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Liverpool, David Leuris Northern Hospital.-Four 1-f.S.’s. AlsoTwo H.P.’s. Each £100.

London County Council.—8th Asst. M.O. £300.Macclesfteld General Infirmary.—Res. H.S. £180.

Manchester, Ancoats Hospital.-Res. M.O. £150.Manchester and District Radium Institute.-Hon. Consulting

Surgeon Laryngologist.Manchester, Barnes Convalescent Hospital, Cheadle.-Res. M.O.

£250.Manchester Royal Infirmary.—Two Clin. Assts. for Surgical Out-

patient Dept. Each P35.

Manchester, St. Mary’s Hospitals.-Four H.S.’s. Each at rate of£50.

Manchester University.-Lecturer in Dental Histology. £ 50.Marie Curie Hospital, 2, Fitzjohn’s-avenue, N.W.-H.S. At rate

of £50. Also Assistant Anæsthetist.National Hospital for Diseases of the Heart, TTTestmoreland-street,

W.-Hon. Physician to Out-patients.Newark Hospital and Dispensary.-Res. H.S. At rate of 9150.Norwich City.-Asst. M.O.H., &c. £450.North Middlesex Hospital, Silver-street, Edmonton, N.—Res. M.O.

£200.

Paddington Green Children’s Hospital, TV.-Hon. Ophth. Surgeon.Redruth, Cornivall, West Cornwall Miners’ and TVomen’s Hospital.

Res. M.O. 200.Rochdale Infirmary and Dispensary.—Jun. H.S. £175.

Royal Army Medical Corps.-Commissions.St. Bartholomew’s Hospital, E.C.-Asst. Physician.St. John’s Hospital, Lewisham, S.E.—Cas. O. At rate of £100.Salisbury General Infirmary.—H.P. £150.Sheffield, Jessop Hospital for TYonzen.-Two Asst. H.S.’s. Each

at rate of £100.Sheffield Royal Infirmary.—H.S., Ophth. H.S., Asst. Ophth. H.S.

Also Asst. Cas. 0. Each at rate of £80.Sheffield, Winter-street, Hospital.-Asst. Tuber. O. £450.Southwark Metropolitan Borough, S.E.-Asst. M.O.H. £600.Stafford, Staffordshire General Infirmary.—H.P. At rate of £150.Surrey County Council.—Asst. M.O. £600.Swindon and North Wilts Victoria Hospital.—H.S. At rate of

£100.Victoria Hospital for Children, Tite-strecti Chelsea, S.W.-Sen.

Res. M.O. At rate of £250. H.P. and H.S. Each at rateof £100. Also Out-patient Anaesthetist. 10s. 6d. perattendance.

Warrington Infirmary and Dispensary.—Sen. H.S. £225.West End Hospital for Nervous Diseases, Regent’s Park, N.W.-

Jun. H.P. At rate of .8100.West London Hospital, Hamnwrmith-road, W.-Asst. Dental. S.

Also Two Hon. Anaesthetists.Westminster Hospital, Broad Sanctuary, S.TV.-Clin. Asst. to

Dental Dept.Willesden General Hospital, eV.TT’.-Res. H.S. At rate of £100.

Births, Marriages, and Deaths.BIRTHS.

BULLPITT.-On Jan. 1st, at the White Cottage, Hatfield Broad IOak, the wife of Cyril M. Bullpitt,L.D.S., of a daughter.

MARRIAGES.

BROMLEY—WALKER.—On Dec. 21st. 1929, at the Cathedral.Manchester, John Frederick Bromley, M.B., Ch.B.,D.M.R.E., to Sarah Walker, M.B., Ch.B.

CUTHBERT—WILSON.—On Jan 2nd, at St. Columba’s Church,Cambridge, William Leslie Cuthbert, B.A., M.B., Ch.B., toDorette, daughter of Prof. J. T. Wilson, Grange-road,Cambridge.

ELLIOTT—PHILLIPS.—On Dec. 31st, at Colehill, Dr. A. F. Elliott,of Oundle, to Eleanor, fourth daughter of the late T. AdamsPhillips, Esq., of South Hill House, Bromley, Kent.

