribers. Voluntary hospitals, if theywere to continue to fulfil a function that no otherorganisation fulfilled, should devote themselves totreating cases requiring their unique special equipment,to training doctors and nurses, and to research.Payments from the County Council might be verymuch larger in the future than they were at present.

The CHAIRMAN closed the proceedings with anexhortation to remember that the voluntary hospitalswere a vital part of the credit of the nation abroad,a mirror of the national life, the loss of which couldnot possibly be contemplated.

Reviews and Notices of Books.A TEXT-BOOK OF INFECTIOUS DISEASES.

Being the third edition of Goodall and Po&oMM’sManual of Infectious Diseases. Revised and inlarge part rewritten by E. W. GOODALL, O.B.E.,M.D., B.S. Lond., lately Medical Superintendentand Lecturer on Infectious Diseases and FeverHospital Administration at the North-WesternHospital of the Metropolitan Asylums Board.London: H. K. Lewis and Co., Ltd. 1928.Pp. 718. 30s.DURING the nineteen years which have elapsed

since the second edition of this manual was publisheda vast amount of work has been accomplished, moreespecially in the fields of bacteriology and immuno-logy. The third edition has increased in size by300 pages and has developed from a manual to atext-book. Dr. Goodall’s long and intimate acquaint-ance with all the infectious diseases met with in thiscountry makes this volume very acceptable to allwho make a special study of such diseases, and atthe same time renders it a very useful reference bookfor students and practitioners. The introductorychapter is specially written for D.P.H. students whowish to know " something about epidemiology."The ordinary student can afford to leave this chapteruntil he knows something about the diseases them-selves. The next five chapters deal with fever, con-tagion and infection, disinfection, rashes simulatingthose of the specific fevers, and sore-throat, andform a necessary introduction to a closer study ofthe actual fevers, which are fully discussed in therest of the book. These early chapters are clearlywritten. Diphtheria, a disease which-in spite ofserum treatment-is still serious, is dealt with verythoroughly in a chapter of 70 pages. Dr. Goodallconsiders that " the Schick test is of no value in thediagnosis of diphtheria," a statement which will notbe readily accepted by those who have had opportunities of studying its significance in this connexion,and who will rather agree with Dr. Rundle in Ker’sManual of Fevers, who says that " 100 per cent. ofdiphtheria cases are Schick-positive at the beginningof the attack." Dr. Goodall does not approve ofswabbing contacts, but recommends Schick-testingand active immunisation as the solution of theproblem of prevention. The author’s experience ofintubation in laryngeal diphtheria makes interestingreading ; no mention is made, however, of feeding bythe mouth in such cases.The chapter on scarlet fever runs to 60 pages and

includes an account of the Dick test, the Schultz-Charlton reaction, and immunisation against thedisease with streptococcal toxin. Dr. Goodall thinksthat the results of immunisation are so far notencouraging. Concentrated scarlet fever antitoxin isrecommended by the author in the treatment of thisdisease in doses of 10-50 c.cm., given intravenouslyif necessary, but he remarks that " the serum appearsto have no effect on complications when once theyhave set in." Most observers will agree with this.The chapter on influenza is interesting, dealing, as

it does, with the pandemic of 1918-19. Encephalitislethargica, anterior poliomyelitis, and cerebro-spinalfever are all carefully considered. In Dr.Goodall’s opinion the prognosis of encephalitislethargica should be extremely guarded, and hequotes the epidemics in Sheffield and Belfast to provethis. For anterior poliomyelitis the Thomas straightframe with headpiece is recommended at first, andlater natural movements of the affected limbs. Dr.Goodall does not apparently advise electrical treatmentlocally, and quotes Lovett, who says " that, after

many years experience of it, he has never been ableto satisfy himself that it was of any value." Manyobservers will agree with this. In the sequel thereis a very clear and useful description of the cerebro-spinal fluid in all these diseases. Dr. Goodall con-siders that the temperature of the measles ward

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should be 60 F., and that the patient should beprotected from draughts with screens. This is

scarcely necessary, and, as long as a measles patientis warm in bed, the freest possible ventilation isundoubtedly best, as recommended by Foord Caiger,and especially by Ker. Recent work on the prophy-laxis of measles is discussed by the author in all itsaspects. The chapters on small-pox, chicken-pox,typhus, and enteric fever are excellent and well worthreading from beginning to end. The chapters onglanders and anthrax are still retained. There arethroughout excellent plates, photographs, diagrams,temperature charts, and tables which the student, inparticular, will find extremely useful, while theappendices contain interesting matter. The readerwill thank the author for dotting the book so plenti-fully with references.Both author and publisher are to be congratu-

lated on the third edition of this volume which isthoroughly up to date and should make a valuableaddition to the library of every medical practitioner.

