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might be cedema of the papilla. Certain toxinsaffected the nerve diffusely ; probably the aryl-arsonates did so. The first basis of classificationshould be into (1) atrophies of localised origin, (2) thoseof diffuse or indeterminate origin, (3) those of unknownorigin. Most cases belonged to the first category,so that one’s concern was mainly with its subdivisions.The main bulk of cells from which the fibres of the

optic nerve arose lay in the retina, so that most

(not all) the fibres were ascending. Some descendingfibres might possibly be concerned with dark adapta-tion. The optic nerve could conveniently be dividedinto three parts-the retinal, the papillary, and theretrobulbar-the last being further divisible intoorbital, foraminal, and intracranial. Any of these

portions might be the seat of the primary lesion.There could thus be three main classes of opticatrophy of localised origin : retinal, papillary, and ’,retrobulbar. In each of the main divisions atrophymight be the after-effect of inflammation or degenera- ’,tion, and these might be locally produced, as bypressure or tractions, or might be systemic degenera- z,tions of unknown origin or due to vascular insufficiency.The inflammations might be either parenchymatousor interstitial.

Retinitis pigmentosa was a familial disease notinfrequently associated with a familial form of innerear or nerve deafness ; occasionally associated with itwas a family history of epilepsy. A close relationshipwas now recognised between amaurotic family idiocyand cerebromacular degeneration.

PAPILLARY ATROPHIES.

In a group of cases the initial damage to the nerve-fibres was at the disc itself ; into this category camethe atrophies due to glaucoma, those followingpapillitis and papilloedema, and a rarer group inwhich a cavernous degeneration of the disc tissuesoccurred in high myopes. There were two maincauses of the atrophy in papillcedema. In the earlystages the nerve-fibres were unaffected, and there wasno functional loss ; but in process of time the nerve-fibres lying in the oedematous fluid began to swelland to show moniliform varicosities. In the third

stage the increasing neurological proliferation in thedisc replaced the degenerate fibres, and in contractingit squeezed and killed the nerve-fibres which were leftintact. In glaucoma the nerve-fibres were mainlydestroyed at the disc as the result of the increasedintra-ocular pressure.

ATROPHY CONSEQUENT ON RETROBULBAR LESIONS.

This group embraced the largest number of cases,and was subdivisible into (a) orbital, (b) foraminal,(c) intracranial. Though some of the inflammationsmight occur in any part of the nerve, or might affectthe whole chiasma, from chiasma to bulb, papillitiswas only an optic neuritis in which the anterior partof the nerve after the entry of the blood-vessels wasaffected. An inflammation might attack the paren-chyma of the nerve directly, or might invade it fromthe periphery through its meningeal coverings andits interstitial fibrous structure. It might be the resultof any form of meningitis, acute or chronic, septic,tuberculous, or syphilitic, and the atrophy resultingmight be either complete or partial. The commonestform of parenchymatous inflammation was associatedwith disseminated sclerosis.The speaker next referred to the optic atrophy

which occurred during ophthalmic herpes. He wasunable to throw light, he said, on the pathogenesisof the optic atrophy in these cases. During the

acute stage of the herpes the eye was not in a conditionwhich allowed of proper examination of the fundus,so the cases were not usually seen until the atrophywas obvious. He did not think the inflammationcould have spread from the Gasserian ganglion to theintracrania,l portion of the nerve. Among the otherlesions acting on the orbital part of the nerve weretumours, which might be either intraneural or

extraneural.The lesions acting on the optic foramen formed an

interesting group of cases giving rise to optic atrophyThe cause most frequently acting here was trauma,but this need not imply a fracture passing through theoptic foramen, for even when there was a basalfracture the optic foramen was sometimes notinvolved. It was not settled whether the opticatrophy in oxycephaly was a result of the narrowingof the optic foramen, or whether the optic atrophyand the deformity of the skull might not be coinci-dental results of early meningitis. But in Paget’sdisease the bony thickening, reducing the calibre ofthe optic foramen, was the cause of the atrophy.

