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go to school associate at home with those who do

attend and that if a single child of a family contracts,say, scarlet fever at school he will probably be a source ofinfection to his younger brothers and sisters. Hence the

fact of children suffering from such maladies before theyreach school age does not acquit the school of responsibilityfor spreading the disease. The original source of infectionin the case of many infants may have arisen thus. The

comparative susceptibility of children at different ages alsocomplicates the question, for if infants are more liable to

suffer than older children, then the number of sufferers athome will tend to rise disproportionately when infectionis introduced into any district. Only a comparison of thefigures for each class extending over a long period of

time could supply trustworthy grounds for arriving at a con-clusion.

The Dundee Social Union lately has directed the prepara-tion of a series of reports upon the physical condition of a

large number of children attending six Dundee schools-

four under the control of the Dundee school board and two

voluntary schools. The reports have been made upon 1000children taken upon no selective plan from the registers ofthe schools and have been collated by Miss MARY L. WALKERand Miss MONA WILSON, with the valuable assistance of

Dr. CHARLES TEMPLEMAN, medical officer of health of

Dundee, who has furnished an introduction. The report onthe general medical examination of the boys was made byDr. ALEXANDER P. Low and of the girls by Dr. EMILY C.THOMSON, while Dr. G. TAYLOR GUILD reported on the ears,throats, and noses of the children, and Dr. E. F. MACLEODNEAVE and Dr. W. E. FOGGIE on their eyes. The results are

exceedingly interesting and show, as Miss WALKER and MissWILSON say in their general preface, that an enormous

amount of actual suffering among children is unnecessaryor preventable, though the causes of the various evils being many the remedies must also be many. Taking pediculosis as an example of an obviously and easily preventable maladywe find that of 1000 Dundee children the number, not onlyof those who were verminous but of extremely bad caseswhere the heads and the bodies of the children were in a

foul state, was large. As a numerical statement under

the heading of " cleanliness of body 177 of the 1000

were classified as "bad," a tabulation which indicates

the presence of vermin. Let us pass now to the more

important subjects of physical development and definite

bodily lesions. Some average measurements of Dundee

children were submitted to the Inter-Departmental Com-mittee on Physical Deterioration as evidence of re-

tarded development and these figures have since been

confirmed by the larger number of observations

made at the instance of the Dundee Social Union.

In these last-mentioned observations the average weightsand heights of children from five to 13 years of age

attending the elementary schools are compared with the

weights and heights furnished by Mr. FRANCIS GALTON tothe Anthropometric Committee of the British Association in1881 and with figures given by that committee in 1883. At

a secondary school in Dundee-the Harris Academy-480children were also weighed and measured in order that acomparison might be made between children attending theelementary schools and children living in the same localityunder better home conditions. At all ages from five to

13 years the height of the boys attending the Dundee ele.

mentary schools compares unfavourably with Mr. GALTON’Sfigures, while the average weight of b)ys of 13 years is aboutnine pounds less than Mr. GALTON’s estimate and the

average weight of girls of 12 years attending the elementaryschools is more than nine pounds below the average of the

girls attending the Harris Academy. The children in the

Dundee elementary schools were, at all ages from which acomparison could be made, distinctly below those at theHarris Academy in both weight and height.

Of the diseases of special organs and regions described inthe reports compiled for, and published by, the Dundee

Social Union we can only mention those affecting the heart,the eyes, and the teeth. Heart diseases were found in the

large proportion of 7’ 47 per cent. of the children ; amongthe boys these included 30 instances of valvular defect, theseveral forms being mitral stenosis, mitral incompetence,pulmonary systolic murmur, and slight impurity of the first

sound in the mitral area. With respect to vision it was

found that only 52.2 per cent. of the children could see toread the standard types at the proper distance. This did not

necessarily mean that their refraction was normal, for, as amatter of fact, only 26 per cent. showed normal refractionand the remainder must have been straining their accommo"dation in order to read the types. The examination of the

teeth led to the general result that caries of the teeth wasvery prevalent, hardly any of the children being free from it.Attention has been drawn lately to the insufficient food uponwhich many of the children of the poor have to subsist andto the impossibility of ill-nourished brains assimilating a dueamount of mental pabulum. The food may in other instancesbe sufficient and the child yet may be unable to thrive upon

, it owing to defect in those much-neglected organs the. teeth. An inquiry carried out by Mr. E. RICE MORGAN1. into the state of the teeth of children in the Swansea

: educational area showed that of 295 children of both sexes

only 11 had mouths free from dental defects, while on an

average each child had more than three decayed teeth.

