708 OCT. 17, I9251 OSTEOPATHY AND CHIROPRACTIC.

33rfttt0) %*Tbttal 3ournat,SATURDAY, OCTOBER 17TH, 1925.

OSTEOPATHY AND CHIROPRACTIC.IN an article on osteopathy and chiropractic publishedin our issue of May 31st, 1924 (p. 963), we endeavouredto outline the main features of those cults, and hintedthat a surplus of this American product was likely tobe dumped into this country in the near future. It isimpossible to estimate the number of arrivals since.

that date,, but the settlement has so far advanced as

to induce osteopaths to demand formal recognition anda legal status, a matter to which we made referencein a leading article on April 11th last (p. 706). Theircause has also been espoused by a small group ofmembers of Parliament, and the Minister of Health(Mr. Neville Chamberlain) has received a deputationin support of it.The subject is one that bears, not only on the

safety of the public, but also on the interests ofmedical practitioners, who will, therefore, be welladvised to make themselves acquainted with itsdetails. For this reason we welcome the forciblepronouncement of Sir Holburt Waring in his presi-dential address to the Medical Society of Londonpublished in our present issue at page 679. He hasdone good service to the profession -in making plainthe real nature of these cults and insisting on thenecessity of taking steps to counteract their influence.As several speakers seemed to recognize in thediscussion (reported at page 701) which followed theaddress, the problem of finding measures that willprove effective is not easy of solution, and is not likelyt. be solved without a thorough understanding of theconditions to be dealt with.

It will be noticed that there are two distinct cults,although they both rest on the same fundamentaltenet-that the displacement of anatomical structuresfrom their normal positions is the sole cause of disease.The practical distinction between the cults is thatosteopathy claims to be progressive, while chiropracticis stationary. The whole pathology of the chiropractoris embraced in one fundamental tenet. He needs no

knowledge of disease; he merely needs to know in whatpart of the body the disease, whatever its nature,exists; his tenet assures him that the cause lies in thesubluxation of a definite vertebra, and this he pretendsto) reduce. With this slender stock-in-trade of know-ledge and technique he has proved a stupendous finan-cial success. This was the original form of chiropractic,and it remains the same to-day; the cult flourishes inAmerica, and is probably more widespread in thiscountry than some of us suspect. It is obviously pure

nonsense, and therefore the appropriate measure toadopt in the first instance is to examine our existinglaws and inquire whether they are adequate to theirpurpose and efficiently administered. It is the dutyof the Legislature to leave no stone unturned toprotect the less educated of our people from suchpersons, and should the existing enactnments appear

to be insufficient, one of the recommendations of theSelect Committee on Patent Medicines (1914) mightperhaps afford a precedent. The Committee advisedthat the advertisement and sale of medicines pur-

porting to cure certain diseases, such as cancer,consumption, epilepsy, locomotor ataxy, and Bright'sdisease, should be prohibited. A similar index mightbc drawn up and chiropractors prohibited from treatingdiseases enumerated in it. The principle was em-bodied in a bill-the Proprietary Medicines Bill-introduced on behalf of the Ministry of Health intothe House of Lords in 1920 by Viscount Astor, thenParliamentary Secretary to the Ministry. The bi-llcontained a list of diseases in a schedule. It passedthrough the Committee stage in the House of Lords,and there were promises that it should be introducedin the House of Commons in the following year, butthe then state of parliamentary business renderedthem impossible of fulfilment.

'phe conditions are somewhat different as regardsosteopathy. Doubtless a large number of osteopathsdiffer very little from the chiropractors abovedescribed; they may have a smattering of medicalscience, which not improbably renders them the more

dangerous. But manv have a considerable knowledgeof modern medical science while retaining, or pro-fessing to retain, their original dogma. Thus wefind it stated in the Supreme Court of Washingtonin 1917 that " a perusal of the successive eataloguesof the schools of osteopathv will show that theirteachings are gradually being expanded, and that themore modern of them now teach in some degreemuch that is taught in the older schools of mnedicine."Some osteopaths have even taken the regular medicaldegree. It is evident that we are here dealing with adifferent type from that of the chiropractor. Probably,however, in the majority of cases, the education ofosteopaths is totally inadequate. Sir Holburt Waringpoints out that a student of an osteopathic or chiro-practic school or college may attend and complete thewhole of his course in eighteen months; laboratoryinstruction in the modern acceptation of the term doesnot seem to exist, and in most of the schools diagnosisof disease is not considered necessarv, and clinicalteaching as praetised in an ordinary medical educa-tion is not- given. We feel sure that the medicalprofession at large will endorse the opinion expressedby Sir Holburt Waring that " instead of the Legisla-ture nmaking possible the licensing of osteopaths ina very limited form of practice, the Medical Acts ou-ghtto be so strengthened that it would not be possible forthe community to be treated by them or any otherunqualified charlatan or quack "; and that " everyonewho is licensed to practise as a medical practitionerin any form should be placed under the same require-ments of knowledge and experience."

There is one further point deserving the considera-tion of the profession. Osteopaths, even without a

licence, are engaged in practice, and, as we havealready mentioned, some few have medical degrees.We have in Sir Holburt Waring's address the pictureof the ijeensed and qualified osteopath as he is knownin his native land. WVhether he believes in hisdoctrine is a matter for his own conscience, but therecan be no doubt that the retention of the name pays.It would be interesting to describe the numerous

troubles that the medical profession in America hassuffered from osteopathv did space permit; but one

detail may be mentioned, since it is pertinent to thepoint we are dealing with. In some of the Statesmedical men have publicly expressed the opinion thatunless the tide of osteopathy and chiropractic is in

some way stemmed they will themselves be under thenecessity of resorting to wholesale advertisement ifthev are to hold their own! The name draws even in

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Oca. 7, t9251 FOREIGN BODIES IN TE AER PASSAGES. TTEN Buazm 709i KRDICL JOlUN.L

this country, and that without the licence and qualifi-cation; nor is this by any means confined to the un-educated. The reason why this should be so is doubt-less capable of analysis; we merely draw attention tothe fact in order to suggest that medical men shouldtake measures to inform- their patients of the absurd-ities of these and other cults.' A small volume,entitled The Medical Follies,' has recently 'been'published by Dr. Morris Fishbein, the editor of theJournial of the American Medical Association; it iswritten in an admirable style, and contains most enter-taining and racy descriptions of celebrated founders 'ofquack -systems. If medical men would place a copyof this volume on their waiting-room tables we think'it would serve a useful purpose in disseminating aknowledge of the true inwardness of osteopathy, chiro-practic, and other such pseudo-scientific systems.

