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was employed, and a large piece of omentum found inthe hernia was resected. He suggested that temporaryparalysis of the stomach had been provoked by circula-tory disturbances or by the shock to the nervous

system caused by resection of the omentum. Giventhis state of paralysis, it only requires the formation ofgas in the stomach or the introduction of food to producethe alarming symptoms recorded. As Dr. Usland pointsout, in about 50 per cent. of all the recorded cases the symptoms developed soon after the administration of Ifluids or solid food.

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THE " LANGHAM " TELEPHONE EXCHANGE.

IN order to provide additional telephone facilities inthe area between Oxford-street and Regent’s Park, andto relieve the pressure at the existing Mayfair exchange,there will be opened, probably in January, a newexchange in Vere-street, W., which will be called"Langham." The area to be served by the newexchange includes Harley-street and the adjacentthoroughfares, and it is proposed to change about600 lines rented by members of the medical professionto " Langham " numbers. The new numbers of theselines cannot appear in the London Telephone Directoryuntil the issue of April, 1921, and to avoid inconvenienceduring the interval (and afterwards if necessary)arrangements are being made by the Controller of theLondon Telephone Service to advise callers of the

changes and, as far asr possible, to divert calls to thenew numbers.

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COLLES’S LAW AND THE WASSERMANNREACTION.

THE observation of the Dublin clinician, AbrahamColles, made a century ago, that a woman mightbear a syphilitic child and show no signs of the diseaseand yet was immune to infection from the child, hasbeen considered so well established as to be termed a"law." In the period before the discovery of the spiro-chaeta of syphilis and the Wassermann reaction attemptswere made to disprove it by bringing forward cases tothe contrary, but they always failed. Two of the greatsyphilographers of the last generation, Fournier andHutchinson, were firm believers in Colles’s law. But thediscoveries mentioned are supposed by many to have Idemolished the "law." Professor J. Whitridge Williamshas recently published a valuable study of the Wasser-mann reaction in obstetrics, based upon 4547 consecutivecases, in which he incidentally discusses the veracity ofColles’s law. It has been found that the blood of Dregnantand puerperal women who were supposed to exemplifythe law almost uniformly give a positive Wassermannreaction. It was therefore concluded that the reasonthe mother was not infected by her child was that shewas already suffering from the disease, which for someunexplained reason existed in a latent form. ButProfessor Williams has found that of the women whopresent a positive reaction only a few give anyevidence of having had a primary sore, and in less than20 per cent. can a history of the usual secondary ortertiary manifestations be elicited. Moreover, veryfew of the patients who have been under his care formany years, many of whom have not been treated,have shown the usual sequelaa of the disease. Again,Is a positive reaction during pregnancy anything morethan evidence of the establishment of immunity in themother against a syphilitic product of conception ?This view is supported by three cases of a positivereaction during pregnancy and birth of a syphilitic childwhich were followed some weeks or months later by anegative reaction. Another observer, Menten, foundthat under similar circumstances a positive was con-verted into a negative reaction in 12 out of 26 cases.Further, if a positive reaction during pregnancy isevidence of the existence of latent syphilis, what canbe said of 63 women in Professor Williams’s serieswho presented a negative reaction and gave birthto 43 definitely syphilitic children’? ’? He also hasseen several cases strongly supporting Colles’s law.

1 Johns Hopkins Hospital Bulletin, October, 1920.

One of them is as follows. In 1896 and 1897 a colouredwoman had her fifth and sixth labours in the out-

patient department, giving birth to healthy children.In 1898 she gave birth to premature male double ovumtwins. One survived and the other died three hoursafter birth. A necropsy showed syphilitic cirrhosis of theliver and interstitial splenitis. Microscopic examinationof the two placentae showed that the first was normal,while the second presented the lesions generally ascribedto syphilis. Thus one twin was normal, the other syphi-litic. On questioning, the woman admitted intercoursewith a man who was under treatment in the hospitalfor syphilis, as well as intercourse with her husband.The subsequent history confirmed this interpretation,for the patient had 11 labours at term with live childrenand normal placentae. The modern tendency to regardpurely clinical methods as inferior and out-of-date, andthe tests of the laboratory as much more reliable herereceives a check. It is curious that while the old" law," based entirely on clinical evidence, still with-stands attacks, the value of one of the latest laboratorytests comes itself into question in conflict with it.

THE SCHOOL MEDICAL SERVICE.