; Such figures need no comment. If we cannot, as HORACE

says, permanently expel nature with a pitchfork, we mayyet perhaps repel physical degeneration with a tooth-brush.

) The result of reading these various interesting reports is

; to learn how much preventable disease is present among thechildren of the poor; while the depression produced by this

, knowledge is tempered by the feeling that never before have, so many wise and charitable efforts been directed towards- the problems of school hygiene as are now at work.

The Colonies and CancerResearch.

A GOVERNMENT Blue-book of some 96 pages dealing withthe subject of cancer research has just been published andpresented to both Houses of Parliament. It contains the

correspondence between the Colonial Office and the governorsor high commissioners of the various colonies with the

object of acquiring information as to the incidence of

malignant disease and its causes, together with materialboth from man and animals for the Cancer Research

1 Swansea Education Committee. Quarterly Report upon theSchools in the Upper Division of the County Borough of Swansea,by E. Rice Morgan, medical officer. Dec. 28th, 1904.

655

Committee to investigate. While its publication is a g

welcome evidence of the general interest which is now v

aroused by the inquiry into the nature and the causes r

of malignant disease, it must be confessed that as regards E

the information which it contains it is, on the whole, t

very disappointing. A gratifying feature of the book is !.

the active and sympathetic interest in the work evinced 1

by so many of the high officials of the colonial service.

Both Mr. JOSEPH CHAMBERLAIN and his successor as

Colonial Secretary, Mr. ALFRED LYTTELTON, emphasisevery strongly and repeatedly the importance of the

research, while many of the governors write sympatheti-cally of the objects of the Cancer Committee and

promise to assist by all means in their power the

furtherance of those objects. Among these we may

mention especially Lord MiLNER and Sir F. M. HODGSON,the former of whom made valuable practical suggestions,which were subsequently adopted by the Imperial CancerResearch Fund, to promote the acquisition of material for

microscopical investigation. The correspondence beginswith a circular letter by Mr. JOSEPH CHAMBERLAIN, thenColonial Secretary, dated May 27th, 1903, and addressed tothe governors and high commissioners of all colonies

and protectorates, containing incl03ures giving details of

the scheme for cancer research and describing the consti-tution of the executive committee being formed for that

purpose, together with an outline of its aims and require-ments, with a view of " enlisting general interest in

the scientific objects as well as the pecuniary position of thefund." Mr. CHAMBERLAIN in his letter requests that thematter may be furthered by giving publicity to it and by anyother suitable means. This was followed by a second

circular letter, dated May 29th, 1903, addressed to governorsand high commissioners of Crown colonies and pro-

tectorates, inclosing a memorandum drawn up by Dr.

E. F. BASHFORD, the general superintendent of research,and stating that "great importance is attached by thedirectors of the inquiry to the scientific investigationof cancer in communities where the conditions of life

differ so widely as in the British Crown colonies," and

requesting that the medical officers will carry out the c

directions in Dr. BASHFORD’S memorandum as completely as possible. A similar despatch was sent out next day to (

the governors of responsible government colonies Copies .of these documents were sent to the Foreign Office with therequest that, subject to Lord LANSDOWNE’S approval, theymight be sent to protectorates administered by the ForeignOffice. On Jan. 13th, 1904, Mr. LYTTELTON sent out

another circular letter giving details of the results obtained

up to that time and requesting information from those

colonies from which no reply had then been received andurging " the necessity of not allowing this important matterto drop but of doing all that is possible to obtain for theCommission the material and information which they requirefor their difficult inquiry."The replies to these repeated requests for information

with a few noteworthy exceptions, among which we mayspecially mention those from Ceylon, Mauritius, Barbados,the Transvaal, and Queensland, have been unsatisfactory,varying from an almost curt statement of the impracti-cability of acquiring the information desired to a mere

general statement or even a vague expression ot opinionvithout statistics to support it. It cannot be too stronglyrged that such expressions of opinion, though interestingand perhaps in some instances containing importantiruths, are valueless from the point of view of exact

scientific investigation. From a number of colonies where

there are extensive native or aboriginal populations, such asBritish Central Africa, British East Africa, and the Gold

