207BIRTH CONTROL.

inhabitants can be relied upon to help them-selves. Such matters as these can only be thesubject of estimate, though prophecy, based uponexpert knowledge and experience, will go far to

direct accurate answers. A question of similarcharacter seeks to ascertain not only the in-

crease or decrease of the local population dueto the war, but also the probability of anysuch altered condition being permanent. A final

question refers to the desire of the Board for

general observations, including information as tothe adequacy of existing accommodation, a questionthe reply to which may be regarded as involving,to some extent, the expression of expert opinion.The majority of the inquiries, however, relateto matters of fact. The Board asks for thenumber of existing houses of specified rateable

values, and of those standing vacant which aresuitable for the working classes and reasonablyfit for habitation. Definite information is requestedas to the prevalence of overcrowding-i.e., ofmore than two persons inhabiting one room-asto any housing schemes already prepared or con-templated by the local authority, and as to the

possibility of acquiring suitable sites by agreement.Inquiry is made as to powers which the local

authority may deem necessary for the acquisitionof land, in addition to those already given by law,and as to the sufficiency of existing facilities forlocomotion.The Local Government Board has, in short, pro-

pounded questions which can be answered witha fair degree of accuracy by a local authoritygenuinely anxious to cooperate with it, and allmedical men, knowing how the housing questionlies at the very root of sanitary reform, will beglad to see the way in which the matter is beingapproached officially. Local authorities should feelassured that their aid is being asked for in a

cause intimately associated with the future pros-perity of the nation, as well as of the particularsection of the public entrusted to their care. In

unparalleled circumstances the task is set to all,and in the interests of all, of repairing the wastageof war, by securing to the survivors of the presentgeneration, and to their descendants, more agree-able as well as healthier and more sanitaryconditions of life than have hitherto been in anyway universal.

MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREATBRITAIN AND IRELAND.-The seventy-sixth annual meetingof the Association was held on July 25th in the rooms ofthe Medical Society of London, under the presidency ofLieutenant-Colonel David G. Thomson, R.A.M.C. Dr. JohnMayne Colles, LL.D., K.C., J.P., Registrar in Lunacy inIreland, and Dr.Alexander Reid Crquhart (since deceased), latephysician-superintendent, James Murray’s Royal Asylum,Perth, were elected honorary members. The meeting alsoapproved the regulations and syllabus for candidates for acertificate for nursing and attending the mentally defective.The Gaskell prize, consisting of 50 guineas and a gold medal,was awarded to Major James Cowan Woods, R.A.M.C., ofThe Priory, Roehampton. The work next in order of merit,that of Dr. Monrad Krohn, was considered to be of highmerit, and it was decided to present him with 15 guineasand a replica of the medal in silver. Dr. C. A. Mercierread a paper entitled Madness and Unsoundness of Mind,"which led to a brisk debate.

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Annotations.

BIRTH CONTROL.

" Ne quid nimis."

IF we may believe correspondence which reachesus, the use of contraceptives is gaining in vogue:their virtues are advertised quite freely, thoughindirectly, with the result that our young men andyoung women are gaining a familiarity with theiruse. We find it difficult to believe that ignoranceis a principal agent in preventing the use ofpessaries and condoms, for in large towns such thingsare exhibited freely in shop windows, and marriedfolk of higher social standard are regularly circular-ised by vendors after the arrival of their first-born, with the result that most adults mustbe aware that measures against conception canbe taken. But many also know that the pessaryand the condom do not offer safe facilitiesfor a kind of superior prostitution within theprecincts of the moral code. They are notori-

ously unable to ensure against venereal infection ;they are equally impotent to deal with any certaintywith the virile spermatozoon. The measures to beeffective have to be applied with constant care andpatient exactitude ; any lapse renders them entirelyineffective, and it is the persons whose trainingfits them for such punctiliousness who refuseto have anything at all to do with measures ofprevention, while those who resort to them rarelyhave the qualities likely to make them efficient.Precisely the same applies here as in similar

appliances to avoid venereal disease. Moreover,the assumed success of birth control among well-to-do people rests upon slender foundation, andthe diminishing birth-rate, which is beginning todescend the social scale, may well have quite otherthan such a material explanation. In an acutestudy of the whole problem in the Medical Timesfor July by Dr. R. W. Wilcox, President of theAmerican College of Physicians, the author laysstress on the broader view of life among the culti-vated classes which finds enjoyment in the appre-ciation of art, science, literature, and the socialamenities, and hence has less need for thegratification of the appetites connected withphysical existence. As the intellectual stimulusbegins to reach the less wealthy classes thebirth-rate will similarly diminish. The moralwhich we may draw from Dr. Wilcox’s study,even if he does not draw it himself, is thatwhat he calls " birth control and that sort of

