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The front wall is perforated by two elliptical openings ; Ithe horizontal and longest axis of each is 100 mm. and the c

shortest 85 mm. ; the centres are 27 centimetres apart. Tothe circumference of each of these there is screwed, by c

butterfly nuts, a brass ring or washer carrying an india-rubber gauntlet, by means of which the operator canmake manipulations in the interior of the instrument with-out introducing contaminations. The boiler is continuous with-

with the body of the instrument and is separated from 4

the latter by the floor, through the perforations inwhich passage is afforded to the steam. At the sidethere are provided a tap and a water-gauge. The dimen- Isions of the boiler are 40 cm. x 26 cm. x 15 cm. Atthe level of the floor of the body of the instrument thereprojects horizontally a flange 5 centimetres wide runninground the outside of the instrument. This flange is

strengthened at ten points by U-shaped brass pieces placedbelow with the concavity outwards. The flange is cut awayabove the hollow of the U, and in each of the spaces soformed there is hinged a bolt carrying a butterfly nut. Theuse of this flange and its nuts and bolts will be indicatedbelow.For the protection of the glass during sterilisation and to

ensure a uniform temperature throughout the instrument ahood is provided. This hood is made of copper, facedexternally with asbestos ; it is provided above with an outletfor steam. In general outline it is similar to the body ofthe instrument which it covers, and its dimensions are suffi-

ciently large to leave space for the short tubes in the roofridge of the apparatus. It terminates below in a flangecorresponding to that described above, to which it is boltedduring sterilisation, a felt washer being interposed. If the

apparatus is to be employed for filling bottles trays must beprovided for these and for the corks; these of course willstand on the floor of the instrument.The instrument as above will accommodate two bottle trays

4’5 cm. x 22 cm. x 12 cm. and one cork tray 14 cm. x

22 cm. x 12 cm. ; the perforations for admission of steamare so placed as not to lie directly under a tray. There is noneed to plug the bottles, they remain sufficiently dry if

placed inverted in the trays. The cork tray should, how-ever, be provided with a removable lid.These dimensions allow for from 90 to 100 tubes of 30 c.c.’s

capacity or less. The accommodation may easily beincreased without any increase in the bulk of the apparatus.The back wall and each of the side walls are perforated byoblong openings strengthened by thickenings of the wall.To these openings are screwed brass washers carrying india-rubber bags, each large enough to hold one tray. Duringsterilisation the extra trays full of bottles are piled up in theinstrument, but on commencing operations are placed in the

‘ bags, which are supported by brass rods or stays. Accom-modation is thus provided for at least 270 bottles.

It may be well to point out that this apparatus may beused for many purposes other than that mentioned ; forinstance, it may by slight modifications be rendered usefulfor the aseptic removal post mortem of such organs as thepancreas. The instrument is made by Messrs. Baird andTatlock.

THE MEDICAL PROFESSION AND INCOMETAX.

(WITH SPECIAL REFERENCE TO SCHEDULE D.)

ONE of our readers in Cambridge writes asking for informa-tion as to all the deductions he can make in sending in astatement for income tax purposes. Not knowing his specialcircumstances it is not possible to state exactly all thedeductions he can make ; but, presuming that he is an ordi-nary practitioner with no other income than that derivedfrom his profession, the deductions he may lawfully claimare fairly clear. Probably, whilst we are endeavouring tohelp our correspondent, it may not be wasting space if wego a little more fully into the operations of Schedule D thanwe had at first intended to. Maybe we shall not be conveyinganything new to the majority of our readers, but, on theother hand, our remarks may be useful to the minority.

