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not only straining its financial resources to the utmostbut they were calling for unreasonable services fromdoctors and nuises.The difficulties to which Sir James referred are

having close attention from the managers of all

big voluntary hospitals in Scotland, for they are allfaced with an increased demand on their servicesand hence with an increased financial strain. The

difficulty experienced in obtaining enough applicantsfor the nursing profession, combined with the effortsto shorten the nurses’ hours of duty, add considerablyto these trials.

PAYMENT BY PATIENTS

Glasgow continues to take the lead in attemptingto obtain payment from hospital patients-not,however, without some opposition as became evidentat the annual meeting of subscribers of the VictoriaInfirmary, Glasgow, last week, when the nomina-tion of the honorary treasurer for a seat on the boardof management was defeated by a candidate whowas nominated from the body of the room. Themeeting was evidently a very crowded one and theallegation was made that the treasurer’s defeat wasdue to a "packed" vote. During the meeting aworkers’ representative pointed out that 14,000had been provided during the year by workers’

organisations ; he objected to anything in the natureof a means test and maintained that anyone whowas eligible for National Health Insurance shouldbe eligible for the Victoria Infirmary without sucha test.

DEADLOCK AT DUNDEE

The trouble about the proposed alterations in thechair of midwifery in Dundee, to which I referredon Feb. 12th, has not been lessened by a conferenceheld last week between representatives of the Dundeecorporation, Dundee Royal Infirmary, and the

university court of St. Andrews. The difficultyhas apparently arisen out of the failure of the

University and the directors of the Infirmary to

agree about an appointment to the hitherto associatedposts of professor of midwifery and visiting obstetricianand gynaecologist at the Infirmary. Lord McGregorMitchell, rector of the University, said that from thepoint of view of the students it could not be deniedthat in the Dundée Royal Infirmary they had anup-to-date and well-equipped institution most suitablefor teaching and that they had as lecturer a lady whoseskill and wide knowledge were unequalled north ofthe Forth. The chairman of the directors of the

Infirmary stated that the directors are not opposed tothe establishment of the Maryfield unit ; but thetransference of the chair of midwifery to the maternityhospital at Maryfield, with consequent developmentof its maternity department, could be achieved onlyat the expense of the existing services provided bythe Infirmary. The directors suggest that there isno room in Dundee for two departments of midwiferyand that any expansion should take place at theInfirmary where there is plenty of room for furtherbuilding and where the running costs would be muchlower. The proposed move would discourage subscrip-tion to their funds.There is always doubt as to what part a university

should play in the appointment of staff to the teachinghospitals associated with it and the unfortunateconflict in Dundee has brought to light a situationwhich might well develop in any of the Scottishmedical schools ; for the attitude of a university andof those who conduct the associated teaching hospitalsare by no means always identical.

UNITED STATES OF AMERICA

(FROM OUR OWN CORRESPONDENTS)

PREMATURE USE OF RABBIT SERUM

IN a letter written to you last summer I describedthe experiments being made with antipneumococcalrabbit serum. These experiments are still progressinghopefully, but premature publicity has brought thedanger that a promising method may be discreditedby too early adoption. To guard against this Dr.Edward S. Godfrey, Jr., health commissioner of theState of New York, has issued a statement

deprecating any idea that the use of this new

method of serum production will result shortly in theavailability of serums highly effective in the treatmentof all of the thirty different types of pneumococcuspneumonia. He finds it particularly unfortunate thatthe hope should be raised that a specific serum curehas been found for the prevalent and extremely serioustype of pneumonia known as type III. There is as

yet no conclusive evidence that this is so. At thesame time the commissioner has made public a

resolution adopted by his pneumonia advisorycommittee which bears on the question. The com-mittee believe that the generalised use of anti-

pneumococcus rabbit serum would be prematurethough in bactersemic patients severely sensitive tohorse serum or for whom no horse serum is available,its use might be justified. Otherwise, however, theyfeel that application of this serum should be limitedto clinical trial in a few selected hospitals until thevalue, safety, and limitations of the method are moreaccurately defined.