THE Annual Report of the Chief Medical Officer of theBoard of Education for the year 1919 (Cmd. 995.Price 2s.) is the best report issued by the medicaldepartment of the Board since its establishment in 1907.The dual function of these reports must be borne inmind, for were they not intended to inform and instructall who have the privilege of paying an education rate,the medical reader might complain that the wealth ofgeneralities hinders important novelties from securinga full measure of attention, and that some of thematerial with which this particular report is repletewould form subject for differences of medical opinion.It is as a year’s record of school medical service thatwe are regarding the report now. An importantdefinition of the position of the school medicalofficer occurs quite early on. Whilst it is essential,the passage runs, that the principal medical officer

responsible to the authority for the smooth and

proper working of the service should be primusinter pares and the recognised chief of his department,it is equally necessary that all the professional officersof the authority should be accorded the status to whichtheir profession and duties entitle them. This is shortlyfollowed by an indication of the possibilities of valuablescie,ntific work for the advancement of knowledge beingcarried out in the service. The school doctor should, itis suggested, throw new light on the incidence anddegree of defect or disease, on the physiology of thechild, on the beginnings of disease, on the relation ofphysique to mental capacity, on the standardisation ofsigns and symptoms, and many other problems thatstill await solution. The specimen tables required,bythe Board, if accurately filled up, should certainlyprovide an adequate review of school medical inspec-tion, but they are so full and detailed that the labourof keeping such records will be considerable. A risk isthus open for mechanical inspection which readilydegenerates into mere drudgery. We wish it hadbeen possible for the Board to lay down a maximumof not more than (say) 20 cases to be subjectedto routine examination during any one session, thusarriving a little more gradually at the desireduniformity.The section of the Report which deals with dental

disease is thorough and good. In it the colossal evil ofsepsis is set forth and the need for extensive provisionof dental inspection and treatment. The employmentof dental dressers is suggested as allowable. The Boardis steadily coming to the opinion that the earlier teethare inspected the better, and dental examination of thefive-year-old entrant is now recommended. In follow-ing up these cases the great value of the schoolnurse as home visitor has been shown beyond doubt.The statement in a footnote that in practice a schooldentist can examine 80 children and record his

findings in a school session of two and a half hoursis evidence again of that time pressure which has

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done so much to eliminate scientific observationand arrest progress in school hygiene. The results ofschool inspection in London show a definite improve-ment in the children’s health, although a wise reticencein drawing conclusions as to general conditions overwide areas forbids more than the assertion that grossdefects are declining steadily. Extension of medicaland dental treatment-the latter, in the words of thereport, not one-tenth of what is required-is the presentkeynote of the school medical service. The school clinichas been vindicated as at once the most effective and inthe long run the most economical form of provision thatcan be made by a local authority in the discharge of itsobligations for attending to the health and physicalcondition of children in public elementary schools.The chapter on cripples is a hopeful review of a subjectwhich is beginning to attract the attention it deserves.Not much weight has been attached to poliomyelitis,epidemics of which leave their trace in a crop of

cripples in the second- and third-year age-groups,but handled early these cases are extraordinarilyamenable to treatment, as has been shown in two largeschools in Chicago. The sections of the Report whichdeal with the crippled child, with the value of physicaleducation, and with the question of juvenile employ-ment will receive further consideration in thesecolumns.

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BENIGN TUMOURS OF THE LABIA.

ACCORDING to Dr. William H. Condit,-’ assistant pro-fessor of gynaecology and obstetrics at the Universityof Minnesota Medical School, who has had an unusuallylarge experience of these tumours in his practice, themajority of the benign growths of the vulva are confinedto the labia majora, and it is extremely unusual for thelabia minora to be affected. The most frequent tumouris the cyst which usually arises from the Bartholinianduct or gland as the result of infection, especially gonor-rhoea, trauma, or simple hypertrophy of the gland.Sebaceous cysts of the labia majora and labia minoraare not uncommon. Dermoid cysts may occur in thisregion, but are exceedingly rare. Fibroid growthswhile rather uncommon are next to the cyst in fre-quency and are the commonest of the benign solidneoplasms met with in this area. Like the retention

cysts of Bartholin’s gland they are liable to undergocystic degeneration as the result of circulatory impair-ment due to the process of growth. During menstrua-tion, and still more so in pregnancy, they increase insize, cause pain, and may become haemorrhagic. Two-thirds of the fibroids of the vulva originate from the sub-cutaneous connective tissue and one-third from the extra-

peritoneal portion of the round ligament. Lipoma of thelabia is one of the rarest gynaecological affections, Kellyhaving collected only 20 cases from the literature in 1906.It presents the same characters as lipomata presentelsewhere in the body, and is liable to be mistaken for acyst, elephantiasis, varicocele, and fibroma. Myxomaof the labia is also rare. In most cases it is benign, butoccasionally it shows signs of malignancy. Lastly, Dr.Condit describes a case of leiomyoma which had

obviously originated from some small unstriped muscularfibres of the Bartholinian duct, and was at first taken tobe a cyst of the Bartholinian gland, but on microscopicalexamination showed bundles of muscle cells running indifferent directions.