There is no doubt that medical men, owing in a largemeasure to the remissness with which they send in their

returns and to their almost entire ignorance of the deductionsto which they are entitled for professional expenses, are

mnually assessed greatly in excess of their earnings. Itcannot be too emphatically laid down that the duty underSchedule D should be computed upon the balance of profits.3n an average of the three years preceding the date ofassessment, thus allowing the possible losses of one or twoyears to be set off against the profits of another year, andwhere the profits are gradually increasing making the assess-ment upon the average of three years instead of upon theenhanced profit of the last year of the period. As an instanceof the former, A. B. at the end of the year 1895 finds thathe has made a net profit of .f.550. In 1894 he made a profitof .f.420, but in 1893 he had a loss of .6260. It would,therefore, work out thus :-

Net profit for 1895 ...............550 0 0" 1894 ............... 420 0 0

970 0 0Less loss for 1893 ............... 260 0 0

Total profits for three years ......... 710 0 0

Average annual profits ............. 236 13 4Less abatement (being under .f.400) ... 160 0 0

Total on which duty is payable .......67613 4

Thus clearly showing the advantage of the three years’average, because, if the duty were payable on the profits ofthe year 1895, he would have had to pay on .f.550, which, at8d. in the .f., would have amounted to .f.18 6s. 8d., whereason the three years’ principle the sum to be assessed was only.f.76 13s. 4d., the duty on which, calculated as .677, amountedto .f.2 2 lls. 4d., showing a saving of .f.15 15s. 4d. Where abusiness has been commenced within the three years, theassessment will be made on the average of profits from theperiod of commencing it to the day on which the last annualaccounts are made up, or to April 5th. If commencedwithin the year of assessment, then the duty payable wouldbe on the profits to the best of the knowledge and belief ofthe person making the return. Where a business alreadyestablished is taken over the incoming proprietor is chargedthe same as his predecessor.Having now briefly described the method by which the

average for assessment is arrived at, it must next be borne inmind that all incomes and profits of .f.l60 and under areexempted from tax, and that an abatement of .6160 is allowedwhen the income does not exceed .6400, and an abatement of6100 when the income is over .6400 but does not exceed .6500.And here it should be carefully noted that to get the

advantage of abatement it must be claimed; it is notsufficient for a person to return his income at, say, .6350,thinking that the surveyor will himself make the abatementof E160 allowed by statute. The surveyor will assess on theamount actually returned, and when no abatement is claimedwill not allow any. Why this should be so, seeing that theAct distinctly allows the reduction, is not apparent.To come more nearly to the question asked by our corre-

spondent, it is not, of course, possible in the short space atour disposal to enumerate at length the many items whichmay, and which may not, be deducted in arriving at thenet profits of the year’s working ; but it should always beremembered that the first principle of income tax is that thesum to be assessed is the balance of profits or gains arisingfrom any profession, trade, or other concern remaining afterthe bond-fide expenses incurred in acquiring such profits havebeen met. If this principle be thoroughly borne in mindand firmly grasped when preparing a return for income taxpurposes, the person making such return will not go very farwrong.We purpose now giving an example of an account which

may very well meet the case of the majority of the readersof THE LANCET, and also serve as a guide to them in makingtheir returns. The account is one which was actually pro-duced to the Commissioners, and is quoted in Affleck’sguide to the Income Tax Law and Practice." 1

A medical man having omitted to make a return wasassessed for 1894-95 at f.700, against which he appealed,and produced the annexed statement (see table on next page).The statement satisfying the Commissioners, the assessmentwas reduced to .f.397, and there being no other source ofincome the abatement of .f.l60 was allowed, and the amount

, upon which tax was payable was reduced from Z700 to .6237.

