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and its termination was marked by a luncheon .given to them by the Government, over which Sir iJohn Gilmour, Secretary of State for Scotland, pre- ’ Isided. The luncheon was not allowed to offeropportunity for many or long speeches, but in pro-posing the health of the visitors Sir John Gilmourstruck a note that was acceptable to the companyand would be received with acclamation by anythinking audience, when he said that all persons ofintelligence were looking anxiously to a peacefulsettlement of the world, and that preventive medicine’furnished a means for mutual development andintercomprehension between all nations. Dr. M. D.Horst, the representative of Holland, replied for thevisitors, and while acknowledging the pioneer partplayed by Great Britain in health organisation andextolling the extent to which multiple activities wereranged under the common title of Health Department,raised laughter by saying that this country appearedto pay no special regard to the value of vaccination.The company, however, warmly applauded his furtherremarks founded on personal observation of thevalue of vaccination. The luncheon took place atthe Carlton Hotel, London, W.

THE SEASONAL PREVALENCE OF DISEASE.

PEHIODICITY is one of the interesting phenomenain epidemiology, and a study of the causes of cyclictendencies of disease discloses fundamental factorsof importance. To be able to elucidate the lawswhich govern these periodic eruptions is to be ableto presage their advent and to formulate measuresfor preparedness and prevention, and to this subjectDr. M. J. Rosenau made a valuable contribution ina paper read at the International Conference onHealth Problems in Tropical America.’ Pandemicsof influenza have been quite irregularly spaced.Measles, again, is a disease which tends to recur ina cyclical manner with considerable regularity. Inthe endemic regions exacerbations recur every twoor three years. The explanation appears to dependupon the accumulation of a new crop of susceptible.children. Infantile paralysis in Massachusetts dis-plays a sort of regularity in its tendency to an exces-sive prevalence about every fourth season. Theseepidemic recurrences are followed by a regulardecline until the next period. Despite the vagariesand uncertainties of this disease, we do know that,as long as the disease prevails, there will be more ofit in the summer-time than in the cold season.A good instance of the uncertain manner in which

epidemic diseases recur is shown by the visitationsof plague in London from 1563 to 1680. Consequently,plague is one of the diseases which have becomestamped upon art, science, and literature. Plaguewas raging in Stratford-on-Avon when Shakespearewas a baby. Another example of irregular periodicityis shown by the story of diphtheria epidemics inBoston, New York, and Chicago, but within recentyears such epidemic outbreaks have not taken place

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and the disease should never again be allowed to get.out of hand. Many diseases recur annually with theregularity of perennials. However, seasonal prevalenceof disease may to a certain extent be violated when acommunicable infection is introduced into a virginpopulation. But on the other hand, when certaincontact diseases which prevail especially in thewinter season in temperate latitudes arc introducedinto the tropics, they have a tendency to die out;thus scarlet fever has never gained a foothold intropical countries, and measles and diphtheria donot, as a rule, become serious problems under thevertical rays of the sun. Yet influenza, pneumonia,and tuberculosis play havoc in tropical lands just asthey do in temporals zones. The effect of latitudeis striking and significant; thus rheumatic feverreaches its highest incidence in March and April inthe United States, but in September and October in

1 International Conference on Health Problems in TropicalAmerica, United Fruit Company, 1921, pp. 28-54.

England. A number of diseases show two peaks ofincidence, one in the spring, the other in the autumn.This is frequently the case with the acute respiratoryand throat infections, but also with tuberculosis,nephritis, a,nd"rheumatimn. The causes of seasonalchanges in health and disease are varied, complex,and largely undetermined. The insect-borne groupof diseases prevail almost entirely during the summer-time--that is, during the hot, moist season of theyear when the insect vectors most aboimd. Theseinsect-borne diseases give us the best examples inepidemiology of endemicity. We have, therefore, norecord of an epidemic of yellow fever in the winterseason.