Dealing next with lesions of the intracranialportion of the nerve, the President said that hereone had to deal with a different set of factors. Dis-seminated sclerosis must still be regarded as an

important cause, the patch often being found toaffect the chiasma and both nerves. Lastly, he askedinto what division tabetic atrophy should be placed,and gave his own contribution, in detail, to a muchvexed question. The primary mode of attack was a

interstitial, but at times it was parenchymatous.Only the pathological investigation of a large seriesof very early tabetics, and the careful correlation ofthe pathological findings with the clinical history,could elucidate the facts.

UNITED SERVICES SECTION.

AT the opening meeting of this Section on Oct. 13th,the presidential address was delivered by Surgeon-Captain S. F. DUDLEY R.., who dealt with some

Psychological Aspects of Specialismin the Services. Ashore, he said, where a team ofpractitioners could be supported by a local population,specialisation worked satisfactorily, but afloat a

general practitioner was still required. Medicine wasbecoming more a science and less an art, and treat-ment more rational and less empirical. The oldpose of competent omnipotence was giving way tothe diffident attitude of the student of nature.Between the purely curative and the purely researchattitude there must be a difference of attitude andoutlook. Telling the literal truth to patients wasincompatible with sound therapeutics, although inthe Services the doctor could be more honest thancould the local practitioner. The only remedyhelpful in every malady was confidence in the doctor.The standard of truth rigorously attained by men ofscience was a very high one; nevertheless the plasticityof the human mind was such that it was possibleto some extent to blend the two attitudes in one man,just as it was possible to blend the diverse attitudesof the hen-pecked martinet on the quarter-deck andin his wife’s boudoir. The essential critical attitudeof the scientific worker was apt to hamper his practicalwork if he worked in both branches of medicine.Many first-class practitioners remained in the samecredulous state as in their student days, and theirpatients were the better for it. The eternal scientificquestion-mark was absent from many minds, and

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many doctors were consciously honest while theyunconsciously deceived themselves.

Specialisation was the essential corollary ofevolution and had both advantages and disadvantages.To-day the specialist specialised too early and tooktoo superior an attitude to the more widely readgeneral practitioner. Friction between the groupsmight hinder progress as well as promoting it byfriendly rivalry. Early specialisation might even

promote a sort of pride in ignorance of other branches.These little failings could be winked at ashore, butwere less tolerable in the Navy. There were not

enough special cases to maintain many specialists,and the Navy could therefore insist on a certain

degree of general proficiency together with specialism.It was an excellent rule that a man must see serviceafloat before promotion. The naval specialist mustbe familiar at first hand with such conditions oflife as existed in submarines and 16-inch gunturrets, as well as those in the V ictOTY and the ark.Analytical psychology showed that specialism formeda complex which widely affected a man’s conduct inmany aspects of life; the general practitione rrecognised this when he feared to send his case ofhousemaid’s knee to a surgeon lest she return withouther tonsils. Nor were psycho-analysts themselvesquite free from this complex. A well-known psycho-analyst had explained sea-sickness as a repression ofan infantile recollection of the rise and fallof the mother’s breast. Surgeon-Captain Dudleycandidly did not feel that this hypothesis was basedon so firm a foundation that bottle-fed recruits shouldbe accepted in preference to their breast-fed fellows.

I THE " AMATEUR

" RESEARCH WORKER.

