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:glycsemia, reduce or suspend the insulin ; but if- coma, is to be avoided the need for insulin is nevermore imperative than at these crises. Most physicianswill agree with F. N. ALLAN’S statement that " theneed for insulin during sickness, even when no foodis taken, is something that everyone should know."It is, however, inexcusable to allow any diabetic

-patient to starve during an intercurrent illness. The

.glucose equivalent of the diet can, and should always,be given in some easily digested form such as sugar,.orange-juice, or milk. The insulin can then beincreased if necessary, and the risk of hypoglycaemia.and starvation ketosis can be ignored.

Annotations."Ne quid nimis."

WILLIAM ERNEST HEMPSON.

THE death of Mr. William Ernest Hempson, who.as solicitor to the Medical Defence Union and laterto the British Medical Association was broughtfor nearly forty years into close association with themedical profession, will be learned with regret by.a large number of our readers. He was a Suffolkman, and received his education at Ipswich GrammarSchool before admission as a solicitor in 1880. He made-a fortunate start in his calling by earlv associationwith the well-known firm of Freshfields, but someforty years ago he made an independent start andfounded the firm now represented by Messrs. OswaldHempson and Colin Oliver, of which he was seniorpartner at the time of his death. The number ofdifficult and delicate situations which were placedbefore Hempson was very large during his long periodof official work, and it was generally admitted thathis advice was sound, while his intimate acquaintancewith regrettable circumstances involving doctorsbrought with it no cynicism, but only a keen desireto alter the professional factors which seemed atfault. In 1928 he relinquished the personal appoint-ment of solicitor to the British Medical Association,and his firm was appointed in his place, while inrecognition of his many years of work he was electedan honorary member of the Association. He servedour calling well, and while the public nature of hisduties secured him high respect, there are manyindividual doctors who will mourn his loss as a friendto whom they had reason to be grateful.

PERFORATING INJURIES OF THE EYEBALL.

IN his Hunterian lecture delivered before theRoyal College of Surgeons of England on Feb. 5th,Prof. J. Herbert Fisher strongly advocated theremoval of magnetisable foreign bodies from the eye-ball by the scleral route, in preference to the morerecent method of drawing them into the anteriorchamber by means of a giant magnet. With the latterprocedure there is considerable risk to both the ciliarybody and the lens of injury inflicted by the foreignbody during its passage from behind forwards, and,as is well known to ophthalmic surgeons, the ultimateresults to vision, when this method is adopted, arenot good in the majority of cases. On the other hand,there are two sources of danger which have preventedmany surgeons from adopting the method of scleralincision. One is the danger of sepsis, and the otherthe danger of detached retina which is liable to followany considerable loss of vitreous. With regard tosepsis, Prof. Fisher pointed out a possible source ofinfection that is apt to be overlooked. Even wherethe lacrymal sac has been successfully removed andit is believed that any possible danger of pneumococcicinfection from a lacrymal mucocele has been averted,it is still possible for pneumococci to lie hidden in

the canaliculi, unless these channels have beencauterised. In one case in which the pathologisthad reported the ocular conjunctiva bacteria-free,this had happened with disastrous results. There-fore Prof. Fisher emphasised the wisdom of alwayscompleting the operation of excision of the sac bycauterisation of the canaliculi. With regard to thedanger of vitreous loss, Prof. Fisher advises insertionof sutures on each side of the line where it is proposedto make the scleral incision before the actual incisionis made, so that after the extraction of the foreignbody the wound may be closed with the least possibledelay. With this precaution the amount of vitreouslost will in all probability be small and even if alimited detachment of the retina does ensue theprognosis is good, contrasting strongly with the badprognosis inherent to cases of detachment occurringin eyes previously diseased or myopic. Two caseswere cited illustrating this point, where reattachmentof the retina took place within a comparatively shorttime, and full vision was retained. A caution wasuttered by Prof. Fisher on the necessity of correct inter-pretation of the X ray skiagrams which are takenwith the object of localising the exact position of aforeign body within the eyeball. At one time, evenat Moorfields, charts were in use from which it waspossible to draw fallacious conclusions in some casesas to whether a foreign body was within or without thescleral coat, and an instance was given in which, if theold chart had been relied on, it would have been

concluded that a foreign particle was situated withinthe eyeball, whereas it was actually lying on theexternal surface of the sclera whence it was removedwithout any difficulty. Prof. Fisher furthercontrasted the sequel of particles of glass remainingwithin the eyeball, which may be harmless exceptso far as their mechanical effects go, with the inevit-able effects of iron particles causing siderosis and thestill more disastrous result of retained particles ofcopper which lead inexorably to the destruction ofthe eye. Finally, he referred to the phenomenonof cystic formations of the iris or anterior chambersometimes caused by perforating wounds which involvethe corneal epithelium in their track.

THE TEACHING OF PREVENTIVE MEDICINE.

IT has been said that the medical profession, likethe phoenix, is destined to destroy itself in a fire ofits own building ; its culminating achievement will bethe abolition of disease, and with it the practice ofmedicine as a means of livelihood. Although thismagnificent end is still remote, there is nowadays asteady supply of contributions to the funeral pyre,and in this category we may place a book1 latelyreceived from the United States. At Harvard-University it was felt, we are told, that the regularcourse in preventive medicine was bound by thelimited time available to confine itself to the questionof the protection of the community as a whole, andthat little was taught conceining the protection ofthe individual. The same probably applies withequal force to the teaching at most English Univer-sities. The student’s curriculum-the diminutive ishardly appropriate at the present time-was consideredalready sufficiently full to make a further additionundesirable. For the last four years the policy hastherefore been adopted of inspiring the teachingthroughout the course with the spirit of preventivemedicine. In this way not only are glimpses givenfrom the first of the way in which the material caneventually be applied in practice, end so the teachingis made more interesting, but alfo throughout hiswhole training the student is imbued with the idea ofthe prevention of disease. Each section is writtenby the teacher of a particular subject, and sets outthe points in prophylaxis that can appropriately beintroduced into the lectures. For example, whileteaching the anatomy of the perineal muscles one

1 Synopsis of the Practice of Preventive Medicine. HarvardUniversity Press.