Coast, the medical officers state with almost strikingunanimity that cancer is rare or unknown amongst them,and yet isolated cases are from time to time recorded, so

that the possibility of conditions operating to prevent suchcases coming to the notice of the medical officers, as pointedout by the committee of the Cancer Fund, must not be lost

sight of. At the same time it is just in such countries thatstatistical details would be of the utmost value could theybe obtained, for although the value of statistics is a matterof much dispute and often ridicule, at the present stage ofcancer investigation, when we are groping in the dark for

likely clues, statistics may afford valuable and promisingindications of lines of research, more especially if it should

be found that the incidence and the most frequent site ofthe disease are found to vary in different countries. Thus

if it should be substantiated that cancer is rare amongstcertain aboriginal tribes in certain countries a promisingfield for research would be opened up.Among the most interesting reports sent in response to the

circular letters from the Colonial Office is that from Sir

ALLAN PERRY, principal civil medical officer of Ceylon,summarising the cases of cancer and sarcoma observed

there. He finds that about 220 deaths occur from these

diseases per annum; that cancer is a comparatively slightdisease in Ceylon, one death from cancer occurring in every16,820 persons living in 1903. In striking contrast to thecondition in this country he finds that it is more common

in men and that the most common site is in the oral cavity,which accounts for 55 per cent. of the cases. The pre-

ponderance in this situation is not confined to men but is

also nearly as marked in women. The next most common

situation is the penis which is affected in 32 per cent. of thecases. Cancer is stated to be more common in the northern

province of Ceylon and it is suggested that the frequencyof the mouth as the primary site is due to chewing betelwhich consists of tobacco, betel leaves, areca nut, anda little slaked lime. It is said that the people of the

northern province are much addicted to betel chewing.The report of Dr. H. LORANS, acting medical director ofMauritius, is also of interest. He concludes from the

statistics of cases treated in the general hospitals that cancerin Mauritius is much less prevalent than in England.During 1903 67 cases of malignant growth occurred amonga total number of 21,356 patients treated and 20 only out of1277 deaths in the hospitals were due to malignant disease.Statistics such as those from Ceylon and the equallyinteresting statistics of the Mayo Hospital, Lahore,published by Captain D. W. SUTHERLAND, I.M.S., in the

Third Report of the Cancer Research Laboratories of

the Middlesex Hospital, show that valuable information

may be obtained from the statistical investigation of

hospital and other records. No doubt the difficulties in the

case of some of the colonies are very great, especially where

656

there are large native populations and no system of deathregistration, but much could be done in the matter of carefulrecord of individual cases and the determination of the

proportion which they bear to the total number of caaea seenby each medical officer of those countries. We feel sure

that the circular letter of Mr. LYTTELTON, dated Nov. 18th,1904, pointing out the great importance of this very questionof the incidence of cancer among native populations willmeet with a generous response from the medical practi-tioners of those districts.

Annotations.

CONVALESCENT HOMES ASSOCIATION.

" No quid nimis."

A CONFERENCE of delegates from all the chief con-

valescent institutions supplying charitable relief to Londonpatients was held at 20, Hanover-square, London, W.,on March 2nd, Sir E. Hay Currie being in the chair.The Presidents of the Royal Colleges of Physicians of

London and Surgeons of England and the President of theHospitals Association were present, together with repre-sentatives from the following convalescent homes: Metro-

politan, Seaford, Eastbourne, Gladstone, and St. Andrew’s,Folkestone. The object of the conference was to obtainsome form of union and cooperation between the various

convalescent homes and it was thought that that could bebest initiated and carried out through a central associationin immediate touch with the hospitals on the one hand andthe homes on the other. The first of the four propositionssubmitted, which were all unanimously agreed to, was thatthe increasing needs of medicine and surgery requiredsome alteration in the character of the relief afforded

by convalescent homes to the poor of London. In pro-posing this motion, Sir William S. Church said that the

