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activity. Lieut.-Colonel Morrison and Major C. de C.Martin state that bacteriophage alone has been provedas effective in the treatment of bacillary dysenteryas is orthodox treatment given in control cases.The leprosy section is particularly full. E. Muir

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propounds his latest views on the treatment withspecial reference to the employment of potassiumiodide ; R. Row amplifies his well-known work on thecurative value of tubercle bacillary autolysate inleprosy ; it must be remembered that it is still doubtfulwhether this action is specific or whether it is due tonon-specific protein. E. V. Pineda contributes animportant paper on the presence of the leprosybacillus in 53 per cent. of the placenta and umbilicalcord of advanced sufferers of the disease. R. Inadacontributes a short comparative study of leptospirse.R. McGuire writes on colour variations in the fungusof Dhobie’s itch, and D. G. Panja believes he has culti-vated the organism responsible for dandruff, which hehas termed Malassezia ovalis. Typhus and typhus-likediseases also attracted much attention, notably fromJ. W. D. Megaw and C. Strickland. Under the sectionof Protozoology, R. Knowles and B. M. das Guptahave studied the influence of the thyroid gland on thecourse of a protozoological infection.No less than 30 papers are devoted to the question

of malaria, divided under three headings-control,general considerations, and treatment. Sir MalcolmWatson writes informatively on the future ofmalaria control in the Federated Malay States.Colonel S. P. James, Drs. W. D. Nicol and P. G. Shutehave studied the habits of anopheles in relation totheir r6le in the spread of malaria from observa-tions made in England, and they have also madeexperiments on the treatment of malaria, from whichit appears that thorough and prolonged quininetreatment of the primary attack has no more effect inpreventing a true relapse than has intensive treat-ment by quinine during the acute phase.

A MEMORIAL TO JOHN THOMSON.ON Saturday, Dec. 14th, a memorial to the late Dr.

John Thomson was unveiled by Sir Thomas Barlow inthe Royal Hospital for Sick Children at Edinburgh.The memorial takes the form of an inscribed marblepanel with a bronze portrait medallion by Mr. Pil-kington Jackson, placed opposite the entrance ofDundas Ward, where Thomson did such a large partof his work. In addition, a medal is to be awardedby the University of Edinburgh for a thesis or

original investigation of special merit and dealingwith children. Recalling Thomson’s appointment in1884 to one of the resident medical posts at theHospital for Sick Children in London, Sir Thomasconfessed that at the outset of their acquaintancehe was not impressed by Thomson’s personality,while some of his contemporary residents esteemedhim but lightly. They little knew then what areserve of quiet power, sound method, and goodjudgment lay beneath that modest, half-deprecatingdemeanour. A slight hesitancy of speech was theoutcome of a resolute determination to cultivate accu-racy of statement. Good botanist that he was, hehad been trained in sound observation. When histwo years at Great Ormond-street were completedand he returned to Edinburgh, Thomson was almostimmediately appointed physician to the New TownDispensary, where he soon developed a successfulchildren’s clinic, and shortly afterwards he waselected assistant physician to the Children’s Hospital.His most important contribution to medical know-ledge was, in Sir Thomas’s opinion, his account ofpyloric stenosis in infants ; an exhaustive report of 100cases under his own care during a series of years openedthe eyes of medical men to the serious importanceof its early recognition, and the vital indications foiits treatment. In this as in all his work he was keento share his knowledge in the give and take of realfellow workers. He was generous in acknowledgingthe help of his colleagues, whether older or younger :jealousy and self-advertisement were both unknown

to him. Later in his career Thomson set himself toengage the interest of the mothers of mentally deficientchildren in simple methods of wakening intelligenceand cultivating self-control. He was determined inhis instructions to use no word or phrase which mightdiscourage or humiliate the mothers, holding by themaxim, " By hope are ye saved." To those thatknew him best, Sir Thomas concluded, the memoryof John Thomson would always be that of a modestgentle true-hearted soul, with a passion for verifica-tion and a deep desire to widen the boundaries ofbeneficent knowledge. The same sentiments wereexpressed in other ways by Prof. G. F. Still, Dr.Logan Turner, and Dr. Robert Hutchison, whowere also present to do honour to a great poediatri-cian. In accepting the commemorative medal onbehalf of Edinburgh University the Principal, SirThomas Holland, pointed out its economic as well asits humanitarian value. There was, he said, as yetno organised research into the psychology of thechild under the age of five years, with the resultthat much harm was done in our schools throughignorance.