KEMPE—MAIN.—On Jan. 2nd, at All Souls Church, Langham-place, W., Charles Gilbert Burlington Kempe, O.B.E., M.D.,&c., of Salisbury, to Violet Gwendolen, only daughter of thelate George J. Main, J.P., and Mrs. Main, of The Priory,Salisbury.

MUIRHEAD—BURNETT.—On Jan. 4th, at the Parish Church,Bedworth, Robert Gordon Muirhead, to Ellinor Marjorie,M.B., B.S. Lond.

DEATHS.BATES.—On Jan. 2nd Joah Bates, M.R.C.S., of Upper Norwood.MARTIN.—On Dec. 31st. Albert Morton Martin, consulting

surgeon, of Bingfield House and Eslington Tower, Newcastle-upon-Tyne, aged 60 years.

NAISMITH.—On Jan. 4th, at Grove Lodge, Tow Law, CountyDurham, James Henderson Naismith, M.B., Ch.M., aged 60years.

N.B.—A fee of 7s. 6d. is charged for the insertion of Notices ofBirths, Marriages, and Deaths.

Notes, Comments, and Abstracts.THE POINT OF VIEW OF A PANEL DOCTOR.

Being the substance of an Address delivered to Oxford andCanrbridge Undergraduates at Toynbee Hall on Dec. 11th

BY HAR RY ROBERTS, L.M.S.S.A. LOND., L.S.A.

THE problem of health was not always treated as a socialor political one. Originally, it may be presumed, thepreservation of health and the treatment of illness werethought to be matters as purely personal as the selectionof dress and the equipment of the home. But, apart fromany development of the philanthropic sentiment, the con-gregation of people in cities, towns, and industrial villagesbrought home to everyone the truth that, in social life, ourneighbour’s health concerns us only a degree less intimatelythan does our own. Over a very long period of years

publicly organised hygienic activities have been steadilyincreasing, though it was only eighty years ago that a greatsanitary reformer wrote : ’’ The human family has now livedin communities for more than six thousand years ; yetpeople have not learned to make their habitations clean.When we have learned that lesson, we shall have conqueredepidemics." Thanks largely to increasing communalcleanliness and to a policy of isolation, since those wordswere uttered our death-rate has been halved and our feverdeath-rate has been reduced to little more than one-fortiethof its then figure.

Until very recently, however, curative and remedialmedicine was still regarded as a personal matter. Publicconcern was supposed to begin and end with prevention,and the full implications of that term are not even yet fullyrealised. Perhaps it is just as well that our ancestors tookthis limited view of social prudence and responsibility, forthe history of curative medicine is none too glorious. Thepoor foundations and consequent fickleness of medicaldoctrine are proverbial. That doctors differ is commonlyassumed to be as natural as that primroses bloom in thespringtime. Not Mr. Bernard Shaw, but a distinguishedphysiologist, said that " the therapeutics of one generationare always absurd to the second succeeding generation."And it was no less a physician than Dr. Samuel Wilkes who,not so many decades ago. expressed his belief " that we knownext to nothing of the action of medicines and other thera-peutic agents. To say that I have no principles is a

humiliating confession."

The Inrprovenaent io Hospitals.Still. at any given time, there is available a certain amount

of medical knowledge and skill, and it is the business ofdemocratic statesmanship so to scheme things that thisknowledge and skill shall be utilised for the maximumprevention of the preventable and the cure of the curable.The rich are always able to buy such skill as is in the market.Until lately the poor have had to take what they could get;and, all too often, it has taken the form of the therapeuticcrumbs that fall from the rich man’s table. We are toldthat, at the beginning of the eighteenth century, St. Thomas’sand St. Bartholomew’s hospitals were the only institutionsin the country provided for the treatment of the sick poor.Even there the fees or " tips " demanded by the porters,nurses, and other employees presented impossible obstacles tothe poorest. Nearly a century later John Howard wrote that" the securities and fees required at admission into many ofthe hospitals bear hard upon the poor, and absolutely excludemany who have the greatest need of relief." " I saw awoman bring her child," he tells us

