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husband, nor at Mr. Smith’s explanation of hissymptoms being occasioned by his occupationinvolving ’ a lot of ’ead work’ when Mr. Smithmeans that he carries a heavy basket of fish on hishead." Above all, the physician must be possessedof patience, and the acid test of patience Dr. Abrahamsdescribes as : a headache, a hot afternoon, a squallingchild sent up with a very deaf old woman, whoknows nothing about the patient. But it is just theidea of " hospes " that means so much in the voluntaryhospital system, that preserves the intimate relation-ship between the hospital patient and the doctor, ofwhich, as Dr. Abrahams says, this country is so

deservedly proud. _____

AMMONIA AND CHLORINE IN THEDISINFECTION OF WATER.

SOME excessively polluted waters are not sterilisedby chlorine supplied in the proportions usuallyfound sufficient. This failure seems to depend on thepresence of colloid or albuminoid matters, generallygot rid of by sedimentation and clarification, which,according to Major C. H. H. Harold and CaptainA. R. Ward, protect the micro-organisms from thechlorine. This action they call " inhibition," and toget over it they propose to add to such water aquarter to a half part of ammonia per million prior toits exposure to chlorine gas, whereby the lethalaction of the chlorine on the organisms is increasedwithout any deterioration of taste. The authorsobserve that in civil life water can be stored to freeit of colloids and organisms, but that there is no timefor that on service in war, when it is hard enough toget water for daily use ; and, besides, water mustbe sterilised at once. The usual measures provedefficacious almost everywhere, but anomalous resultshad occurred and lacked explanation at the time.Heavily polluted water being only used in direnecessity it was likely that just at the time therewould be no laboratory available to make chemicaland bacteriological observations. Therefore theauthors set themselves to examine the question.They experimented at first with cholera, typhoid,dysentery, and other excremental organisms, exposingthem to chlorine in various strengths for 45 minutes,and on finding B. suipesUfer the most resistant of themall, they pursued their researches with this organismalone. Definite amounts of broth cultures and ofchlorine were added to 200 c.cm. of autoclaved tap-water, the free chlorine remaining after 45 minuteswas estimated, the difference, or

" deviation," i.e.,the amount gone into combination, being a guide tothe killing power of the mixture. The deviationwas uninfluenced by one kind of organism more thanby another, but it was affected by the amount of brothpresent. Inhibition occurred in the presence of colloids,excess of organisms, fsecal or vegetable matter.When ammonia, about one-third part per million,was added 15 minutes before the chlorine, there wasmore deviation and the killing power was increased.Rideal showed that ammonia compounds are speciallypenetrative. Organisms or colloids take up firstammonia and then chlorine ; 3 chloramine or otherchlorine-ammonia compounds of high coefficient areproduced in situ where they exercise their maximumeffect. The paper should be widely read byall interested, as it has important bearing on safecampaigning. ____

THE FIRST ORTHOPÆDIC CLINIC IN HOLLAND.IT is remarkable that orthopaedics have hitherto

received so little attention from the medical professionin Holland, but this condition is likely now to beremedied by the opening, at Leiden, of a new ortho-paedic clinic--the first in the country. For more thanten years a number of infirmary buildings have beenunder construction in Leiden, supplied with labora-tories, clinics, and dispensaries for every branch ofmedicine at a total cost of some 21,250,000. One ofthe buildings, which was originally designed for afever hospital, has been allocated to the Society

1 Journal of the R.A.M.C., June and July, 1924.

for the Welfare of the Crippled and Disabled. Thishospital has accommodation for 40 beds, 20 of whichwill be paid for by the Government and will be usedfor teaching purposes. Dr. Murk Jansen, who isnow lecturer in orthopaedic surgery at the university,has been appointed director. Many difficulties hadto be overcome before this project could be carried out.The strong opposition to the establishment of theclinic on the part of some surgeons is noteworthy,our Dutch correspondent writes, as giving an idea ofthe old-fashioned professional outlook in Holland incertain directions. The surgeons there have con-

tinually opposed the separation of any branch ofmedicine from surgery, and for this reason it took along time before oto-rhino-laryngology, dermatology,and urology became separate specialties. For thesame reason, too, there are in Holland no surgeonswho specialise in surgery of the abdomen or brain.It must be remembered that for many years in allthe British medical centres specialism was looked atwith considerable suspicion, one fact being insistedupon and another fact suppressed. It was con-

tinually pointed out that there could be no soundspecialism that was not founded on general medicine,but it was a long time before it was allowed thatprogress along special lines would be most surelyarrived at by special work. The first is true, butthe second is no less true. The establishment ofthe new clinic, under an orthopaedic surgeon so wellknown as Dr. Jansen, should do a great deal tofurther in Holland the development of this branchof medical science. ____

COMPULSION IN THE TREATMENT OFVENEREAL DISEASE.

THE experiments on compulsory notification ofvenereal diseases abroad are being watched with keeninterest at home. Some time ago the journal of theNational Council for Combating Venereal ’Diseasespublished results achieved by the methods in forcein Australia and Canada, and replies received to aquestionnaire issued to State and public health depart-ments in August last appear in its pages for July.1In Queensland, of the 568 cases notified for failure tocontinue treatment, 365 resumed after being warned,4 were summoned (of whom 3 then resumed treat-ment), and 4 were brought before the court and fined.In Queensland it seems that in general the infectedare only too willing to continue treatment, it is thenomad population which defaults. In Tasmaniafour defaulters resumed after being followed up byan official of the department and no cases were broughtbefore the court. In Tasmania notification andcompulsory treatment has, it is stated, not led toconcealment, but yet has not achieved the goodresults expected. The tracing of contacts has provedquite unsuccessful. In Victoria, of the 6599 cases

in six years who discontinued treatment, 3099 weretraced and 3028 resumed, 71 were summoned (63 ofthem then resuming treatment), and 8 were broughtbefore the court. The fear of publicity is felt inVictoria to have had some effect in causing conceal-ment of disease, but the notification of a defaulterby name has not diminished attendance. In l-estA 1tstralia, of 320 defaulters 232 were traced, 24 werebrought before the court, 16 cases being withdrawn,and 8 were fined. Here notification and compulsorytreatment has not led to concealment or diminutionof attendance, although wrong addresses are givenwhich lead to difficulty in tracing defaulters. In

i Ontaerio 5 per cent. of cases discontinued treatment toosoon ; the scheme has not led to concealment or todiminution of attendance. In Quebec no legal measuresare taken to induce patients to continue treatment,and it is felt that even confidential notificationprevents the patient from coming to the clinic. Itis evident that the effect of compulsion in the treat-ment of venereal disease is not proving easy to assess,and although the steps taken to deal with thosewho discontinue treatment have achieved a largemeasure of success, unanimity has not yet been

1 Health and Empire, July, 1924.