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the average number of days off work per case 2-2.On the whole in this one office 6233 days were lostin the year from common colds, among which, be itnoted, were generously included acute bronchitisand tracheitis. Two periods of maximum incidencewere observed, the first following the advent of coolweather in the late summer and early autumn, thesecond during the following January or Februarywhen the coldest weather of winter prevails. Thistwofold prevalence suggested the occurrence of twotypes of catarrhal fever, possibly interrelated insome way. From a careful study of the figures itappears that in New York there is a close relationbetween the number of common colds and the riseand fall of the weekly mean temperature, a drop of10° F. carrying with it an increase of 18 colds per weekin this group of 6700 people. A chart reproduced in theBulletin shows graphically the inverse ratio of coldsand temperature. On the other hand, relative humidityand total precipitation seemed to have little or no

influence on the incidence. The Bulletin suggests thatthe annual downward swing of temperature can becompensated for by proper attention to clothing, toventilation, and to the heating of homes, work-places, and means of transportation. We need notconclude, and, indeed, the Bulletin does not imply,that the fall of temperature in itself is responsiblefor the infections-it may just as well be the indoorhabit of life to which the drop of temperature gives Irise ; and it remains to be seen whether the evil

would be substantially mitigated by keeping theinsurance clerk all day long, at work and at play,in a uniform temperature. Experience does notsuggest that those who pay most attention to warmingtheir aura secure thereby much immunity in com-parison with their less protected associates. Therelationship between the two groups of minor infectionsis being further studied. We are glad to learn thatthe U.S. Public Health Service is inaugurating a

study of common colds over a prolonged period.It is remarkable what little definite knowledge thereis regarding the epidemiology of these mis-calledminor ailments, which are the bane of civilised lifeand a constant menace to the prestige of medicine.

A SORDID STORY.1

THE publication of the story of a trial that hasexcited considerable emotion of an unwholesomekind in the public mind, within about 12 monthsfrom its conclusion, is open to the criticism thatthe time which has elapsed is too short for dispassionateand therefore impartial examination of the evidenceto be possible. This latest volume of the excellentNotable TrialsSeries has been edited by a journalist ofability, who has not confined himself in his introduc-tion, as some of the lawyers who have treated othercriminal trials for the same publishers have done, toa judicial setting forth and summary of the facts andcircumstances of the case. He prefers to criticisejudge, counsel, and conclusions of the jury, mainlyin order to convince us that Edith Thompson waswrongly convicted. He condemns, for example, SirHenry Curtis Bennett, a not inexperienced advocate,for having

" lost one of the opportunities of his life-time when, after the confused and uncertain openingof the Solicitor-General," he did not keep Mrs.Thompson out of the witness-box, and leave theprosecution to fulfil their admitted obligation to

prove the case against her. He condemns equallythe very unemotional judge who tried the case, forreferences to Bywaters as " the adulterer," assertingthat adultery is to young people of the present day" merely a quaint ecclesiastical term for what seemsto them the great romantic adventure of their lives."Mr. Young appears to us hardly to appreciate theposition of a jury, who had to consider whether Mrs.Thompson, in fact, suggested and instigated the

1 Trial of Frederick Bywaters and Edith Thompson. Editedby Filson Young. Notable Trials Series. London and Edin-burgh : William Hodge and Co. 1923. Pp. 293. 10s. 6d.

murder of her husband, which she did nothing toprevent when it took place, rather than whether shewas determined, when she wrote he notorious letters,that Bywaters should stab Thompson, or believedhim to be capable of doing so. However, whateverher mental reservations may have been, neither hercondemnation, nor his, laid any heavy responsibilityon the medical witnesses called by the prosecution.Dr. P. S. Drought, who described the wounds onthe murdered man, was quite clear that the fatalwound was due to the last blow inflicted, and was ofthe opinion, but not positively so, that the blow wasstruck from behind ; and his evidence, on the whole,was not inconsistent with the story which was told byRywaters, and which was not believed by the jury,in description of how the struggle began. Mr. J.Webster and Sir Bernard Spilsbury, if they did notprove that Mrs. Thompson had never administeredpoison or powdered glass to her husband in order tokill him, stated that no traces of any such attempts tomurder remained in the organs submitted to them.The medical and scientific evidence in the case wasneither vital nor challenged, and it is not necessaryto recapitulate here the history of a crime and a trialstill fresh in the memory of those interested. Weregret the way in which a sordid story has beenpresented. _____

THE VENEREAL DISEASE SOCIETIES:A FUSION OF WORK.

