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strength may follow. This holds true also for loco-motor ataxia, inasmuch as after childbirth ataxiaincreases and bladder and intestinal troubles maysupervene. That spinal and cerebral tumours,syringomyelia, progressive spinal muscular atrophies,hereditary chorea, lateral sclerosis, and severe formsof epidemic encephalitis form absolute indicationsis beyond dispute. In doubtful cases Dr. Buchlerholds that social and eugenic considerations may beallowed to influence the decision, but only in minordegree.

UNITED STATES OF AMERICA.

(FROM AN OCCASIONAL CORRESPONDENT.)

EPIDERMOPHYTOSIS.

THIS disease, which is also known by a host of

pseudonyms such as " athletic foot " or " swimming-

pool itch " is believed by many dermatologists tohave taken first rank among skin diseases in thiscountry. It is supposed to have been imported byAmerican soldiers returning from the war. Probablythe majority of regular habitues of gymnastic hallsare now infected with this distressing parasite.It abounds in schools and colleges and seems to bespread especially in damp places such as showerbaths and swimming pools. One measure of prophy-laxis that has been suggested is to arrange for bathersto soak the feet in 15 per cent. solution of sodiumhypo sulphite before putting on their shoes andstockings. The following recommendations have beenissued by the New York State Department of Health.

1. Inspection of the feet and toes of all bathers andexclusion of those showing infection. The disease may showaround the base of the nails or between the toes as a rawopen sore or as small or large blisters, or it may resembleeczema.

2. As the fungus will grow readily on silk and cotton goods,leather and probably on damp wood, all equipment such asbenches, stools, diving boards, steps, rubber mats, and floorsshould be washed daily with a strong solution of chlorinatedlime or soda. Canvas mats or pads should be abolished.

3. Prevention of exchange of unsterilised towels, suits, orbathing slippers.POISONOUS PROPERTIES OF MAPLE SUGAR " SAND."The New York State Department of Health has

recently examined and reported on samples of maplesugar " sand " to the consumption of which the deathof two children in the State had been attributed. Thechildren had found an old can containing some ofthis chalk-like substance, had filled the can withwater and drunk the solution. They developed a

violent gastro-intestinal inflammation with profusestools containing blood, marked prostration, and

rapid lowering of body temperature before death.The sample of " sand " examined in the Statelaboratories was obtained by filtration of freshlymade maple syrup. It was found to be a complexsubstance consisting mainly of calcium malate.Since magnesium malate is known to produce severediarrhcea in adults in doses of 9 g. or more it seemsprobable that calcium malate was the poisonresponsible for the children’s deaths.

HEALTH WORKERS TO TOUR MEXICO.

The American Public Health Association is tohold its annual meeting this year at Fort Worth,Texas, from Oct. 27th to 30th. At the close of theconference a special tour of Mexico is to be under-taken by invitation of Dr. Rafael Silva, the chiefof the Mexican Health Department, with the approvalof the President of the Republic who has invited thedelegates to visit him in his historic castle. A special Itrain will be at the service of the delegates.

INSANITY AND THE LAW.

The degree of responsibility of a criminal cannot besettled, it is now admitted, either by definitions or bya board of experts; there will always be honestdifferences of opinion which cannot be subjected toany scientific test. The important matter is not aphilosophical conception of free will, but a practicalquestion of the future behaviour of the criminal. Letthe jury decide, then, whether or no the prisoner at thebar actually committed the crime. The prisoner isthen to be studied by a board of experts with a viewto prescribing treatment for the correction of hisanti-social behaviour and the protection of society.The following five principles have been adopted bothby the American Bar Association and, at its recentmeeting, by the House of Delegates of the AmericanMedical Association. 1. That there be available toevery criminal and juvenile court a psychiatricservice to assist the court in the disposition of offenders.2. That no criminal be sentenced for any felony inany case in which the judge has any discretion as tothe sentence until there be filed as a part of the recorda psychiatric report. 3. That there be a psychiatricservice available to every penal and correctionalinstitution. 4. That there be a psychiatric reporton every prisoner convicted of a felony before he isreleased. 5. That there be established in eachState a complete system of administrative transferand parole, and that there be no decision for or againstany parole or any transfer from one institution toanother, without a psychiatric report.

AUSTRALASIA.(FROM OUR OWN CORRESPONDENT.)

THE PRIMARY FELLOWSHIP EXAMINATION.

THE College of Surgeons of Australasia have officiallyannounced that they have received notice that theCollege of Surgeons of England will hold a primaryFellowship examination in August, 1931. The exami-nation will be held in Melbourne, presuming that notless than 25 eligible candidates are found desirous ofbeing examined. There is no doubt that all who can willtake advantage of this opportunity, but even underthe present arrangements distance is still a factor.Melbourne is the most central city for the purpose.but it is still a long way to come from outlying parts.Many have expressed some disappointment that ithas not been possible to arrange for the papers to be-set concurrently in Adelaide, Melbourne, and Sydney,and for the viva-voce examinations to be held ineach city separately. It is understood that this

suggestion was made to the Australasian College, andno doubt there were good reasons why it has not beenaccepted. Nevertheless, such a scheme would givemore prospective candidates an opportunity to takethe examination.