, Poor remuneration was a great hardship to thelaboratory worker, but he had the consolation of

knowing that he spent his life doing the work heliked best. The Services offered one of the finestfields for the research worker; he should look onhis research as a hobby and not expect reward for Iit, and he must put his service duties first. Onthe whole, the rewards of research in the Serviceswere greater than those outside. In a modern shipof war a man with a little resource and applicationcould carry out valuable laboratory investigations atsea. There were, moreover, vast fields of researchin such subjects as the food, clothing, hygiene, andpsychology of the men, and in administration. Hecould publish or not as he liked, but his own journalswere always eager for copy. Research was a moreabsorbing hobby at sea than cross-word puzzles orpoker. If something useful emerged from the pastime,so much the better, but that was not the main objectfor the amateur research worker. Neverthelessmany question sought answers-e.g., What was thereal incidence of toe-rot ? What was the best way ofairing bedding during a spell of continuous badweather Why were sailors so attached to patentmedicines, and did this habit do them any harm ? ‘What were the psychological factors underlying a"

happy " and an "

unhappy "

ship ? What wasthe best way for an ordinary medical officer to dealwith a surgical emergency on the high seas without t

expert help ? "1

AUTHORITY IN MEDICINE.

Experimental work on animals had proved of thegreatest value to clinical medicine; the observationalmethod had received a new impetus. In discussinga subject it was useless to say that Prof. Highbrowhad given such an opinion without saying why hesaid it, or giving the reference to his original paper,

.

so that the reader could look up the argument forhimself. If the" amateur " research worker published

, his work he must do so in proper form. Hero-worship was a great element in social life, but just forthis reason it must be carefully watched in scientificwork. The average modern worker approached hissubject with greater caution than did the ancientsjust because he realised his ignorance to a far greaterextent than his forefathers had. Much valuablework had been done in the editing of old text-booksand finding out how many of their statements werereally correct. As Sherlock Holmes had said, " Itis a capital offence to theorise before one has data."

NEW REMEDIES AND AMBIGUOUS WORDS.

An important part of research work and one

peculiarly liable to the post hoc fallacy was thetesting of modern therapeutic agents. Trotterregarded this fallacy as a kind of conditioned reflex ;any cause was better than none, and if the realcause were inacceptable or not evident any strikingevent was supplied to relieve the acute mental agonyof not knowing why. There was only one reliablemethod of testing any new treatment and that was totreat alternate admissions without any selection what-ever until a sufficient series had been collected and thedata carefully examined. The smaller the differencesthe greater the number of cases required to establishthem. A scientific attitude of masterly inactivitywas hard to maintain in face of the patient’s andrelative’s sufferings, and more patients were over-

treated than under-treated.Words and phrases could often be different and

mean the same thing, and vice versa. There mustbe no ambiguity of meaning if medicine was toadvance. The Services could insist on more honestdiagnosis than other branches of practice, and mightsurely allow " I do not know." The category of" P.U.O." had much to recommend it; it was honestand did not confuse the work of the statistician.The doctor could at least be honest on official sickreturns, if not to his patients. Words like " typhoid

"

and "virulence" often meant different things todifferent writers ; when words of this kind had to beused they should be carefully defined. It was

extremely difficult to convey the exact shade of

meaning that an author wanted to attach to the

phrases he used. Original papers-not abstracts-must be studied, for they usually conveyed a slightlydifferent meaning.The seeker after truth should always put to himself

a short catechism when he was confronted with anystatement to which he was not personally indifferent-" Do I believe or disbelieve this thing, either becauseI want to, or because it is the custom of my herd andmy heroes to do so, or because of an uncontrolled posthoc argument, or because I have misunderstood theauthor ? " In this way he could greatly, thoughnever completely, reduce the subconscious bias thatswayed all our thoughts and actions. These remarksconcerned only science ; how far it was possible tocarry their principle into daily life the speaker didnot pretend to know. As regards everyday life hewould take the advice of King Solomon : "Be notrighteous overmuch, neither make thyself overwise;why shouldst thou destroy thyself ? "

A HOSPITAL FOR DOWNHAM, KENT.-It is pro-posed to build a hospital of 50 beds at a cost of z28,000in this thickly populated district of working-class homes.The population of Downham is 36,000, of whom 20,000are children, and the neighbouring hospitals are constantlyovercrowded. -