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in America. Statistics of this sort are admittedlyunbiased, and their accuracy will not, of course, bedisputed. But what is by no means equally evidentis the soundness of the conclusions founded onthem by the advocates of total abstinence. In an

article published in the A1nerican Uytder°un°iterfor July, 1913, and now issued in pamphletform/ Mr. Phelps, the editor of that journal, iand a well-known authority on insurance questions,draws attention to what he very reasonably regardsas the most serious source of fallacy in this

particular statistical argument-namely, the possibledifferences in other respects besides drinkinghabits between the contrasted groups of abstainersand non-abstainers. As supporting his criticism,he quotes the results of an investigation carriedout by Dr. Dwight, medical director of the New

England Mutual Life Insurance Company, whofound that total abstinence from tobacco appearedto have almost exactly the same relation to

longevity as total abstinence from alcohol. Thisfact suggests the need of extreme caution before weassume that the lower mortality of total abstainersis wholly due to their avoidance of alcohol.

Possibly we should be nearer the truth in adoptingthe view put forward tentatively by Mr. Phelps thatabstainers, whether from alcohol or from tobacco,are as a class of somewhat different type or liveunder different, and on the whole less strenuous,conditions as compared with the general run of

persons who indulge in these luxuries. At all

events, it is clear that insurance statisticscannot be regarded as furnishing any legitimateground for the assertion that the moderateuse of alcohol is injurious to health, and the

attempt to represent them as proving such a

statement can only do harm to the cause of truetemperance. ____

SKIAGRAPHY OF THE FALLOPIAN TUBES.

THE investigation of the ureter and pelvis of thekidney by means of X ray photographs followingthe injection of silver salts (collargol especially) isso successful and so generally practised byurologists that the extension of the same principleto the Fallopian tube must have occurred to

gynaecologists as practicable. Dr. W. H. Cary, of

Brooklyn, has carried out the idea, and reports hisexperience in the March issue of the AmericanJounwl of ObstetriC8. In a patient who complainedof continuous pelvic pain without any gross physicalsigns to account for it he injected 10 c.c. of collargolsolution through the cervix under anaesthesia. Hethen opened the abdomen and found the solutionoozing from the right tube, but none flowing fromthe left one. After freeing some adhesions thelatter was removed; it appeared to be normal untildissected afterwards, when it was found to be com-pletely occluded near the uterine end. Thisocclusion was well shown by the X ray photo-graph taken just before opening the abdomen. Itis clear that this method, if it proves to be safe,may influence very markedly the diagnosis of thecause of sterility and its treatment in cases

where Fallopian obstruction is shown to exist.The process is contra-indicated whenever recent

pelvic inflammation or any form of infectionexists. Dr. Cory suggests that at least threemonths of freedom from acute inflammatory

1 The Supposed Death-rates of Abstainers and Non-abstainers andtheir Lack of Scientific Value. By E. B. Phelps, M.A., F.S.S. NewYork: Thrift Publishing Company. 1913. Pp. 30.

symptoms should elapse before undertaking it.

Retro-displacement of the uterus or prolapseof the adnexa may cloud the picture; theformer should be corrected before the injectionis made. The patient is placed in position withthe X ray apparatus and plate all ready for action.By speculum and tenaculum the cervix is exposedand steadied. A glass intra-uterine instillation tubeis passed through the os, which it should fit

closely; the silver solution is then slowly injectedand the skiagram immediately taken. The averagecontent of the uterine cavity is stated at eightminims. It remains to be seen whether this pro-cedure is free from risk, and also whether thecollargol has any beneficial action on tubal in-fections.

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THE VICTORIA HOSPITAL, BLACKPOOL.

THE regrettable dispute between the medicalmen at Blackpool and the board of management ofthe hospital appears to be no nearer a settlement.The circumstances out of which it arose were

described in THE LANCET of March 21st, p. 867.Since then, at the annual meeting of donors andsubscribers to the hospital, after a prolonged dis-cussion a resolution, based upon a suggestionof Dr. T. Carr, was carried unanimously to theeffect that the medical men of the town should

appoint a committee of six to explain whatreorganisation and changes the medical prac-titioners would be prepared to accept. At a

subsequent meeting, however, of the medical

profession practising in the- town it was resolvedto forward a letter to the board stating that untilthe medical men’s demands for two seats on the

board, for the resignation of the matron, and for theresignation of a medical practitioner still on theboard were complied with, the medical men refusedto meet the board. The letter was forwarded, andin reply the board has stated that the matron hasresigned and that the board has received her

resignation with regret, but that the board has nopower to comply with the request for two seats, asits members are appointed by the donors andsubscribers. The medical member of the boardwas appointed by the donors, and the boardhad, they said, no power to call for his resigna-tion even if it wished. It would seem, and it isa matter for extreme regret, that a deadlockhas arisen without full discussion and at a pointat which discussion might have resulted in a wayout of the difficulty being found. That the difficultyis one not easily to be arranged, even after eachside has had the opportunity to express its views, isonly too evident. The medical men on the oneside possess full sympathy not only from themembers of their profession, but from a largesection of the lay public. They are seekingnothing for themselves, but primarily have

espoused the cause of two nurses whose treat-ment meted out to them by the board, underthe immediate observation of the medical staffof the hospital, has appeared to that staff to beharsh and unjust. It may here be said that fromall accounts of that treatment which have beenmade public it was such as might well justify theattitude of the medical men, and it must be remem-bered that, whatever there was in the conduct ofthe nurses which the board resented, the disputearose out of complaints with regard to the

feeding of the nursing staff, as to the justiceof which the medical staff was well able to