This cautious attitude gets support from a report(published in the New York State Journzccb of ]ÿledicint3of Feb. 15th, p. 245) from the Hospital of theRockefeller Institute for Medical Research on thetreatment of 67 cases of lobar pneumonia distributedamong nine different types. In 13 cases of type IIIno evidence of the therapeutic effectiveness of

type III antipneumococcus rabbit serum was

demonstrated. The mortality-rate for the remainingcases treated with antipneumococcus rabbit serumof the homologous type was 3-7 per cent.

. VITAL STATISTICS FOR 1937

The earlier reports of vital statistics for the lastcalendar year are arriving. The MetropolitanInsurance Company, always among the first to renderan account, describes 1937 as " a star health year."Eight causes of death-typhoid fever, scarlet fever,tuberculosis, chronic nephritis, diseases arising outof pregnancy and childbirth, homicides, accidentalburns, and railroad accidents-broke previous recordsfor low mortality. The expectation of life at birthreached a new maximum of 60-7 years. The dropin pneumonia mortality despite an increase of deathsfrom influenza is significant. The alcoholism death-rate is the lowest since 1921.

HEALTH OF NEW YORK STATE

Dr. De Porte finds the health record of New YorkState for 1937 "

outstandingly favourable " andnotes with especial satisfaction the levelling off orreversal of trends which in recent years have given riseto serious public concern. For the first time in ten

years there has been an increase in the number ofbirths. The infant mortality-rate (45) was lowerthan ever before ; the maternal mortality-rate (38deaths per 10,000 total births) represents a reduction

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of more than 20 per cent. from that of the preced-ing year, which was in its turn the lowest on record.The death-rates from three of the important diseases

of childhood-measles (0-4 per 100,000 population),scarlet fever (0-7), and diarrhoea and enteritis under2 years (5’7)-were the lowest ever recorded, and therates from diphtheria (0-6) and whooping-cough (1.3)were practically equal to the minimums of 1936.The sustained decline in the mortality from diphtheriais held to be a direct result of the application of

scientifically proved methods of prevention and cure.In 1908 more than twenty thousand cases of diphtheriawere reported in this State ; last year cases totalled

only thirteen hundred. In 1908 there were 2468deaths from diphtheria; last year only 80. Nocases of the disease were recorded in 1937 in forty-two of the sixty-eight Upstate cities and villages withover 10,000 population, and deaths were recorded inonly six of these urban communities : Buffalo (2),Binghamton, Endicott, Lackawanna, Syracuse,Yonkers (1 each). The total number of cases of

reportable diseases, exclusive of syphilis and gonor-rhcea, was considerably below the 1936 total, or theaverage for 1932-36. Compared with the precedingyear there has been no increase in the combinednumber of deaths ascribed to diseases of the heart,blood-vessels, and kidneys. Although the upwardmovement of the cancer death-rate continued, theincrease was, proportionately, the smallest in a

decade. The rise in the tuberculosis death-rate in1936 was only temporary, and the 1937 rate was thelowest in half a century. Finally, notwithstandingan increase in the mortality from diabetes, syphilis,and influenza, the total death-rate was, with oneexception, the lowest in the history of the State Depart-ment of Health. A total of 640 cases of poliomyelitiswere reported, more than three times the total for1936 but considerably less than the annual averagefor the five-year period 1932-36.

AUTOMOBILE ACCIDENT STATISTICS

The 1937 report of New York State’s Motor VehicleBureau is less cheerful. Since 1925 there have beenwell over a million automobile accidents in NewYork State, involving a death or personal injury,the number of deaths being 35,654. The motorvehicle accident experience for the year 1937 wasone of the worst in the history of New York State.During this year there were 82,085 accidents in which3065 persons were killed and 106,482 persons injured.