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THE first scientific meeting of the Section of Tropical I,Medicine, Royal Society of Medicine, will be held at thehouse of the Society, 1, Wimpole-street, London, W., onTuesday, Nov. 30th, at 5 P.M., when a paper will beread by Dr. F. G. Rose on the Incidence of Filariasis inBritish Guiana. Demonstrations will also be given andclinical cases shown. Fuller particulars were givenlast week, and will be found to-day in our Medical Diary.

1 Surgery, Gynecology and Obstetrics, November, 1920.

BRISTOL MEDICAL SCHOOL: e ANNUAL DINNER.-This dinner will take place on Dec. 9th in the LesserColston Hall, Bristol. Dr. George Parker will preside andSir Robert Jones will be the guest of the evening.

THE GENERAL COUNCIL OFMEDICAL EDUCATION AND

REGISTRATION.

THE Winter Session of the General Medical Councilopened on Monday, Nov. 23rd, under the presidency ofSir DONALD MACALISTER. In addition to the memberspresent Sir Charles Tomes attended as the guest of theCouncil. The official notification of the appointment ofDr. D. J. Coffey as Representative of the NationalUniversity of Ireland for three years from July 30th,1920, having been read, Dr. Coffey was introduced tothe Council by Dr. MAGENNIS. Three members of theCouncil intimated their inability to be present duringthe session-Dr. J. A. Macdonald, Dr. D. Hepburn. andDr. Matthew Hay.

President’s Address.

The PRESIDENT, in his opening address, pointed outthat by the recent death of Dr. William Bruce they hadlost a former colleague who sat for 20 years as DirectRepresentative for Scotland and who had left an

honoured memory as a leader of professional thoughtand action among Scottish practitioners. He alludedalso to the honour that had been done to Sir CliffordAllbutt in his appointment to the Privy Council.He reported the Bill for the amendment of the

Dentists Act to be in a forward state of preparation,stating that the Minister of Health had furnished repre-sentatives of the Council with opportunities of statingtheir views at various stages. The Dangerous DrugsBill he reported as having passed into law, though itwas probable that the Pharmacopoeia Committee of theCouncil would be consulted as to the regulationsgoverning such details as the manufacture, sale, pre-scribing, and dispensing of opium, cocaine, and otherpotent drugs. ,

Of the interim reports of the Medical ConsultativeCouncils for England and for Scotland, he said that theproposals in these documents for the better organisationof medical practice required the fullest discussion onthe part of the profession and of the public, as theircommon aim was to render more effective the mani-fold services which the profession of medicine inall its branches is capable of rendering to thenation. One great message of these reports heconsidered to be that the professional training offuture medical practitioners must be improved; andhe urged that the Council, one of whose principalfunctions was the standardisation of medical education,should consider both as a body and through its enlargedEducation Committee, the whole subject of the revisionof the curriculum. Of the various inspections of finalexaminations in medicine, surgery, and midwifery, hesaid that the official confidential reports had beenreceived, and that he might at this stage say, aftercritical study of the documents, that they gaveabundant evidence of the care bestowed by licensingbodies generally on the fulfilment of their importantpublic function.The remainder of the report dealt largely with the

question of medical reciprocity within the Empire, andthe President noted that movements in Canada, in theProtectorate of South-West Africa (lately German), inthe territory of Tanganyika, in South Australia, and inTasmania, had been towards that end. He also called

special attention to a visit of inspection made last Mayto the United States by Dr. Norman Walker, Mr. H. J.Waring, and Sir Humphry Rolleston on behalf of theRoyal Colleges in London and Edinburgh, which hadresulted in favourable reports on the methods of theAmerican National Board of Medical Examiners, thusconfirming his statement to the Council a year ago thatinfluential movements towards the establishment ofhigh and uniform standards of professional qualifica-tion throughout the American Commonwealth weretaking place.The President also announced that Sir ArchibaldBodkin, having been appointed to the important legal