745

perature rising to 100° F., the breathing becominghurried and the patient being stupefied. Sherecovered, but optic atrophy remained, andvision amounted only to distinguishing move-

ments of the fingers. In this case the alcoholwas applied to a raw surface for four days. Canthis dangerous poison be absorbed through theintact skin ? There is no evidence that it can,

although the opportunity has been abundantlypresent in the extensive use of methylated spiritsfor making liniments and for disinfecting the handsand arms of surgeons. But, as Dr. McKechniesuggests, it is possible that investigation mighttrace cases of moderate impairment of vision to thecontinued external use of methyl alcohol. He isnot " taking any chances," and has discontinued itsexternal use since encountering this case.

MALARIA IN ENGLAND.

No cases of indigenous malaria have beenreported in this country so far during thepresent year. So Sir Ronald Ross tells us in thememorandum which we print on another page.Three conditions are, of course, essential for thehome production of malaria : (1) The return ofinfected soldiers from abroad; (2) the presence ofanopheline mosquitoes ; and (3) access of one to’theother. In regard to (1) the large proportion ofinfected soldiers are concentrated in eight malariahospitals on specially selected sites, although thearticle in another column of this issue by MajorA. J. Hall, Captain E. Williams, and Captain S.Douglas on two cases which developed a fatalinfection after reaching this country should

put every medical officer on his guard to lookfor sporadic cases. In regard to (2) Sir RonaldRoss consolingly says that anophelines are com-paratively so scarce in most parts of Britain asto render the danger minimal. But the dangeris there and is only to be avoided by close attentionto the third link in the vicious circle. In regard,therefore, to (3) strict instructions have been issuedthat in places where mosquitoes abound all cases ofmalaria are to be collected in sheds protectedagainst the entry of the insects. On the care withwhich Sir Ronald Ross’s memorandum is read andlaid to heart by all those who have to do withfebrile disorders in returned soldiers depends theimmunity of our civilian population from an infec-tion which is easily acquired and with difficulty gotrid of.

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TOBACCO AND TUBERCULOSIS.

IN the American Review of Tuberculosis forMarch Dr. W S. Duboff, of Colorado, tilts atthe view that smoking is harmful in pulmo-nary tuberculosis, especially when complicatedby laryngeal disease. His conclusions are basedon the observation of 1000 patients at thesanatorium of the Jewish Consumptive’s ReliefSociety, whom he classifies as non-smokers, exces-sive, moderate, or light smokers. The fact that inthe course of pulmonary tuberculosis women areas subject to laryngitis as men is, in his opinion,practically equivalent to an acquittal of tobacco;and his tabulated analysis showing that in mostcases of throat disease associated with pulmonarytuberculosis the patients were non-smokers leadshim to the sweeping generalisation that " tobaccoobviously does not predispose to laryngeal com-plications." In the same journal Major Gerald B.

Webb, M.O.R.C., deals with 3288 soldiers, whoselungs were auscultated with special reference to thedetection of " smoker’s rhonchi." These bronchialrhonchi were audible in most of the men whosmoked cigarettes, whereas the majority of thenon-smokers, pipe-smokers, and cigar-smokers didnot exhibit this sign. Of the men examined 20 per-cent. were non-smokers, and of 233 men dischargedfor tuberculosis from a command numbering about25,000, 22 per cent. were non-smokers. From evi-dence of this type the author suggests that eveninhaling cigarette smoke does not aid the outbreakof pulmonary tuberculosis. He quotes in supportthe case of R. L. Stevenson, whom he describes asan inveterate cigarette-smoker, but who lived tadie of apoplexy, an ex ttno disce omnes line ofargument which medical men do not often misuseso entirely. A third opinion is given by Dr. JuliusDworetzky, of Otisville, N.Y., who considers tobaccoas well as alcohol to be a direct irritant to thethroat. Neither of the two first authors attempts.to meet the objection to tobacco that its use

promotes spread of infection. Their argumentsthat tobacco is innocuous to the smoker himself, asfar as tuberculosis is concerned, are mainly basedon rather slender statistical evidence. But theirpapers are useful as a stimulus to further researchand as a check on the anti-tobacco fanatic, whowould at all costs rob the consumptive of theinestimable solace that smoking often brings.

Dr. F. W. Edridge-Green has been appointedSenior Ophthalmic Surgeon to the Central LondonMedical Boards (National Service).

Sir Arbuthnot Lane, Sir James Mackenzie, andColonel Herbert .Bruce, C.A.M.C., have started forAmerica as delegates to the American Medical-Conference.

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KING EDWARD’S HOSPITAL FUND FORLONDON.

THE annual meeting of the Governors and General Councilof this Fund was held at St. James’s Palace on May 14th,the Speaker of the House of Commons being in the chair.The accounts and balance-sheet for 1917, which were pre--sented by Lord Revelstoke, having been adopted, Mr. F. M.Fry brought forward the draft report of the Council, whichshowed that the total receipts for the year were jE258,572, ofwhich JE1518 were contributions to capital and JE237,OMreceipts on general account. The League of Mercy contri-buted JE15,000.The grants made for the year amounted to JB190.000, being JE20.00&

more than in 1916 and JE32.500 in excess of the grants made in 1912 and1913, the years of the highest distribution before the war. Of the-amount distributed, B181.000 was given to London hospitals—jE140,02&in aid of general maintenance, £ 12,150 to the reduction of debts onmaintenance account, and .S28.825 towards improvement schemes or inreduction of liabilities on such schemes undertaken before the war.Mr. Fry said that the Fund had continued to encourage hospitals to post--pone all schemes of capital expenditure not exceptionally urgent or notalready in hand at the outbreak of war, and the total grants in aid ofnew schemes were only JE8675. Grants for maintenance, largely due tothe munificence of Lord Astor, were .B8750 more than in 1916and .e34,650 more than in 1915. Of .S9000 distributed by the Con-valescent Homes Committee, JE7050 was allocated to consumptionsanatoria, and .S1950 to convalescent homes. The grants to sanatoriaenabled 62 beds to be reserved for the use of patients in Londonhospitals. The total sum distributed during the last ten years was

JB1,614,000. Since the foundation of the Fund 21 years ago .E2,458.415had been distributed. During the year the amount spent on adminis-tration was .E3460 10s., or JB1 9s. 0._’,-d. per JE100 of the total amount

received, as compared with B3161 2s. 3d., or 19s. 4M. per 2100 in theprevious year. The increased expenditure had been occasioned mainlyby additions to the remuneration of the staff.

The Speaker, in moving the adoption of the report, whichwas unanimously carried, stated that for the first time theGovernors had this year secured the services of some lady-visitors.