" and with tears leave2s. 9d. for the nurse, and 6d. for the steward." In 1678 theout-patients at St. Bartholomew’s were limited to eight perweek. Still, it may be doubted if the poor lost much bythe slightness of the institutional treatment in those pre-Listerian days. The mortality-rates of such simple opera-tions as limb amputations were appalling, and, of course,none of the more complicated surgical measures constantlyand successfully carried out in every hospital to-day waseven attempted. Writing in 1867, Sir James Simpsonsaid : " In hospitalising men we decrease their health-rateand increase their death-rate. The man laid on an operatingtable in one of our surgical hospitals is exposed to morechances of death than an English soldier on the field ofWaterloo." So recently as the third quarter of the lastcentury, of upwards of a million women delivered in hospital,some 35 per 1000 died ; whilst, of a corresponding series ofdomiciliary confinements, less than 5 per 1000 proved fatal.

To-day, no one familiar with the facts would for a momenthesitate confidently to enter any of the big general hospitalsin this country if he needed any but the most rudimentary

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medical or surgical treatment. There he can be sure of thehighest skill available, and of everything in the way ofequipment that modern knowledge and ingenuity havedevised. Once he is safely in bed in a ward in any one ofour voluntary hospitals, docker or dustman can count onreceiving treatment at least equal to that which prince ormillionaire can command. The results being what they areit is truly astonishing that the electors have for so longallowed their political representatives to trifle with thequestion of adequate hospital provision. It is stated thatthere is, at this moment, a waiting list of 5000 seekingadmission to the Royal Edinburgh Infirmary alone.

Club Practice.Since the middle of the last century, when parish doctors

were appointed in every district to provide domiciliarytreatment under the poor-law for those unable to make anymedical provision for themselves, there has been a steadilyincreasing recognition of the desirability-on public, philan-thropic, and prudential grounds-of arranging for some sortof medical supervision and treatment in times of stress.Parish doctoring was, for the most part, not such as tolead those not so compelled to trust themselves to its minis-trations. Throughout the country a system of voluntaryclubs grew up, the members of which, by paying a few pencea week, were guaranteed, in addition to sundry moneypayments during illness or old age, the services of a doctorwhen necessary. These club doctors received but a smallannual payment in respect of each member-generallyabout four shillings, out of which drugs had to be provided-and, although many gave a service fully up to the standardrepresented by contemporary medical knowledge, the systemput too great a strain on professional and technical honour.Club doctoring came to be looked upon as but one shadebetter than parish doctoring, and accordingly the politicalground at the end of the first decade of this century seemedready for some big national scheme of domiciliary treatment-a readiness which Mr. Lloyd George and other astute,public-spirited or philanthropic politicians sought to exploit.

National Health Insurance.Thus it was that, in 1912, the Health Insurance Act came

into operation and every wage-earner in the country wasprovided with a panel doctor of his own. Unfortunately,the methods of politics, rather than those of science or ofstatesmanship, were the ones employed in bringing aboutthis medical revolution. In practice politics all too ofteninvolve the squaring of vested interests. Mr. Lloyd Georgewas faced by powerful corporations whose goodwill, or atleast compliance, was essential to the enactment and carryingout of his proposals. The big Friendly Societies and theindustrial Insurance Companies were quieted by beinggiven the control and administration of the various cashbenefits to be provided. The doctors, seeing the dangerwhich confronted that independence of judgment and thatpersonal relation between them and their patients on whichthe best practice has always been based, were up in arms.But they also proved susceptible to financial promises.Consequently, in the discussions and the bargainings betweenthe Government and the medical profession, it was rate ofpayment rather than efficiency of service that always stoodfirst on the agenda.

The Defects of the Panel System.The one piece of medical organisation that emerged is

what we are now familiar with as the panel system ; theworking of which has at least been an interesting experimentin democratic methods. Considered in the large, the panelservice represents a great advance on any collectivelyprovided medical service that preceded it. Moreover, any-one familiar with the conditions of private medical practiceamong the city poor at the beginning of the present centurycan but recognise the immensity of the improvement thathas taken place. The doctor-so far as insured persons are con-cerned-is spared the humiliating experience of taking froman ill-nourished family a fee which represents to-morrow’sdinner ; nor need he apologise for visiting his pneumoniapatient as often as he thinks it desirable. Personally. Ihave always felt that it would be a good thing were theprivate and individual acceptance of medical fees made apenal offence. like the acceptance of secret commissions :but perhaps I am a little biased in this matter. Still, Ithink that plenty of other doctors with similar experienceof industrial practice in pre-insurance days will feel much asI do.