BROKEN EXPLORATORY NEEDLES.

It was something of a coincidence that the issue ofTHE LANCET with recommendations about the break-

age of hypodermic needles (May 17th, p. 1083) shouldhave arrived in Sydney during the progress of an

action, the result of such a mischance. This actionwas one of more than usual interest, because thedoctor had not disclosed to the patient the fact thatthe needle had been broken. The patient had twobrothers who were doctors, and the broken needlewas accidentally discovered by X rays. Briefly thefacts of the case are as follows. The plaintiff allegedthat on Friday, Jan. 30th, 1928, the doctor was-

performing an exploration of his chest, broke, or

allowed to break the needle he was using, but did not

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in the after-care of his patient take appropriate steps Ito guard against the harm which might have been

i

caused by the presence of the needle. The action wasattributed to negligence, and it was further allegedthat the fact that the doctor concealed the presenceof the broken needle from the patient also amountedto malpractice. Subsequently the needle had causedthe plaintiff suffering and financial loss. An opera-tion for empyema was performed about an hour afterthe exploration. The evidence showed that the

- patient was suffering from bronchiectasis. Thedefence was an admission of the accident but a denialof negligence. ’ It was stated that the needle hadbroken off during a fit of coughing whilst the doctor-was emptying pus from the syringe. The doctor-contended that it is impossible to tell a faulty needleby its appearance, and further that the presentcondition of the patient was the result of bronchi-ectasis. Numerous expert witnesses testified that in I’its present position the needle was doing no harm.The reasons given by the doctor for not telling the !

patient, X raying him, or attempting to remove

the needle, were that in the serious condition of thepatient it would have been unwise to have informedhim or his wife of the accident, that as he felt certainit was doing no damage he took no further steps inthe matter, and further, that operation for removalof the needle would have been harmful.The jury in their verdict found that negligence had

been proved and awarded the plaintiff costs at 9100.There is no doubt that the fact of the doctor notdisclosing the breaking of the needle weighed heavilyagainst him. A number of questions concerningbroken needles arose during this case : the responsi.bility of the doctor for the use of an unsound needle;the propriety of not telling the patient that theneedle had been broken; if the fact is disclosed, whenand to whom it should be disclosed in the case of apatient who is seriously ill; the responsibility of thedoctor for taking steps necessary for the recovery ofthe needle or to guard against possible harm causedby its presence.

PUBLIC HEALTH SERVICES

RESULTS OF ARTIFICIAL LIGHT TREATMENT

FOR TUBERCULOSIS.

BY G. LISSANT COX, M.D. CAMB.,CENTRAL TUBERCULOSIS OFFICER, LANCASHIRE COUNTY COUNCIL.

THE following brief account of treatment by arti-ficial light is based on a report for the year 1929presented to the Lancashire County Council. Lightcentres have been established at 12 of the 24 tuber-culosis dispensaries in the administrative county.Treatment at each dispensary has in the greatmajority of cases been given by two carbon-arclamps (Sunrae pattern) for general treatment, andone Kromayer mercury-vapour lamp for local treat-ment. For obstinate cases it has been found helpfulto resort to ancillary forms of treatment, such as

curetting, cauterising, aspiration, or application ofointment.

Summary of Results.1. Artificial light treatment, undertaken at dis-

pensaries by the tuberculosis officers and tuberculosishealth visitors, has continued in 1929 to give satis-factory results, particularly in regard to patientssuffering from tuberculosis of the skin and tuberculousadenitis with abscess formation and skin involvement,which conditions are very slow in yielding to otherforms of treatment.

2. Of the total patients attending light centres,77 per cent. were able to continue their normaloccupation during the course of treatment.

3. 30 per cent. of the patients treated during theyear were assisted by the payment of their railway,’bus, or tram fares to the dispensary light centres.

4. In regard to the 60 skin cases which became" quiescent and apparently cured," the averageduration of the disease before the patients com-

menced light treatment was 10 years 8 months,whereas.the average duration of light treatment was10t months.

5. For the 252 cases which became " quiescentand apparently cured," the average duration of thedisease before the patients commenced light treatmentwas 4 years 8 months, whereas the average durationof light treatment was 9 months.

6. The average cost of artificial light treatmentat the 12 centres amounted to 4s. 6td. per patientper week.

* Includes : (1) any patient who did not receive two months’treatment ; (2) patients ceasing light treatment prematurely-e.g., removals, unwilling or unable to continue ; and (3) patientstransferred to sanatoria or hospitals.

7. Of the 252 cases concluding treatment in 1929on becoming " quiescent and apparently cured,"the consultant tuberculosis officers would normallyhave recommended 211 for treatment at hospitals.Based on the average duration of treatment of suchcases, the cost would have been not less than JS4792,whereas their treatment at the dispensary lightcentres actually cost (all inclusive) £ 2240-a savingof 22552.