’ An exception to the rule is typhus fever.which prevails in winter-time, but subsides with the

warm weather. This paradox is, however, easily

explained by the fact that lice are more common incold weather. There is evidently some factor in thebionomics of the louse which makes cold weatherfavourable for the completion of the cycle of events.Malaria may, however, occasionally be more prevalentin winter than in summer. An instance of this hasrecently been reported from Russia in the winter of1922-23, where an epidemic spread steadily through-out the winter with the thermometer varying from20° to 30° U. below zero, the spread of the diseasebeing apparently due to the fact that the butts ofdrinking-water in the almost tropical heat of the loghouses of the peasants afforded ideal breeding-placesfor the anopheles. The seasonal prevalence of theintestinal diseases has a ’general resemblance to thatof the insect-borne infections. This is the case withtyphoid fever, cholera, dysentery, and the summerdiarrhoea of infants. The incidence and intensityof these infections become greater as we approachthe tropics. Winter-home outbreaks of intestinalinfections frequently occur. Water-borne typhoidfever has a predilection for the winter season. Whencities like Albany, Philadelphia, and Chicago improvedtheir water-supplies the typhoid fever rate becamemarkedly lower and the seasonal prevalence was

reversed.The importance of the seasonal prevalence of disease

is further emphasised by the fact that such diseasesas poliomyelitis and encephalitis lethargica, whichin Britain have their period of maximum incidencein the late summer and autumn and in the winterrespectively, occur under reversed conditions inAustralia, where poliomyelitis is a disease of thefirst half of the year, and encephalitis of the third andfourth quarters. This point was mentioned byDr. 1. K. Chalmers, medical officer of health forGlasgow, in the course of the Watsonian lecturesdelivered recently to the Royal Faculty of Physiciansand Surgeons of Glasgow.

THE CARE OF CRIPPLED CHILDREN.

THE County Borough of Portsmouth has found ahappy solution of the problem of how to deal withthe crippled children in its district. At a meetingin Portsmouth Town Hall on March 20th the Mayor,Councillor F. Privett, was enabled to hand ove’.’ tothe trustees of the Lord Mayor Treloar Hospital forCripples, Alton, a cheque for :B10,000, raised byvoluntary subscription, in return for which thetrustees have agreed to set aside 50 beds in perpetuityfor the treatment of the young cripples of Portsmouth.It is little over a year ago that certain citizens of theborough decided to raise a fund in order to providetreatment for the town’s crippled children. The firstidea was to erect a small orthopaedic hospital on theoutskirts of the town ; further consideration, however,showed that the money could be more advantageouslyexpended by endowing beds in an existing institution.As a result of this decision the trustees of theHospital at Alton were approached and agreementwas arrived at. By a trust deed the Portsmouth Cor-poration have now allotted to them 50 beds for whichthey pay a maintenance of :Os. a week. The

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- surgical staff of the Hospital, whose original effortstook cognisance mainly of crippling caused by tuher-culosis, has been extended to cope with differentforms of orthopedic work, and the crippled childrenof Portsmouth up to the age of 16 years, no matterto what cause the infirmity may be due, can nowsecure at Alton whatever treatment, surgical or

.otherwise, may be necessary. The agreement hasreceived the cordial approvement of the Ministry ofHealth and Board of Education, and the procedureadopted by Portsmouth is one which, provided thetrustees of the Treloar Hospital were agreeable,might well be followed by local authorities in thelocality. Other counties might well consider the.advantage of similar centres in their midst, andmake the development possible by financial support.Education authorities must shortly make provisionfor the crippled children of their districts, and toattempt to do this by the erection of small ad hochospitals will not only prove expensive but, what isstill more important, such a course can never securefor their patients the efficient treatment which isavailable at a large institution capable of engaging ahighly specialised surgical and medical staff.

OXALURIA.Calcium oxalate is a normal constituent of the

urine, but in conditions of health the amount issmall, between 15 and 20 mg. being excreted during24 hours. Upwards of 30 mg. may be considered- as pathological, though this quantity may notcause any definite symptoms. Its solubility in theurine is small and varies with the reaction, for invery acid urine probably the normal quantitypresent is completely dissolved ; but in amphoteric,alkaline or even slightly acid urines only a minutetrace goes into solution, the remainder being passedas crystals. Oxalic acid is produced from a largenumber of substaaces in the human body-forexample, from the carbohydrates by oxidation,from protein and nucleo-protein by breaking downof their complicated structure, and even fromfats and allied substances such as glycol. Inaddition, oxalic acid and its salts are presentin varying proportions in many common food-stuffs, amongst which the following are examples- -spinach, rhubarb, sorrel, gooseberries, straw-berries, beetroot, cocoa, tea, and chocolate. Briefly,the sources of oxalic acid formation in the humanbody during the processes of digestion are verynumerous. There is one additional fact of physio-logical importance-viz., the relatively greater Rolu-bility of magnesium oxalate than the calcium salt,for the suitable administration of magnesium salts inthe diet can increase the amount of oxalate excreted,and so diminish the tendency to oxaluria.The surgical manifestations of oxaluria are not

