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e.g., ext. belladonn. gr. Ti, menthol gr. , ext. valeriangr. 1, pulv. valerian gr. i. Hot applications-e.g.,compresses of flannel wrung out in hot water-willalways prove comforting.

4. Reduction of Putrefaction.—Mention has beenmade of the influence of food in this connexion. Ofintestinal disinfectants I cannot speak with anyconfidence. Lactic acid, however, is often valuable,but as patients with colitis cannot tolerate milk, apure culture is preferable to a soured milk. Vaccinetherapy is rarely admissible, based as it is on so com-plicated a bacteriology as that of the intestinal tract.

5. General Treatment.-When spa treatment leadsto good results it is not easy to apportion the credit dueto the climate, the routine discipline, and the suggestiveeffect. Yet climate is certainly of some importance.I have had the humiliation of experiencing failureafter reproducing faithfully and in every detail atreatment which had been remarkably successful inLausanne. Patients with colitis are very intolerantof cold, and advice to be warmly clad in flannel andto wear an abdominal binder should be insistent.The benefit of a few weeks in bed is explained not onlyby the rest but by the constant warmth. Entero-ptosis is generally present, but as usual it is difficultto estimate the extent of its effect. It is certainlya contributory factor to constipation, and benefitfrom treatment by a suitable abdominal support isunquestionable. Whether anaemia is present or notit is well to give a course of intramuscular injectionsof cacodylate of iron, sodium glycerophosphate, andstrychnine. Exercise must be graduated accordingto the inclination and physical capacity of the subject,but only open-air exercise should be encouraged.Massage, especially of the abdomen, may be of valuebut should be stopped if pain is produced. Galvanismhas often a sedative effect on the intestinal spasmand the abdominal nervous system in general.

6. Surgical Treatment.—Were one satisfied, first ofall that the colon itself was diseased, and secondlythat it is in any case rather a superfluous organ,one might be more encouraged to consider ileo-sigmoidostomy or more formidable surgical procedure,of which I have had no personal experience.

7. Treatment of the Nervous System.-This is toovast a subject for consideration here. Unfortunately,the majority of patients develop a mental outlookwhich, if it has not reconciled them to a life of completeinvalidism, has at least prepared them to make theworst of a bad job. So they tend to persist in a mode ofliving which is only too likely to perpetuate thedisability-want of exercise, of fresh air, of interestsand of occupation. The disappointment of previousfailures and the lack of confidence engendered by thecontemplation of contradictory views as to theaetiology of their condition do not contribute to anenthusiastic cooperation in what must necessarily bea prolonged undertaking. Inasmuch as the psychicalhandling of a patient means individual study, itwould be tedious to indulge in generalities. But onething may be mentioned. Although a conscientiousadherence to details must be secured, too manysufferers have had their attention so intimately drawnto their excreta as to become monomaniacal. Letthe patient understand from the outset that the taskof examination must be left to others.

8. Treatment of Acute Attacks.-Occasionally theaccumulation of large quantities of inspissated mucusleads to an attack of very severe abdominal pain forwhich absolute rest in bed is imperative. Moist warmthis applied to the abdomen. The diet is reduced to plainEvian water and water-gruel made with creme d’orge,arrowroot, or rice for two days. An injection ofmorphia and atropine is given for relief of the entero-spasm. A large, warm, olive oil enema immediatelyfollowed by a pint of warm water is slowly administered.Two hours later evacuation of the mucus will becompleted by the injection of two pints of water at99’F. containing half a drachm of pure oleate of soda.

ADOLPHE ABRAHAMS, M.D., M.R.C.P.,Physician, Hampstead General Hospital; Assistant

Physician, Westminster Hospital.