conference was not intended to reflect in any way onconvalescent homes. All members of the medical professionwere most grateful for the benevolence which had providedsuch institutions. He explained how the one scale of dietthat was the rule at convalescent homes rendered themunsuitable places for the after-care of patients recoveringfrom certain well-known diseases. He also pointed out thedisadvantage of another almost universal rule that no patientcould be received at these institutions who had an openwound. These defects could be obviated by rearrangementamongst the homes. Mr. J. Tweedy, who seconded themotion, showed how the need had arisen for alteration in thecharacter of the relief afforded to convalescents. Sir ThomasSmith pointed out how the great increase in the number ofoperations at the London hospitals had intensified the needfor the conference which had been convened. Sir R. DouglasPowell insisted on the recognition of the fact that there wasno necessity for building new institutions and explained howthe present accommodation for convalescents could be

utilised by means of suitable cooperation. The next

motion, proposed by Mr. E. A. Gruning, seconded byLady Frederick Cavendish, and supported by Mr. M. 0.

Fitzgerald, arranged for the formation of an associationto be called " The Convalescent Homes Association,"which shall consist of convalescent institutions supplyingcharitable relief to London patients, the object of the asso-ciation being to form a representative council to centraliseeffort and to promote efficiency and economy. On the pro-position of Lord Lytton, seconded by Dr. J. KingstonFowler, it was decided that the council shall consist of onerepresentative from each convalescent institution and one

representative from each of rhe great general hospitalsof London and of such other lay and medical representa-tives whom it may be considered advisable to invite, thefollowing to be ex-officio members of the council : The Pre-bidents of the Royal Colleges of Physicians of London andSurgeons of England, the Dean of the Faculty of Medicineof the University of London, the President of the CentralHospital Council, and one representative from each of thegreat hospital funds. Sir Henry Burdett in a short speechproposed that a small executive council should be electedfrom the general council and that the honorary secretariesshould be Dr. S. H. Habershon and Mr. Fitzgerald. Thiswas seconded and after having been duly passed by the

meeting a hearty vote of thanks to the chairman concludedthe proceedings.

-

"THE NATION’S DRINK."

UNDER the above heading the Standard has recentlypublished two admirable articles by "an expert" on (1)wine made in England; and (2) whisky made in England.The readers of THE LANCET well know our attitude uponthe subject of drink and its adulteration and the writer in theStandard indorses in a striking way all that we have written.He completely exposes the humbugging tricks of a certain,and, it is to be feared, very large, section of the wineand spirit trade and his contribution throughout furnishesa strong appeal for immediate and serious legislativeintervention. The worst feature of it all is, perhaps,that the practice of blending spirits is conducted underthe very noses of Government officials who know perfectlywell how flagrantly misleading to the public is the nomen-clature adopted on the labels o bottles of brandy, whisky,and other spirits. We are almost weary of keeping thesefacts before the notice of our readers but our hopeis that by doing so the day of retribution will be broughtnear. When shall we have a Government brave enoughhonestly and seriously to face this question ? The articlesin the Standard are surely sufficiently convincing for anyintelligent person and they are evidently written by awell-informed writer. If they are not convincing the state-ments are a sufficient indictment to warrant the appointmentof a committee of inquiry to determine what are the real

facts. Its labours would, we are sure, reveal a discredit-able state of things. If the public were merely conceded anhonest description and an honest label they need hardly askfor more. The detention of all spirits in bond for a specifiednumber of years would, we fancy, be a wholesome provisionfor the nation and the adoption of a revenue stamp on thebottle certifying how long the spirit had been so detainedwould be a progressive step.

THE IMPORTATION OF DISEASED PORK FROMDENMARK.

AN interesting correspondence has recently taken placebetween the Danish Minister of Agriculture and the medicalofficer of health of the City of London in regard to the

importation of diseased meat from Denmark. It would

appear that some years ago an arrangement was madethat in all cases in which such meat was condemnedin the City markets as unfit for food the labelsattached thereto should be forwarded to the DanishCommissioner in order that inquiries might be madein each particular case. This system of returning labelswas agreed to, provided that steps should be taken

which would preclude the possibility of any diseased meatbeing imported from Denmark. So far as relates to

beef this system produced an excellent result but it has

miscarried in the case of pigs. During the three months

October, November, and December, 1904, Dr. W. Colling-ridge reports that 39 pigs so marked were seized and during