FOREIGN BODIES IN THE AIR PASSAGES.WE publish this week (p. 686) the paper by ProfessorChevalier Jackson of Philadelphia on overlookedforeign bodies in the air and food passages, with whichhe introduced the discussion on this subject in theSection of Laryngology, Otology, and Rhinologv atthe Annual Meeting of the British Medical Associationat Bath; he afterwards gave a demonstration of themechanical problems met w-ith in the bronchoscopicand oesophagoscopic extraction of foreign bodies.

It is hardly an exaggeration to, say that no greaterdevelopment has taken place during the past quarterof a century in medicine and surgery than that ofperoral bronchoscopy. Just as the laryngoscope inthe past brought the larynx into view, so endoscopyhas revealed the entire length of the oesophagus andthe cavity of the stomach, and it has also exposed allthe ramifications of the bronchial tree to direct vision.The rapidity of progress in this special branch duringrecent years is shown by the fact that it is only thirtyyears (1895) since Kirstein, following the work ofearlier pioneers in the development of oesophagoscopy,first showed to laryngologists the possibilities of)eroral endoscopy by introducing his direct methodot examining the larynx-a method which brokeentirely fresh ground, and was quickly followed bytracheoscopy and bronchoscopy.

Killian, greatly impressed with Kirstein's work,immediately began to devote his whole time to thestudy- of endoscopy, with the result that, two yearslater, he was able to demonstrate the practicability ofbronchoscopy, and to show that the air passages couldbe explored far beyond the bifurcation of the trachea.His early demonstrations created a profound impres-sion, and laryngologists of every nation commencedvigorously to studv this new branch. By intro-dtucing bronchoscopy. Killian created a method bywhich .a great saving- of life has been accomplished, assho9wn by a reduction in the death rate from laryngo-scopic days of 30 per cent. to between .5;3 and 1.7pe Icent. at tlie preseult day in the hands of the skilledcu0osco is,t Bv bringing.-to perfection instrumentsand techniquelb.49 also; mnade tit etsier for others tofollow and.ncarzy. on his worli. -Ami7nong those whofollowed in the footsteps of this->great teacher, the

"father of bronchoseopy,." no *nanryce stands- out withmnore brilliantey and honour than 'that. of ChevalierJackw-son, wx-ho, may well be teirmed the doyen of

1 The Mled7ical Yollies. MOyrris; Fislibein, M.D. NewV Yoi,,: Bni andL1veright. lS5.' (Cr. Sgo, pp. 23S 2 do1llrs.)

endoscopists." The great Bronchoscopic Clinic whichhe initiated and has built up by his indefatigableenergy stands as a landmark of his genius and of thework he has accomplished. This N-as recognized in1920, when the Universitv of Pennsylvania-the oldestuniversity in the United States--established the firstchair for the teaching of bronchoscopvx-an(I oesophago-scopy, and Chevalier Jackson, in whose honour thechair was founded, was made professor.Nor were British laryngologists lacking in, initiative

or skill in developing this new branch of theirspecialty, for they early recognized the practicalimportance of Killian's work and quickly adopted hismethods. Waggett, and D. R. Paterson (of Cardiff),in 1903 and 1904, were the first in this country totake up the study of Killian's work, Paterson contri-buting a paper to this JOURNAL. in 1906 on "Thedirect examination of the oesophagus and upper airpassages," while a paper by Waggett on " Directlaryngoscopy, bronchoscopy, and oesophagoscopyfollowed in 1908.' Since that date many compre-hensive articles have been published, and many casesof successful removal of foreign bodies have beenrecorded in our columns. During recent years endo-scopic technique has been greatly improved andsimplified, and the direct examination of the bronchiand oesophagus has become in this country part ofthe everyday life of the larvngologist, with the r-esultthat the removal of foreign bodies is now only rec&-de'dwhen some special feature or difficulty deservesrecognition.Endoscopy is not confined to the few. Each and

every laryng,ologist has become his own endoscopist.Every young laryngologist considers the subject apart of his specialty, and trains himself to be capableof dealing with any case of foreign body which maycome under his care. That this is so is confirmed bya summary of such cases compiled and published byIrwin Moore, which shows that 174 cases of foreignbodies successfully removed from the air and foodpassages, and reported to the Section of Laryngologyof the Royal Society of Medicine between 1908 and thepresent date, were dealt with by thirty-six separatelaryngologists, without special trained assistants ortrained team work beyond the co-operation of a radio-logist. These cases do not by any means representthe total number of foreign bodies removed in thiscountry.

Chevalier Jackson's paper on overlooked foreignbodies, published in this issue, is of the greatestclinical and practical importance, in view of the factthat as many as 1,485 cases of foreign body havepassed through his hands during the past twe.nty years,.and that the data for his paper have been carefullycompiled by him with the assistance of a skilled anddevoted group of associates-Dr. Ellen Patterson,Dr. Gabriel Tucker, Dr. Louis Clerf, and Dr. WillisManges-and the valuable help of Dr. Thomas MIcCrae,-Professor of Medicine in the Jefferson AMedical College,.Philadelphia, who, it -will be rememubered, deliveredthe Lumleian Lectures before the Royal College ofPhysicians in 1924 on " The clinical 'feattures of foreignbodies in the trachea and bronchi.' Amongst these1,485 cases there we-cre over 200 in wi-hich forerinbodies had been overlooked for periods varying,from' a month to thirty-six yeas,owing, as Pro-fessor Jackson points' out, 'to insufficient considera-tion being given-from a diagnostic standpoint-to:Ithe possibility of the presence of a foreign body. This_is a large percentage in viexv of the fact that 98 per

E 1 BRITISH MEDICAL JOUR.A-.L, 1908, ii, 897.

11 ..- . ."

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710 OcT. I7, 19251 JAMES NIVEN.

cent. of foreign bodies in the bronchi and lung tissue,localized by present-day methods, can be successfullyremoved by the skilled endoscopist with the help ofperoral endoscopy.From a careful analysis of all the cases which have

come to his clinic Chevalier Jackson enumerates thepitfalls which may lead to the overlooking of theforeign body, and cites illustrative cases. He is ofopinion that one of the chief causes of failure is thata foreign- body does not occur to the physician as- a

dia-gnostic possibility- even -in cases in which clearpositive evidence is present; he attributes this failuret) faulty medical teaching and training, and to the factthat a foreign body is rarely included in the list ofdiagnostic possibilities that ought to be excluded inevery case of pulmonary disease. He lays it downas a general rule that the possibility of a foreignbody must always be remembered in every ailingor sick child. The overlooking of foreign bodiesmay also be caused by failure to attach sufficientimportance to the initial symptoms of choking andgagging, which are rarely absent when a foreign bodyreaches the air or food passages. Again, he lays downthe rule that every case in which there is the slightestintimation of a foreign body, or of the patient havinghad an attack of choking, gagging, strangling, or

