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year with no apparent improvement. This is a

problem which must be probed rigorously at no latedate.

Cardiganshire.The total number of children examined, excluding

re-examinations, was 2233, and of these only 3-8

per cent. had no defect. Of 378 cases deferred fortreatment for nose and throat trouble 37 receivedoperative treatment. There appears to be some

difficulty in obtaining treatment for this defect. Halfof those requiring treatment for visual defect receivedit under the local education authority’s scheme.Dental hygiene is receiving special attention ; Dr.Meredith Davies must have great difficulty in gettinghis scheme for the use of tooth-brishes in school

put into practice since in many schools there is lack ofwater. An extensive review of the water-supply andsanitary arrangements reveals 50 out of 100 schoolswith no water-supply, and ten where the purity of thewater is questionable. The number of teachersattending the special classes on physical trainingshows great enterprise and industry in this department.

BUCHAREST.(FROM OUR OWN CORRESPONDENT.)

Treatment of Laryngeal Turrtours with Sunli,ght.AT a recent meeting of the Medical Society Dr.

Pheanan showed several cases of laryngeal tuberclewhich he had treated with great success by the raysof the sun. Hundreds of such cases have been reportedof late in various journals, so that this method oftreatment has apparently found general a,doption.The method is simple, requiring only the use of aconcave mirror, and failing this, a toilet mirror ; inthis latter case a throat lens is necessary, which thepatient can easily be taught to manipulate himself.The mirror is hung in a sunny room ; the patient seatshimself before it, and with his throat mirror can reflectthe rays into the larynx where the tumour infiltrationor ulceration is present. Under the influence of therays the tubercles (and some other swellings) dis-appear in a very short time, seldom exceeding 40applications. One of the cases presented by Dr.Pheanan had suffered from tuberculous thickening ofthe left cord with tuberculous ulceration, which wasnow smooth and pliable after 20 applications. Hisexperience was that the infiltrated forms were morestubborn. He had recently supplemented the treat-ment by painting the mucous membrane affectedwith adrenalin in order to increase the specific effectof the rays, as the blood seems to retard their action ;he gave also injections of tuberculin, on the lines advo-cated by Spengler in Germany and Sorgo in Vienna. Byapplying adrenalin anaemia is produced, and therebythe intensity of the rays on the deeper structures isincreased. Unfortunately for this form of treatmentweather does not, as a rule, permit of an unbrokencourse; hence the necessity of resorting to artificialsun rays afforded by mercury-vapour lamps.

Drawbacks of Pasteurisation of 3,lilk.At a meeting of the sanitary officers in Bucharest

it was argued that current views on the value ofpasteurisation will have to be altered. The professionhas for many years been in the habit of recommendingthe use of pasteurised milk for the poor of the largetowns. Sanitary experts in various countries,however, are contesting the wholesomeness of milktreated by this method. Pasteurisation causes thediminution of bacteria, but the decrease is onlytemporary, and pasteurised milk when examineda day or two after preparation is found to containa larger number of bacteria than ordinary milk.The organism chiefly affected by pasteurisation is thelactic acid bacillus, a bacillus which has the meritof making its presence felt by the acidity impartedto the milk. The products of the lactic acid bacillusare quite harmless if, indeed, they have not the

positive therapeutic effects imputed to them byMetchnikoff, and therefore it would seem that pasteur-isation has the effect of destroying a harmless bacilluswhose products, being easily discernible by theiracidity, might act as a sign of presence of otherorganisms. Pasteurisation has no inhibitory poweron the growth of these other possibly pathogenicorganisms. At the same time it may be granted thatpasteurisation does not in any way depreciate thenutritive qualities of milk, whatever effect it mayhave on it from the point of view of taste.

A Case of Plague in Odessa.It is reported from Odessa that a case of plague has

occurred there, the patient having been assistant cookon board a vessel which arrived from the Far East.When the ship left India it was reported that on boardship all were well. As the ship waited in Odessa for14 days, and the cook had spent daytime in the city,it was considered probable that he was infectedthere. In consequence, however, of dead rats beingdiscovered on board, measures were taken to destroyrats and to disinfect the ship. The patient’s illnessdid not develop until the ninth day after the shiplanded in Odessa, and it proved fatal after two days.Precautions have been taken for preventing the spreadof the disease.

