44

just resigned. The letter was published in the dailypapers, and stated :-

" I note that the Minister said : It is quite obvious thatwhere male patients have got out of hand it is more desirablethat a male medical officer should be appointed to dealwith them.’ To avoid the misunderstanding that mayarise from this statement, perhaps you would allow me topoint out that my duties at Portrane since my appointmentcomprise the charge of the female patients and femalestaff, and relief duty for the male medical officer who hascharge of the male patients and male staff, the latter onlybeing emergency medical attendance. The question of* discipline ’ amongst the male patients was not withinmy province.

" As the vacancy occurs on the female medical staff,it should be obvious that, in the interests of the public andthe patients, a woman medical officer ought now beappointed."It looks as if the Minister of Local Government weretrying to escape from a false position into which hehad been led by some of the more reactionarymembers of his staff. It is well, however, that hewas tackled on the subject at once, as it would bedeplorable if any obstructive policy on the part ofhis department were to interfere with the employ-ment of women doctors in asylums.

Payment of Asylum Medical Officers.It is not only in regard to the employment of

women doctors in asylums that the Ministry ofLocal Government is tending toward a reactionarypolicy. In the same letter to the Grangegormancommittee as was mentioned above, it was laid downthat future appointments to assistant medicalofficerships should be made at a salary of 2300 with-out allowances for a period of two years’ probation.At the end of that time the salary should be increasedby £50 a year. The chairman of the committeepointed out that if such a salary were adopted,the medical officer would be paid less than the headattendant. The resident medical superintendentadded that it would be impossible to go to the medicalprofession with such a proposal, as the pay would be ’,less than that given to the carpenter. It does notappear whether the Ministry thinks that the disciplinewhich it-so much desires would be promoted by makingthe tradesmen superior to the medical officers. ,

Queen’s University, Belfast.Sir William Whitla was appointed a Pro-Chancellor

of Queen’s University, in place of the late SirSamuel Dill, at a meeting of the Senate on Dec. 23rd.Sir William Whitla resigned his active duties as

professor of materia medica and therapeutics a fewyears ago) and was then elected to represent theUniversity in Parliament, when the ability whichhe had shown in the science and practice of medicinebecame equally evident in his work as a politician.

SCOTLAND.

(FROM OUR OWN CORRESPONDENT.)

Is Nervous Disorder Blameworthy ?I HAVE been asked by a prominent Edinburgh

citizen whose work, though he is not a doctor, bringshim in contact with nervous disorder, why it is that inScotland such disorders-hysteria and the like-andeven definite insanity are regarded in some way ascriminal or as highly blameworthy. His point isthis, and I give it as far as possible in his own words :-

" I have known one case of suicide from this cause.

The victim’s relatives could not rid themselves of this notion,and though they were affectionate in their behaviour, theynevertheless conveyed the idea to the unfortunate patientof being a guilty encumbrance upon the earth. To take aless serious example, I have heard a man who spent threeyears on the Western Front complain bitterly of the con-tempt with which certain persons at home treated himwhen his nerves finally broke down. Another individualwho had suffered from several severe attacks of depressionand had been treated with considerable injustice both byhis near relatives and business acquaintances, finally decided

to emigrate from the country in the hopes of finding a morehumane atmosphere elsewhere. Cases also occur where anorganic incurable disease is treated as a mere nervous

symptom which could be got rid of by an effort of the will.It seems to be certain that in melancholic cases the condemna-tion of relatives and of the world is a confiimation of thepatient’s own condemnation of himself and exerts anenOImous pressure against him. Such persons often behavein public, it is true, in an excited manner and give theimpression of conceit, when they are in fact only in a stateof extreme morbid anxiety and depression.

" The cases I have mentioned occurred in Scotland, wherethe effect of the severe Calvinist religion still lingers. TheSheriff-Substitute of Ross and Cromarty at Stoinoway, inLewis (i.e., the county court judge) stated in letters to theScotsman some months ago that religious melancholia is morefrequent in Lewis than in the other islands of the OuterHebrides whose inhabitants are Catholics, and I have heardthis opinion confilmed by a doctor who had made someinvestigations into lunacy in these islands. In England,life is more humane and civilised than in Scotland, owing tothe gentler type of religion and the long period in whichtradition and culture have had the opportunity of develop-ment, and it is possible that such cases as those I havementioned are in comparison with Scotland less frequent.In glancing at the literature on this subject I have not noticedmanv references to the effect of the hostile attitude of theworld upon the nervous or the mentally diseased, except inClouston’s Hygiene of Mind.’

