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THE EYESIGHT OF SAMUEL PEPYS.To the Editor of THE LANCET. I

SIR,—I have read with interest the address of Mr. D’Arcy Power to the Samuel Pepys Club. As a literary achievementit shows both industry and ingenuity, but the arriving at adefinite prescription for Samuel Pepys, Esq., seems to suggestthat the modern quack method of -I diagnosis and treatmentby correspondence" need no longer be viewed with pro-fessional disfavour. The ease with which a specialist, onhearing Pepys’ symptoms, at once prescribed "+2 D. or+2’5 D. convex glasses" is very striking, as is also thefacility with which Mr. Power himself added +0’50cylinders axis 900. Of course, Samuel Pepys cannot trythese spectacles, and there is therefore no means of bringinghome to the prescribers any possible error arising out of the"correspondence" method, but the whole episode casts asomewhat lurid light on the specialist and his work. I amnot well enough versed in optics to criticise the theoreticalaccuracy of the prescription, but it would really be interest-ing to know on what grounds the "axis 90° " was arrivedat in the unavoidable absence of the patient ; it seems" uncanny," if it is not a little joke.

I note that Mr. Turlington advised Pepys against usingreading glasses which do magnify much," and that Mr.Power characterises this advice as ’’ snperlatively bad, forhe was clearly recommending Pepys to use concave glasseswhen in reality he needed convex ones." On the face of itthis is not so clear. I understand that concave glasses donot magnify at all, but rather diminish the size of an object.There is surely significance in Turlington’s word much," andit might be more fair to interpret his advice as a wise recom-mendation to use the lowest convex glasses that the patientcould read with, rather than indulge in the luxury of muchmagnification. The literal terms of the advice can hardly besaid to suggest concave glasses.

Incidentally, it does seem a pity, as Mr. Power suggests,that Mr. Pepys did not " sit upon his tubes and crush them,"seeing that a revolution of the laws of dioptrics was so

imminent, and depended with a fair amount of certainty onsuch a likely accident. It looks as if Providence had misseda splendid opportunity.

I am, Sir. yours faithfullv.Liverpool, June 22nd, 1 A. ROSS CARMICHAEL.

EMOLUMENTS IN THE INDIAN MEDICALSERVICE.

To the Editor of THE LANCET.

SIR,—In your annotation in THE LANCET of May 13thwith reference to I I M. B.’s letter re the Indian MedicalService you rightly state that it is Lord Morley’s disastroussuggestion to cut down the civil appointments at presentheld by the Indian Medical Service that has so harmed theservice, but at the same time you seriously underestimatethe bad pecuniary emoluments of the Indian MedicalService. As an example of the small opinion the IndianGovernment have of the worth of their medical men, theRoyal Engineers at home draw less pay than officers of theRoyal Army Medical Corps of corresponding ranks at home.In India the reverse is the case, and not only this, butthe R.E. officer draws more than an I. M.S. officer of

corresponding rank. You must remember that an R.E. getshis professional education at Government expense. An officerof the Royal Army Medical Corps draws actually less pay inIndia than while serving at home (officers of the IndianMedical Service draw slightly more pay than the RoyalArmy Medical Corps). Eighteen months ago the pay of theIndian army officers was raised and not the Indian MedicalService, so that now these officers draw practically the samepay as the Indian Medical Service in spite of not havinghad the previous long expensive education a doctor has toundergo.When an R E. officer goes into civil, he draws considerably

more pay than in military employ. An I. M.S. officer,on the other hand, draws 50 rupees less. For many years acivil surgeon will make practically nothing in private fees.Also, there is such a block in civil now, that one cannot getin under about eight years’ service.

Another crying grievance of the Indian Medical Service is

that the cadre is kept so small that leave is extremelyhard to get. One is entitled to two months’ privilege leaveevery summer, but, as a matter of experience, one is luckyto get it on an average every other year. Leave home, too,is extremely hard to get. Officers who have been serving forover five years find they are unable to get leave owing to theshortage. Then again the number of transfers a juniorofficer gets is nothing short of a scandal. One constantlyhears of junior officers having 12 or 13 transfers in his firstthree or four years.

I am afraid I have sent rather a long letter. You seemedsurprised that "M.B." should state that living has gone up100 per cent. and the purchasing power of the rupee down50 per cent., but this is well recognised out here. Polo,shooting, &c., are rapidly becoming the rich man’s sport asin England. I am, Sir, yours faithfully,May 31st, 1911. I.M.S.

THE BUBONIC PLAGUE IN EGYPTIN 1911.

To the Editor of THE LANCET.