1 Guide to the Income Tax Law and Practice : by J. Affleck, Jun.,Manchester, 72, Market-street. Price 5s.

46

The cost of maintaining consulting-rooms, apart from the.actual place of residence, for the exclusive purposes of businessis a legitimate item for deduction, as will be noticed in the.above statement, and all expenses incurred in the up-keep ofsuch rooms may be deducted. When the place of residence isused also partly for business purposes a sum not exceedingtwo-thirds of the annual value or rent may be allowed by theCommissioners, and should be deducted when making thereturn. Another item which may be deducted (and which,unfortunately, is -no stranger to the medical profession) isthat of bad debts, as also doubtful debts, according to their- estimated value. Under the heading rent, rates, &c., shouldbe included fire-insurance premiums, all rates, gas and water,rents, and rent of business premises, but .not the amountpaid for income tax. No allowance is permitted for thislatter, or for any sums paid as salaries to partners or

principals, or for the maintenance of themselves, or families,or establishments. The amount of the premium paid for life’insurance or for a deferred annuity, either on the life or forthe benefit of the person making the return, or on and forhis wife, may be put in, provided that it is not more thanone-sixth of the income from every source, and provided alsothat it does not so operate as to give total exemption.For instance, a person with an income of <8170 who paid E15.a year for life insurance would not be permitted to claim

DR.

seeing that its members are not engaged in trade) is that thelosses sustained in one concern can be set off against theprofits acquired in another. For example, the above-mentioned C. D., who returns his income from the partnershipaccount as ;E375, nig7ct be engaged in another concern andhave sustained a loss on his year’s working amounting to.6225. He would be entitled to set this against the .f.375,reducing his income to .B150, which, seeing that it isunder the minimum, <8160, would exempt him altogetherfrom the payment of any duty that year. Whilst on

the subject of partnership, we may mention a case whichrecently came under our notice where the partners made thejoint return and paid the duty demanded. One of themafterwards filled up the usual official form (No. 11) annuallycirculated by the Inland Revenue authorities stating hisincome as such and such a sum, and the usual demandnote for payment of duty followed. The duty was

accordingly paid, the person making the return overlookingthe fact that the duty had already been paid on his incomein the joint partnership account, and, therefore, was notagain chargeable. Instead of setting forth the particulars ofhis income he should have filled in Table No. 4 on the formdeclaring that he was a partner in trade chargeable underthe joint assessment of the firm.j With regard to claiming repayment of duty, most people

CR.Profit and loss AO(Jollnt for Th’l’ee Years-1891-92, 1892-93, 1893-94.

total exemption, nor would abatement be allowed where ithad the effect of reducing the income below .E500. Itshould be borne in mind by those who have any incomearising from dividends, interest, &c., that in nearly all casesthe amounts have been taxed before being paid over to them,and consequently should not be returned under Schedule D Iif they have been so taxed. Where a partnership exists andthe profits when divided are under E500 for each partner,the parties should claim to be separately assessed (fillingup Table No. 5 on page 3 of Form 11), as by thismeans abatement or total exemption may be claimed. Forinstance, A. B. and C. D. are in partnership, and the net profitsfor their last financial year amounted to .8750. If this sumbe returned under a joint partnership account the duty pay-able on the full amount would be 25. If, on the otherhand, they claimed to be separately assessed, and their sharesin the business were equal, they would each return theirincomes as .B375, claim abatement of :E160, and if therewere no other deductions to be made, such as life insurance,&c., would each pay duty on ;E215, amounting to .f.7 3s. 4d. ;or if the net profits of the partnership did not exceed Z320 theycould, where separately assessed, claim exemption altogether.Another advantage of the separate assessment (though one,perhaps, not particularly affecting the medical profession,

are under the impression that income tax once paid is lostfor ever. No doubt the authorities are not anxious to dispelthis notion, seeing that it annually brings in many thousandsof pounds to help to swell the national revenue. But repay-ment can be obtained, provided the claim for such repaymentbe made within three years next after the end of the yearof assessment to which the claim relates. Thus a personlodging a claim now could recover for the years 1893-4,1894-95, and 1895-6 ; and after next year’s tax is paidcould include 1896-7 as well, if the claim for repayment bemade before April 5th. Should, however, the claim be

delayed to April 6th, the amount for the year 1893-4 would *be lost for ever, as April 6th is after the end of the financialyear. The necessary forms for claiming repayment can beobtained from the surveyor of taxes in the district in whichthe person claiming resides. As the inland revenue authoritiesalso are not behindhand in claiming payment of back duty, itmay be pointed out that it is doubtful whether under Statute43 and 44 Vict., c, 19, sec. 63, back duty can be recoveredby the Crown after the expiration of the year followingthe year of assessment. Surveyors will, as a rule, submitthat there is no bar to the claim of the Crown ; and onesurveyor with whom we recently conversed on the subjectexpressed his ignorance of the section of the statute referred

47

to, but in a sufficiently half-hearted manner to cause us to- doubt whether his ignorance was real or assumed.

