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likely to be reconciled by intervention from without. Lord DAWSON and Lord MOYNIHAN are unquestion- iably right in saying that the duty of institutingsuch an inquiry belongs to the medical professionitself. Doubts which have been raised as to thedisposal of funds by the Radium Commission, andthe competence of the Commission itself, could beset at rest by a public inquiry, if they had notalready been set at rest by simpler means. Butthe ascertaining of clinical and experimental facts,the pooling of experience, and the weighing ofconflicting views are the only bases of reconciliationand future action. These are the task of medicine.

RHEUMATIC INFECTION IN CHILDHOOD.IN Cardiff C. J. MCSWEENEY 1 finds that the

incidence of rheumatic carditis is 5’8 per 1000 ofthe elementary school population, while W. G.SAVAGE has estimated the incidence in Bristolat 7°7. The average figure for the counties roundBristol was in the neighbourhood of 2 per 1000,and this strongly suggests that there is some factorin urban life which plays an important part inrheumatic infection. MCSWEENEY notes that over66 per cent. of the cases occur in the cold wetmonths of winter and spring, and that in over73 per cent. the disease comes on between the

ages of 5 and 10. There was no appreciable asso-ciation of rheumatism with damp houses, dentalcaries, state of the tonsils, or frequency of sore-throats. Cardiff is fortunate in having specialhospital accommodation for these children, andit appears that at least one bed for every 1000 ofthe school population is needed for their efficienttreatment. The value of this hospital treatmentis shown by the fact that, in the period reviewed,of the total 222 children admitted only 29 hadnormal hearts, but 135 were discharged with nodemonstrable cardiac lesion. Incidentally it wasobserved that children treated in open-air sheltersimproved more rapidly and relapsed less oftenafter discharge than those who slept indoors. TheCardiff experience also supported the opinion thattonsillectomy does little to prevent the onset ordecrease the relapses of rheumatism in childhood.

Six hundred of the Cardiff children were groupedaccording to their social status in an attempt toassess the significance of gross environmentalfactors in the aetiology of the disease. It wasshown once more that rheumatic children are

seldom met with in well-to-do homes, and alsothat the incidence is greatest not among destituterecipients of public assistance but among thosewho, without actually suffering privation, have astruggle to make ends meet. That rheumaticinfection may occur amongst public school-childrenis shown by W. H. BRADLEY, who has latelyrecorded 3 two epidemics in a public school. These

epidemics were closely associated, and ran parallelwith epidemics of sore-throat due to a bœmolyticstreptococcus. The rheumatism followed the naso-pharyngitis, when this was recognisable, after an

1 Arch. Dis. Child., December, 1931, p. 367.2 Interim R port of Inquiry in Gloucestershire, Somerset, and

Wiltshire. Brit. Med. Jour., 1931, ii. (Suppl.. p. 37).3 Quart. Jour. Med., January, 1932, p. 79.

interval, in the way described by B. E. SCHLESINGERand W. SHELDON, which is held to suggest an allergicstate. In the two epidemics different strains ofstreptococcus were isolated, and the sore-throats.which they produced were distinct in their clinicalappearances. BRADLEY therefore agrees withSHELDON that while rheumatism itself is notinfective the preceding nasopharyngitis, whichsensitises the patient, probably spreads as a

droplet infection.A difficulty that confronts all students of

rheumatic carditis is how to know when the

patient may safely be released from active restraint.and allowed to return, partially at any rate, to anormal life. This is largely dependent on thequestion, not yet definitely answered, whether the-morbid process is a drawn-out smouldering infec-tion like tuberculosis, or consists of a series of-

relapses with cessation of activity in the interval.White blood-cell counts have in general provedof little value in determining the activity or other-wise of the disease, but in our issue of Jan. 9thW. W. PAYNE and also F. BACH and N. GRAYHILL showed that the sedimentation rate of the-blood may be useful in this respect. A raised

pulse-rate has long been regarded as an indicationof a progressive cardiac lesion, but since the pulse-rate is easily affected by purely psychic factors itsvalue as an index of activity is largely vitiated.SCHLESINGER 4 has tried to get over this difficultyby studying the pulse-rate during sleep. He findsthat the normal sleeping pulse-rate is on the average10 lower than the " alert " rate. From his studyhe believes that if the sleeping pulse-rate is raisedand approximates to the alert rate so that thenormal difference is abolished, we have an indica-tion of active carditis. Even if this difference isabsent, a sleeping pulse-rate persistently abovenormal is in his opinion strongly suggestive ofactivity.

THE LONDON CLINIC AND NURSING HOME.

IT has often been pointed out that the mostmodern and elaborate equipment for the treatment,of disease is available in this country only for therpoor and the rich. But though the rich can obtainthe advantages, the different branches of treatment.are never found under one roof. While an expensivenursing home may offer a comfortable room, a.

good cuisine, first-class nursing, and an up-to-datetheatre, the pathological investigations will have-to be made somewhere else and usually the X rayexamination somewhere else again, while consul-tants who have equipped themselves with special’diagnostic apparatus may have to be visited in

yet other neighbourhoods. Even the very richfind the procedure dear. It is the object of the-promoters of the London Clinic and Nursing Home,which was opened by the Duchess of YORK lastweek, to provide fuil facility for the diagnosisand treatment of disease under one roof and at a

price which the middle class can afford.The great building at the north end of Harley-,

street and Devonshire-place claims to be, in design4 Ibid., p. 67.