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TREATMENT OF CATARACT AND GLAUCOMA

IN MADRAS.

Lieut.-Colonel R. E. Wright’s professional reportlof the Government Ophthalmic Hospital, Madras,for the year 1928 will be of interest to ophthalmicsurgeons everywhere. The average number of opera-tions for senile cataract alone is over 1500 a year.Precautions to prevent squeezing on the part of thepatient while on the table and to secure quiet after-wards include novocain injections to block theseventh nerve and into the orbit, and the druggingof the patient to such an extent as sometimes toamount to a kind of twilight sleep. Various forms ofconjunctival bridge flaps have been tried during theyear in order to maintain the lips of the section incontact, but the natives, it seems, are more liable toconjunctival bleeding than Westerners, and bloodclot under the bridge sometimes interferes withhealing. In Colonel Wright’s opinion no form ofbridge is so efficient as suturing the lips of the section.Various types of operation are performed, but inthe great majority of cases the capsulotomy operationis chosen, usually with a peripheral iridectomy. Ina proportion of cases Barraquer’s intracapsularextraction is performed, a procedure not now popularin this country ; but no mention is made of ColonelHenry Smith’s intracapsular method.

In the Madras Hospital they classify all theirprimary cases of glaucoma, whether acute or chronic,into posterior segment types and anterior segmenttypes. In the former the important factor is theincrease in the volume of the vitreous ; the anteriorchamber early becomes shallow, but the cupping ofthe disc does not appear till late. In the anteriorsegment type, on the other hand, the anterior chamberis not shallow and cupping of the disc is an earlysymptom, and in these cases it is suggested the block-ing of the angle of the anterior chamber takes a moreimportant part in causation. A systematic investi-gation of 100 cases was undertaken along these lines,which may help towards resolving the perennial con-troversies. As to non-operative treatment or treat-ment preliminary to operation, eserine drops are thegreat stand-by, but in certain cases their effect wasgreatly enhanced by simultaneous employment ofadrenalin. Glaucosan and amino-glaucosan are notso highly spoken of. In well-marked cases a decom-pression operation, preferably trephining, was alwaysnecessary eventually.

Elsewhere in the report there is reference to anepidemic of superficial punctate keratitis whichoccurred in 1928. Over 800 cases were seen beforethe end of that year. Like herpes febrilis it appearsto be due to a non-filtrable virus, and is probablyidentical with the keratitis described by Herbert in

1 Madras Government Press, 1929. Rs. 2.

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Bombay in 1901, and by Kirkpatrick in Madras in1920. The affection is known to Western ophthalmo-logists but not in an epidemic form.

AN IDEAL OPERATING TABLE LAMP,WHAT the surgeon needs when he is operating

is an illumination of the field, concentrated andyet practically shadowless, along with a high verticalcomponent of intensity, ensuring penetration intodeep cavities. The intense light must be confinedto the wound area, but at the same time the roommust be sufficiently illuminated to prevent difficultiesfrom mal-adaptation of the eye. The high in-tensity should be produced without striations or

glare, and the’source of light should be as unob-trusive as possible. At a meeting of the Illu-minating Engineering Society, held at the HomeOffice Industrial Museum on Dec. 10th, Mr. ErnestStroud described a special unit designed to fulfil allthese conditions. It consists of a number of prismaticplates formed into a panel or false ceiling of relativelylarge area. The construction of the plates is such asto refract the light rays which reach them into aconverging beam of high intensity. Each plate is12 in. square, and made up of quarter-concentricprisms, and four plates are grouped into one large lens24 in. square of 12 in. focus length. The complete unitcontains 15, 18, or 21 of these 4-plate groups, itsdimensions being 6 ft.widebylO, 12,or 14 ft. long. Overeach group of plates is fitted a lamp and reflector insuch relation to each other that the maximum beamstrikes the centre of the operating area ; thus witha 15-group system the combined 15 concentratingbeams coming from different directions build up andfocus their rays over the predetermined area. Themethod differs from a reflector system in the largenessof the area whence the light comes, which securesadequate diffusion, avoids harmful shadows, andabsolutely avoids glare. The overflow from the lenssystem gives sufficient general illumination to avoidcontrast glare, and the optical characteristics of thelens are such as to allow for the varying thicknessesof bodies and heights of tables. With a 15-lenssystem employing 15 lamps of 150 watts each, or2250 watts in all, the maximum horizontal illuminationis 1050 ft. candles, on a plane 45° from the verticalit is 725 ft. candles, and on a vertical plane facing thecentre of the table 175 ft. candles ; these high inten-sities being developed without any semblance of

glare. The smooth sides of the glass plates are

towards the source of light, and since the com-plete unit can be totally enclosed so as to form theceiling of the operating theatre there need be nocollection of dust and no obstruction projecting intothe operation theatre.

