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very little affected; the arrest of growth falls ch iefl3on the spheno-ethmoidal region, leading to a markedretraction of the nasion and supra-orbital region ojthe forehead.In the profile drawings the skulls are orientated

on a plane which passes through the fronto-malalsuture in front and the posterior inferior angle of theparietal behind-a plane which I find very useful foithe comparison of skulls in which the facial partsare absent or broken. I have fitted each profileinto a framework of lines, the horizontal lines being100 mm. apart and the vertical 190 mm. When anormal skull is orientated as I have indicated andplaced in such a framework the vault should reachthe upper horizontal and the lower part of the fore.head the anterior vertical line. In achondroplasiathe vault tends to rise far above the upper hori.zontal line and the supra-orbital region, to fall faishort of the anterior vertical line. In the Chestelskull the vault rises 8 mm. above the upper hori.zontal line ; in the Egyptian skull 16 mm. On theother hand, the lower frontal region falls 26 mm,short of the anterior vertical line in the Chestexskull and 30 mm. in the ancient Egyptian.The explanation of those peculiar features-the

elevation of the vault and retraction of the supra-orbital region-lies in the manner in which brain-space is obtained in the subjects of achondroplasia,Owing to the arrest of growth in the basal parts oithe skull the brain expands upwards and laterally,giving the vault of the skull its high and globulalform. The drawings of the vault bring out othercharacteristics of the skull in achondroplasia.The length of the Chester skull I estimate to be

183 mm., its greatest width 149 mm. (Fig. 2), theheight of the vault above the ear holes 120 mm. ;the cubic capacity must have been about 1450-1500 c.cm. The bones are thin, those of the vaultvarying from 4 to 5 mm. ; at the glabella thethickness of the frontal bone is only 12 mm.

It is very difficult in such cases to form anopinion as to sex, all the sexual characters beingmasked, but I suspect that in both the Chester andEgyptian cases the sex was feminine. Althoughthe teeth in the Chester skull are much worn, andmany of them lost from disease-apparently notcaries-the sutures of the vault are still clearlyseen; I think the age of the individual may beestimated at about 40 or 50 years.

References.—Newstead; Annals of Archæology and Anthropology,vol. vi., No. 4. Dr. Murk Jansen: Achondroplasia, its Nature andits Cause, 1912. With introduction by Professor Elliot Smith.Keith: Journal of Anatomy and Physiology, 1913, vol. xlvii.,p. 189. Cautley: Diseases of Children, 1910.

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Scottish Board of Health and Panel Chentists.THE Scottish Board of Health have issued a state-

ment with reference to the claim put forward by thepanel chemists for a 50 per cent. increase on the Scottishscale put forward, but not granted, in 1913, or a 200 percent. addition to the rates at present in force. In other

words, the dispensing fee of 2d. would in every case beraised to 6d. Apart from the profit on drugs, the Boardclaim that in a 50 hours’ working week, dispensing sixprescriptions per hour, the average annual paymentwould be 375, whether the assistant were qualified ornot. The Board believe that the rate is considerably inexcess of the actual average remuneration, and thateven a fully qualified assistant is not generally paidmore than X250 per annum, and that their offer leavesample margin for any reasonable increase in salaries of

assistants. The rate claimed by Scottish chemists isconsiderably in excess of that for England, and theGovernment will not agree to so substantial a differencein the two countries. Further, the chemists claim adispensing fee of 6d. for every service rendered, even inhanding over a finished article, which might be delivered tothe general public in the ordinary course as a sales trans-action. Chemists, says the statement of the Board, receiveno less than 33! per cent. gross profit on each ingredientof a prescription in addition to the dispensing fee. TheBoard think that chemists generally are not aware ofthe profit the tariff is yielding, and state that an

investigation undertaken by the Drug Accounts Com-mittee at the Central Checking Bureau in 1916 showedthat the gross profit on drugs as shown by a scrutiny ofover 200,000 forms was over 50 per cent. Over andabove this the dispensing fees showed an averagepayment of 2’31d. While the dispensing fee hasremained the same, the profit on drugs has steadilyrisen, and for the first half of 1919 ’shows an increaseover 1913 of nearly 47 per cent. The Board emphasisesthe danger of insisting on such a demand as the present.A general refusal of Scottish chemists to contractwould compel the Board to consider an entirelydifferent method for the supply of drugs, and mighteven entail the closing of the panel for a considerabletime.