It was, I believe, the original intention of Mr. LloydGeorge and his advisers to establish throughout the countrya salaried service of district insurance doctors, and manypeople regret that the original intention was not carried out.Many arguments may be advanced on either side, the forceof which varies with the point of view. It is, of course,desirable, in the interests of national health, that con-

scientious doctors shall be free to act according to their own

judgment, regardless of the whimsies, prejudices, and mis-conceptions of ill-informed patients. Under the panelsystem, which makes the doctor’s income depend mainly onhis popularity, a certain measure of scientific independence isinevitably sacrificed. But, if we regard the prime functionof the panel service as the providing of a " benefit " for th&individual patient-the sort of service he would normallyprovide for himself if he had the money-then, in the presentstate of popular education, it is far better for the insuredperson to be in a position to express his dissatisfaction by" changing his doctor " just as a private patient can anddoes, than to have no remedy except that of making a formalcomplaint to some committee or administrative officer.Though good and conscientious doctors do their best workwhen least interfered with, such men do good work underany scheme. The panel system has materially raised thestandard of medical treatment in poor areas, and it hasdrawn to those districts hundreds of fairly competent youngpractitioners who, in the old days, would never have thoughtof facing the discomforts involved for the small fees thenobtainable. But, in the course of raising the generalstandard of industrial medical treatment, it has tended to.discourage originality and to formalise the relation betweendoctor and patient. These evils are, however, not essentialaccompaniments of the system. Their existence may, infact, be more accurately attributed to the self-assertivenessand spiritual pettiness of a bureaucracy-lay and medical-that is more and more firmly establishing itself. Unless thisis changed we may increasingly expect to find that menof character and independence will avoid the panel service,which will attract mainly those susceptible to the bait of afairly good assured income for uninsnired routine work.A vicious circle has been established. Suavity appeals

to the average patient no less than skill; a mere formalobservance of the regulations satisfies the authorities andpaymasters ; outstanding excellence wins neither praise norreward in either quarter. Originality and devotion, as

things are at present, are as likely as neglect or incapacityto bring the practitioner before some or other tribunalentitled to demand an explanation of his eccentricity.

The Remedy.But these extraneous defects could readily be removed if

the great body of medical practitioners were as concernedwith technical efficiency and professional honour as with theInsurance Committee’s quarterly cheques. And the sameis true of those limitations, artificial and illogical to a degree,which go far to sterilise medical work under the HealthInsurance Act. What can be said of a national systemwhich, whilst providing some kind of medical service forthose employed members of a family who are over the age of16 years, leaves the rest of the household to get along thebest way they can ; which puts " out of benefit " a marriedwoman who devotes herself to her home and children andwhich furnishes only such medical treatment as even poorpeople can most easily obtain for themselves-viz., suchas can be given by

" a general practitioner of average com-

petence and skill ? " In actual practice this " treatment "

works out at the annual prescribing and provision of millionsof gallons of " medicine," probably not more than one-tenthof which has the slightest therapeutic significance. " Heis the best doctor who knows the worthlessness of the mostdrugs." Treatment is more and more demanding specialistknowledge and elaborate equipment, and these should beavailable promptly and conveniently to all those who reallyneed them.The enormous fall in the death-rate that has characterised

the last half century is due hardly at all to strictly ’’ medicaltreatment " in the old sense of the term. Mainly the creditbelongs to our effective sanitary service, to aseptic surgery,to sounder hygienic notions, and to an improvement in thegeneral standard of living. In spite of its enormous possibili-ties, it is difficult to place high valuation on the part in thepromotion of the national health played by the HealthInsurance Act, as at present administered and medicallyinterpreted. Either the panel system should be abolished,or the whole population-at any rate the whole working-class population-should be brought under it. Apart fromthe treatment of minor ailments calling for no particularspecialist skill and no particular equipment, and the directing-of the domiciliary treatment of such illnesses as call for littlebeyond nursing and symptomatic drug therapy, the paneldoctor might most usefully be employed in the work ofnreliminary diagnosis and of hvgienic education. For thefirst of these duties he is already moderately well trained ; ;-for the second he is hardly trained at all. If we are to-Droduce a reallv effective health organisation the GeneralMedical Council will have to examine in a revolutionaryspirit the whole system of medical education in this country

