your chest should be flat

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scourges in Iceland-continued to decline, only25 lepers being still alive in the country, and thenumber of cases of hydatid disease fell from 46 in1927 to 11 in 1936. During this year 32 abortionswere induced under the terms of the Birth ControlAct which came into operation in 1935. Breast-feeding was so universal that only 1.2 per cent. of theReykjavik babies were exclusively bottle-fed. The

proportion of bottle-fed to breast-fed babies was,however, somewhat higher in the country as a whole.The total number of doctors in Iceland in 1936 was140, while 205 midwives were in active service.Dentists are rare, and trained nurses do little workoutside the hospitals, of which there were 43. with1140 beds, or 9-8 beds per 1000 inhabitants. Of thesehospitals, 35 were general, with 641 beds. Thetuberculosis sanatoriums contained 284 beds.

YOUR CHEST SHOULD BE FLAT

FORTY years ago Dr. Woods Hutchinson, in his"Studies in Human and Comparative Pathology,"corrected the common misapprehension that thetuberculous chest was as flat as it looked. He foundby measurement that it was, in actual fact, rounderthan the healthy chest, so round indeed that the

scapulae, aided by the accompanying poor muscletone, had difficulty in resting on the back of thethorax and tended to slip forward, giving the typicalbut misleading effect of a flat chest. He found,moreover, in comparing structural development atdifferent ages, that the thorax is normally round atbirth, and alters gradually to the broader, flatterchest of the healthy adult. The thorax of animals, inorder to allow closer approximation and free move-ment of the forelegs, is deep and rounded-in the dog,for example, the ratio of depth to width is 3 : 2-and the chest of the four-months human embryois much the same shape. Structurally, therefore, thetuberculous chest seems to be one of arrested develop-ment. Dr. Weisman now takes up the matterfrom this point. From measurements of 20,000school-children, and vital-capacity tests of 500, heconfirms that as the child gets older the thoraxbecomes progressively broader and flatter, with a

decrease of thoracic index relative to growth, heightand weight, and an accompanying increase of vitalcapacity. He then gives his own figures, as well asthose of other investigators, for measurements oftuberculous chests, and shows that these are deeperand underdeveloped, having a higher thoracic indexand a lower vital capacity. The measurements ofthe chests of 40 patients who were non-tuberculousbut suffered from chest complaints such as bronchitisand asthma fall between the tuberculous and normal.Differences of race and nationality do not affect thegeneral findings, but where environment is such thatgrowth becomes stunted or weakly the round andimmature thorax is far more common than where

living conditions are good. The social implications ofthese facts are clear. Weisman’s aim is to attractattention to a logical and fundamental prophylaxis oftuberculosis by ensuring nutrition and social condi-tions for children compatible with normal healthygrowth. When development in childhood is poor itshould be hastened, he says, not only by improvedgeneral conditions but by specific exercises. Theforms of activity that, through evolution, havegradually changed the shape of the thorax from thequadruped to the apes, and finally to the uprightstructure, are climbing and wide free arm move-

1. Your Chest Should be Flat. By S. A. Weisman, M.D.,F.A.C.P., assistant professor of medicine, University of Minne-sota. London: J. B. Lippincott Co. 1938. Pp. 145. 9s.

ments. Similar exercises-ball-games, climbing, andapparatus work-Weisman maintains will ensure

correct development, and he has advocated, withbenefit, a change-over to this type of activity in anyschools where standing rhythmic exercises havealtogether superseded apparatus work. His bookmay do much towards preparing the soil for health,and may also rouse the social conscience to an appre-ciation of increased resistance in preference to thesanatorium cure. His title, however, is provocativerather than accurate : the better slogan would be" Your chest should be broad."

FEES FOR MEDICAL REPORTS

THE medical practitioner must often have heardthe wise advice that before he gives a report to

solicitors, he should require a guarantee that an

adequate fee will be paid him. Once the report hasbeen given, the vantage ground for negotiating forfees is lost. The practitioner should either obtainthe fee before giving the report or else should get awritten undertaking from the solicitors that they willbe responsible for the fee. Even when this is done,the practitioner may not be at the end of his difficulties.In a recent case solicitors who had made themselvesresponsible for the fee attempted to repudiate theirliability on the ground that the report was of no useto them. The practitioner consulted the London andCounties Medical Protection Society of which he wasa member. Proceedings were taken against thesolicitors in the county court and judgment was givenin the practitioner’s favour for his fee and the costsof the claim.The facts of the case were simple. The solicitors

were apparently engaged in litigation on behalf of apatient with a history of mental instability againstwhom some allegation of insanity had been made.They asked the doctor to report upon the patientand to deal in particular with his previous medicalhistory and that of his family. There was no

difficulty over professional secrecy. The patientgave his written consent to the report being made ;indeed he himself had suggested to the solicitors thatthey should apply to the doctor for the information.The doctor, as it happened, had not seen the patientfor six years. This fact was well known to the patient;it did not vitiate the value of the doctor’s knowledgeof the medical history of the patient and his family.It gave the solicitors, however, an excuse for decliningto pay the doctor’s fee. If they had known, theysaid, that the doctor had not seen the patient forsix years, they would never have asked him for areport. As already mentioned, the county court

judge decided that the fee must be paid. If a

potential witness were to be rewarded according tothe hopes or disappointments engendered by his

prospective evidence, an uncomfortably speculativeelement would be introduced into the relationsbetween medicine and the law. A simpler principlewas involved-namely, that professional men shouldkeep their word. To give them their due, theygenerally do.

GROWTH HORMONES IN INSECTS

IT has long been known that growth in vertebrateanimals is largely controlled by hormones circulatingin the blood. Only of late years has it been discoveredthat growth in insects is similarly regulated. Cater-pillars that have finished feeding will not turn intopupse if their brain is removed, but they will do soif the brain is reimplanted in the abdomen. Apparentlythe brain secretes a growth-promoting hormone.