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A SCULPTOR OF YOUTH.1

A BEAUTIFUL book has recently appeared describingthe work in marble and bronze of that accomplishedsculptor, Tait Mackenzie, a professor in the medicalschool of the University of Pennsylvania. Theimportance of Tait Mackenzie’s sculpture lies in thefact, as Mr. Christopher Hussey says in a criticalresume of Mackenzie’s work, that we have here thefirst considerable attempt since the marvellousaccomplishments of Athens to take for the sculptor’smain subject the athletic ideal. For many yearsbefore his present appointment Mackenzie was

director of physical education at McGill University,and in 1894, when he first occupied that chair, hehad made few or no attempts in sculpture, thoughundoubtedly it was then that he was receiving theformative influences which enable him to-day toexpress his ideals of motion and rhythm in thehuman body. When, as now, athletics occupy soprominent a place in educational life it is certainthat the Greeks have once again shown the way to

1 Tait Mackenzie, a Sculptor of Youth. By ChristopherHussey. London: Country Life, Ltd. 1930. Pp. 107.With 14 figures and 91 plates. 25s.

great accomplishments for those who have thenecessary receptive attention, instruction, and finethought. The contents of Mr. Hussey’s book consistlargely of excellent representations of Mackenzie’sbest known work, with a running commentary ofappreciation which though enthusiastic appearsalways to be justified. While the large imaginativegroups will command most of our admiration-andrightly so-medical men will be interested in theportrait medallions, for they include representationsof, among others, William Osler, Crawford Long,Wilfred Grenfell, Chevalier Jackson, Robert Jones,Weir Mitchell, W. W. Keen, and Charles BrockdenBrown. Brockden Brown’s chief claim to publicinterest is that he is always cited as the first Americannovelist, with the funny suggestion that he imitatedWilliam Godwin, but medically speaking he is remark-able in that he wrote in " Arthur Mervyn " a wonderfuldescription of an epidemic of plague from personalobservation of the horrors that fell upon Philadelphiaat the end of the eighteenth century.

The Clinical Interpretation ofAids to Diagnosis.

A Series of Special Articles contributed by Invitation.

LVIII.INTERPRETATION OF RADIOGRAMS OF THE

ALIMENTARY TRACT,PART V.*-LARGE INTESTINES.

THE food arrives in the caecum in about four hoursand should be somewhere near the splenic flexure innine hours, but the times at which it arrives at differentparts are so extremely variable that even approximatefigures are far too definite. The normal colon as seenafter feeding with barium is shown on Fig. 23. Atypical picture of a normal colon distended by anenema is shown in Fig. 24. Individuals vary to anamazing degree, and even yet the movements of thelarge intestine are not clearly understood. There is noperistalsis in the ordinary sense and the shadow of thefood in the colon remains inert hour after hour. WingateTod, using serial films over a long period (a very riskyprocedure for the subject), thinks that he detects avery slow rhythmic peristaltic movement which wecertainly do not detect on screen examination.Whether it is or is not present, however, the mainfactor in the movement of food through the largebowel is one that is unique and is not comparable to

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any other in the body. It is difficult to obtainobservations, for the movement occurs only occasion-ally, at no fixed time, and without the slightest sub-

shadows, the divisions in the intestinal. shadow,disappear and that, quite suddenly, the whole columnmakes a forward rush, usually from the region of thehepatic flexure, the column passing quite rapidly on,perhaps as far as the sigmoid or even to the rectum.Sometimes there is a partial rebound, but within aminute or so the haustral segmentation has againappeared and it is once more a picture of still life. Move-ments such as this-mass movements as they are called- occurs perhaps three times a day, but we do not know,for we only detect that they have occurred by thecompletely altered disposition of the shadows. Thefirst mass movements that were seen were estimatedto have occurred in three seconds, but later observa-tions suggest a quarter of a minute as a more usualtime. Naturally, therefore, the rate of progressthrough the large bowel cannot be gauged accurately.The limits of the normal, which are wide enough inthe stomach, become wider and wider as we go furtherdown the alimentary tract until in the large intestine

1 Parts I., II., III., and IV., respectively on the Œsophagus,the Stomach, the Duodenum, and the Small Intestine with theAppendix, appeared in THE LANCET of Nov. 30th, Dec. 7th, 14th,and 21st.