coughing, should be looked upon as prima facie anexample of foreign body. He maintains, in short, thata foreign body should be regarded as present until thecontrary is proved by every means at command. Thephysician may be deceived by the absence of anyhistory, especially in children, or he may not inquirewith sufficient care as to an attack of choking orgaggilng.The outstanding factor, however, in the overlooking

of foreign bodies in the broncho-tracheal tree whichdeceives the physician is the " symptomless interval,"often of prolonged duration, between the initialsyipptoms of choking and gagging and the laterpulmonary symptoms. It is also to be rememberedthat in any given case more than one foreign body maybe present, and that though one has been removedanother or several others may remain. This mistakemay be guarded against by the rigid enforcement ofthe rule always to have an x-ray examination made,not only before but after removal of any foreign body.It is possible that a foreign body may be coughedup, but this rarely happens, and waiting may bedangerous. Cases under Jackson-'s-observation showedthat only 3 per cent. of foreign bodies known to havereached the bronchi were coughed up. The intimateassociation and co-operation of the physician, theradiologist, and the laryngologist in dealing withforeign bodies is consequently one of the most impor-tant factors in successful diagnosis and removal.A negative radiological report should not be taken asexcluding the presence of a foreign body, but shouldalways be followed, if there is any doubt, by endo-scopic examination.

Cases of foreign body in the air passages maysimulate in their physical signs and symptoms suchcommon diseases as asthma, bronchitis, broncho-pneumonia, empyema, abscess, bronchialism, andtuberculosis. Chevalier Jackson maintains that untilevery medical practitioner is taught to consider itnecessary to exclude the possibility of a foreign bodyin every case of acute or chronic pulmonary disease,foreign bodies in the lungs will continue to be over-looked. Such conclusions and advice coming from sodistinguished and experienced a specialist should betaken to heart by every medical practitioner.

JAMES NIVEN.Sm GEORGE NEWMAN has sent us the following: I regretthat, owing to my absence in Geneva on official business,I was unable to respond to your invitation to write a fewlines on the loss which the medical profession has sustainedby the death of Dr. James Niven. At the Ministry ofHealth we all had a profound appreciation of this remark-able man, who was one of the'deepest and most originalthinkers -that the public health service'ever had. Againand again those who believed- that -they had broken fresh

ground found the problems 'stated and'-their solution pro-

claimed in Niven's writings of years before. But' he was

always glad to help in subjecting even his 'own conclusions

to the fire of criticism, and so long as the truth appeared to

be more nearly revealed he seemed as enthusiastic in dis-

covering flaws as in vindicating any theories of his own.

His writings were not a reflection of the fashionable views

of the moment, they were the result of original thoughtand prolonged personal observation. Indeed, they are to

medical workers a legacy of immense value. His annual

reports were studied by his colleagues in the public health

service as classical statements which seemed to belong to

the grand period of the middle nineteenth century. Much

less was known of his writings than deserved to be known,as a great deal of his best work was only recorded in the

annals of the Manchester City Council. They were, in his

active period, extremely numerous, varied, penetrative,and suggestive, and his reputation amongst medical officers

of health was such as no other man of his generationenjoyed. Niven's outstanding characteristic was his

amazing avidity for work. He took to work as his

pleasure, vocation, and duty. Not only did he labour for

long hours and consume much midnight oil, but he worked

with a fury of concentration that would soon have worn

him out if he had not possessed an iron constitution. He

never expressed an opinion on a subject until he had

mastered it in detail, and any report presented to him

which lacked the thoroughness he loved would lead to an

interview in which the reporting officer was likely to be

subjected to a ruthless cross-examination. Labour-savingdevices did not appeal to him. He seldom dictated, but

wrote out his correspondence and reports' in his large, firm,characteristic calligraphy. Niven was not quick to compre-hend a new idea. It would be received with something in

the nature of a blank stare, which gradually changed into

an expression of tentative welcome or rejection. In some

matters, however, he had an intuitive quickness of appre.hension. His judgement of a man was soon formed. But

he had an open mind, and was always ready to consider anyproposal, no matter how wild it may have appeared at first

sight, or how much opposed to his own views. His habits

of work were neither methodical nor oonventional. He

would carry important letters in his pocket, and discover

them by accident inconveniently late for reply. Yet the

working of his mind was a model of method. It worked

like a first-class, well oiled, logical machine guided by a

keen, critical judgement that rarely misled him. The

expression of his considered opinion created the feeling that

there was nothing more to be said. He was not a diplomat.He lacked the art of managing men to gain his object.His naive sincerity and his concealed but fiery sympathywith the suffering and the weak seemed an uncertain equip-ment for negotiations in municipal and professional affairs.

But he met the cutest diplomatists apparently without

being aware of their designs, and after a little hesitation

calmly led the way to his appointed -goal. His ideas

triumphed by reason of their intrinsic merit, backed by his

transparent sincerity. He was not a " popular " officer,but he was profoundly respected for his public spirit and

utter unselfishness of aim. He scorned advertisement and

the,petty arts by which some men seem to advance in. public

Thu BaiosMEDICAL JOUR1AZ.

OCT. 17, 19251 OPPORTUNITY IN THE SERVICES FOR RESEARCH. TnxBnR1Ts 7LMHDIC&LJOURNAL 711

life. At our table rounid he was Sir Bors, grave and solidand thoughtful, but his smile when it came was a sunny

one. Niven had reserves of manner which not infrequentlywarmed into asperity. Many who met him thought he

was cold, but he was actually extraordinarily warm-lheartedand kindly. In his vie intimne he had the tenderness of a

woman and an unexpected and ample capacity for affection.Perhaps his nilost striking personal characteristic was thepower he had of awakening an almost passionate affectionin those who worked intimately with him. His staffbecame his disciples. When they met in later years hegenerally became the subject of their talk, and often storiesof him were exchanged. Thei unique humour of thesegenerally lay in some clash between Niven's great-hearted,absent-minded simplicity and the conventionality of some

accidental circumstance. " I often think of you all," hewrote in one of his letters to an old pupil, "though onlya duumb person." He found difficulty in making friend-.ships, anid much of what lie wanted to say remiiained unsaid.-Niven's department in Manchester was the training groundof many public health workers in whose memory he will liveas the master from whom they learlned their craft and as

a dearly loved friend. They will remember those timeswhen, at the close of some specially urgent and strenuous

task, the "'old man " over his pipe would pour forth a

stream of reminiscence or humorous comment, expressedwith a felicity of epithet and brilliant terseness of phrasethat unfortunately seldom found its way into his publicutterances. In such moments his rare and richly giftedspirit found congenial expression. His humour bubbledover, hlis good nature became a pervading influence. Tothose who, were privileged to work with him the shock ofhis tragic passinig has been keenly felt, buthis memory

remains as ani inspiration and a precious possession, andhis work endures, not as a memory only, but as a drivingforce and a guiding light of world-wide influenice. Nivenlives, and will live, in the results ofhis work, and such was

the consummation which tohis strong soul was that which

wasmliost " devoutly to be wislhed." He had no thoughtfor self, and his kindness and generosity to those who were

privileged to work with hini is shown in his Observationson the History of Public Health Effort in Manchester,published at the time whenhe relinquished office. It mightindeed be said of him-" His life was gentle, and theelements so mix'd in him, that Nature might stand up andsay to all the world, This was a man."