"

Mv informant, further, is of opinion that muchmight be done by the medical profession to create amore humane and intelligent public opinion. Hefeels that condemnation has a demoralising and evenfatal effect in alienating the victim from the world,whereas respect and consideration have the oppositeeffect. In the Middle Ages the insane were flogged.He considers that the treatment which the mentallydisordered often receive nowadays is less violent, butessentially no less brutal.

St. Andrews Institute for Clinical Research.The work at the Institute, St. Andrews, for the

spring term will deal with various aspects of thequestion of renal efficiency. The meetings are heldin the Institute on Tuesdays at 4 P.M., and thesyllabus promises an interesting series of papers anddiscussions. The subjects for discussion duringJanuary are the following : Metabolism with specialreference to the Kidney, on which Prof. E. P.Cathcart, of Glasgow, will read a paper ; the Eye andthe Kidney, a lantern demonstration by Dr. MaitlandRamsay ; the Clinical Application of Tests for RenalEfficiency (Prof. Adam Patrick). On Thursday,Jan. 22nd, Prof. F. J. Charteris will give a demon-stration of kidney cases in his wards in the RoyalInfirmary, Dundee, and a meeting of the Associationfor Clinical Investigation will be held in the RoyalInfirmary, Edinburgh, on Saturday, Jan. 31st. Allpractitioners are cordially invited to all meetings ofthe Institute.

Edinburgh University Extensions.At. a recent meeting of the Edinburgh University

Court, the Principal, Sir T. Alfred Ewing, announcedthat, substantial donations had been recently made tothe University in response to repeated appeals. Atthe time of the graduation of the Prince of Waleslast month it was announced that Sir Alexander Granthad made a gift of £50,000, and more recently otherdonors have given sums amounting to 16,600. Muchmore, however, is still required to allow the mosturgent wants to be met,. It was decided to proceedat once with the scheme for the alteration andextension of the department of surgery in connexionwith the grants recently received from the RockefellerFoundation for the development of clinical teachingand research.

Royal Infirmary, Edinburgh : Retiral of Mr.Alexander Miles.

At a meeting of the Edinburgh Royal Infirmaryon Dec. 22nd, at which the Lord Provost presided,the retiral on Dec. 31st, 1924, of Mr. Alexander Miles,senior surgeon to the infirmary, was announced, inaccordance with the infirmary regulations as to tenure

45of office. Mr. Miles was appointed house surgeon tothe Royal Infirmary in 1889, his chief being Mr.Alexander G. Miller, now the doyen of the surgicalprofession in Edinburgh. Ten years later he becameassistant surgeon and in 1910 was promoted to therank of surgeon, his retiral at the present time marking Ia milestone of 15 years’ service in the wards. Theboard expressed their gratitude for Mr. Miles’sservices by asking him to allow his name to be placedon the roll of consulting surgeons, and in the minutewhich embodied this request a sincere tribute waspaid to his professional judgment and skill. Mr.Miles, in conjunction with the late Prof. AlexisThomson, was the author of one of the best knowntext-books produced by the Edinburgh School ofSurgery, and wrote an admirable monograph on thehistory of the school. For many years he was surgicaleditor of the Edinburgh Medical Journal.

Glasgow Western Infirmary Jubilee.At the annual Christmas meeting of the friends

of the infirmary and members of the staff, ColonelJ. A. Roxburgh, Chairman of the Board of Managers,announced in his report that the financial position ofthe infirmary was in a more satisfactory positionthan it had ever been at any other period of its history.Colonel Roxburgh said that 50 years ago last monththe Western Infirmary had opened its doors for thereception of patients, and since 1874-75, when thenumber of indoor patients was 1253, the infirmaryhad been growing in usefulness and in accommodation.In the first year the number of outdoor consultationswas 5916, while last year it was 149,325. The wardsin the original building numbered eight, to-day thenumber of wards was 32. Originally intended as theclinical school for the University on its then new siteat Gilmorehill, the infirmary had throughout itshistory maintained a close connexion with the Univer-sity, and the Regius Professor of Medicine and theRegius Professor of Surgery still conducted theirclinical teaching in the wards of the Western. TheWestern Infirmary was one of the earliest hospitalsin the country to start an X ray department and thishad been in active operation for a number of years.In the research department the progress from thesmall room in which Dr. Coates began the work in1875 had been almost beyond belief had they notthe splendid buildings of the pathological instituteand the clinical laboratory and the work done in ithem as a reminder of the strides made in this i,connexion within the last half century. One of the latest additions had been the massage and electricaldepartment which was now a recognised school fortraining. The teaching of nurses had also of late yearsbeen very much developed and rendered more efficient.With regard to finance the Chairman said that althoughthe ordinary income had never been wholly adequate,yet it was encouraging to note the way in which theemployees in the public works had within the lastfew years come to recognise their responsibility in thematter of helping the various charitable institutionscarried on for their benefit. Although the financesfor 1924 were satisfactory, nevertheless the gapbetween ordinary expenditure and ordinary incomestill remained very wide.