The Future.Since the establishment of the Ministry of Health some-

thing has been done in the way of coordination. But the-

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’Ministry has far too many and too mixed duties and interests.The whole problem needs to be considered from the point ofview of national requirements ; free from the dominance ofparsimony, local or sectional jealousies, or vested interests.Between the several units which make up the medical armythere is little cohesion, little inter-relation. Nor, in spite ofthe unctuousness and fine sentiments which characteriseso many medical utterances, is there as yet any widespreaddesire among practitioners to subordinate temporary andpersonal advantages to the well-being of the nation or tothe perfecting of the service of which our guild is the

,privileged instrument.

PUBLIC HEALTH IN KENYA.

A GOVERNMENT report for 1928 on the Colony andTrotectorate of Kenya has just been issued. Referring topublic health it states that the most outstanding featureof the year with regard to the incidence of communicabledisease was the occurrence of a number of severe outbreaksof malaria in certain parts of the highlands of the colony.In all six districts were affected, four being native reservesand two being European farming areas, or " settled dis-tricts." The latter had been affected to some extent bythe epidemic of 1926, while the four native reserves, so far.as is known, had not previously suffered from malaria inepidemic form. In 1926 the most serious incidence occurredin the central highlands, but in 1928 the latter were notseriously affected, the incidence of epidemic malaria beingconfined to the north-western highlands-that is, to themore or less continuous stretch which lies to the north-westof the Great Rift Valley and between the valley and thebasin of the Victoria Nyanza. The position for a time wasundoubtedly serious. It is a matter for some satisfaction,however, that there is now an increased appreciation of thefact that under present conditions malaria, even in non-endemic areas, may from time to time become of graveimportance. No other unusual incidence of communicable,disease occurred during the year, and it cannot be said thatthe general health of the population of the colony as awhole was less satisfactory than in previous years. In theabsence of accurate vital statistics it is impossible to measureany small variations in the general standard of healthwhich may be occurring. ,But work was carried out during 1928 which at a later date

will allow of more accurate estimates being made of the results ’,of the medical, sanitary, agricultural, and social develop-

’’

ments which are now taking place in the native reserves. ’,This work was undertaken more particularly in connexionwith the ankylostomiasis campaign which was carried outin the Digo Reserve on the coast, where large numbers ofthe natives who presented themselves for treatment weresubmitted to a full and careful physical examination andthe results recorded. The findings confirm the opinionwhich has been expressed in many previous reports to the.effect that the standard of health which prevails amongAfrican natives is generally at a low level, and that, withfew exceptions, the physique and capacity of the popula-tion are affected as the result of infection with those endemicpreventable diseases which generally prevail where thestandard of culture of the people and the cultivation of thedand is still primitive. In the reserves other than Digothe collection of information regarding the physical andpathological condition of the inhabitants has also beenpursued. Of the general observations which have beenmade, perhaps the most outstanding have reference to theincidence of infection with intestinal worms and the effect- of such infections on the population. Hitherto, amongthe diseases resulting from infection with intestinal worms,hookworm alone has received much attention, but duringthe past year evidence has been accumulating which indi-cates that the disability which results from infection withtapeworms and roundworms is by no means negligible, andthat in countries such as Kenya, where the infections arecommon, the diseases which result play a much larger partin lowering the standard of the public health than hashitherto been realised. In the Teita Reserve, in UkambaProvince, a sanitation campaign was carried out, theinfection with which it was hoped to deal beingroundworm.