OPPORTUNITY IN THE SERVICES FOR RESEARCH.LEUT.-GENERAL SIR WILLIAM LESHMAN, K.C.B., F.R.S.,Director-G eneral of the Army Medical Service, devotedhis presidenitial address in the War Section of the RoyalSociety of Medicinie on October 12th to the subject ofresearch in the services. He explained that by research

he meant, not only those experimental inquiries demandingexpert knowledge and special equipment, but any workwhich had for its object to addto; the existing knowledgeof the causes, treatment, and prevention of disease. It was

true that in view of diminiished personnel the present

time did not seem quite appropriate for suggesting to

overworked officers that they should voluntarily add to

their already heavy duties; but, after all, the services were

only passing through a temporary phase of depression, andsuch a phase, familiar enough to thosewhoo ad seen lonlgservice, eventually passed away, and was succeeded byconditions better even than those which had preceded it.The facilities which the services presented for such researchas he had defined were far greater than those enjoyed bymost civil practitioners. Excellent material was available

iii the men over whom the medical officers had constant

ssuervision; the past history of these mien was well known

and fully recorded, they were available for systematic or

periodical examinatioln, anid uniform sta,iidards of pro-

cedure could be employed. All this was, as a rule, out ofthe question in civil practice, save perlhapss in connexion

with schlools and certaini other ins-titutions. The abundanceand variety of the morbid coiiditioiis wlicli camei underobservation in the services also called for remark. Itwas not infrequently sai(l by people outside that officersin the servico saw only the commoner ailments to, wlichhealthy young manhood was liable, anid that the bulk oftheir experienice was in the treatment of minor comlplainitsand venereal disease. But this was not true even at thetime wheni he joined the army, in 1887, and nowadays thevolume, and importance of medical and surgical work in thearmy-anid he thought he could speak for the otherservices as well-conmpared favourably with that of allbut the largest metropolitan or provincial hospitals. Theequipment of the theatre and the laboratory in the serviceswas maintained in a condition well abreast of modernrequirements. Whatever tests were considered necessaryas helpful to diagnosis or accessory to treatment were

readily available, specialist and consultant services could beprocured immediately, and altogether, in all but the mostisolated stations at home or abroad, it was possible tocarry out every method of investigation, and to observear1d record the progress of cases by the most modernstandards. Furthermore, all officers enjoyed the privilegenowadays of admirable post-graduate courses, just at themoment in their professional careers when they were likelyto benefit by them most. Whether or not theirprofes-sional predilections were sufficiently definite to lead them toseek for further special instruction in a particular branch,they were all given the chance of bringingthemselves wellup to date in their rapidly moving profession. Anmia in

the services, therefore, was well equipped for makinlgvaluable observations along many lines of professional work,either by himself, or, whatwvas often more desirable, withthe readily available help of specialist colleagues. Tlherebyhe mado his professional life infinitely more interestingtohiimself, and there was always a chance that a particularinvestigation might end in bringing to light somethingof great importance. But Sir William Leishman warnedintending investigators that two qualities were essential-absolute honesty and inexhaustible patience. Theinvesti-gator needed some of the qualifications of the dry-flyfisherman, for whom there was such hope in every cast as

to carry him happily through a blank dayand leave himwith cheerfulanticipations for the morrow. He went onito indicate, in admirably chosen words, the method ofmental approach towards a piece of research. The youngofficer, he said, should begin by asking himself in whatparticularlinie of professional work he was most interestedand would most desire to become expert; he should thenthink over them any branches of the chosen subjectandselect one or two of them for closer scrutiny. He shouldlay special stress on cases which in his own experience hadpuzzled him, in which he had felt unsatisfied as to explana-tions of etiology, or in which the treatment had proved inhis hands unsuccessful; and, of course, he should acquainthimself with the literature of the subject. Presently hewould find certain questionis, challenges, and criticismsshaping themselves in his mind, and he should then ask

himself how he could make and record his observations soas to give a clear-cut answer to his own questions. But

he had also to renember that he must convince others as

well as himself, and that those who heard or read his

work would be quick to notice the absence of any relevantdetail. With care, honesty, patience, and a cheerfulphilosophy he might confidently hope to reach some resultworthy of comniiunication to a society or journal. Betteradvice than this to the young investigator we have neverheard. Sir William Leisliman next touched on the valueof collective research, in which several workers in different

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712 OcT. 17, I9251 OMR WILLIAM HAMER.

places concenltrate oni thle same investigation. It had been

followed in the army with encouraging and substantial

results, altlhough the exigencies of the service had broughtsomle promising lines of investigation to a premature halt.

Such research not only accelerated progress, but multipliedthe checks upon each observer, and the mere fact that

workers at a distance from one aniother were engaged on

the same problem anid confr olnted the same cdifficultiesstimulated intercommiiunlicationi alnd broke down the isolated

feeling of the orker whlo p-ursued a solitary line. In

conclusion, the presidenit spoke of the way in which the

services, with their ideal conditions for obser vation and

control, might lielp the civil si(le of the profession, which

itself had been so generouLs inl help to the services.

SIR WILLIAM HAMER.

SIR WILLIAM HAMER, imiedical officer of health anid school

medical officer to the Lonldoni County Council, wlho retires

on December 31st next after serving the Council for a

period of nearly tlirt--four years, including fourteenyears in his preselit position, will be entitled to a retiringallowance of £S1,121 a year, but in order to secure the

benefit of his advice anid experience after his retirement

the Council, at its meeting on October 13th, decided to

retain Iiis services in a consultative capacity for a period of

two years, and that he should receive a fee of 600 guineasa year for these services. At the same meeting a reportwas presented by Sir John Gilbert, chairman of the GeneralPurposes Committee, placinig on record the appreciationfelt by the Council for the valuable services renidered bySir 'William Hamer to the cause of public health in London

durinig the period of his associationi w-ith the Counacil. Itwas stated that O011 of tlle mlost importalnt developmentswitlh which Sir William had been associated had been the

growth and organiization of the school medical service.When he took up his appointment in 1912 the scheme ofmedical inspection and treatment was in its infancy.Under his conitrol it had become a far-reaching undertakingunder which every year 300,000 children were medicallyinspected, 300,000 children seen by school dentists, over