SIR,-The apparent indifference of the authorities and ofthe public to the ravages of the plague in Egypt is verysingular. From the commencement of this year to Junethere have been more than 1400 cases, compared with some700 in the corresponding period of 1910. For the week

ending June 3rd the returns indicate a slight diminutionin the number of cases, perhaps owing to the weather,but the innumerable rats in the villages are probablybecoming more universally affected. The provinceswhich this year have suffered most severely are Assouan,with 491 cases, of which 307 proved fatal ; Keneb, 505cases, 392 fatal ; and Assiout, 186, of which 93 terminatedfatally. The type in some places is most virulent. LastDecember a native sanitary officer, despatched to endeavourto combat an outbreak in a village in the Delta, caught theinfection the day after his arrival and died within 24 hours.This failure to wage successful warfare against the plague isdue to the attempt to try natives in posts previously assignedto Europeans. In the sanitary department in country dis-tricts, unless British officials are augmented in numberand authority, and thus certain necessary precautions andcleansings enforced upon the fellahin, a recrudescence ofthe plague, with its attendant misery and injury to thetourist season, is much to be dreaded.

I am, Sir, yours faithfully,June 24th, 1911. TRAVELLER.

A YEAR’S COST OF RUNNING A MOTOR-CAR LIMOUSINE COMPARED WITH

THAT OF A BROUGHAM.To the Editor of THE LANCET.

SIR,-A year ago I changed my brougham for a motor-car.The brougham, two horses and a coachman, and all other

expenses, including all renewals, cost on an average Z210a year. The mileage was estimated at 4000 = ls. 0½d. permile. The carriage was used for the purposes of the practiceonly, one horse in the morning and the other in the after-noon. The initial cost of a 15 h. p. Daimler Limousine, readyfor the road, with spare wheel and all accessories, was £543;the initial cost of brougham, two horses, harness, &c., wouldbe nearly 300. The first year’s expenditure on the car,including chauffeur (.E.90), insurances, rent, rates, petrol,new tyres, and all other expenses, amounted to £201 2s. 1d.,to which £108 12s. 2d. must be added for depreciation (i.e.,20 per cent. of initial cost) ; the total expenses for one yearwere, therefore, £309 14s. 3d. The miles run in the yearwere 5203, of which 1128 were for pleasure and 4075 forprofessional purposes. The cost of running per mile worksout at ls. 2¼d. Therefore £241 19s. may be stated as thecost of the car for one year to the practice as com-

pared with .6210 for the brougham. The total petrolused for all purposes was 294 gallons, or 17s milesto the gallon. As 500 miles were run with a defectivecarburetter which gave only 10 miles to the gallon in thetown with frequent stoppings, and only 13 miles in the open

country, and as on a holiday 816 miles were run on 35 gallons

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(= 23t miles to the gallon), it is obvious that the mileage pergallon of petrol now will be about 20 in the town, in whichthe motor runs about 14 miles a day and stops and startsabout 30 times.The tyres on the steering wheels are an expensive item.

The four wheels of the car and one spare wheel were fittedwith Continental tyres with the following results :-Onefront wheel plain tyre is still running at 5293 miles ; onefront wheel plain tyre burst at 5160 miles ; one rear wheelstudded tyre split at 1851 miles ; one rear wheel studdedtyre ran only 2565 miles when most of the studs were outand the cover was worn through. Avon tyres were thentried. One rear wheel studded tyre ran only 2245 mileswhen most of the studs were out ; it was then retreaded and

put on a front wheel. A rear wheel cross-grooved Avon hasrun only 1300 miles and is now off for repairs, it having abig cut in it as well as a patch of the canvas exposed.Other tyres of the same makes gave like results. Many ofthe streets of my town are paved with rough cobble setts,which I think pull out and wear the studs quickly. I am

therefore using now plain tyres on the back wheels as well ason the front. Altogether I spent .E30 6s. 7d. on tyres in thetwelvemonth.The only mechanical breakdown in the year was caused by

the breaking of a ball race which prevented the use of the carfor a day and a half. It occupies the chauffeur two to threehours each day to keep the car smart and in running order.The great advantages of the car are obvious-viz., greaterspeed, and therefore saving of more time each day for eitherleisure or study. Ease and comfort in travelling, and alsomore light in a Limousine. The rapid motion through theair is exhilarating, whilst trundling along in a brougham issomewhat depressing. The car never tires as horses do.

Long journeys do not upset the day’s work as formerly, sincethey can be taken in so short a time.The advantages of a Limousine over a landaulette or open

body are: No need to alter one’s dress nor to wrap up incold or wet weather ; with the windows down between thebody and the chauffeur, no draught, yet more air and morelight than in a brougham. All the parts being fixed, theydo not rattle loose as in a landaulette, nor does dust blowinto the body or on to the occupant. Then there is the

pleasure and health derived from touring and the advantagesof having a rapid mode of travelling at one’s command at anytime during the day or night. With a silent Knight enginethe absence of vibration and noise is a great advantage to adoctor and his patients. I should say that to a busy man anexperienced, steady, and trustworthy chauffeur is a sine quânon. I am, Sir, yours faithfully,June_ 30th, 1911. F.R.C.S. ENG.

MEETING OF CANADIAN MEDICALASSOCIATION IN MONTREAL.