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and scientific equipment, the perfect nursing home,with all the resources of a modern hospital. It isrun by a board of directors for profit, but thewishes of the medical staff will, it is understood,be paramount, in respect of the interests of theircharges. The chairman is the Duke of ATHOLLand the house governor is Sir ERNEST MORRIS,well known as the director of the London Hospitalfor many years. Thirty-six consultants form whatis known as the " medical group." Each of themhas a consulting-room and an office in the building ;these they rent from the directors in the ordinaryway, and they have first call on the beds. TheDuke of ATHOLL, however, pointed out in his

speech at the opening that the clinic is not a" tied house " but that any member of the medicalprofession can secure a bed for a patient if he wishes.When the clinic is full there will be two residentmedical officers, but any general practitionerwhose patient enters the clinic can continue to

attend, together with the consultant of his choice,as in an ordinary nursing home, except that theuse of the operating theatres is limited to surgeonson the staff of recognised teaching hospitals.Every nurse on the staff is State-registered and theporters and attendants are all ex-Service men

personally selected by the chairman ; and the chefcomes, we learn, from a well-known restaurant.The pathological and radiological departments arerun by a separate company formed by the medicalgroup. Beyond a moderate interest on the moneysubscribed, all profits will be devoted to improve-ment of equipment and the reduction of fees topatients of the clinic who cannot afford the ordinaryrate. Only members of the group will have the

privilege of obtaining reduced rates for thoseunder their care who cannot afford the customaryrates, which will always be charged to any outsidepractitioners who make use of the laboratories.The building occupies a site of two and a half

acres and has cost over £430,000. The rooms aredistributed over ten floors and there is nearly amile of rubber-paved corridors, all of which are

lit by a system of glass-fronted alcoves ; hungacross every corridor there is a glass sign-boardbearing the name of every member of the staff,so that when he is wanted his name can beilluminated in all parts of the building. Nearlyall the patients’ rooms front on to the courtyard,so that they are as far as possible from streetnoise. Where necessary, double windows are

provided, and the problem of vibration has beenovercome by padding the steel foundations withheavy felt. Every room has its own hot and coldivater-supply, telephone, bathroom, and lavatory,and all the furniture is of walnut or African

mahogany covered with cellulose, so that no

polishing is needed. Each bed has a three-buttonswitch beside it, so that the patient can press ared light to indicate that he wishes to be leftquiet, a blue light when he wants to call a nurse,and a green light when he wants to call a maid. *These lights shine outside in the corridor and alsoshow a small tell-tale light in the room to assurethe patient that his apparatus is working. Thereare no bells or buzzers. One floor is to be devoted

, to children and another to dietetic cases, whilethe seventh floor is for maternitv and includes

: two special labour rooms and a roof garden for thebabies. On the eighth floor are the seven operating

. theatres, including a dental theatre and an ear,, nose, and throat theatre. Each is equipped with

sterilising, lighting, and ventilating apparatus,not of any predominant British production.The cheapest room is priced at eight guineas a

week, and the " luxury suites," at thirty-five guineas,include a second room for a relative or maid and a

nicely furnished sitting-room. " This," said LordMOYNIHAN at the opening, " is a new venture,a venture fraught with the deepest significance

, to the profession and to the public ... a clinic tosatisfy the most fastidious demands." The LondonClinic should offer unusual opportunities for tea.mwork among specialists, and for the collection of

, statistics.

A SCHOOL HEALTH SERVICE.IT was the tragedy of Dr. Parlane Kinloch’s career

that he just did not live to see the larger fruits ofhis administrative genius. His own department wasstrengthened and remodelled but the time was too

. short for the close appreciation of the difficulties of

, medical men and other health workers in the field, whichwas his special gift, to take full effect. In a letter toSir Arthur Newsholme, written a day or two beforehis death, he admitted that his review of the healthservices with reference to efficiency and results wascompelling him to the conclusion of the need fordefinite reorientation. "At this stage," he wrote,

’ " I would illustrate my point by reference to anyone of our services, say, the school health service.

! At the initiation of the service, I think we all generally! took the view that, with a system of periodic examina-

tion of school-children, we should be able to detectdivergencies from health and minor and major defects,the correction of which would prevent the develop-ment of more serious disease. The defects thrownup by the school health service are, in order of fre-quency, carious teeth, diseased tonsils and adenoids,enlarged glands, rickets, discharging ears, &c., andit is obvious that these conditions are either thelate, and in some cases, the irreparable effects ofmalnutrition or the end-products of earlier infectiousdiseases, including catarrhal and respiratory infec-tions. In other words, routine inspection is revealingconditions that cannot properly be remedied as

detected, and it would appear that we must go muchfurther back and secure the adequate nutrition ofthe expectant mother and of the infant and growingchild in its earliest years ; we must improve the diet,to increase resistance to the infections whose end-products are revealed by school health inspection ;and we must provide a medical service that willdeal with infections in their earliest stages and soby early and intensive treatment prevent complica-tions and sequelae. The school medical service,"Dr. Kinloch went on to say, " yields no evidenceof the incidence of morbidity in child life. Whenevera child becomes ill, it disappears from the schoolhealth service and comes under the care of the familydoctor.‘’ And he concluded with the pregnantremark : " It seems to me that we shall have toswing the whole service into the hands of the generalpractitioner and concentrate on fitting him to dis-charge the functions that this proposal requires ofhim."