1,000,000 examinationis made by schlool niurses in connexionwith the personal h-giene sclheme, 1,500,000 attendancesmade by230,000 childreen at lhospitals anid treatment centres,and over 100,000 attendanices made at cleansing stations.The activities of the school medical service during thisperiod had resuilted in strikinig improvemlents in the healthand physique of the children in the schools. On the generalside of the public hlealtlh wi-ork the mlost important develop-menit of Sir William Hamer's tenure of office had been theadoptioni of a comiprehensive scheme for the treatment of

tuber'cullosis, unider lwhichl provision was niow made for theinstitutionial treatmenit of over 6,000 patients annually.Other new and important services which had been placedunder hiis direction and control since 1912 included thescheme fol the diagnosis anid treatment of venereal diseases,the work of the formnler clhemical departtment, the medicalexamination aiid supervision of defectives under thle MentalDeficiency Act, the supervision of lying-ini lhomles, and thesuperivision of nurse infants unlder the Children Act. Hisriesearches into the incidence of inifectious diseases hadmade himn olle of the most distilnguished autlthorities uponepidemiology. In par ticular hiis work upon typhoid feveranid upoin1iniflueniza and its associated group of diseases hadfurniisheld a series of brilliant reports to the Council, andhad contributed materially bothi to establish clearer con-ceptions of the nature of these diseases anid to open up new

lines of preventive measures. There is reason to hope that,althoughthe retiremenit of Sir- William Hamer is on thegrounid of healtlh, this will not pre-lude him fromii under-

takilng the limited duties of the consultative post.

JAMES MACKENZIE INSTITUTE FOR CLINICALRESEARCH, ST. ANDREWS.

Ix- an address introductory to the winter session of theJames Mackenzie Inistitute for Clinlical Researchl, St.Andrews, the honorary director (Dr. Maitland Ramsay)gave illustrations from ophthalmology of the extreme valueof symiiptoms in early diagnosis, and -demoiistrated how aknowledge of thle mechanisim of their production. throuwslight uponi the pathology of disease. -While- .the act ofsight is dependent on the ilitegrity of (a) the dioptrioapparatus, (b) the rods anid cones, and (-c) tlieir nervousconnexions, the funictional uniit which transforms light intonerve impulses consists of thle rods and cones-an illustra-tion of the essential imi-poltanice of a study 'of receptors,Like all funictional uInits, their efficienicy is pr'oportional tothe state of their capillary blood supply)1, interfereince-withwhich results in, lowered efficiencpy. Disturbance of irdsand cones leads to distuirbance of light miiimumll, wYhilediminution in activity of ganiglio'n cells and -nerve fibres isfollowed by alteration in the liglit difference. Congestionof the clioriocapillaris, therefore, is followed by changoin the lighit miniimum anid congestiol 'of the capillariessupplied by the retinal artery by cbanige in the lightdifferencle, these two synmptomns beinig; thelrefore. dof greatdliagnostic value. He added niumlelous illustrations to showthe value of recognition. of eally symptomis in. the diagnosisof serious diseases of the eye.

LONDON SCHOOL OF HYGIENE AND TROPICALMEDICINE.

TtHE new sessioni of tihe London Schiool of Hygiene andTropical Medicine opened oln October 5th. The class forthe general course is full, and a numiber of applicants havebeen unable to gain admission. This is initeresting in viewof the fact that the course lnow occupies twelity weeksinstead of eleven as formerly, and thlat the fee is thirtyguineas in place of twenty. It will be rememibered thatthe board of management adopted a scheme for thoestablishmnent of four research studentships, the holdersof which, in addition to carryilng out research in theirrespective subjects, are to act as demoilstratolrs in theschool. The posts were advertised, anid from a iuimber ofapplicanits the following were selected by the Apl)ointmnentsCommittee: Elntomology, Dr. Mary V. F. Beattie; helmiiintlio-logy, Dr. Dorothy L. Millar; protozoology, Dr. S. Aniniecke;tropical bacteriology anid pathology, Dr. W/. K. Dunscombe.Fourteen students lhave been enirolled for theispecial cour'sein parasitology for the D.P.H. Thiirteen of these arecandidates for the examination. A few studlents lhave alsobeen admitted for special courses. TIme niew buildinigs ofthe sclhool have not yet beeni beguni, buit e understandthat the preparation of tlhe plans is iin ani advaniced stage.

I-EM-HETEP, THE EGYPTIAN DEITY OF MEDICINE.THB eighty-fifth session of the Readinig PathlologicalSociety was inaugurated oni October 8tlh by the custoiuaryoration, the orator oni this occasioni being Sir WilliamArbuthnot Lane, Bt., whose subject was " The causationof disease anid the failure of civilizationi." A ceremony ofunusual initerest preceded the orationi-the presentationby Sir Stewart Abram, physiciani to the Royal BerkshireHospital and ani ex-president of t-he society, of a president'sbadge or jewel as a souvenir of his term of office. Hitlhertomedicine has recognized as its patronal deity the somewhatlegendary Aesculapius, who is supposed to have lived atthe timiie of the siege of Troy, but of whom no biographical.details are extant. The new badgeA of the Reading Patho-logical Society represents the far more venierable Egyptiandeity of medicine, I-em-hetep or Imhotep, whose name

signifies "he who cometh i'n peace." This famous tgyptian

TEE U JITSinIMEDICAL JOUJRNAl.I

=

OCT. 1-7, 1925_ CHARLES BELL AND MODERN NEUROLOGY. rTx BSTER 713LMEDICAL JOuBUAL 71

lived about 2,900 years B.C., and was a learned, many-sidedman, who filled, amongst other offices, that of vizier to aPharaoh of the third dynasty named Zoser. Further, hewas a noted architect, and built the earliest pyramid knownto history, the Step Pyramid of Sakkarah, near Cairo.Above all, however, he was distinguished as a physician,

and so impressed his fellowcountrymen with his skill in

: the ars medendi that he waseventually acknowledged and

...... worshipped throughout Egyptas the deity of medicine. In

~ his honour temples were

i... erected in various parts ofthle country, and to themflocked patients from far andnear. Many miraculous curesare reputed to have takenplace at his shrines. Thejewel presented by SirStewart Abram consists of a

pen dant in hand-chiselledgold and enamel, designedand made by Mr. Omar

......Ramsden of London. Theoval plaque of enamelrepresents I-em-hetep, theEgyptian god of medicine,the image of the god being