Presentation to a Scottish lTedica-L ]}fan.The residents of Culter, Aberdeenshire, and surround.

ing districts have made a presentation to Dr. RobertRannie, who has practised in Culter for over 30 years,and to Mrs. Rannie. Mr. A. F. Irvine, of Drum, spokewarmly of Dr. Rannie’s efforts to undertake the workof a particularly large district, stretching as far asPortlethen and Muchalls, during the war. The giftswere subscribed to by close upon 500 people. Dr.Rannie, in returning thanks, referred to his work forthe National Health Insurance Act. He had a panel of1000, and in the seven years since the Act had comeinto force the relations between him and his patientshad always been cordial.

]}fedico-Chirurgical Society of Edinburgh: Debate onPsychotherapy.

At the meeting of this society held on Dec. 3rd adiscussion took place upon psychotherapy. The dis-cussion was opened by Dr. George M. Robertson, whogave a general outline of the subject in an exceptionallyinteresting and able paper. It is, he stated, only com-paratively recently that the importance of psycho-therapy has come to be recognised, though it has beenunconsciously practised from the earliest times. Mostsymptoms are mental, such as malaise, discomfort,sense of ill-being, pain, and in every case the brain isthe ultimate seat of their interpretation. For anysymptom to be fully appreciated complete consciousnessis necessary, and hence it is that psychotherapy can beof great value in removing or relieving symptoms, notonly in functional cases, but also in those where theirproduction is dependent upon some definite anatomicallesion. Cases cited were pneumonia, toothache,whitlow, and inoperable cancer. Dr. Robertson then

gave instances of diseases which were the resultof auto-suggestion, and showed how this mightalso be a means of retarding recovery-instancingparticularly the slow recovery in war neuroses duringthe continuance of hostilities, and the hysterical com-plications of rheumatism. Disease might also result orbe prolonged in consequence of suggestions -receivedfrom other people-as in hysteria major-and invalidismfrom any cause might be protracted by similar means.The mind is more susceptible to suggestion duringdisease, especially of a toxic nature, than in health,and hence, although psychotherapy cannot remove theorganic changes of morbidity, it can nevertheless be ofgreat value in relieving suffering. The influence of themind over the body is well recognised, one of the bestexamples being the phenomena which occur aftersevere emotional disturbance-such as fright-whichis followed by circulatory disturbances, palpita-tion, sweating, &c. It has even been stated thatblisters may be produced by psychic influences,every precaution in the case cited having been

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taken to preclude any possibility of fraud. Treat-ment by psychotherapy in the modern sense was

probably first employed about the time of the FrenchRevolution, when the " moral treatment of the insane "was introduced. Further progress was made whensusceptibility to suggestion was noted first in individualsunder the influence of hypnotism, and later in the

waking state. The use of psychotherapy, however, canbe traced to a much earlier period, and it doubtlessexplained the success of amulets and charms, weaponsalve, sympathetic powder, faith cures and the benefitsobtained from religious relics, as well as at the successesattributed to Christian Science. The most importanttherapeutic influence of the physician was that of hispersonality, and the confidence which his patientshave in him plays a large part in the success of histreatment. Of the many drugs in use only a smallnumber had any definite and proven value. All had seendrugs introduced which apparently at first were of value,but shortly were abandoned as useless, hence the advice:" Hurry up and take the new medicine, while it stillcures." The methods of employing psychotherapy werenumerous, and varied according to the individual practi-tioner. The simplest form-and one which everydoctor was constantly using, even though unconsciously-was suggestion. The giving of a prescription and atthe same time telling the patient the action expectedfrom it was an example of its use. The personality ofthe physician was of paramount importance-undueanxiety on his part, if apparent to the patient, mightprolong an illness or intensify symptoms. Persuasion,by a combination of instruction, education, and argu-ment, was a more active form of suggestion. Psycho-analysis might be of value in given cases, but wasseldom successfully employed above middle age, andmight give offence to the patient, and in some cases proveactually harmful.In the discussion Dr. H. C. Marr spoke of the value of

psychotherapy in cases of shell shock, but opposed itsgeneral use as risky. Dr. A. Ninian Bruce dealt particu-larly with psychotherapy in early incipient insanity,and Dr. D. Murray Lyon gave an outline of psycho-therapeutic methods with illustrative cases. ProfessorJ. C. Meakins, Dr. D. Chalmers Watson, Dr. Yellowlees,and Dr. A. J. Brock also contributed to the discussion.

Glasgow Medico-Chirurgical Society : Detail inAbdominal Operations.

