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far we believe the British administration must bearits share of the discredit. The official efforts that havebeen made to improve maternity conditions have inthe past been mostly feeble and sporadic. In the lasthalf century, however, some significant changes have eoccurred, in this as in other social departments. TheParsees of Bombay are, of course, not actually Indianin origin, but they have assimilated many Hinducustoms, and their communal life is still largelydominated by a comparatively illiterate priesthood.In spite of this, however, and the violent oppositionhe at first encountered from a large proportion of hiscompatriots, the campaign initiated by Sir TemuljiNariman, M.D., for the introduction of modernmaternity measures, has long ago been brought to atriumphant conclusion, and the Parsees, who used tobe as archaic as the Hindus in this respect, have nowas good obstetric facilities as any community in theworld, and make use of them to the full. This advancecould not have been made without a parallel introduc-tion of education, particularly for the women, andMiss Rathbone justly observes that this is thefirst and most pressing need of India. Alongwith this general educational movement must gothe supersession or training of the dais. It hasbeen the fashion until recently, particularly amongstthe medical profession, to contend that the attemptto make them into responsible assistants to dealwith the dai is hopeless. We think this viewis wrong. India, in spite of the legendary pagodatree, is a poor country, and to wait for an ade-quate supply of midwives trained on conventionallines would be to wait for a very long time. The daiis an awkward problem, but experimental schemes ona small scale have lately shown that it is not impos-sible to persuade her to undergo short courses ofpractical training which, in successful cases, converther from a deadly menace into a useful adjunct ofvillage life. Rural midwifery presents a task whosevery fringe the regular nursing profession will neverbe able to touch, and the regularisation of someinferior maternity agency, such as the dai.<;, is evenmore necessary than the provision of elementarymedical aid in the smaller villages, where fullyqualified doctors are not available. The establish-ment of infant welfare centres in the larger towns hasalready done much to open up the allied question ofantenatal instruction and to supplement the work ofthe hospitals as regards infants and young children,and the same principle might with advantage beextended to the districts, where it would be a valuablereinforcement to the existing medical agencies.

OPERATION FOR CONGENITAL STENOSIS OF

THE BILE-DUCTS.

WHEN there is congenital abnormality of the bile-ducts the smallness of the structures involved and theassociated jaundice have usually deterred surgeonsfrom operating, and comparative failure seems to haveattended the efforts of those who have made theattempt. But a fresh stimulus to the surgical treat-ment of this condition is given by the work of W. E.Ladd,’ of Boston. He operated on 11 out of a seriesof 20 children with narrowing of the ducts, and foundthat eight were suitable for surgical treatment, sixof whom recovered. These six include one infant of3 months with atresia of the common duct, for whichcholedochoduodenostomy and cholecystostomy wereperformed ; one of 5 months with the same abnorm-ality which was cured by cholecystgastrostomy; one

of 3 months with stenosis of all three ducts, successfullytreated by cholecystostomy and dilatation with aprobe ; and one of 4 weeks in which obstruction ofthe common and cystic ducts was relieved in the sameway. In the other two cases partial obstruction of thecommon ducts was satisfactorily treated by chole-cystduodenostomy, but the patients were 5 years old,and the condition hardly seems to deserve the term

1 Jour. Amer. Med. Assoc., 1928, xci., 1082.

congenital stenosis of the bile-ducts as it is understoodin the literature. As Ladd remarks, both the natureand degree of abnormality vary considerably, so thatdifferent operations are necessary in different cases.For small infants with an obstructed common ducthe recommends anastomosis of the common duct tothe duodenum over a catheter, pointing out thatintroduction of a catheter into the duodenum throughthe gall-bladder and common bile-duct is an importantpart of the technique, as it ensures patency of theanastomosis which is otherwise difficult to obtain onaccount of the smallness of the structures. He thinksthat operation is desirable as soon as the diagnosisseems reasonably certain, before there is wasting orconcurrent disease, and he says it may be undertakenwith expectation of success in any case in which eitherthe common duct or the gall-bladder has a patentconnexion with the liver. Only those who have seensuch cases in life and examined the structures atautopsy can fully realise the technical difficulties ofthe operations which he advocates. But the fact thatinactivity means certain death, while interventionevidently can be successful, undoubtedly justifies hisplea that it should be tried more often. It will beinteresting to learn the subsequent history of the casesoperated on successfully.

THE &AElig;TIOLOGY OF PELLAGRA.

