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amount of fluid required for original salvarsan is given.The doses should always be smaller than for youngerpersons, and there should be three or four days’ intervalbetween each injection. Supporting treatment shouldbe combined with antisyphilitic therapy.

A SUBCONSCIOUS MOTIVE FOR STRIKING.

Now that the coal strike is over advantage may begained by suggesting other influences than wage ques-tions, which may have provided an unconscious impulseto strike among the miners. Strikes, we believe,frequently depend upon underlying reasons whichcreate unrest among the workers, reasons which donot appear among the points at issue. Professor E. L.Collis, in a letter which appeared in the Times in

September, drew attention to the fact that the ballots,especially the first one taken, showed a very unequaldesire for a rest on the part’of the various coal-fields,thus:— .

Coal-field. Percentage voting,

Coal-field. for a strike.

The above list (arranged in order according to the sizeof the majority) only includes those coal-fields forwhich the Registrar-General publishes mortality data.The most recent data arranged in order according tomortality are as follows:-

Coal Miners.

The similarity in the order of the coal-fields arrangedby these two methods is remarkable. Yorkshire

(italicised in the tables) is the only field notablyout of place; but in August of last year the minerson this field indulged all by themselves in a sixweeks’ strike or rest ; undoubtedly this past eventaffected the voting. Allowance having been made forthis exception, the order of the coal-fields in the twotables is so closely correlated as to point to a commoninfluence determining both. The question may fairlybe asked whether the voting recorded not so muchan answer to the question on the ballot paper as theamount of discontent resulting from ill-health presenton the various fields. Certainly the figures suggest thepossibility that if the mortality, especially that due toaccidents, on all the coal-fields had been as low as thatfor Nottinghamshire there would have been no two-thirds majority for a strike.The most important cause of death among miners is"accidents," which is always in excess on all coal-fields ; possibly here lies one reason for unrest amongminers, on the supposition that a community expe-riencing an undue number of accidents will be like aregiment experiencing heavy casualties-that is, it willbe liable to " get the wind up

" or (to employ language of

modern psychology) to be constantly suppressing thesensation of fear. From this influence irritation andneuro-psychoses arise, for, as Dr. C. S. Myers has

pointed out in a book which we review in anothercolumn, "in dangerous trades the workers show a

tendency to neurasthenia. This is especially markedamong coal-miners. Of the cases of nervous breakdownoccurring during the late war, a disproportionately largepercentage was found among soldiers who had beenminers." Most practitioners on coal-fields will agreethat miners do exhibit an undue tendency to neur-asthenia. The same argument might be held to applyto railway workers ; their tendency to strike needs nocomment; they appear with the coal-miners among thelist of occupations with the highest mortality fromaccidents. Other instances might be quoted, but theymight give the impression that accidents are the onlyinfluence which affects health so as to produce socialunrest. This would be wrong. We hold that a com-bined study of vital statistics and of the epidemiologyof strikes would disclose other important factors. In ’

passing we would remark that the lowly paid andpoorly housed, but healthy, agricultural labourer isdifficult to induce to strike.The health and happiness in the mining industry are of

humanitarian interest to the whole community, whileon the utilitarian side practical action should imme-diately be taken if those who control the coal-fieldsdesire to avoid future trouble. An active safety-firstcompaign should be set on foot on up-to-date lines,especially in Lancashire, South Wales, and Yorkshire.America has been teaching us how to proceed by firstseeking the cooperation of the workers through work-men’s safety committees. Action on these lines is

already being taken with signal success in our factories.Other things might also be mentioned which wouldimprove the welfare of miners, such as pit-head bathsand the sending of food trolleys carrying hot meals intothe workings from a central kitchen. But for thenouoment we are content to lay stress on the point thatsocial unrest depends on ill-being, the forerunner ofill-health ; and to appeal to politicians to appxeciate theimportance of health to the community so that theymay cease to struggle with their problems in the dark.

ACUTE POST-OPERATIVE DILATATION OF THESTOMACH.

THE interesting discussion by Mr. W. G. Spencer, inMedical Science for November, on acute dilatation of thestomach, its causes and treatment, may be supplementedby the following case, recorded by the Norwegiansurgeon, Dr. 0. Usland 1 :-His patient was a sea captain, aged 51, with an easily

reducible, indirect inguinal hernia on the right side and arather large, irreducible femoral hernia on the left side.The local anaesthetic used for the radical operation on bothsides was a 0’5 per cent. solution of novocain. containing10 minims of adrenalin to the 100 c.cm. Altogether 120c.cm.of this solution were used, and immediately before theoperation 1 cgm. of morphine was injected subcutaneously.Bassini’s radical operation was carried out without difficultyon the right side, but on the left side the hernia containedadherent omentum, the detachment and resection of

which provoked some pain. Otherwise the operation, whichlasted about one and a half hours, was perfectly painless.Next day he felt well, but the abdomen was somewhat dis-tended, and in the evening he complained of an increasingsense of oppression in the upper abdomen. He slept badly,and next morning he began to vomit. The pulse was 80, thetemperature 36.2° C. There was diffuse distension of theabdomen, but little tenderness. Later, he complained ofnausea, a sense of great pressure in the chest, and ofimpending death. He was pale, cyanosed, and bathedin a cold sweat. The pulse of 120 was small and soft,and there was considerable dyspnoea. The abdomenwas distended, and when a stomach-tube was intro-duced much gas and at least 3 litres of a brown-greenfluid escaped under high pressure. The stomach wasthen irrigated with 20-25 litres of water, which gavesome relief. Complete and instantaneous relief was

obtained by a change to the prone posture and the tilting upof the pelvis by a pillow. About half an hour later therewas a free escape of flatus, and ultimately complete recoveryfollowed.The only similar case which Dr. Usland can find was

recorded by Lyle.2 In this case, too, local anaesthesia.

1 Medicinsk Revue, 1920, xxxvii., p. 95.2 New York Medical Journal, 1911.