The opening meeting of this society was heldon Nov. 21st, when Mr. A. Ernest Maylard, thePresident, delivered an address on the Practical Signifi-cance of Attention to Detail in Abdominal Operations.It was not, he said, in books, and but rarely in specialmonographs that such surgical minutiae were described ;rather they were to be observed in the practical workof individual surgeons. No detail should be consideredtoo trivial ; it might lessen the possibility of subsequentcomplications, hasten the process of repair, or diminishthe occurrence of pain. Details in abdominal opera-tions could be considered in connexion with (1) theabdominal parietes, (2) the parietal and visceral peri-toneum, (3) the viscera. The incision should, wherepossible, be carried through aponeurotic tissue, as theefficient healing of the aponeurosis is the surest pre-ventive against subsequent hernia. As few cuts aspossible should be made ; to

" dissect " an incision wasto lacerate the tissues, so that in addition to the timeentailed dissection also exposed devitalised tissue to therisk of autogenous infection. In the closure of a woundthe most perfect possible co-aptation of the marginsshould be aimed at, so that no spaces be left for theaccumulation of blood, serum, or liquid fat. Hence, ifthe deep part of a very fat wound cannot be effectuallyco-apted it was wise to introduce a small rubber

drainage-tube along the floor of the wound. Tightstitching, more likely to occur with interrupted thanwith continuous sutures, especially if the knot was a" reef " and not a " surgical " one, led to strangulationof tissues and should be avoided. The " granny " knotand so-called " anchor " dressing were undesirablebecause apt to cause discomfort to the patient. Theprocedure, advocated by Dr. C. J. Bond. of wipingthe wound previous to its final closure with 3 or

4 per cent. iodine solution, was of proved value,but not the least soiling of the peritoneum mustbe permitted, as it would almost certainly lead tothe subsequent formation of intraperitoneal adhesions.Of details associated with the parietal and visceralperitoneum one most frequently neglected was thefailure to evert the edges of the peritoneum in suturingthe parietal wound, the result being the formation ofadhesions. In suturing a visceral wound, on the otherhand, the peritoneal edges should be carefully inverted.The edges of divided peritoneum should of course beseized by sharp hooks, and not by pressure forceps.Among details associated with the viscera all rawsurfaces must be carefully obliterated, not only toprevent subsequent adhesions, but to avoid infection ofthe peritoneal cavity from the intestinal canal. Allundue mechanical irritation of the peritoneum, by longexposure, undue manipulation, or prolonged contactwith foreign material, such as dry gauze compresses orplugs, must be avoided, as must also any accumu-lation of extravasated blood, which may laterbecome organised into fibrous tissue. With a viewto inhibiting the formation of organised tissue duringthe period required for the healing of the peritoneallesion, a 3’8 per cent. solution of citrate of soda should beused for soaking gauze compresses, &c., and for washingaway blood and other exudates from the peritonealcavity. It was doubtful whether drainage-tubes wereof any service except to drain distinct abscess cavitiesand the pelvic cavity when it is practically a largeabscess, and it was certainly pernicious to retain themfor any length of time, as ulceration might result fromtheir pressure on the bowel. The retaining safety-pinshould never be inserted through the centre, as thelumen was thus partially occluded. As to sutures, if theskin edges are united by non-absorbent material, suchas silk or silkworm gut, not less than 10 days shouldelapse before removal in wounds which have healed byprimary union. The patient after an abdominal opera-tion should be kept in the recumbent position until it isfelt that the cicatrix will not yield, and a good test ofits complete organisation is that when pressed upon nodifference can be felt between it and the surroundingparts; in other words, any obvious thickening alongthe line of the incision indicated that soft tissue wasstill present. On an average the period of recumbencymay be taken as four weeks.-A discussion followed theaddress, in which Dr. H. Jones, Dr. G. Balfour Marshall,Dr. W. D. Macfarlane, and others took part.Dec. 8th.

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IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

Royal College of Sitrgeons in Irelccrand.

AT a meeting of the College, held on Dec. 5th, Mr.John B. Story, the President, in the chair, Surgeon-General R. H. Sawyer, A.M.S., was unanimously electeda Member of the Council in the place of the late Mr.Richard Dancer Purefoy.

Disease in Belfast.At a meeting of the City Council, held on Dec. 1st, it

was announced that between Oct. 19th and Nov. 15th1 case of typhoid, 700 of scarlet fever, 2 of puerperalfever, 18 of diphtheria, 32 of erysipelas, and 1 of cerebro-spinal fever had been notified, as well as 101 of tuber-culosis. During the same period there were in Belfast860 births and 537 deaths, making a natural increase of323. There were from zymotic disease 63 deaths, 51from pulmonary tuberculosis, 69 from diseases of therespiratory organs, 42 from pneumonia, making a

total of 111 from chest affections. Ninety childrenunder 1 year died in the same period. The death-rate from all causes was 17’4, from zymotic diseases2’0, and from chest affections 5’3 per 1000 of the popula-tion. It was reported that the scarlatina epidemic wassubsiding.

Typhoid Outbreak at Castlederg.In the Spamount district of Castlederg, co. Tyrone,

there is an outbreak of typhoid fever, nine cases being