IT is now more than a year since the fact wasestablished that vitamin B is a dual entity, of whichone part only, now called vitamin B 1, representsthe previously recognised antineuritic or anti-beri-beri factor. The two factors have a somewhatsimilar distribution among foodstuffs, and yeast isparticularly rich in both. Since yeast in some formhas been almost universally used as the source ofvitamin B in dietary experiments, it has come aboutthat nearly always the two factors have inadvertentlybeen given together. The second factor, vitamin B 2,has been further protected from discovery by thecircumstances that, in experiments on the rat,when both factors are withheld the animal alwayssuccumbs first to the neuritic symptoms, and diesbefore any sign of the second syndrome has time todevelop. In other words, the reserve of vitamin B 2always outlasts that of vitamin B 1, when neithervitamin is offered in the food. H. Chick and M. H.Roscoe found, last year, that an alcoholic extractof yeast, in which vitamin B 1 alone is present,cures the neuritic symptoms and keeps the rat aliveuntil the second deficiency has time to manifest itself.The latter is marked by ophthalmia and skin symptoms-i.e., loss of hair and a characteristic dermatitis onpaws, ears, and neck. The most interesting featureof the discovery lies in the identification, .by J.Goldberger 2 and his colleagues, of this syndromewith the well-known disease of pellagra. Theyhave proved that pellagra in man may be cured andsubsequent relapses prevented by the administrationof dried brewers’ yeast, as well as by a number ofother foodstuffs. They used a commercial prepara-tion of the Harris Laboratories, Tuckahoe, N.Y., atfirst in a daily dose of about 50 g.,3 but later 15 g.was found sufficient.4 4 In the outbreak of pellagrawhich followed the deprivation caused by the Missis-sippi floods,5 yeast was prescribed as the routinetreatment, with canned salmon, beef, or tomatoes asan alternative. The aetiology of pellagra is not,however, completely cleared up by these experiments,since the exact relation of pellagra to maize-eatingis not yet fully established. The disease occurs ona large scale entirely in maize-eating countries, butit is not yet known whether the whole maize grain ispellagra-producing or whether only a certain fraction,

1 H. Chick and M. H. Roscoe : Biochem, Jour., 1927, xxi., 698.2 J. Goldberger and R. D. Lillie: U.S.A. Public Health

Reports, Washington, 1926, xli., 1025.3 Goldberger and W. D. Tanner- Ibid., 1925, xl.. 54.4 Goldberger, G. A. Wheeler, Lillie, and L. M. Rogers : Ibid.,

1926, xli., 297.5 Goldberger and E. Sydenstricker : Ibid., 1927, xlii., 2706.

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left after milling, is responsible, as in the relationbetween rice and beri-beri. It should be easy toascertain whether vitamin B 2 is present in maize,before and after milling. It is curious that somemaize-eating communities, such as certain nativesof South Africa, do not suffer from pellagra.The explanation of their immunity remains to beworked out; it may be traceable to a differentprocess of milling. Whatever the exact circumstancescontributing to its causation, the prevention of pellagrain man is in sight. The disease, like beri-beri, will bestamped out as soon as it is realised that it is pooreconomy for a State to allow its citizens to suffer froma disease which can be avoided by the provision of amore adequate diet.

BAYLISS-STARLING MEMORIAL FUND.

MANY of our readers will remember that an appealwas issued last year (see THE LANCET, 1928, i., 718)for subscriptions to provide a memorial to thelate Prof. Sir William M. Bayliss and Prof.Ernest H. Starling. We learn that the results ofthis appeal have been such as to enable the committeeto fulfil the objects which they had in view. Thesum collected will, apart from subscriptions whichare still arriving, amount by the end of January tosomething over .62600. Large contributions havebeen made by physiologists abroad, particularlyin America and Germany, and from many distin-guished members of the practising side of the medicalprofession. The Memorial Fund Committee wishesit to be made known how the sum raised will bedisposed of. A small part of it has been employed ’,in the preparation of a simple memorial tablet inbronze. This, which has been designed by Prof.A. E. Richardson, F.R.I.B.A., bears the words :&mdash;

WILLIAM MADDOCK BAYLISS, F.R.S.1860 1924

ERNEST HENRY STARLING, F.R.S.

1866 1927

It is proposed to erect it in the entrance-hall of thedepartment in which they spent so many fruitfulyears, where it will occupy a suitable place abovethe bust of William Sharpey. Most of the money,however, will shortly be transferred to the Universityof London to be held in trust for the creation of aBayliss-Starling Studentship, the object of whichwill be to enable a selected graduate in science, orgraduate or undergraduate in medicine, of suitablestanding, to spend a year or more in acquiring aknowledge of physiology and biochemistry prepara-tory to commencing research work in that subject.