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THE MANSON MEMORIAL MEDAL.

ON Sept. 26th, at the London School of TropicalMedicine, the first medal struck in memory of SirPatrick Manson was presented to Lady Manson. Major-General Sir William Leishman, F.R.S., made the pre-sentation in the presence of a small gathering which

included several of Sir Patrick Manson’s most eminentfellow-workers. Sir William Leishman, referring tothe feeling among those connected with the schoolthat the building should contain a worthy portraitof Sir Patrick Manson, said that despite the privatenature of the appeal made for funds to be devoted tothe provision of such a portrait, a sum of £ 300 wasrapidly collected, which left a considerable balanceafter the portrait had been obtained, together withmezzotint reproductions for presentation to eachsubscriber to the fund. It was decided to devote thisbalance to the striking of a medal, to be known as theManson Memorial Medal, which would be presentedtriennially to any worker who gained distinction intropical medicine. Sir William Leishman concludedhis short address with a reference to the devoted skillwith which Lady Manson had assisted her husband’swork, not in direct association in the laboratory, butindirectly by the no less important creation of asympathetic atmosphere and by encouragement in the

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times of difficulty encountered by every researchworker. Dr. P. H. Manson-Bahr, son-in-law of LadyManson, replied briefly on her behalf.The medal, the obverse of which bears a fine

profile portrait reproduced in the accompanyingillustration, is in bronze. The reverse bears the words" London School of Tropical Medicine." In future,a device representing " Tropical Medicine and

Hygiene " will also appear on the reverse, in r(-cog-nition of the fact that recipients of the medal will beselected by the Council of the Royal Society of

Tropical Medicine and Hygiene. The medal is thework of Mr. J. R. Pinches, of 21, Albert Embankment,London.

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The Services.

ROYAL NAVAL MEDICAL SERVICE.

Surg. Cmdr. E. D. J. O’Malley is placed on retd. list.

ROYAL ARMY MEDICAL CORPS.

Lt.-Col. M. Swabey retires on ret. pay.Maj. and Bt. Lt.-Col. W. F. Tyndale relinquishes the temp.

rank of Lt.-Col.

Maj. J. W. S. Seccombe is placed on the half-pay list onaccount of ill-health.

Maj. F. E. Rowan-Robinson is placed temp. on the half-paylist on account of ill-health.

Capt. D. W. John retires receiving a gratuity and is grantedthe rank of Maj.Temp. Capt. G. S. Ware relinquishes his commn. and

retains the rank of Capt.

TERRITORIAL ARMY.

Maj. H. H. B. Cunningham resigns his commn. and revertsto the Regular Army Res. of Off. (Royal Irish Fus.), and is Igranted the rank of Lt.-Col.

Maj. D. H. Weir relinquishes his commn. and is grantedthe rank of Lt.-Col.

G. F. Wilson to be Capt. with pay and allowances of Lt.The undermentioned Capts., having attained the age

limit, are retired and retain their rank, except where other-wise stated : J. P. Milton, C. H. Caldicott, H. C. Adams,E. Osborne, and F. A. W. Drinkwater (are granted the rankof Maj.), J. Carroll.

Capt. J. H. Robinson relinquishes his commn. and isgranted the rank of Maj.

Capt. E. A. Mackenzie relinquishes his commn. andretains the rank of Capt. -

FOREIGN DECORATIONS.

His Majesty has given permission to the following to wearthe decorations and medals awarded to them by the AlliedPowers for distinguished services rendered during the latewar : .Maj.-Gen. Sir William Grant Macpherson (DistinguishedService Medal, conferred by the President of the UnitedStates); Col. Arthur Mayers Connell, T.D., T.F. (Officier ofthe Ordre de Leopold, conferred by the King of the Belgians);Col. Cathcart Garner and Temp. Lieut. Henry GrahamArnott, R.A.M.C. (Officier and Medaille d’Honneur avecglaives en Vermeil, respectively, of the Legion d’Honneur,conferred by the President of the French Republic) ;Lieut.-Col. (temp. Col.) James Currie Robertson, I.M.S.,and Lieut.-Col. Alfred Edmond Weld, R.A.M.C. (Reserveof Officers) (Officers of the Order of the Crown of Italy,conferred by the King of Italy) ; Bt. Lieut.-Col. John AllanAnderson, R.A.M.C. (Order of St. Sava, Third Class, conferredby the King of the Serbs).