THE eighth annual report of the National Councilfor Combating Venereal Diseases has just beenissued and covers the year ending June, 1923. Whilethe Council has to regret a pecuniary stringencywhich has been common to all voluntary associationsin these times of financial stress-a stringency whichhas compelled them both to cut down their personneland move to smaller offices-the latest report showsthat activity in propaganda has in no way been abated.The outstanding feature of the year has been a wideand also intensive dealing with venereal problemsinternationally, which culminated in the institutionof the Union Internationale for the study of thesubject, and the last report of the National Councildeals fully with the objects of this new union. Thereis also issued with the report a precis of the importantmeeting held in November last at which the fusion ofthe National Council for Combating Venereal Diseaseswith the Society for the Prevention of Venereal -Disease came into definite form, with the result thatthe British voice in international affairs will now havethe advantage of unanimity in principle. It will beremembered that at a previous conference of thetwo bodies the following resolution had been approved:

Subject to the approval of their respective executives thisconference resolves itself into a deputation to the Ministry ofHealth to urge that the law should be altered so as topermit properly qualified chemists to sell ad hoc disinfectants,provided such disinfectants are sold in a form approved andwith instructions for use approved by some competentauthority.It was then seen that the main obstacle to concordwas about to disappear, and at a meeting last Novemberof the National Council it was announced that bothbodies had accepted the report of a committee ofinquiry on the matters at issue, so that the newchairman of the National Council, Lord Trevethin,was able to state that the damage to both organisa-tions in the eyes of the general public, due to theirdissensions, would no longer be felt.

In respect of the international movement, Mrs.Neville-Rolfe, the general secretary of the NationalCouncil, attended a conference at I’aris, when it wasagreed that a union should be formed of all thenational organisations engaged in the work of com-bating venereal diseases. The immediate workbefore this union is stated under the followingheadings : Rendering non-infective the maritime andcolonial services ; surveillance of emigration; sur-

veillance and concerted action along the frontiers ;international measures for the suppression of quackery;a single moral standard for both sexes ; and to study

41

generally the principles of legal responsibility, icompulsory notification and treatment, and penalties.There is, then, every chance that some of the gross 1 e,causes of the dissemination of disease will disappear, while the voice that should be heard with particular respect, as coming from the main maritime power of the world, will lose none of its emphasis from detaileddifferences of opinion among honest workers.

THE WORSHIPFUL COMPANY OF PLUMBERS.

Dr. F. J. Waldo, recently Master of the WorshipfulCompany of Plumbers, has re-issued his little historyof the Company, which makes interesting and informingreading. This history dates back through manycenturies and shows how a craft guild, by tenaciouseffort, can maintain its organisations in the face ofmany vicissitudes. The Charter of James I. bringsus definitely into a modern sphere of thought, for itstated that it was granted for the utility, advantage,and relief of the good and honest, and for the terrorand correction of the evil, deceitful, and dishonest.The ordinances of the Company from the reign ofEdward III. up to this charter are set out, togetherwith a description of the arms of the Company, inthe following phraseology of Elizabethan heraldry:-

" And whereas the most ancient and necessarye Seyenceof Pluming dothe no lesse deserve to be remunerated thenany other mysterye or Arte whatsoever, I the saydeClarencieulx King of Armes by power and aucthority ofmy office, granted unto mee by Letters Pattent under theBroade Seale of Englande have geven graunted assignedand allowed and by their putes doo gyve graunte assigneand allow unto the sayde Companye of Plumers and theiresuccesors forever this theire Armes and Creast following :Vialt or on a Cheveron Sable towe soodring irons in saultorwith a cutting knyfe and a shaver argent ; in Cheife betweentwo sounding leades proper, a Jacobs staffe of the seconde,and in poynt a water levell of the same. And for theireCreast upon a Heaulme on a wreath or and sable a ffountayneargent garnished on the toppe with an Archangel holding asworde and a Ballance or with this their ancient worde ordevice Justicia et Pax."

As is well known, a system of voluntary registrationof plumbers was inaugurated by the Company ofPlumbers 40 years ago at the time of the InternationalHealth Exhibition. The Company is not wealthy, asmay be gathered from the fact that its chief source ofincome has been derived from the sale of its hall, and itis reasonable to think that the time may have comewhen the registration of plumbers should cease to bevoluntary and those who desire to become plumbersshould pay a definite fee of registration after showingthat a certain standard of proficiency has been reached.A high standard of plumbers’ workmanship is necessaryfor the carrying on of the business of this life, as theCharter of James I. indicates, and all the public isinterested in is being able to distinguish a man ofcompetence and training from the father of JosephVance, and in promoting a proper system of technicaleducation for those responsible for domestic sanitation.