During the year the incidence of plague was not notable-and was chiefly limited to a small outbreak in Nairobi andsporadic outbreaks in the endemic areas of the NyanzaProvince. In the settled areas the incidence was very low.Four sporadic cases occurred in Mombasa. Throughoutthe year five cases of small-pox were reported, but in nocase could the source of infection be traced. Of the acutefevers, pneumonia, as usual, caused much sickness, and inthe towns especially, and among the poorer section of the m’ban native population this disease was responsible for a high mortality. In the native reserves yaws, in spite of II

the large number of cases which have been treated duringrecent years, continues to cause much disability, and it isonly in the Kikuyu district of Fort Hall that there wouldyet appear to have been a large reduction of the incidence.The total number of cases treated in 1928 was 85,617. Incertain parts of the Nyanza Province the incidence ofsyphilis presents a problem of some magnitude, and duringthe year increased efforts have been made in these areasto induce patients to attend regularly for treatment. Theseefforts have met with some degree of success, but thenumber of patients so attending is still small in proportionto the numbers who do not return after they have beenrelieved of their more distressing symptoms.The work of the medical department during the year

was carried out on normal lines, except that in certainnative reserves particular attention was devoted to helminthicdiseases and the treatment of syphilis, while in the townsparticular attention was given to the control of malaria.The investigation of mosquito conditions received specialattention. The general health of native labourers may beconfidently said to be steadily improving. This is due inpart to the progressive realisation by employers of theimportance of an adequate and varied diet and of sanitarysurroundings, and partly to the regular system of Govern-ment inspection and exhortation which is maintained bythe principal labour inspector and his officers.The range of temperature between different parts of

Kenya is very wide. At Lamu on the coast the mean shadetemperature is 80° F. ; at Mombasa it is 77° F. ; in Kisumu,on the Victoria Nyanza, it is 72-5° F. ; and in the RiftValley and highland areas is normally between 58° F, and650 F. The rainfall is generally well distributed. Recipi-tation varies considerably with the physical configurationof the colony. The average annual rainfall, taken over anumber of years, ranges from 19 inches at Athi River, onthe plains some 20 miles south-east of Nairobi, to 86 inchesat Songhor in the Nandi Hills east of the Victoria Nyanza.The low-lying districts on the northern frontier are dry.The heaviest rainfall is normally experienced from Marchto June, and October to December. Hail is of compara-tively rare occurrence, and is confined to restricted belts.Frost does not occur below 8000 feet except in some damphollows. The land area is 219,731 square miles, and thewater area 5229 square miles, the latter including the largerportion of Lake Rudolf and the eastern waters of theVictoria Nyanza, including the Kavirondo Gulf. MountKenya, after which the colony is named, is 17,040 feet inheight and is capped by perpetual snow and ice. MountElgon, also an extinct volcano, is 14,140 feet in height andis slightly below the level of perpetual snow. The AberdareRange contains Settima (13,000 feet) and Mount Kinangop(12,816 feet). The Mau Escarpment attains a height ofover 10,000 feet. The total population of Kenya is nowestimated at 2,891,691. By a census taken in 1926 it wasshown that there were then included 12,529 Europeans,30,583 Asiatics, and 10,557 Arabs. The number of Africans,by a rough calculation, is put at 2,838,022.

CARDIAC IRREGULARITY AND THYROID

TOXEMIA.

IN ’a discussion of the cardiac irregularities associatedwith hyperthyroidism S. W. Wisharti has just described acase, which is one of six similar cases he has observed, inwhich paroxysmal auricular fibrillation proved to be theearliest sign of hyperthyroidism. The case described wasthat of a girl, aged 28, who during one year had six attacksof fibrillation at irregular intervals, the maximal durationbeing two days. In five of these an electrocardiographicexamination was made, and this showed fibrillation with arapid ventricular rate. On none of these occasions wasthere any clinical evidence of hyperthyroidism, and thebasal metabolic rate was within the limits of normal onrepeated estimation. At the end of one year this patientdeveloped clinical signs of early Graves’s disease, a sinustachycardia of 110, and a basal metabolic rate of plus40 per cent. Thyroidectomy was performed, and the glandshowed the typical histological picture of Graves’s disease.During the year following operation her health was excel-lent and there was no return of fibrillation. Wishart con-

siders that auricular fibrillation and flutter are the irre-gularities most frequently met with in hyperthyroid condi-tions, and that these may be the earliest detectable signsof thyroid toxaemia. He argues that because removal ofthe thyroid causes an apparently complete recovery in theparoxysmal types, the changes in the heart muscle mustbe transient. This view is supported by the absence ofsubsequent cardiac enlargement or changes in the T-waveor the development of signs of cardiac failure.