ULTRA-VIOLET LIGHT IN MENTAL HOSPITALS.

IT has become the custom to regard the provision Iof ultra-violet ray apparatus as a sign of progress inmental institutions, and to assume that committeeswhich have the welfare of their patients at heartwill add this form of therapy to their equipment.Its use is, however, still limited, as shown by therecent inquiry of the Actinotherapy Subcommitteeof the Royal Medico-Psychological Association. IA letter addressed to 200 mental hospitals elicited47 replies, from which it was learned that 16 institu-tions had ultra-violet apparatus and eight more

hoped to have it soon. The discussion on the subjectat the Section of Psychiatry of the Royal Society ofMedicine on Jan. 8th showed that the medical staffof mental hospitals who have had actual experienceof " artificial light " are convinced that it is justified.If there are any to whom irradiation ht-s proved itselfa failure, they did not attend to put their experiencesbefore the meeting. With certain reservations as toselection of cases and administration by experiencedphysicians-reservations which apply to this treat-

ment in all forms of disease-the psychiatrists presentagreed that real benefit had been obtained by theirpatients. Dr. Dove Cormac reported, on four years’experience of ultra-violet light at Parkside MentalHospital, that the patients had shown a markedincrease of body-weight, improvement in appetite andmuscular activity, a slight average decrease in bloodpressure, and distinct exhilaration. He held that,while the treatment was bad for hyperthyroidism andmelancholia with agitation, it undoubtedly curtailedthe depressive period in the manic-depressivepsychosis, benefited mild melancholia and anergicstupor, and rendered the delusional patient moreamenable and his delusions less dominant. He hadfound the carbon arc better than the mercury-vapour lamp. With his conclusions Dr. A. C.Hancock, of Barming Heath, agreed, laying par-ticular stress on the value of local applications forseptic foci. Sir Henry Gauvain gave an interestingaccount of the effects of heliotherapy at Alton on theminds of disabled children. Marked improvementwas observed both in " mental age " and in cheerful-ness. Dr. G. de M. Rudolf, of Claybury, sounded awarning note by exhibiting a weight chart extendingover several years and showing periodic rises. Hadonly a small part of this chart been available, one ofthe rises might well have been attributed to theultra-violet light treatment.

Another aspect of the problem was stressed byDr. R. Bourdillon, who pleaded for " more light andless invisible radiation " in actinotherapy. TheSeptember midday sun in temperate latitudes atsea-level gave half a gramme-calorie of visible lightper square centimetre per minute, whereas a patientstanding three feet away from a mercury-vapourlamp received only one-hundredth of a gramme-calorie. Therefore 15 minutes of a mercury-vapourlamp was in this respect equal to 18 seconds ofSeptember sunlight. He urged that exposure tothe mercury lamp should be called ultra-violettreatment and not light treatment. The carbonarc approaches more nearly to sunlight, but variesenormously according to the particular electrodes andother factors. Very little is known, continued Dr.Bourdillon, of the effects of ultra-violet rays, becausethey have so seldom been administered unmixed, butthey certainly lead to the production of antirachiticvitamin D and they burn the skin. The vitamin Dcan be much more cheaply and easily provided by theoral administration of irradiated ergosterol, whilethe value of burning is difficult to appraise in generaltreatment though incontestable in some skin diseases.The visible and near infra-red rays certainly pene-trate more deeply. The magnificent results of helio-therapy in surgical tuberculosis are undoubted, buthere the effects of ultra-violet rays have not yetbeen accurately distinguished from those of otherfactors such as cold air. There was reason to fearthat the great utility of ultra-violet radiation insome diseases had caused undue neglect of the evengreater value of radiations of longer wave-length forgeneral treatment. Dr. W. A. Potts admitted in thediscussion that he had obtained very much betterresults in hospital patients than in private patients.and he ascribed this to the fact that light treatmentin a hospital was a kind of social outing. The nervouspatient was reassured by the " old hand," and theparticularly depressed patient was always put nexta cheerful one. Dr. Albert Eidinow pointed outthat the mercury-vapour lamp was designed expresslyfor acute and subacute disease, to produce a rapideffect and the maximum change in the blood, andthat these diseases could not be treated with lampsthat gave out a great degree of heat. In mentaldiseases, as he said, we have a totally differentproblem and need quite different radiations. Thechronic case calls for longer radiation and heat, apleasant, warm, practically non-erythema-producinglight, perhaps best supplied by a very powerfultungsten filament.

There is clearly a difference in outlook betweenthe physician whose object is to improve the health