FRENCH CONGRESS OF DERMATOLOGY AND SYPHILO-LOGTT.—A congress will be held at Strasbourg in connexionwith the Pasteur centenary celebrations on July 25th to27th, 1923. The questions to be discussed include desensiti-sation in skin diseases, naevo-carcinomata, the early treat-ment of syphilis, and the various methods of introducingthe curative agent in syphilis. The congress will be pre-ceded by that on cancer, already announced in our columns,and followed by an International Conference on leprosy,which will take place on July 28th and 30th. Further infor-ma,tion may be obtained from Prof. Pautrier, 2, Quai St.Nicholas, Strasbourg.

Correspondence.

THE DIAGNOSIS OF MORAL IMBECILITY.

"Audi alteram partem."

7 the Editor Of THE LANCET.SIR,-Dr. Henry Herd, in his interesting discussion

of the problem of moral imbecility in THE LANCET ofSept. 30th, points out that some modification of thedefinition contained in the Mental Deficiency Act isnecessary. He suggests a new definition under thetitle" morally defective persons." By this means hegets rid of the difficulty that in the present definitionsthe word " imbecile " is used side by side in two differentconnotations. In the term " moral imbecile " theword is clearly used in its older and wider meaning of" weakness." Only in the last 30 years has themeaning attached to the word been narrowed down tothat intended in the other definition-viz.. a grade ofmental deficiency above that of idiocy. When Prichardfirst described the class of case now labelled " moralimbecility " he designated the condition " moralinsanity." The moral deviate shows behaviouraberrations which are of exactly the same general typeas those of persons whose conduct brings them withinthe scope of the Lunacy Act, and the introduction oftemporal implications such as early age, permanency,and the association of intellectual defects, as necessarilyantecedent for the application of the Mental DeficiencyAct, clouds the issue. This difficulty is well shown bythe large number of persons who have been committedto prison for antisocial actions, who are subsequentlyconsidered to come within the provisions of the LunacyAct, and are accordingly certified as insane.

It is, however, doubtful whether any new definitionwill clear away the ambiguity which exists at present,The so-called " definitions " in the Act are generalisa-tions only, which have not sufficient precision to be ofassistance in the legal sense, and from the point of viewof the certifying medical officer lead to confusion anddoubt. The remedy, as has been implicitly suggestedby Sir Bryan Donkin (THE LANCET, 1920, ii., 979),appears to lie in a unification of the Lunacy and theMental Deficiency Acts, simplified by the deletion ofthe limiting clauses at present contained in the defini-tion clauses of the latter Act. Conduct is the criterionin both enactments, and if an individual in hisconduct fails to reach the average level of the commonopinion of the time, as expressed by the- laws andregulations of the community in which he lives, thena single inclusive Act should be enough to meet theaca_ T am Sir* vnnra faithfully

GEORGE A. AUDEN,School Medical Officer, City of Birmingham.

Sept. 30th, 1!JBJBJ.

PROVISION FOR THE SUBNORMALEX-SERVICE MAN :

THE NEED FOR A DEMONSTRATION-CENTRE.

To the Editor of THE LANCET.

SIR,-In your timely article of Sept. 23rd on thispressing question you urge the incontrovertibleprinciple that aid must be given to enable injuredmen to support themselves. But there is now solittle money to spare that it seems only fair to thepublic to inquire whether our existing machinery isupon a sound and economic basis.The problem of the subnormal worker is a difficult

one at the best. The recent Parliamentary SelectCommittee have recommended certain changes in ourway of handling it. Time and altered conditions havecertainly introduced new factors into it, and it cannotbe overlooked that great outlays of public and privatefunds have been already made, which have notalways produced commensurate results. I would notsuggest that this was entirely avoidable. The effortsmade to re-educate and place the subnormal workerhave been largely experimental. It is only lately that