1 Amer. Jour. Surgery, 1929. n.s., vii., 329.

114

AN EXPERIMENT IN CHILD GUIDANCE.IN the course of a recent discussion on the difficult child,

reported in THE LANCET of Dec. 14th last (p. 1261), somespeakers hinted that the podiatrist was too often forgottenwhen psychiatrists, psychologists, and social workers setabout the task of helping maladapted children. TheChildren’s Clinic at 85 Clarendon-road, W.1, is an attemptto approach the problem from the podiatrist’s point of view. A fundamental belief underlying the work of theclinic is that physical and mental conditions are invariablyassociated, and there is a biochemical department to studythe correlations between biochemical findings and nervousconditions. Another development of this belief is the gym-nastic department; every child takes part in rhythmicexercises and free movements in order to give full value tothe correlation between posture and habitual physicalactions on the one hand and temperament and mental out-look on the other. On the psychological side the clinic hasmethods of its own which are not described in the report,beyond the rather vague statement thr;t by special kinds ofplay the children are allowed and encouraged to work outtheir own problems and bring their difficulties to light. Thesituation is then explained as far as possible to the child, theparent, and the school teacher. As every child psychologistknows the parents are often the cause of the trouble, and theparent’s department at this clinic is doing what it can tocorrect faulty adult attitudes. The mother is also taughtwhat diet and hygiene is necessary to build up the child’sphysical health. There is a mother’s room where motherssit while they are waiting for their children, and where theyform a club to discuss the virtues and vices of cinemas, theproper bedtime for small people, and such-like matters. Atpresent the clinic is open only on two afternoons in the weekand its work has to go on in rented rooms. Fifty-fivechildren have been seen during the first year and there is awaiting list. The work is admittedly in an experimentalstage but the experiment is worthy of a fair trial. For thisa house is almost essential, and the report is issued with anurgent appeal for funds to equip this house and to provideproper remuneration for the staff.

AN INDIAN NATIONAL SCRIPT.

Dr. A. Latifi, LL.D., has written a brochure advocatinga national script for India and the paper has been circulatedby the East India Association. There is no doubt that thereplacing in India of what the author calls a " jungle ofscripts " is a pressing matter, for educational training islimited by the confusion, which has also the unfortunateresult of limiting the number of European scholars whomake personal research into Indian science. Dr. Latifipoints out that there are three linguistic candidates for theprovision of a national Indian alphabet, the Arabic, theDevanagri, and the Roman, and he finds the superiority ofthe Roman obvious. The Arabic script has, he reminds us,been tried and found wanting, while as between theDevanagri and the Roman the significant remark is madethat Devanagri can in many respects be regarded as identicalwith Sanskrit, while Sanskrit can be intelligibly renderedinto Roman. The details of a reformed script on the Romanpattern would naturally be left to the settlement of an expertcommittee, but for the use of those interested, as well as ofsuch a committee, Dr. Latifi submits a scheme of his proposedtranslation into Roman Urdu.

A SURVEY OF BLINDNESS.

FOR the past four years the Colorado Commission for theBlind have been attempting to collect accurate informationabout the amount of blindness within the State. The resultof their study together with the analysis of 150 private casesis reported by Dr. Edward Jackson,l of Denver. The 1053cases reported to the Commission do not afford a completerecord of blindness in the State, for all of the blind do notseek assistance, but their analysis is of unusual value’inasmuchas the great majority of these cases have been examined forthe commission by a specialist. All who do not conform tothe standard of blindness-less than 1/10 vision in the bettereye-have been excluded from the analysis. Cataract wasthe most important single cause (160 cases). Most of thecataracts were " senile." Opacities of the cornea were nextin frequency (157 cases), this being the chief cause of blind-ness in 49 cases arising from trachoma. In 151 cases blind-ness was attributed to lesions of the retina and choroid, recog-nised by ophthalmoscopic examination. Atrophy of theoptic nerve (132) was due certainly in 22 cases and probablyin many more to syphilis. In three cases it came from drink-ing wood alcohol, and in others probably. it is said, fromalcoholism and tobacco. There were 97 cases of glaucomanot sufficiently advanced to be classified under optic atrophy.Injury was the cause of blindness in 66 cases. high myopia