Special Articles.UNITED STATES OF AMERICA.

rr (FROM AN OCCASIONAL CORRESPONDENT.)

a CONFERENCE OF OHIO HEALTH COMMISSIONERS.e THE State of Ohio comprises a rural population of- six millions, divided amongst 88 counties. The public’. health organisation of this community is very young,s as may be judged from the fact that the annual con-e ference of health commissioners held from Nov. 19the to 24th was only the fourth in its history. Ideally. each county and each town of 5000 inhabitants or

more should be in the special jurisdiction of a healthcommissioner. Actually there are 42 county commis-sioners and 26 city commissioners employed as full

t time public servants, while a large number of doctors1 in addition give a part of their time to public health. work. The health laws of the State provide that allr these men shall attend the annual conference at the- public expense, and there was, therefore, a goodb audience gathered at Columbus to hear the distin-

guished speakers who had been invited to read papers.b These included Surgeon-General H. S. Cumming,

of the United States Public Health Service; Profs.A. W. Freeman and W. H. Frost, ot the TohnsHopkins School of Public Health; Dr. Haven Emerson,

L professor of public health at Columbia University;: Dr. E. R. Hayhurst, professor of preventive medicine, at the Ohio State University; Dr. Luisly Williams, and. Dr. W. H. Park, as well as other speakers of inter- national fame.l

6’oopefaMoH of General Practitioner and HealthCommissioner.

, The most significant lesson of this conference, and, one that any European observer could not have failed

to remark, was the extent to which the whole medical’

profession of the State is mobilising itself behind theprojective measures of preventive medicine. The

’

president of the State Medical Association was presentand pledged the unlimited support of his organisation.The Columbus Academy of Medicine entertained thecommissioners at their own house with many cordialand fraternal expressions of goodwill. Moreover, itwas clear that the two large campaign measureswhich have been planned for the coming year willstand or fall by the loyalty with which the professionas a whole supports them. This is clearly an integralpart of the policy of the State Director of Health,Dr. John E. Monger, himself a practising physician,determined, so he says, to return to that calling, andone of the methods by which he appears to havesucceeded in convincing the doctors of this State thatsocial medicine is not necessarily medicine that hasbeen socialised.

The Cure and Prevention of Diphtheria.The provision of free antitoxin to all cases of

diphtheria is a legal obligation of each health com-missioner. Until recently the price of serum had beena good deal higher than just profits for the manu-facturer need have dictated. The State Departmentof Health had arranged to purchase on a large scaleat a reasonable rate and the main subject to bediscussed was the method of distribution. In thelarger cities, as for example in Cleveland, the serum iskept in ice-chests at every police-station. In thecountry it has sometimes been distributed throughthe pharmacists and sometimes given to the privatepractitioner, who must account for its use (thusproviding a useful check on the reporting of suspectedcases). Both these methods are open to the objectionthat the serum is frequently not preserved in an ice-chest. A better method seemed to be to keep thewhole stock in the office of the Health Commissioner,where it may always be reached in a few hours.The discussion on the prevention of diphtheria was

ushered in by an interesting paper from Dr. W. H.Park, president of the American Public Health

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Association and director of the New York City HealthDepartment Laboratories. Dr. Park described theuse of the Schick test and toxin-antitoxin immunisa-tion in New York. There it is hoped to immunise thisyear about 100,000 school-children and some 20,000children of pre-school age. The response of thepublic after four years of educational and prophylacticwork is distinctly more cordial. The whole work hasbeen carried on by eight doctors, eight nurses, andeight assistants, and the results are shown in thefollowing table, which was obtained from Dr. Park.

In 1923, if the rates continue for the last six weeks as tor the first 46 weeks, there will be about 8000 caseswith some 550 deaths, or a rate of less than 10 per 100,000. Dr. Park suggested that the increasedincidence during the first two years of the campaignmight be due to improvement in reporting cases as aresult of the extra attention to the subject of diph-theria. It will be seen that the death-rate has been cutin half, although not more than one-third of the childrenhave been immunised, and no compulsion whateverhas been exercised. The Ohio Department of Healthhas adopted as its slogan, " No child in Ohio need dieof diphtheria." Actually some 1000 die yearly fromthis disease. With 169 health commissioners at work,strongly backed by the whole medical profession andarmed with toxin-antitoxin to be supplied by theState, we should see a reduction in mortality evenmore rapid and more striking than that in New York.