1129

form and express an opinion. Again, in con-

nexion with the constitution of the board, themedical men of the town are certainly en-

titled to hold opinions, and to have those

opinions carefully and sympathetically weighedby the subscribers to the hospital. At thesame time, a board may naturally hesitate to admititself at the outset of a discussion to have been

wrong in the initial stages of the matter to bediscussed. The affair has reached a stage at

which every attempt should be made to bringabout a settlement, and, if this cannot beobtained by the parties meeting, it may be sug-gested that they should refer their differences toarbitration. It should not be difficult, or at

any rate not impossible, to find persons of

experience in hospital management absolutelyindependent of local prejudice or interest, andhaving the necessary judicial qualities, who wouldbe willing to give careful hearing to both sides,and be able to decide in the best interests of the

hospital what the future constitution of its boardshould be-and this may now be regarded as theessential matter in dispute. A pronouncementas to the incidents which have been referred to inconnexion with the nursing staff could be added.It would, however, be necessary for both sides toagree to abide by the arbitration.

A NEW CUTANEOUS REACTION IN PREGNANCY.

IT is now generally recognised that the process ofgestation is associated with general changes in theorganism as well as with the growth of the foetusand the local alterations in the uterus. It hasbeen proved that some of the glands with internalsecretions show definite histological changes, andnumerous observers have found that in pregnancyprotein substances foreign to the normal blood arein circulation. Abderhalden has further provedthat the organism produces defensive ferments tobreak such proteins down. He has applied thisobservation to develop a test for pregnancy, whichis at present on its trial. The idea occurredto Dr. Ernest Engelhorn, of Erlangen, that it

might be possible to demonstrate the presenceof these substances by inoculation, on the

analogy of the tuberculin reaction of von

Pirquet, the luetin reaction of Noguchi, and thetrichophyton reaction employed by dermatologists.As a consequence he has made some observationsin collaboration with Dr. Hermann Wintz, and theseare published in an interesting preliminary notein the .MMMCeMe/’ .Mecli,2’inische Woclzezzsclz7v,ft ofMarch 31st. Starting with the assumption thatmaterials from the placenta must enter into thegeneral circulation of the pregnant woman, theyhave prepared a placental extract to which theygive the name

"

placentin." They do not give thedetails of its preparation, but simply state that it isa somewhat complicated process and that they areengaged in experiments with a view to its simpli-fication. They have used this substance exactly inthe same manner as tuberculin is employed in vonPirquet’s reaction. The site of inoculation isinspected at 12, 24, and 36 hours afterwards. A

positive reaction consists in an inflammatoryswelling and reddening of the inoculated areas,with a light brown staining around them. In

every case two places were inoculated withthe placentin, a third line being simplyscratched with the lancet as a control. Incases showing a positive result the reaction

is usually most distinct after 36 hours. In 70pregnant women the test was positive in everycase, the pregnancies being of all stages from thesecond month to full term. The reaction wastried in 54 non-pregnant patients, includingchildren and 13 men. In all adult persons it

gave a negative result, save that in threewomen who were inoculated very shortly beforethe expected onset of the period a slight irrita-tion of the inoculated area occurred, but so

slight that in comparison with the reaction inpregnant women it could only be called negative.Dr. Engelhorn and Dr. Wintz point out that thisresult may be of some interest in the light of therecent observations of Kjaergaard to the effect thatbefore the period there is an increase in the pro-teolytic power of the blood serum in women, andthat the serum under these conditions may give apositive Abderhalden’s pregnancy reaction. One

peculiar result was obtained with the inocula-tions of placentin, in the case of a child, aged6 years, with an affection of the bladder, thereaction being positive. The authors are now

engaged in further investigations. They make noclaim as yet for the practical value of their reactionas a diagnostic measure, but hold that it is at leastof theoretical interest. It is, further, of some

significance that very shortly after parturition a,

negative result is obtained.

THIRD INTERNATIONAL CONGRESS ON DISEASESOF OCCUPATION.

THIS Congress will be held in Vienna from

Sept. 21st to 26th, and the arrangements in con-nexion with it are now being rapidly completed.In our own country a very powerful committee hasbeen got together for the purpose of obtaining con-tributions and promoting efficient representation atthe deliberations. The Home Secretary, the

Right Hon. R. McKenna, is Honorary Presi-dent ; Sir Thomas Oliver, President; whilst themembers are Sir John Collie, Sir ThomasFlitcroft, Professor John Glaister, Professor SheridanDelepine, Professor Eurich, Dr. H. LangleyBrowne, Dr. J. Hedley, Dr. J. Dallas Pratt, Dr.W. Hamilton, Dr. F. Shufflebotham, Dr. HerbertJones, Dr. C. H. Milburn, Dr. T. D. Lister, and Dr.R. W. Edginton. Dr. T. M. Legge is chairman ofan executive committee, to which Mr. W. F. Deardenis acting as honorary secretary. The Home Officewill be represented at the congress by Dr. Legge,and various medical associations have intimatedtheir intention of sending delegates. Discussionswill take place under eight separate headings, andpapers which come within the scope of any of theseare cordially invited. They are: (1) fatigue ; (2) workin hot and humid atmosphere; (3) industrialanthrax; (4)pneumoconiosis; (5) effects of electricityindustrially; (6) occupational poisonings-lead, &c.;(7) ill-effects of occupation on hearing; and(8) general communications. Papers will be printedin the language in which they are written, withan abstract in both French and German, andthe general proceedings will be published inthe two languages mentioned. Contributors aretherefore requested to send their matter type-written, along with an abstract. As transla-tions will take a considerable time papersshould be sent to the general secretary, Dr. E.

Teleky, Turkenstrasse, 23, Vienna, IX., on or beforeMay 1st. The meetings will be held in the Houseof Parliament, and there will be an exhibition