MALARIAL TREATMENT IN SYPHILIS.

Die Malariatherapie der Syphilis. By Dr. JOSEFMATUSCHKA and Dr. RUDOLF ROSNER. With anIntroduction by Prof. ERNEST FINGER. Vienna :Julius Springer. 1927. Pp. 84. M.4.80.

THIS is the first account we have seen of theapplication of malarial treatment to syphilis in general.It records observations extending over four years andembracing 500 cases, in only 135 of which the nervoussystem was involved; and since the effects of malariaon the various forms of nervous syphilis are now widelyknown the main interest centres in the treatment ofthe other cases. The argument on which the authorsbase their wider application of malaria therapy isthat as salvarsan and mercury are not direct spiro-chseticides their apparent action in the human bodymust depend on inducing a reaction of the humanorganism. It is this reaction and not the drugs them-selves which destroy the infective agents; the actionbeing apparently a mediate one, it seemed that theeffect of any course of chemical treatment must dependon the state of the human body concerned and thatvarious influences might increase or decrease the body’sreaction.

Fever was already known as a powerful adjuvant,but experiment showed that alone it could not effecta cure, and might, in fact, hinder later treatmentcombined with intensive salvarsan courses it gaveextremely good results. In early syphilis-that is, withinfections of less than two years’ standing-suchcombined treatment rendered the Wassermann Ireaction of the blood negative in 99 per cent. of cases Iand in all these cases the negative reaction wasmaintained ; the cerebro-spinal fluid became negativein all cases in ’which before treatment it had beenpositive, but there were a few cases in which fluidpreviously negative to the Wassermann test becamepositive during the treatment. Serological relapseshave hitherto been extremely rare, but clinical relapses,though still very few in number, have been a littlemore frequent. With infections of longer standing theresults, while less brilliant, were yet better than thoseobtained by any other method of treatment, theWassermann reaction of the blood becoming negativein 61 per cent. and that of the cerebro-spinal fluid in55 per cent. of cases ; no serological relapses have beenobserved in this group. In selected cases of pregnancythe treatment was well tolerated and gave excellentresults. Congenital syphilis responded partially tothe treatment, cases of early interstitial keratitis beingaborted and those of the established condition beingoften greatly improved.The authors of this brochure are convinced that in

malaria therapy medicine has a powerful new weapon.Their technique, which is fully described, involves twoinoculations of malaria, and they find that theincubation period is on the average five days. Duringthe attack of malaria the Wassermann reaction, if

not already positive, usually becomes so. The mostimportant contra-indication to the treatment is cardaicdisease. Many individual cases are described andvarious problems raised are discussed.

Altogether this is an interesting account of a

valuable piece of pioneering work.

Reports and Analytical Records.AUSTRALIAN WINES:

(1) MELVINA WHITE; (2) IMPERIUM RED.(SOUTHARD AND Co., LTD., 2, ST. DUNSTAN’S HILL, E.C.)

(1) Melvina White (Australian), when analysed, wasfound to have the composition :-

Preservatives were tested for with negative results.The wine is of a rich type and possesses an agreeablepalate and aroma. These qualities in conjunctionwith its purity add to its value as a wine for tonicpurposes.

I (2) On analysis Imperium Red (Australian) gaveI the following results :-

Preservatives, and colouring matter not natural toa red wine, were tested for with negative results. Themineral matter contains iron to the extent of 2-6 partsper million of wine. The wine has a rich sweet fruityflavour, and resembles a good port in appearance,aroma, and palate. It is a pure and sound wine, andthe presence of organically combined iron may beregarded as an asset. So high grade an Australianproduct merits the attention of medical men and otherswho have to advise on matters of food and beverages.

New Inventions.A NEW FORM OF TRIAL FRAME.

IN estimating by retinoscopy the refraction ofschool-children the combination of the ordinary trialframe and head band here illustrated has been found

convenient. It can be readily fitted to-the varyingsizes and shapes of the head and once fitted remainsfirmly in position. I have given it a year’s trial andcan confidently recommend its use.The apparatus has been made for me by Messrs.

Down Bros.Reading. JOHN PARRY PRICE, M.D. Oxf.