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already, whether the suspicion, when accurate, shouldbe confirmed. There are obvious disadvantages in abald statement of facts, and one should be guidedlargely by the history accompanying the case. A

newly married woman can acquire an acute infectionfrom a mild and almost forgotten gleet nearly asreadily as from an acute infection in the male.Similarly, women after childbirth, or when debilitated,may succumb to an infection which normally mightnot affect them. Again, a woman can harbour thegonococcus in the cervix, apparently for years, untilsome fortuitous circumstance precipitates an acutesalpingitis. Obviously, there are great difficultiesin apportioning blame in these circumstances, andno hard-and-fast rule is applicable. Legally, onlyevidence of the presence of the gonococcus in smear orculture can be accepted as a positive proof of thediagnosis, although it is well known that the organism icannot be isolated in a large proportion of genuinecases of gonorrhoea in women. The wise course,therefore, would be to treat the condition adequately,and, only if called upon, to pronounce definitely, afterbacteriological proof, on the nature of the disease.

SPRING TIREDNESS AS A VITAMIN-DEFICIENCY.IN a paper illuminated by some instructive statistics,

Dr. R. Ehrstr6m, of Helsingfors, has made out a casefor regarding spring tiredness not merely as a neurosis,but as an expression of vitamin deficiency. His firstgraph represents a study of the first attendancesduring 1921 and 1922 at the University Polyclinicin Helsingfors of patients whose symptoms were

exclusively or mainly characteristic of neuroses.

There were 3039 such patients whose first attendancesduring the 12 months of the year are mapped out inthe heavy line of the graph. It will be seen that. these

N= NEUROSES , , S= SUICIDES.

first attendances were most frequent in the spring-the period when general lassitude is most common.After midsummer the graph shows a rapid fall which,except for two slight interruptions, is maintainedtill the end of the year. The dotted line represents themonthly incidence of the 5471 suicides committed inFinland in the period 1851-1907. It will be seen ata glance that the profile of the two lines is remarkablysimilar, and Dr. Ehrstrom suggests that this similarityis due to identity of the factors responsible for both.Their height towards midsummer might suggest tothe casual observer that the sunlight and warmth of the iearly summer had exercised a deleterious effect on thestability of the nervous system, but this is an explana-tion which Dr. Ehrstrom does not accept. Theincidence of neuroses between April and August andbetween October and February was as 9-1 to 7-2, and,in the case of suicides, as 10-1 to 6-5, and these differ-ences were, in his opinion, a matter of accessory foodsubstances or vitamins. The good effects of an adequatesupply and the ill-effects of an inadequate supply ofthese substances would seem to be comparatively slowin showing themselves. In the spring, and even in

1 Finska Läkaresallskapets Handlingar, 1924, lxvi., 210.

the early summer, the inhabitants of Finland stillsuffer from the inadequacy of their vitamin suppliesduring the winter, and the good effects of an adequatesupply of vitamins being also tardy, December findsmost persons in Finland still enjoying the benefitsof the short summer of Northern Europe. As Dr.Ehrstrom puts it:

" We are well in the autumn afterthe light and open-air life of the summer, and we feelunwell in the spring after the darkness of the winterand a sojourn within four walls. Welive, so to speak,in the autumn and winter on the stored-up light of thesummer." The fact that animal life in general suffersfrom the same handicap as human beings in thismatter prevents the inhabitants of Finland frommaking good the shortage of vitamins in the vegetablekingdom by living on the animal kingdom and itsproducts. Dr. Ehrstrom’s study and the conclusionhe draws from it, although going at present a littlebeyond the facts submitted, certainly stress the valueof the accessory food substances and the importanceof agencies such as sunlight., for which we have onlyimperfect substitutes. Let us hope that we may be ablein the future to bottle and tap such substitutes at ourown free will, regulating them with the precision ofthe gardener whose reservoirs of water enable him toregard with equanimity a persistently cloudless sky.

MEDICAL EXAMINATION OF FACTORYENTRANTS.

THE Association of Certifying Factory Surgeons hasissued a report in which adverse comment is madeupon the findings of the Home Office Committee onthe medical examination of young persons for factoryemployment. These findings, which were brieflystated in our issue of May 24th, are important in thatthey deal with the very basis of factory medicalservice, and are concerned with the examination ofover a quarter of a million juveniles every year. Boththe report of the Association and the findings of theCommittee agree in holding that at present all is not asit should be. Many of the criticisms in the reportseem to us to be well founded, and they cannot bereadily put on one side, as they express the opinion ofthose practically acquainted with the present position.Perusal of the findings of the Committee and of thecomments of the Association leaves an uncomfortableimpression that the Home Office Committee have beenmore concerned with deciding what department shouldcontrol the work than with making the work reallyeffective. In their short and hurried existence theydid not delve deep or consider the fundamentalquestion how to apply the principles of public healthmedical service, as undertaken by local authorities,to our factory organisation. The Ministry of Healthcalls upon local authorities to carry out certainmedical duties, the Ministry bears a proportion of theexpenses incurred, while it leaves to each authority freechoice of medical personnel for carrying out the duties.Local authorities appoint for themselves the doctorwho is to inspect their children at school, and who,able to obtain advice from medical experts at head-quarters, becomes a trusted adviser on all mattersconcerned with the health of the local school popula-tion. So it is with other branches of the public healthservice which relies essentially on local acquiescencein sound advice rather than upon compulsory action.This method, for various reasons, has not beenfollowed in factory medical service. Here the factorypresents a new grouping of the population, whichshould, like the locality, have free choice of its medicalservice. But, in fact, the appointments have beenmade in London, the fees to be paid have been fixed inLondon, and revision of the appointments has notbeen a habit at headquarters. Hence, the factoryowner has come to regard the certifying surgeon moreas an interfering outsider than as a useful friend.The wonder is not that factory medical service isunsatisfactory, but that it is so little unsatisfactory.This it owes to our national capacity for service evenwhen badly organised. The question is whether thetime has not come to revise the factory service on the