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559 THE EYES IN HOT CLIMATES. fractured clavicle occurred, but this is not real evidence of repair in a malignant growth. P,tients who have suffered a pathological fracture of the femur secondary to breast cancer have even been known to get union and walk for a time. The simplest explanation is that only a portion of the thickness of the bone was destroyed by the growth. The remaining unaffected area, after fracture, was able to throw out so much callus as to form a support of weight bearing capacity. It has been frequently observed that bone metastases occur in cases where the original growth is quite small, so it would be of great practical imp rtance to be able to ascertain whether the bones are affected or not when the patient seeks surgical aid. According to A. Piney! certain charac- teristic blood changes occur when the growth invades the bone-marrow, by which this invasion can be ,, recognised. Whilst this statement is true in some cases, it does not seem to be so invariably ; the characteristic blood picture was absent in the case under discussion. It is, however, important on occasion to make the blood examination, for positive evidence might show that operative interference would be useless. ____ THE PRESENT POSITION OF THE DENTAL PROFESSION IN ITALY. WE have received from Dr. F. Montuschi, dental surgeon to the Italian Hospital, a report on the recent legislation in Italy to regulate the practice of dentistry. ’The Royal Decree of Oct. 16th, 1924, made the possession of a degree in medicine and surgery com- pulsory for the practice of dentistry. This compulsion dates back 34 years from the Boselli decree, but subsequently all those who had practised dentistry by virtue of minor diplomas granted by various universities continued to do so and, as is the case now in England, many who had practised without a diploma were allowed to continue after an examina- tion in the subject. The Boselli decree did not become law until 1912 with the concurrence of both branches of the legislature. There was, however, in Italy an absence of good schools for the teaching of dentistry and such medical men as wished to practise it conscientiously were obliged to go abroad. Many of them came to our Royal Dental Hospital until the foundation of three dental institutes at Milan, Bologna, and Florence, each of which has a curricu- lum of one year’s duration. In Rome a small but influential group continued to ask for a doctorate in dentistry independent of medicine and surgery, somewhat after the type of the American D.D.S. 1 They wanted the medical student after his fourth year to relinquish his studies and join the school of dentistry and dental mechanics which was to be established in Rome, and after a curriculum of two years to pass an examination which would confer on him a doctorate in dentistry and dental prosthesis. These ideas found sympathy from the Minister of Public Instruction in Signor Mussolini’s Cabinet, who, owing to the full powers conceded by Parliament, secured at the end of 1923 the approval of the Council of Ministers for a decree establishing a national school of dentistry and dental mechanics in Rome; this meant the institution of a degree in these subjects at the end of the prescribed course of study and the passing of a special examination. This decree aroused violent opposition, as medical opinion had pronounced in favour of a compulsory degree in medi- cine and surgery for dentists. Augosto Murri wrote expressing his views as to the indivisibility of dentistry and general medicine and advocating that the former must be considered as belonging to the same category as other medical specialties, and a few months later the Minister who had approved of the decree was replaced by Senator Casati; then the Mussolini Cabinet rescinded the decree and substituted a new one which re-affirmed the principle of a compulsory degree in medicine and surgery for the practice of 1 Brit. Jour. Surg., 1922, x., 235. dentistrv. The new decree stiffens the statute of March 31st, 1912, since it not only requires all dentists to be previously qualified in medicine and surgery, but enjoins upon all future medical practitioners the undergoing of a practical test in dentistry and mechanics to enable them to practise the art of medicine. It is not that the medical graduates of the universities, to which the new statute allows freedom in regulating their special studies, will all be finished dentists, but they will at least know enough to guide them in investigating each case and adopting proper treatment, especially in rural districts where there is no expert dentist. In Italy the future medical practitioner will have a knowledge of the fundamentals of dental science, as he has of ophthalmology and dermatology. For dentists in the future-i.e., medical specialists in dentistry and prosthesis-the general university reform actuated by Gentile efficiently provides in the same way as it does for all other specialists. This measure enjoins that no one can arrogate to himself the title of " specialist " in any branch of medicine without having acquired the relative diploma granted by each university. Anyone who does not conform to this rule will be suspended from practising, so that in the near future the public will be able to distinguish the true from the false specialist. In fact, this same reform allows each university to establish special post-graduate schools in any subject, equipped for granting, after examination, specialists’ diplomas. As far as dentistry is concerned, there already exist in Italy the three dental schools of Milan, Bologna, and Florence with a yearly curriculum; and now, in order to ma,rch with the times, these have profited by the present didactic legislation and have biennial courses, while other schools will of necessity spring up. Italy will thus be the first among progressive nations to require all medical practitioners to know at least the principles of dentistry and dental mechanics and to insist that all who practise other medico-chirurgical specialties shall, after having obtained their degree, pass a special examination which will be proof of a real knowledge of the specialty they intend to practise. ____ THE EYES IN HOT CLIMATES. IN a paper on Ophthalmology in Egypt, read at a recent meeting of the Section of Tropical Medicine of the Royal Society of Medicine, Mr. A. F. MacCallan, at one time Director of the Egyptian Government Ophthalmic Hospitals, gave some valuable instruc- tion on the care of the eyes in hot climates. While fatigue, ill-health, and worry bring out latent defects in the eyes in any country, a hot climate causes greater fatigue than a temperate one, and this fatigue, lie pointed out, may lead to fatigue-indigestion with resulting physical depression. Worry, whether of official or of private origin, similarly may cause ill-health. Under these conditons he found that trifling errors of refraction, or slight degrees of heterophoria, exerted effects quite out of proportion to their actual severity, and he emphasised the importance of careful correction of these errors, generally under a cycloplegic such as homatropine. In a highly sensitive patient, whose nerves were con- stantly being jarred by physical or mental discom- forts, the correction of a very small degree of astigmatism might make all the difference between happiness and misery. In a country such as Egypt, the healthy emmetropic eye of the European becomes painfully affected by the sun’s glare in the summer when motoring or riding along dusty roads or over the desert. It is the heat rays from the red end of the spectrum which cause this. To prevent the effects of glare, Mr. MacCallan advises the wearing of protective goggles of Crookes B or B 2 material; but if discomfort is complained of the refraction of the patient should be verified under a cycloplegic. There are, he states, other varieties of protective glasses, which theoretically are more absorbent of the heat rays than Crookes glasses, such as peacock