Regular Physical Evamiiiations.The movement for a " nation-wide health examina-

tion campaign " has been sponsored by the NationalHealth Council for some years now. The AmericanMedical Association has also warmly endorsed thismovement, as I have indicated in a previous letter.Dr. Haven Emerson, the chairman of the com-

mittee of the A.M.A. Council on Health and PublicInstruction, introduced the subject with a paper inwhich he divided the public health movement intothree eras : the era of police and quarantine from1700 to 1900 ; that of the voluntary health organisa-tions, beginning with the present century; and thepresent era of health examinations and popularhealth instruction, which brings the whole publicinto active endeavour towards the suppression ofdisease. He showed how all modern health move-ments, infant hygiene, school hygiene, anti-tuber-culosis, &c., are all dependent upon frequent contact between the individual and his physician. Theresult may be typified by the tuberculosis work inNew York clinics. Whereas formerly it was rare tosee a new patient who was not in an advanced stageof the disease, last year 70 per cent. of the patientscoming to 31 tuberculosis clinics in that city were nottuberculous at all. It is now the rare exceptionto see a case for the first time at an advanced stage.He suggested that the physician should examineapparently healthy individuals not less often thanlaid down below.

The public needs to develop a conscience in thismatter. At present many people who would bechagrined if their roof were to leak and make a spoton the dining-room ceiling are not at all ashamed iftheir child’s heart leaks. The professional organisa-tions cannot advertise themselves, the need forregular examination must be taught by the voluntaryassociations and by health officers, but the pro

fession needs to equip itself for this kind of work, forwhich it has been inadequately trained, and in whichit has too little experience.

After a discussion, in which several speakers repre-senting the medical association supported the move-ment and emphasised the importance of thoroughnessand care in making the examinations, Dr. Hayhurstannounced the plans that have been made for launch-ing this campaign in Ohio.

KING EDWARD’S HOSPITAL FUNDFOR LONDON.

GRANTS TO HOSPITALS AND CONVALESCENTHOMES.

A MEETING of the President and General Council ofKing Edward’s Hospital Fund, for the purpose ofawarding grants to the hospitals and convalescenthomes for the present year, was held on Dec. 18th,the Prince of Wales being in the chair.

- Lord Revelstoke (hon. treasurer) in reporting theamount received for general purposes by the Fund toDec. 3rd, said that this time last year he had expressedthe hope that the income to be derived from themunificent legacies of Lord Mountstephen and SirThomas Sutherland would form the nucleus of apermanent increase in the distribution. The Fundhad already received a large part of this increasedincome. The total income from all investments hadreached £145,000 this year, as against £114,000 in 1922.On the other hand, ordinary legacies had decreased,although for the past 12 months they still reached thesubstantial figure of £47,000. The net result was thatthe Fund was able to distribute £235,000, or £15,000more than the amount distributed a year ago. Theordinary income from subscriptions and donations hadbeen well maintained, owing largely to an anonymousdonation of 6,500 received in May. The estimatesalso included the amount which the Fund hoped toreceive from its largest contributor, the League ofMercy. There was every hope that the sum of£235,000 would be provided very nearly, if not quiteout of the current income of the year.

Sir William Collins, in making the annual statementon behalf of the League of Mercy, said that so far asthey could tell from the subscriptions at presentreceived, a sum of £14,000 would be handed over tothe King’s Fund before the end of the year. Thiswould make a total sum of £353,000 handed over tothe Fund since the foundation of the League. Addingthe grants made to hospitals outside London, thetotal came to £407,682.The Chairman of the Hospital Economy Committee(Mr. Leonard L. Cohen) presented the report of theCommittee on

Recovery Branches of London Hospitals,the general conclusions of which were : that, inview of the advantages to the patients, the develop-ment of recovery branches deserved encouragement,subject to the proviso that before a branch is estab-lished those responsible for its finance should realisethat the apparent cheapness resulting from the lowcost per bed at the branch was largely illusory ;that its establishment was a form of hospital extensionand must be budgeted for as such ; and that noform of extension should be undertaken withoutparticularly careful consideration both by the hospitaland by the King’s Fund, until the restoration ofvoluntary hospital finance had been completed.

Dr. H. Morley Fletcher seconded the adoption ofthis report, and the motion was carried unanimously

The Chairman of the Distribution Committee (SirCooper Perry) presented the report of the Committeeon the

Distribution to Hospitals(including recovery and convalescent branches). Thisstated that a new principle had been adopted thisyear in drawing the distinction between the distribu-