2
388 the sale outside the asylum of some of the garden produce is first deducted. Unfortunately, this item is not stated separately, but is set down with money received from the sale of " articles and goods " (presumably manufactured) as well as garden produce. An important step towards realisation by the local authorities of the importance of an adequate, varied, and fresh dietary would be a balance-sheet on which the garden produce is shown to be taken over at ’, market rates, or on which some other device is adopted to ensure easy comparison between expenditure on food at different hospitals. It does not follow, of course, that the cost of food taken by itself is an indication even of quality or quantity, certainly not of variation. The patients’ milk bill or its equivalent in maintenance of cows would be no less if the medical officers enjoyed the cream therefrom, as alleged by Dr. Lomax. The medical superintendent of one of the largest Poor-law infirmaries recentlv achieved a considerable improvement, combined with a diminished expenditure, by the appointment of an expert domestic economist as sister-housekeeper instead of promoting a ward sister according to precedent. Still, though money spent is by no means an absolute sign, a comparison of costs in different mental hospitals in conjunction with their respective diet sheets, might afford valuable evidence of efficiency, or, on the other hand, of carelessness or leakage. It is significant that among the proposals accepted by the conference already referred to as desirable, many coincide with those put forward in the memorandum just issued by the Quaker Medical Society, and again with those emphatically cham- pioned by Dr. Lomax. This unanimity encourages the hope that certain of these reforms may be speedily .adopted, especially since the Board of Control appears to agree that they are desirable. An innovation proposed by the Board itself, in a report, as yet unpublished, on the Lomax charges, will be welcomed on all sides. When examining Mr. Trevor, Dr. Bedford Pierce quoted from this report a few lines expressing the hope that, in the future, voluntary women visitors would be allowed freely to enter public mental hospitals, with the double purpose of brightening the lives of the patients and forming a channel whereby the conditions inside asylums might become better known to the general public. Mr. Trevor denied that this was a new scheme, saying that it had been the feeling of the Board for some time that such visitors should be allowed. This would be an extension of the present system of visiting committees in the sense that the new visitors would be selected with discretion from leisured members of the general public and not from busy members of the local council. These appointments would involve no expense and might lead to greater public confidence in asylum administration, as well as to the comfort and happiness of the patients. --- "ON THE EDGE OF THE PRIMÆVAL FOREST." LIKE Arnold de Villanova, Dr. Albert Schweitzer is a doctor in three faculties-theology, medicine, and philosophy. He is a professor at the University of Strasburg and is also an accomplished organist, having been for some years the organist of the Paris Bach Societv. Dr. Schweitzer had read much about the condition of the natives in tropical Africa and was struck by the miseries which they had to undergo from disease : so he made up his mind to study medicine and to go out as a medical missionary to do ’, what he could to help. He graduated as M.D. in 1913, and, accompanied by his wife, who was a qualified nurse, left Europe for the Gaboon, under the auspices of the Paris Evangelical Mission in the same year. The station to which he was appointed was Lambarene on the Ogowe, a little south of the Equator and in longitude about 8° E. Here he and his wife worked for four and a half years. In his book entitled " On the Edge of the Primaeval Forest " (London : A. and (’. Black, Ltd. 1922. Pp. 180. 6s.) Dr. Schweitzer relates his experiences very simply, and it is evident that he did excellent work. Among his most prized possessions was a pedal piano, specially constructed for the tropics, with winch the Bach Society of Paris had presented him so that he could keep up his practice even in Africa, and he tells us that in the intervals of his professional labonrs lie solaced himself with playing. It would be interesting to know what the natives thought of, let us say, the grept F major Toccata, that wonderful composition which sounds majestic even on a pedal piano, and on a big organ has much of the feeling of a tropical forest. Sleep- ing sicknesss, malaria, various surgical affections, especially hernia, leprosy, and tropical phagedena, were the diseases which Dr. Schweitzer found most common. After his wife, his chief helper was a native named Joseph, who was extremely handy. He had started life as a cook and his anatomical knowledge was derived from the kitchen. Thus he would bring up a patient saying, ’’ This woman has a pain in her left upper cutlet," or "This man’s right ’gigot’ hurts him." Among other matters Dr. Schweitzer was struck by the knowledge of poisons which exists among the native medicine-men, and of one in par- ticular which apparently produces mania, ending, after a more or less extended period of time, in death. Dr. Schweitzer’s remark as to general problems of missionary work and the relations of white to black are illuminating ; he makes a shrewd observation as to the difference between Catholic and Protestant missions : " The Protestant mission puts in the first place the building up of Christian personalities, while the Catholic has in mind before all else the establish- ment on solid foundations of a church." In 918 Dr. Schweitzer came home to recruit his health, but he tells us at the end of his book that he is going out again. We congratulate him both on his book and on his work. TWENTY YEARS OF ANTIRABIES INOCULATION. I THE Bacteriological Institute of Lyons has recently published the collected results of its antirabies department, from the date of its foundation in 1900 up to the termination of its twentieth year of existence.l During this period a total of 12,886 persons has been treated coming from some 15 departments. As in many institutes, the method of treatment has been somewhat modified from that originally devised by Pasteur in the direction of greater intensity and the earlier use of the more virulent material. The course usually occupies 25 days, but is varied according to the site and severity of the bites. Treatment is commenced bv the inoculation of rabbit’s cords which have been dried for 7 days, the subsequent injections being made daily with cords of increasing virulence. The least attenuated virus in use is a cord which has been dried for 2 days and this is reached on the fifteenth day of treatment. In 11 of the 20 years covered by the report the mortality in effectively treated cases was nil ; the average mortality over the whole period is 0-085 per cent. and the average number of persons treated 640 per annum. From the annual report of the Pasteur Institute of Paris2 for the year 1920 we already know that during that year 1126 persons were treated with a mortality of 0’53 per cent. It is to be noted that this is the highest mortality which has obtained since 1888, the third year of function of the Institute. It is also worthy of note that 86 of the treated persons belonged to Category " -B. "-i.e., persons bitten by a dog proved to have been rabid- and that none of the deaths which occurred were in this class. Amongst other information furnished by the Lyons report is evidence of the recrudescence of rabies which has occurred in France during and since the period of the war. This is attributable in the first place to the general disturbance of civilian life in the early stages of the combat, associated with the abandonment of dogs, especially in the invaded areas, the mobilisation 1 Annales de l’Institut Pasteur, vol. xxxv., No. 12, December, 1921. 2 Ibid., vol. xxxv., No. 9, September, 1921.