based on an exquisite early bronze statuette in theWellcome Historical Medical Museum. The god is showniii profile, seated on a golden " throne of knowledge,"while his feet rest upon a footstool representing the solidearth, which is surrounded by a green band symbolizingthe cultivated strip of land that is watered by the Nile.The river is of heraldic blue and white, flowing by in fulltide, the background shows the blue sky of the East. Thedelicately wrought frame is surmounted by a double-headedand winged serpent, from which is suspended the Egyptian"ankh," the symbol of life. The border is made up oflotus buds springing from a lower space inscribed with thename " I-EM-HETEP." At the back is engraved thefollowing inscription: " George Stewart Abram commandedme to be wrought for the Reading Pathological Society,in October of the year of our Lord MCMXXV." Aftera few words by the donor of this artistic badge, acordial vote of thanks was proposed by the president ofthe society, Mr. W. B. Nelson, who expressed thegratitude the society felt for this unique gift. In support-ing the resolution Dr. J. B. Hurry gave a sketch of thelife of I-em-hetep, and pointed out how preferable it wasfor medicine to have as a patron deity a man of flesh andblood who had played a great part on the stage of history,rather than the semi-mythical Aesculapius, who is supposedto have lived about 1,700 years after I-em-hetep. To theReading Pathological Society belongs the honour of havingbeen the first in this country to recognize the claims ofI-em-hetep to be regarded as the deity of medicine."I-em-hetep," to quote the late Sir William Osler, "isthe first figure of a physician to stand out clearly fromthe mists of antiquity."

AN UNUSUAL ANAESTHETIC FATALITY.AN inquest was_held b~y the-West Ham coroner on October8th on the body of a hid, aged 16, who died in most unusualcircumstances at Queen Mary's Hospital, Stratford. OnSeptember 7th he had a cycling accident riesulting in afracture of the jaw, and an operation was performed onOct,ober 5th. Dr. J. Keith Davidson, house-surgeon at thehospital, said that in the course of the operation warm airhad to be used in order to keep the patient's teeth dry. It

was applied with a dental syringe. Ether and oxygen wasthe anaesthetic employed. On the third application of thesyringe an explosion occurred at the back of the boy'sthroat. Acute haemorrhage followed, and despite everyattention the patient died within ten minutes; he hadbeen under the anaesthetic for twenty-five minutes. Mr.Percival P. Cole, surgeon to the hospital, who performedthe operation, said that the light at which the dentalsyringe was warmed was fully six feet away fromthe operation table; there was no naked flame near.Within two or three seconds of the explosion bright redblood came from the patient's nose, and the wholeapparatus burst into flames. Mr. Cole explained thatduring the war 1,600 patients suffering from similarinjuries passed through his hands, and what was done herewas merely routine work. The explosion, he thought, musthave arisen from the mixture of vapours; he himself usedthe syringe, and satisfied himself that it was not red-hot.The teeth had been smeared with alcohol in order to makethem perfectly dry; otherwise the dental cement would notadhere. The explosion occurred when the operation waspractically over. He had never heard of such an accidentbefore. Dr. Niel McDonald, anaesthetist to the hospital,who gave the anaesthetic, said he had never comeacross anything like this before, nor had he seen anyaccount of such a thing in surgical literature. Dr. AngusKennedy, who made a post-mortem examination, said thatthe cause of death was rupture of the bronchi and collapseof the lungs; there was no sign of burning in the mouth.The jury returned a verdict that the boy's death was anaccident caused by the explosion. We understand that Dr.McDonald intends to communicate a report of the caseto the Section of Anaesthetics of the Royal Society ofMedicine.

CHARLES BELL AND MODERN NEUROLOGY.AT the opening meeting of the Section of Neurology of theRoyal Society of Medicine, held at the Middlesex Hospitalon October 8th, Dr. H. Campbell Thomson gave his presi-dential address on " The work of Sir Charles Bell in rela-tion to modern neurology." Dr. Campbell Thomson beganby pointing out that men of science were most oftenremembered by some particular discovery associated withtheir names, while the principles underlying such a dis-covery and the position the discoverers held with regardboth to their predecessors and to those that followed wereapt to be overlooked. Sir Charles Bell was no exceptionto this rule, and while his name is particularly associatedwith the functions of the spinal roots, his work was closely.linked to what had been taught in previous times and alsoformed an important starting point for those who cameafter. Bell- came from Scotland to London in 1804, andevidently found his first Sabbath in this city very depress-.ing. He took a tumbling-down house in Leicester Street,Leicester Square, and here founded his famous museum,which was purchased by the Edinburgh College of Surgeonsin 1825. Bell's main interest at first lay in anatomy, buthe soon realized the importance of function in relation tostructure. In 1807, as shown by a letter to his brother,he was already on the track of the problem of nerves ofsensation, and was considering the doctrine of the specificityoL nerves. His work on this subject consisted at first inthe examination of all the spinal nerves, in which theirexact resemblance to one another was noted, and by experi-ment Bell slhowed that tle -two roots had different func-tions. The cran-ial nerves next received attention; it wasthe fifth alone which appeared to him to resemble the spinalnerves and be responsible for the double function of senseand motion. Ho particularly investigated tlle nerves ofthe face, and by experimenits on an ass he was able toshow a differenice between the functions of the fifth andseventh nerves. The physiology of the nervous system at

714 OCT. 17, I925] THE "NEWELL" TREATMENT OF TUBERCULOSIS.

this period was practically in the state in which it hadbeell left by Galen, and there was intenise antagonism in

certain quarters to Bell's views, which, however, in thewords of one of his contemporaries, " led to the entireremnodelling of nervous physiology." Bell's accuracy ofobservation is well shown by his description of the hemi-

plegic's inability. to raise the slhoulder voluntarily whilethe l)aralysed mluscles contracted during respir ation, andhe coneluded that there muist be a separate inniervation forvoltuntary and involuntary lovemuents. He also recog-

niized thle importance of miiuscle sense, and after confirmingthe observationis of Meckel and Monro on the distributionof sensorv nerves to muscles, lie concluded that the imiipulsespassinlg from the muscles to tlhe central nervous systemn were,

esseiitial for " the governance of tIme muscular frarmie."Bell anticipated the later discover'ies concerlned withreciprocal innelrvation when he attached a weight to thetenidon of an extensor muscle, anld observed that the weiglhldescenlded on the contraction of the opposing flexormuscles; to explaini this he imagined the occurrence ofperiplheral inhibition. A cer tain amount of controversyhas taken place over the part Bell took in differentiatingthe spinal roots, and in this conlnexion an address to theBritislh Association in 1833 by Dr. W. C. Henrv as, Qr.