realised, and Mr. Bathe Rawling wa,s able to collect aninteresting array of facts and warnings in his paperto the Medical Society of London on Mondayevening. Be dealt first with that group of casesin which the oxaluria produces an abdominalcondition, which may be, and has been, diagnosedas acute intestinal obstruction. Mr. Rawling’s firstpatient, manifesting this condition, was his ownhouse surgeon. who was suddenly seized with abdo-minal pain accompanied by vomiting, abdominaldistension, and complete constipation. The patientwas seen by Sir D’Arcy Power and Sir AnthonyBowlby as well as by Mr. Rawling. All agreedthat acute intestinal obstruction was present anda, laparotomy was performed with a negative result.The next day, the patient having show-n no improve-ment, a general surgical consultation revealed a

unanimous opinion that acute obstruction was

still present, and a second exploration was advised.Fortunately the patient passed small quantities offlatus, and enemata now succeeded in producingadmirable results, a second operation becomingunnecessary. The urine was later found to be smokywith blood and heavily laden with oxalate crystals,

and later a small calculus was passed. Quite soonafter Mr. Rawling saw a second example, again ina medical man, who presented a very similar clinicalpicture, but the condition was diagnosed without,operation. The noticeable feature in both cases

was that the patients neither felt nor looked as illas they should have done if their trouble had reallybeen acute intestinal obstruction. Furthermore, inthe first case the patient was convinced that theparalytic condition of the intestine was largely dueto a dose of morphia. These cases Mr. Rawhngcited as examples of acute abdominal manifestationsaccompanying oxaluria, but there are other andmore numerous examples of chronic intestinaldisturbances due to the same cause. They maybe somewhat vividly described as " windy " patients,who suffer from recurrent attacks of abdominalpain with distension, neither very severe but ofsufficient intensity to make the patient seekadvice. The explanation suggested by Mr. Rawlingis that there is a reflex disturbance of the sym-pathetic nervous system controlling the intestinesfrom the renal nerves. The existence of suchabdominal manifestations calls attention to thegreat importance of a routine examination of theurine, and further it must be realised that the

general ’condition of these patients is not consistentwith the diagnosis of acute intestinal obstruction.Apart from the well-recognised group of patientswho suffer from hsematuria due to oxaluria, thereis one other surgical condition found at times com-plicating an excess of oxalates in the urine, and thatis a urethral discharge, which may vary from aslight mucous stickiness to a frank muco-purulentdischarge. The importance of this class of casecannot be overestimated, for the obvious mistakein diagnosing gonorrhoea may have disastrous effectsto both patient and surgeon. Sir William Willcox,in the course of the same debate, dealt with thephysiological source of the oxalates and the treat-ment of their excess in the urine, and in doing soafforded a well-timed warning that the presenceof calcium oxalate crystals does not necessarilyentail oxaluria, and that such grave conditions ashad been mentioned can only be attributed tooxaluria in the absence of definite evidence suggestingother more obvious lesions. He recommendedcareful dieting by excluding all those foodstuffsknown to be rich in oxalates, by choosing foodsrich in magnesium, by avoidance of hard drinkingwaters, and the establishment of a proper hygienichabit of life.

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A SOCIAL evening will be held by the Royal Society.of Medicine at 1, Wimpole-street, London, W., onMonday, May 4th, when Dr. Robert Hutchison willgive an address on " Dr. Samuel Johnson andMedicine," illustrated with 18th century portraits.

THE announcement was made last week, as thesepages were in the press, that Sir Humphry Rolleston,in accordance with universal expectation, has beenappointed to follow his old friend Sir Clifford Allbuttas Regius Professor of Physic in the Universityof Cambridge. On every ground the appointmenthas been hailed with satisfaction.

I ROYAL COMMISSION ON NATIONAL HEALTH INSUR-ANCE.—The twenty-second meeting of the Commission washeld at the Home Office, Whitehall, on March 19th, SirAndrew Duncan in the chair. The examination of Sir NormanHill, Bart., on the working of the Seamen’s National InsuranceSociety was resumed and at its conclusion he gave evidenceas to the special fund for seamen. Thereafter the InsuranceCommittees of Coventry (Mr. H. W. Wale and Mr. LeeGordon), Cheshire (Mr. G. Wright and Mr. F. T. West), andLeicestershire (Alderman Goodacre and Mr. T. Crew) gaveevidence on the constitution and administrative work ofinsurance committees, particularly with reference to themedical. and treatment benefits. The Commission announcethat proof copies of the oral evidence and the relativestatements submitted at the meeting of March 5th are nowon sale at II.]}!. Stationery Office (2s. 3d.).