SYPHILIS AND THE TABOO

Estimates of the incidence of syphilis in the UnitedStates range from 2 to 10 per cent. of the population,and the surgeon-general, Dr. Parran, believes that ifcertification were accurate syphilis would be foundto be the chief cause of death. The enormous black

population is a reservoir of infection that has noexact equivalent in Europe, for in the large towns, itis said, the average young male negro has a positiveWassermann. During 1937 there were signs that thecountry was awakening to the magnitude of this

problem and that there was an increasing demandfor drastic steps to check the disease, especiallyamong young adults, who are most liable to attack.In various universities undergraduate papers startedcampaigns for compulsory Wassermann tests for

incoming students, but at the University of Minnesota,where 7000 students were tested, only 6 positivereactions were found, and it seems that syphilis is

very rare among undergraduates generally. TheInstitute of Public Opinion carried out a number ofsurveys during the year to discover how far the

public were prepared to go in stamping out this

scourge. The surveys showed overwhelming majoritiesin favour of government bureaux to distribute infor-mation, government treatment clinics, and a law

requiring a test for venereal disease for all personsseeking marriage licences. There were smaller, butdefinite, majorities in favour of clinic treatment beingfree, and the punishment of known syphilitics whoignore the treatment provided for them. So far thefederal government have not found the 25 milliondollars which the surgeon-general estimates is neces-sary to finance an adequate programme of educationand treatment, and the response to invitations tohave a Wassermann done has been so immense that

existing facilities for treatment have been swamped.This is natural as the organisation of clinics takes

time, and pending the introduction of a federalscheme clinics are being provided on many differentlines by local health authorities.Above the legend " No Longer Taboo " the Literary

Digest of Jan. lst publishes a photograph showing alarge crowd of young men and women with bannersbearing the slogans " Chicago will Stamp out

Syphilis," and " Friday the 13th is Unlucky for

Syphilis." " The first step in the war againstsyphilis," says the caption, " was to bring the fightinto the open. Over 1000 Chicago boys and girlshelped in a city-wide campaign."

IRELAND

(FROM OUR OWN CORRESPONDENT)

THE DUBLIN HOSPITALS

IT is understood that the statement made in thepublic press a fortnight ago in reference to the futuredevelopment of the Dublin hospitals, of whichmention was made in my last letter, althoughunauthorised is substantially correct. The various

hospitals are to submit their plans as soon as readyto the Minister for approval, taking as their basisthe recommendations in the report of the HospitalCommission. In the meantime a committee of the

hospitals concerned is engaged, in consultation witha senior officer of the Minister’s staff, in working outa scheme for a central hospital bureau which will actas an admission bureau to the hospitals, and therebyget rid of the difficulties which, at present, often causeconsiderable embarrassment to both the patient whorequires hospital treatment and his medical attendant.The decision of the Minister has given great satis-faction to the medical profession in Ireland, whoseanxiety had been roused by a long period of suspense.

SIALOGRAPHY OF THE PAROTID

SlALOGBAPHY is the radiography of opaque sub-stances injected into salivary glands. Writing inthe Quaderni di Radiologia (1937, n.s. 2, 139) on itsuse in the diagnosis of diseases of the parotid.A. Magnoni says that he uses 40 per cent. lodopin forthe purpose. As a contrast medium for salivary ductsthis has the advantage over Lipiodol that it is muchless viscid. He describes his particular technique indetail and illustrates his paper with sialograms fromcases of epidemic parotitis, suppurative parotitis,parotid tumours, parotid lymphadenitis, chronicparotitis, and parotid calculus. In conditions such asa mixed parotid tumour or a parotid lymphadenitis,sialography is seldom of more than academic interest.Unfortunately Magnoni has not always been able tocorrelate the radiographic findings with accuratebacteriological and cytological information about thesaliva, and this leaves some of the interpretationsopen to doubt.