Thomson said, of great imiiportance. In dealinig with thetlhen recently a-cquired kniowledge of the physiology of thenervouis system Henry stated that the holnour of the dis-coverly beloinged " exclusively to Sir Charles Bell." He-went oni to say tllat Mayo had, bv hiis study of the cranialnerlves, beemi able to corr ect cer'taini errors in detail inBell's work, anid Heniry also disposed of Magendie's claimsby pointiig out that this worker had stated that his experi-ments were made withiout knowledge of those made Qanlierby Bell. Despite tIme fact that sonie of Bell's conclusionswere inicomplete or failed to stanid the test of tiniie, hliswork gave stuell an impetus to physiological research that helhas been comiipar ed with Harvey. Bell's talents as an

artist aire well shown by the illustrations in hiis Anatomyof Eixpurcssion, anid his position as a surgeon was fullyrecognized. He was elected surgeon -to the MiddlesexHospital ill 1814, anid he fouLndedl the mnedical school of thatinstituitioIi a few nionths before beinig inivited to occupy thechiair of surgery at the University of Ediniburglh in 1835.Durinlg Dr. Campbell Thomson's address certain of Bell'ssketchles, inicludilng " Sunday in. Scotland " and " Sundayin Enigland " and illustrations from his Antatomay ofExpression, were shown by the epidiascope. His portraitanld an interesting collection of sketches, books, and otlierrelies eme afterwards on view.

JAPANESE HEALTH ORGANIZATION, PAST ANDPRESEN T.

Ii' anivthinig is needed to demonistr ate the value of tImeLeague of Nationis' organizationi for the interlchanige ofstudy by miiedical officers of healtl, it will be founid in thepublicationi of thirty-six lectures' w-hich have been preparedby varaious Japaliese authorities for the instructionl ofmeldical officers of hlealth from Far Easterni couintriesdurling ani interchanige study tour in Japan between Octobemanid Decenmber. Tlheso lectures cover the whole field ofhygienle. Saiiitary adminlistrationi, water supplies, dis-posal of waste products, contr ol of food, milk nnd

beverages, serums and vaccilnes, minier al sprinigs, patenit

medicinies, opium alid lnarcotic dr ugs, anid the var ious

brinhelies of social medicinlo aiid social llhgieie arenot only described as they exist in Japan-, but eacls51bjett is inltroduced by a iiiost ilnterestilng anid in-structive accounit of its hIistory in Japani fr oiii theearliest times. In the lecture oem w-ater suppliees, for

exampl)le, we- are told that tlhe existing waterworks inX,Health Organ ization in Japan. League of Nations-Health Organiza-

tiong-.H.332. (Pp. 280.)

Tokio are the oldest in the empire, and date back to the

year 1590. Againi, in connexion with food supplies we

learn that animal meat was used as a, food until the intro-

duction of Buddhism some foulrteen hundred years ago,when an imperial decree prohibited the eating of the mneat

of cow, horse, donkey, dog, or chickeln-a prohibition wlhiclseems to have held good until the restoration in 1868.

The whole series of lectures is full of curious and inter-

esting information of this kind, and their publication bythe League of Nations now provides those who may not

have the good fortunie to take part in the interchange studytour in Japan with a comlendium of facts of an historical,

scielntific, and instructive clharacter which greatly enhance

the admiration we alreadv lhave of the work of the medical

officers of that fascinatiilg counltry.

THE "NEWELL" TREATMENT OF TUBERCULOSIS.

TEIE number of cures for tuberculosis submitted every yearfor public appreciatioll does niot seem to diminish. As a

rule, after a hectic carcer ini the advertisement columnisof newspapers and nmagazines, anid even on omnibuses anid

hoardings, most of tlieiii cease to occupy any large placein the public eye. Sonme continue their career on a

smaller scale of niotoriety; others apparently disappear

altogether. Last sprinig John Bull published some articles

oni the " Newell " treatment of tuberculosis. The treat-

ment was to be admiinistered by lypodermic injectioni, anid

it was announced that the medicanielt was to be supplied

onily to members of thie medical profession. No indication

was given as to its ingredients. A niumiiber of letters weie

received at the head office of the Britislh Medical Associa-

tion from medical miiell asking for information, but ino

satisfactory reply could be. made as the composition of tlheremedy was not stated. Accordingly, on April 28th the

Medical Secretary wrote to Dr. J. Stenison Hooker, who, it

was understood, was then acting as chairmiiani of a com-

mittee of medical men whicll had been established to

ilnvestigate the treatmiient. Dr. Cox inquired what arrange-

ments were being made to deal with the matter in accor(l-

ance with the traditions of tlle professioni. Dr. Hooker, illhlis reply, said that the discoverer lhad asked that for the

presenut the composition of the remedy should remaini a.secret, and added that " in. view of the huge and vital

issues at stake tlhe coimmittee and myself have agreed to

gicant tlhis, to us, veryv reasoniable request." This is the

only foundation for a paragraph which appears in a

pamphlet recenitly issued to the medical profession. Tlhepaaragraph is: " The British Medical Association, a short

time afterwards [after April 2nd], wrote the Chairman of

the Committee of Investigationl asking for information

conicerning the movement, an(d that body was supplied witlthe inifor matioln applied for." The inforniation actually

supp)lied was of the nebulous kinid we have indicated, anid

nothing more was done at the timne. On September lOtla notification was received to the effect that Dr. StensoniHooker had found " it necessary to transfer the super-

visioni of the dispatch of the Newell treatment for tuber-

culosis to H. W. Whyte, M.R.C.S., L.R.C.P., Chairman of

the Medical Committee of Investigation, at 23, Fitzroy

Square, London, W.1." It was added that Dr. StensolnHooker retained " the positioni of vice-clhairman to tlhecomimittee anid chief medical officer at the prinicipal Lonidoii

clinic for treatmiienit " in Spanislh Place. The pamplhletreferred to is entitled, " Treatise of the Newe1l Tuber-

culosis Treatment, for circulatioln to the Medical Professionlonly "; in it we read that the sponsors for the Newell

treatmiient are dealing somethingwhich whole

spheres niext tlhe

pamiphilet professes to give the niatuire of the inlglredielntsthle remedv. It is stated conitaiin conlstituenits. of

tIhe first said promiiotes helaltlhy suppuration,

or rather, healing suppuration"; second,

t THE BRITISHMUDICL JOU3NAL

714 OCT. I7,I925]~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

OCT. 17, 1251 FILTERA.BLE VIRUSES. TnzDitmsORA 715OCT. 17, 119251 FITR- IIU8 [MZIDCAL JOURNAL 1

of a vegetable nature, a noni-irritatinig tonic kiowni toancient writers, irdAluding Dioscorides anid Pliny. Thethird conistituient, it is said, is also vegetable, and was wellkniown to the ancionts, especially to the Egyptians. Ofthe fouirth constituent it is stated that it is " a salt," thatits employment, is followed by leucocytosis anid that it isa vaso-dilator. The tubercular deposits sooni become, thepamphlet states, infiltrated by the leucocytes anid undergofibraid degeneration, so that eventually the imprisonedbacteria and their products become disintegrated andrendered harmless. The fifth constituent is said alsoto be a vegetable and to act as a powerful stimulatorto the liver and to aid the stomach in digestion. Aswill be seen from what has beeni said, an-d miorefully from thel pamphllet, there is here nio disclosureof the. nature of the ingredients of the alleged remedy.Aniother section is heade-d " Reasons for niot divulgingthe exact nature of the formulao employed." Thesereasonis are that the committee " are immediately, vitally,and successfully dealing with an immenise problem ratlherthan spending our time an(d energy in theorizinig firlstand healing afterwards," anid that the ultinmate verdictmmust be giveni by the patienits anid tho public in general.''