In concluding our remarks on the subject generally, wedesire to point out that we have scarcely touched even thefringe of the matter, as any attempt to deal with the whole.question would occupy far more space than we have at ourdisposal, and would probably not be of any particular interest4o the profession. But we trust that the remarks called forthby the question of our Cambridge correspondent will belound useful both to him and to medical men generally.

IMPORTANT IMPROVEMENTS IN THEAPPLICATION OF THE "X" RAYS

TO MEDICINE.DEMONSTRATION AT "THE LANCET" OFFICES.

WE announced in our issue of June 6th that an importantimprovement ha,d been effected by the General Electrical

Company of Berlin in the Roentgen apparatus, and especiallyn the vacuum tube, so that it was possible to observe peolili-

arities in the interior of the head and throat, and especiallythe action of the lungs and heart, by direct inspectionwith the fluorescent screen. The results were demonstratedbefore several medical men representing the chief European.capitals at the recent Twenty-fifth Surgical Congress at

Berlin. This demonstration was repeated (for the first time,we believe, in London) at THE LANCET Offices on Tuesdaylast in the presence of several distinguished physicians andsurgeons. Dr. Oscar Levy undertook the demonstration, whichwas attended with marked success. The vacuum tube he

employed contained two concave electrodes, midwaybetween which is situated a platinum disc in a plane of’45 degrees. One or other of the electrodes, according towhich gives the best results, is connected up by means of awire to this disc, the wires from the coil being attachedto the concave electrodes so that the anode is duplicated.The screen employed measured about ten inches byeighteen inches, and consisted of small crystals of platino-’cyanide of barium dusted on to an adherent surface.

Although the results obtained are probably capableof further improvement, still they were sufficientlygood to indicate the probable value in the very near

future of the "x" rays in diagnosing certain conditions.They were, at any rate, far in advance of anything,that has yet been achieved. It was thought on the

discovery of the x" " rays that a new epoch in

diagnosis had been reached. Experience, however, hassince shown that the application of the discovery wasrestricted to the exploration of the extremities in theexamination of bony structure and in the search for foreignbodies. The photography of the chest and abdominal

cavity by means of the" x" " rays has been attended withbut small success, at least to be of any value in medical,diagnosis. By means, however, of this new tube, whichappears to afEord the maximum energy in regard to the pro-duction of "x" rays, the labour and trouble of photographymay be dispensed with, and a direct vision of certain abnor-malities of the heart and in the chest may, as was shown inthis demonstration, be gained.The following were amongst the results shown. When

the head was placed between the tube and the screen the’thickness of the scalp was easily visible, the hair not

appearing. The light penetrates the cartilages of the nose,which are only visible in slight shadows. The frontalcavity and the antrum of Highmore are to be seen as dis-tinctly lighter areas. In the neck are to be seen the shadows sof the oesophagus, of the hyoid bone, and the cartilagesof the larynx (the last not as distinctly as the hyoidbone), which both in rest and in movement are easily de-tected. If the light be thrown through the thorax frombehind the screen givee the following picture: In the middleoccurs a dark broad stripe, the sternum ; on both sidesare to be seen horizontal shadows crossing each other,which are plainly the ribs; the lower margin of the thoraxis represented by a shadow, the left side of which is paleand thin, but the light side is intensely dark. The

picture is still better if the rays be thrown from thefront and the screen placed behind, only in this case the