New Operation Theatre for the Royal Infirmary,Montrose.

At a recent meeting of the board of the infirmarya resolution was passed permitting the erection of anew operation theatre at an estimated cost of 17,000,and to devote £500 donated to the infirmary by SirJames Warwick, of Edinburgh, and also part of 2500bequeathed by the late Mr. W. Slogie, of Montrose,for this purpose. At the same meeting it was announcedthat the late Mrs. M’Cay, of Londonderry, a native ofMontrose and daughter of the late Adam Burnes, awell-known Montrose solicitor, had left the residueof her estate to Montrose Infirmary, LondonderryInfirmary, and St. Dunstan’s Hospital. The sumbequeathed ..to the Montrose Infirmary is understoodto be considerable.

SOUTH AFRICA.

(FROM OUR OWN CORRESPONDENTS.)

Public Health Congress.DELEGATES from all over the Union of South Africa

gathered on Nov. 24th at the Scientific and TechnicalClub, Johannesburg, for the second annual PublicHealth Conference. Dr. Ernest Hill, the medicalofficer of health, East London, presided, and manyinteresting communications were made.

Municipal Milk Control.Durban is at the present time in the throes of

controversy over the new draft Milk By-laws. Thedairy-keepers declare that these by-laws will bringtheir ruin, and contend with some reason that themilk-supply of Durban is not inferior to any in theworld. The whole subject of milk control was dealtwith by Dr. S. J. Clegg, formerly deputy M.O.H. forNewcastle-on-Tyne and now M.O.H. for Durban,at the Johannesburg Congress. The dairy inspector,Dr. Clegg contends, is not to be regarded as a police-man. The sanitary conditions of Natal are good,and the milk by-laws in South Africa generallyalready in advance of those in force in England andWales. Everything turns on the firm and sympatheticadministration of these by laws. Medical opinionat the Congress was, on the whole, in favour ofpasteurisation, although recognising the value ofraw milk.

Plague in South Africa.A conference on plague, called by the Minister of

Health of the Union of South Africa, was held atBloemfontein on Nov. 13th under the presidency ofthe Minister of Health, the Hon. D. F. Malan.The Minister, in his opening address, recalled that

it was over 20 years since plague had been firstintroduced into South Africa, and referred to thefact that in India since its reintroduction in 189611 millions of persons had perished from the diseasein that country. The Government had decided toincrease their grant to the South African Institutefor Medical Research with a view to further researchon the subject, and to equip a mobile field laboratory.The elevator system of handling grain was provinga blessing in this connexion, but a year or two wouldelapse before it was in full operation. Dr. J. AlexanderMitchell, Secretary for Public Health and MedicalOfficer of Health for the Union, reviewed the aetiologyof plague, its history, and the present position of thedisease in the country, giving a table of its regionaland colour distribution for the last 24 years. In1924 the districts concerned included Albert, Coles-berg, Bloemfontein, Boshof, Brandfort, Bethulie,Hoopstad, Kronstad, Lindley, Senekal, Heilbron,Philippolis, Smithfield, Winburg, Wolmaranstad, andKrugersdorp. The incidence so far recorded thisyear was 51 whites with 27 deaths, and 303 colouredwith 195 deaths. No definite evidence was obtainedas to what agency was keeping the infection alive,but veld rodents were suspected. In 1920 an investi-gation into the rodents and small animals in theaffected districts was begun by Mr. Austen Roberts,naturalist to the Pretoria Museum, and Mr. Powell,an expert tracker and trapper. In February, 1921,a farmer in the Kronstad district sickened and diedof plague. He had been in the habit of taking amid-day siesta under a clump of bush near his farm,and a large colony of gerbilles and multimammatemice were found close by this, thoroughly infectedwith plague, and several dead bodies of the animalswere found on the surface of the ground. Since thenthe existence of widespread plague infection of veldrodents had been demonstrated. It was regardedas probable that the present outbreak was the resultof the recrudescence of plague infection amongstwild rodents that had been acquired by them duringthe plague prevalence of 1900-05. The infection hadbeen found most commonly in the gerbille, which was