Thel panmphlet states that the comimittee is steadily com-piling the results of the treatmenit, aind proposes topublish them. Meanwhile it gives some samples wlhich dotiot appear to rise above the testimoniials wlhiell are verycommonly given to any. remedy for consumpltioni nlewlyadvertised. It seems to us that medical prac-titioniers canlhavo nio hesitationi in making up theii miinds as to thecouirse they should take, and the l)amphlet itself, apartfrom what we lave said, affords sufficient ground for adlecisionl.

INCOME TAX.IT is at this time of year that the genieral issuie ofniotices of assessment is made, alidndedical practitionersaro advised to examine these unwelcome documenits closelvand withlout delay. If the figures are lnot understood or theamount of the assessment is considered excessive, a lettersh1ould be sent at once to the inspector of taxes askinig forfurtlher inforination or objecting to any particular figures;even in the former case it is sometimes advisable to statetllat the assessment is objected to because the twenty-oledays allowed for the lodging of objections may be held tobar a future request for a reduction of the gross assessment.This applies more particularly to cases where the deprecia-tioni allowance authorized by this year's Finance Act canbe claimed and has not been received. Personal allowanicesand reliefs for 1925-26 can be claimed at aniy time withinisix years, but in this connexion also- promptitude is desir-able; the Exchlequ'er is entitled to a sufficiently large slhareof a practitioner's ealrnings; it is quite unnecessarv toinflate that shalire by procrastiination ol neglect.

THE MEDICAL PROFESSION AND THE ARTISTS'RIFLES.

THE close bond uniting the medical profession to thedistinguished corps known as the Artists' Rifles is notgenierally known. In the ol0( Volunteer days, long beforethe Territorial Army was organi7zed, a company in thecorps was composed entirely of medical students anddoctors, Guy'z and St. Thomas's Hospitals providing m11ostof its mnembers. After a lapse of many years this bond hasbeen restored by the presenCe of the Artists as the guard

fc lhonour wlhen H.M. the King opened the Britislh MedicalAssociation House in Tavistock Square. The new buildingand thel Artists' hceadquarters in Duke's Road are only, asthe crow flies, about 150 y-ards apart. W0e un1derstandthlat tohe corps nleeds recruits, and fathers withl sons inLondonl pursuing their n;cdical Or othler professional studiesnmight dIo far worse than urge them to jOinl. Besides serious

military instruction, the corps affords opportuniities (sohard to find in London) for every kinid of sport, as well asan occasion for joining a " school of arms " with -a recordat the Military Tournament of w-hich it is justly proud.

FILTERABLE VIRUSES.VACCINIA AND VARIOLA.

FOR some years the Medical Research Council ias promonOtedresearches into the nature and properties of the so-calledlfi'terable viruses and into the widely various and destruct-tive diseases with which they are associated. One of theworkers engaged in these researches is Dr. Mervyn Gordon,F.R.S., who has carried out his investigationis at St.Bartholomew's Hospital. He has already reported researclwork on the virus of influeinza, and three years agoaddressed the Section of Bacteriology of the AiinualMeeting of the British Medical Association oni this subject.Ee found himself handicapped, however-partly owing tothe irregular supply of material, partly by lack of know-ledge of h-ow to handle sucll organisms as the virus he hadisolated, but chiefly by the difficulty in deciding whetherthe illness from which an experimental animal sufferedafter inoculation with this virus was true influenza or not.It was also often hard to say whether the experimentalanimals that showed no symptoms escaped throttgh anatural or acquired immunity. Therefore he (letermined toconcentrate his attention on a filter-passing vir1US thatwould produce an unmistakable lesion in a laboratoryanimal, and he chose vaccinia as the virus to study; inmost of his experiments lie used rabbits-aiiinials whichrespond to inoculation with vaccinia vir'us by typicalcutaneous lesions. Dr. Gordon gave a preliminiary accountof his results to the Section of Pathology and Bacteriologyof the Annual Meeting of the British Medical Associationat Bath this year. His remarks were publislhed in ourissue of August 1st (p. 192); his full text is published in thereport1 of the Medical Research Council now issuLed.The report consists of three chapters; the first is a

general introduction defining the object of the inquiry andgiving ani account of the work of previous investigatorswith regard to vaccinia and variola; it is accompanied bya loIng series of references to the literature. The secondclhapter describes and discusses Dr. Gordon's own studies ofvaccinia, and the third deals in the same way with hisinvestigations of variola. The report is ver'y well puttogether, each chapter being divided into sections witlhexplanatory titles.

INTRODUCTION.The first thirty pages of the introductory clhapter con-

tain in a series of sections a condensed review of previousinivestigations along lines similar to those which Dr. Gordonhimself has undertaken, anid form a valuable contributionto the literature of the subject. The new work reported inlater pages was planned in the following way. Since themicroscopic examination and conventional culture testshave presented great difficulties, Dr. Gordoni h)as confinedhimself to experimental work, and employed the skini ofthe rabbit as a " reagent " for detecting the presence ofvaccinia virus, and succeeded in making his tests quanti-tative by submitting his material to a known degree ofdilution before inoculation. Tlhe virus grows in the rabbit'sskin, and he increased his stock of virus by scrapinig thelesions. Having standardized this method lie embarked onthe extensive research described in the next two chapters ofthe report. During the time that this experimenital studyof the vir'us of vaccinia was in progress, five outbreaks ofsmall-pox in various parts of the country provided anopportunity of comparing specimens of the virus of variolawith that of vaccinia. He was able, therefore, to extendthe field of his investigations, and bring ani alreadyacquired expert method to bear on the important practicalquestion-s of the relation between vaccinia and variola- andthe comparisoni of the virus obtained from severe cases ofsmall-pox with that from the milder cases sometimesreferred to as alastrim.

1 Medical Research Council, Special Report Series, No. 98. Studies ofthe Viruses of Vaccinia, and Variola. By M. 11. Gordon, C.M.G., C.B.E.,D.M., F.R.S. H.M. Stationery Office. (Pp. 135, with 5 plates, 1 in colour.Price 3s. 6d. net.)