vertebrse are seen, and not the sternum. The shadow-line,which is constantly moved on inspiration and expirationfor about three inches, is the diaphragm, and thedarker shadow on the right side is the liver and thelighter on the left is the stomach. This picture shows,further, that the diaphragm and the ribs are situated at avery acute angle with one another. Another big shadow isseen immediately above the diaphragm and in the middle ofthe thorax. This shadow (that of the heart) consists of anintensely dark central part with a relatively light periphery.The movement of the heart is distinctly visible, principallyat the apex, but on close examination the movement of theaorta may be noticed also. The heart shadow and the move-ment are emphasised after a deep inspiration has been taken.If now the tube and screen be moved downwards the light isthrown through the stomach. The limits of this organ maybe well seen, but the definition is far better after it hasbeen distended by the administration of an effervescingmixture.The following cases are of interest as having been demon-

strated by Dr. Max Levy (the designer of the tube) in Berlin,in collaboration with Professor Grunmach and Dr. Dubois

Reymond, with substantially the same apparatus which wasemployed by Dr. Oscar Levy (his brother) at THE LANCETOffices on Tuesday last. In the first case, that of arterio-sclerosis, a man aged fifty-six years had complained ofheart trouble. An examination with the screen of the radialand ulnar artery gave results in harmony with the palpation.There were to be seen distinct thin shadows besides thethick shadows of the bones. The rise and fall of the

diaphragm were distinctly seen, but instead of measuringone and a half inches on a deep inspiration being taken itmeasured only three-quarters of an inch. Intensely darkstripes were visible in the region of the coronary arteriesindicating calcification in the horizontal as well as in theperpendicular position, but less in the latter case. Justabove the heart shadow a very dark and broad movingshadow was visible, which was twice as broad as the normalshadow of the aorta. Case 2 was that of a young man agedtwenty-six years who had suffered from haemorrhage of thelungs eighteen months previously. His mother suffered fromphthisis. He complained of respiratory trouble, but littlecould be diagnosed by ordinary methods. On viewing thethorax by means of the screen and new tube three or fourdark patches in the right side came into view perfectly dis-tinct and in striking contrast to the normal transparency of thelungs ; the left lung was free from patches. The conclusionwas drawn that the calcification of the previously affectedparts of the right lung had supervened, which were thoserendered visible by the "x" rays. Two other cases illus-trated the value of the application of the "x" rays inetiology.

In two cases of mitral insufficiency, both showing on per-cussion enlargement of the heart, the diagnosis was confirmedby the shadows of the heart appearing considerably enlargedon the screen, but the first case, in which there was also

high pulse tension, showed a great hypertrophy of the leftventricle. The second case showed no such hypertrophy,neither was the arterial tension increased. In the first case alsothe Roentgen picture of the thorax showed above the enlargedheart shadow another broad, dark, moving shadow, whilein the second case this shadow was only half the size andmuch lighter. The broad big shadow was similar to thatdescribed in the case of arteriosclerosis, and is easilyaccounted for by the calcification of the aorta. The differ-ence in the etiology of these two cases was made plain bythe use of this screen. The hypertrophy in the first casedepended upon arteriosclerosis ; in the second case, in whichthe shadow of the aorta was normal, the morbus cordis hadobviously arisen from an attack of articular rheumatism, ofwhich the patient gave a history.These results demonstrate pretty conclusively, we think,

the possibility in the near future of the " x " rays becominga powerful aid in diagnosis coupled with the employment ofa fluorescent screen. Already it has been fruitful in not

only confirming previous methods of diagnosis, but in afford-ing means of ascertaining with some precision certain sym-ptoms which by methods now employed would not beindicated. The movements of a complex joint, such as thecarpus, were clearly seen, and will throw a new light uponsurgical anatomy.

’BYe are indebted to the Electrical Company, Limited, of

122 and 124, Charing-cross-road, for the loan of the Lewmodification of vacuum tube-the invention of Dr. Max Levy