(FROM A SPECIAL CORRESPONDENT.)

THE forty-fourth annual meeting of the Canadian MedicalAssociation opened on May 7th. All the sessions were heldin the Anatomical Laboratory of the new medical buildingof McGill University, Montreal, except that the address inmedicine was delivered in the gallery of the Art Association.At the general meeting the President-elect, Dr. GEORGE

E. ARMSTRONG, of Montreal, was installed, and addresses ofwelcome were given by Dr. GUERIN, mayor of Montreal,himself a medical man, and by Dr. PETERSON, Principal ofthe University. Some business matters were attended to andthe report of the Milk Commission of the Canadian MedicalAssociation was read.On the afternoon of Wednesday the section meetings

began. The meetings of the section on Preventive Medi-cine were especially interesting, and it may be said thata symposium in this section on Typhoid Fever and Water-supplies was a conspicuous success. On Thursday morninga general meeting was again held in the Department ofAnatomy, when the address of the President, Dr. G. E.Armstrong, was read. Unfortunately, Dr. Armstrong hadhad to leave the meeting on the previous day on account ofillness, and was not sufficiently recovered to deliver his ownaddress, which was therefore read in his absence by Dr. A.HUTCHINSON, of Montreal.

Presidential Address.The address was largely concerned with a retrospect of the

history of the rise and development of the association inCanada. A portion was devoted to a consideration of theRoddick Bill for Dominion registration, which Dr. Arm-

strong characterised as the most forward medico-politicalquestion before the profession in Canada to-day. He

hoped that with the adoption of the Act beforelong the English-speaking provinces would unite on a

uniform standard of matriculation, although Quebec wouldhave to remain outside on account of different educationalmethods. Referring to the value of research work Dr.

Armstrong declared that English researches of a century agowere the profitable milch cows of foreign nations to-day. In

discussing the pure water problem Dr. Armstrong stated thatin his opinion in such a country as Canada, with its abundantwater-supply, it was a reproach to any municipality, great orsmall, to have water-borne diseases. The housing problem wasnext dealt with, and it was pointed out how much it had beenintensified in Montreal and other cities by the introductionof swarms of immigrants, many with low standards of livingand general habits which did not tend to healthy bodies,sound minds, or good citizenship. There ensued slum lifeand an inevitable degeneration amongst the third and fourthgenerations of city dwellers, with the result that a largeproportion of people became charged upon the State. Hetherefore urged that the Canadian Medical Associationshould work to demonstrate to municipalities that moneyexpended in providing the working classes with betterhouses, wider and better aired and lighted streets, would beinfinitely well rewarded in a lesser expenditure for police-courts, prisons, asylums, and hospitals, thus inverting theprinciple that "The means to do ill deeds makes ill deedsdone." Canadians had no excuse for repeating the mistakesof older civilisations and in this way they could best aid thechurches and the temperance and moral reformers.

Address in Surgery.Dr. A. PRIMROSE of Toronto delivered the address in

surgery. The speaker said that being a young countrysomething of the spirit of the pioneer settlers had beeninherited, and thus Canadian medical men were more

ready to develop along lines which might be new andrevolutionary in character. The consequence of this adapta-bility and willingness to learn had been that nowherewas work done in surgery with more general efficiencythan could be found in the hospitals of Canada to-day.Dr. Primrose, like Dr. Armstrong and all the principalspeakers, both at the McGill celebrations and at the meet-ing of the Canadian Medical Association, paid heartfelttribute to the memory of Dr. James Bell of Montreal, whodied somewhat suddenly a few weeks ago. His great meritsas a surgeon, a man, and a citizen were referred toin fitting terms. Dr. Primrose, while allowing that con-servatism in surgery was good, said that pure prejudiceoften passed as conservatism, and therefore care shouldbe taken that no prejudices were harboured and that con-servatism should in no way be allowed to hinder betterjudgment. The speaker pointed out that in all ages theadvance of science had been hampered by prejudice, andthat even in these enlightened times prejudice was not dead.The technique of Lister, for example, did not make the head-way that was its due, on account of the opposition ofsome of the distinguished medical contemporaries, and itwas a remarkable circumstance that foreign surgeons hadbeen more quickly convinced of the great value of

antiseptic treatment than had those of his own country.Dr. Primrose eulogised Lord Lister as the almost perfecttype of the logical scientific mind. He urged thatmedical students should have a prolonged and efficientcourse of instruction in preliminary science, and opposedthe view held by many that such training was unnecessary.Reverting again to the question of conservatism in surgeryDr. Primrose said that although a conservative attitude wasto be commended it should be that type of conservatismwhich was tempered with ability to use calm and deliberatejudgment in determining what was best for the patient;and when new light was thrown on some obscure problemmedical men should be ready to abandon any erroneousideas which might hitherto have been held, and be preparedto advance, looking for no finality in present-day methods,but always endeavouring to attain the ideal.