THE CASE OF INSURANCE PRACTICE.

AT the Court of Inquiry into the insurance capita-tion fee, whose first sitting is to-day, Friday, Jan. 4th,the case presented on behalf of the insurance practi-tioners by the Insurance Acts Committee of the

= British Medical Association will run on lines whichall familiar with the question have confidentlyanticipated. And as the arguments are sound wewould not have them altered. Medical men workingunder the National Health Insurance Acts cannot.and do not, expect to escape the effects of financial stringency, but the medical profession has alreadygiven evidence of its willingness to make sacrifices,while the conditions of panel practice are so arduousthat unless remuneration is adequate the quality ofthe service must be rendered less secure. The well-known places in which the services of insurancepractitioners can be differentiated from the work ofprivate practice are again set forth with great clear-ness and in proper perspective.

Modern Technique in Treatment. A Series of Special Articles, contributed by

invitation, on the Treatment of Medicaland Surgical Conditions.

LII.

THE PALLIATIVE TREATMENT OFTOOTHACHE.

IT often happens that an individual afflicted withtoothache seeks the aid of a doctor because that of adentist is not available. Successful relief of the painrequires a knowledge of the pathology of dentaldisease. Toothache or odontalgia is due to twocauses : inflammation of the pulp (commonly, thougherroneously, called the nerve), or pulpitis, and inflam-mation of the dental periosteum or periodontitis. Acorrect diagnosis is essential, for the treatment of thepain arising from these conditions is different.

Due to Two Causes.

Pulpitis usually arises as a sequel to dental caries,though it may follow occasionally from other causes,such as fracture of a tooth. The pulp is a delicateand complex structure containing an abundance ofnerve fibres and blood-vessels, which enters the toothby a narrow opening at the end of the root. Thecavity in which the pulp lies, being formed of dentine,is rigid. Thus in hyperæmia of the pulp the dilata-tion of the vessels occurs at the expense of otherelements of the pulp, and is most marked at theconstricted entrance. This serves to explain thesevere pain of pulpitis and the reason why suppura-tion and gangrene so commonly occur ; the delicatenature of the pulp and the anatomical factors allowof only a limited power of repair. The pain is sharpand shooting ; it tends to occur in acute paroxysmswhich may suddenly cease, and is usually worse atmeal-times, for food gets jammed into the cavityand increases the tension. Thermal changes affectthe pain. Sometimes cold will relieve it in the earlystages by constricting the blood-vessels ; later bothheat and cold intensify it. Chemical stimuli (sweetand acid substances) may increase the pain, possiblyby altering the osmotic tension in the pulp. Thepain is usually more severe when the patient liesdown. If the pulp is actually exposed at any point,pressure on this pxp03ed area causes excruciating pain.Even cotton-wool pressed lightly in the cavity causessuffering out of proportion to the pressure used. Inthe later stages, when suppuration has commenced,the pain becomes worse and throbs ; it may not be

, localised in the tooth which is the cause, but may bereferred to any other tooth on the same side, evenfrom a lower molar to an upper. In such a case a

, painful stimulus applied to the lower tooth maycause an immediate exacerbation of pain referred tothe upper. The pain may be referred to other areassupplied by the fifth nerve, and, in addition, theremay be associated areas of hyperæsthesia of the skin

- of the face, which have been mapped out by H. Head., Periodontitis.—The periodontal membrane is both a- supporting and nutritive structure. Its fibres are

attached to the root and to the bone of the socket;i thus it is the means of attaching the teeth to the jaw.The membrane is well supplied with blood-vessels

ô and nerves. Although the periodontal membrane isfrequently infected via the gum margin, as in pyor-

. rhcea, the inflammation rarely gives rise to pain, for1 the pocket formed by the progressive ulceration from7the surface allows of drainage and prevents tension., When the periodontal membrane is infected via thes pulp canal following gangrene of the pulp, pain isf conunon. A normal tooth is capable of slight move-- ment in all directions through stretching of the fibrese of the periodontal membrane. This buffer-like actionf of the membrane lessens the impact of mastication.In periodontitis the engorgement of the -t vessels

causes the tooth to rise slightly in its socket, the