1 Amer. Jour. Ophthal., December, 1929, p. 965.

clearly the cause in 43 cases, and probably in others. Dr.Jackson concludes that the majority of eyes that becomeblind could have been kept with some sight by early propertreatment. The prevention of blindness, he says, depends on(1) securing good treatment at the earliest possible time;(2) ability of physicians to diagnose disease that may leadto blindness when the eyes themselves seem to be little ifat all affected ; (3) the understanding that diseases whichdo not usually affect the eye may in some cases cause blind-ness and need to be watched with this in mind ; and (4)the ability of oculists to recognise dangerous conditions andtheir willingness to make decisions and to operate whenblindness can only be prevented by prompt medicalintervention.

T.C.P.

A PREPARATION whose full style is Trichlorophenyl-methyliodosalicyl has been put on the market by BritishAlkaloids, Limited, 104, Winchester House, London, E.C., asa general antiseptic and germicide, while there is evidencethat as an electrolyte it has proved of value in the treatmentby ionization of cases of arthritis. The preparation istestified to by many members of the medical profession asbeing non-toxic and analgesic, and a useful application asgargle or spray in affections of the nose and throat, and as a

lotion in wounds and scalds as well as in eczema, chilblains,and haemorrhoids.

A UNIVERSITY IN THE CAUCASUS.

To the Editor of THE LANCET.

SIR,—On Jan. 12th, 1930, the Baku (now Azerbaidjan)State University will celebrate its first jubilee. Born in thethroes of civil war after the break-up of the old regime inRussia, this University has, during its 10 years of existence,become so bound up with the general and national cultureof the country that Azerbaidjan can hardly be imaginedwithout it. It opened with three courses in the medicalfaculty and the very beginnings of a philological faculty.Now there are the faculties of medicine, jurisprudence, andpedagogy ; there are 2300 students, and the University hasalready given 1300 doctors to the Republic. The teaching inthe faculty of pedagogy is in Turkish, whilst in the otherfaculties it is in Russian. The great majority of the scien-tific workers belong to the native population.The nucleus of the University was a small group of pro-

fessors, chiefly from the faculty of medicine (V. S. Razou-moffsky, 1. I. Shirokogoroff, A.A. Oschmann, A. M. Levin)and from the former philological faculty, who, with part ofthe students from the medical faculty left, for objectivereasons, the Transcaucasian University at Tiflis, in the fullassurance that in Azerbaidjan they would find the bestconditions for a continuance of their work. The prognosiswas correct ; at present the University is not only the culturalcentre of Azerbaidjan, but is becoming a centre for the wholeUnion of Soviet Republics. In the not distant future it willbe without doubt the vanguard of culture in the neighbour-ing countries of the East.

I am, Sir, yours faithfully,

Jan. lBt, 1930.I. SHIROKOGOROFF,

Professor of Morbid Anatomy.

OCCIDENTAL MEDICAL BOOKS TRANSLATED INTO

CHINESE.

Dr. Thomas Gillison is returning to China shortly at theage of 70, to continue his translation into Chinese ofmedical text-books. He is already responsible for thetranslation of Cunningham’s Practical Anatomy, Luff’sChemistry, and Mitchell Bruce’s Materia Medica. Dr.Gillison was from 1883 to 1918 principal of the LondonMissionary Society’s Hospital at Hankow, and then joinedthe staff of the Shantung Christian College Medical School,one of the chief medical training centres in the East. In1923 he returned to Hankow where he continued to workuntil his retirement last year. He holds the Chinese Orderof the Excellent Crop.

Erratum.—In the list of New Year Honours published inTHE LANCET last week the order conferred on SurgeonRear-Admiral Robert William Basil Hall should have beenrecorded as the C.B. (Military Division).

MANCHESTER YEARLY INQUESTS.—The number ofdeaths reported to the Manchester City coroner during1929 was 1368. Inquests were held in 452 cases. Motorfatalities amounted to 105, or 20 more than in the previousyear. In Salford last year 219 coroners’ inquests were held,and the largest number of them—42—concerned streetaccidents.