thing " may well be left alone. He is a kind ofmodern Gamaliel, assuring us that if " that sort of

thing " is at variance with the laws of nature andmorality it will come to naught, and thereforewe may let well alone. Dr. Wilcox contributesmaterially in two directions to our knowledge ofthe subject. He states that the birth-rate isessentially determined by the working of an

economic law to the effect that prolificity variesin direct ratio to the productive value of the child.If the school period is prolonged, or child labour islimited, or the cost of sustenance is increased, theproductive value of the child is diminished and thebirth-rate falls. This, he states, has been anobserved fact for generations. Two at least ofthese factors are present in our own generation toreduce the birth-rate among the manual workers,and it may therefore be unnecessary to assume

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the existence and efficacy of extensive birth controlas a dominating factor. Dr. Wilcox relieves thediscussion of a distasteful subject by a delightfulanalysis of the birth-control propagandist. Hefinds him in general a sufferer from mentalstrabismus, accentuated by intensive cultivation,essentially an egotist who, if he recovers from anattack of one propaganda, becomes, as a rule,afflicted in rapid sequence with other attacks of alike nature. This particular propaganda hasfurnished to Dr. Wilcox an opportunity of an

interesting psychological survey.

PARLIAMENTARY REPRESENTATION OF THEUNIVERSITIES OF EDINBURGH AND

ST. ANDREWS..

WE published last week in our advertisementcolumns the address of Sir W. Watson Cheyne tothe electors of Edinburgh and St. Andrews Univer-sities, where a representative committee has invitedhim to become their Parliamentary candidate. SirWatson Cheyne is a graduate of the University of-Edinburgh, although his life work has mainly beendone from London as a centre; and we feel certainthat, if he is ’elected, Parliament will obtainfrom him no partisan support of Scottish or

English interests, but the solid counsel of a manwho has arrived at the head of the profession ofall others that has the public welfare most clearlyat heart. The good doctor thinks always of thepublic first, and it is rather a reflection uponmodern society, in this country at any rate, thatthe calling of medicine has suffered for its altruismin not obtaining the public support which enlight-ened opinion should give it. Sir Watson Cheyne’slong and distinguished career as a surgeon ensuresthat the scientific interests of medicine will alwaysbe present to his mind. It is fitting that twoancient Scottish Universities from which so manydistinguished members of the medical professionhave graduated should be represented in Parliamentby a distinguished surgeon.

RAT-BORNE FEVER.

THE febrile condition occasionally following thebite of the rat, to which our Paris correspondentalluded last week, is of special interest at the

present time, when the rat is a constant companionof the man in the trenches. Dr. T. J. Horder, in theQuarterly Journal of Medicine for January, 1910,described three cases of irregular periodic feverfollowing the bite of a rat, and to these Dr. G. S.Middleton added a fourth in THE LANCET ofJune llth, 1910. In a brief note on rat-bite feverin the "Medical Annual" for 1913 Dr. F. J. Charterisdescribes the characteristic sudden attack of feverrepeated. at intervals of a few days, each attackbeing ushered in by a rigor. He states that in anumber of cases salvarsan was used and cut shortthe disease. Dr. Herbert French, in a later numberof the Annual, also calls attention to the periodicityof the febrile attack, which recalled to him some ofthe characters of relapsing fever. We shall hardlybe wrong in assuming that rat-bite fever is in factdue to an infecting organism, although as yet noone has succeeded in isolating it. We should like,however, to suggest that the type of temperaturechart in all the cases we have cited of thisfever is curiously reminiscent of the charts oftrench fever given by Major Arthur F. Hurst,

R.A.M.C., in THE LANCET of Oct. 14th, 1916, and ofthe charts of the Volhynian fever, described as

occurring in the German trenches, especially onthe Russian side, of which we gave examples inTHE LANCET of March 3rd. No one, as far as weknow, has claimed that trench fever is due to thedirect bite of the rat, but the opinion is gainingground that it is a spirochætal disease conveyedindirectly by a parasite from animal to man, andthat the rat is the animal to blame. Rat-bite feverand trench fever may differ only in the presence in ’

one case of an intermediate host. There should beopportunity in the trenches for a comparative studyof the two fevers.

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CREW ACCOMMODATION IN STANDARD SHIPS.

SHIPOWNERS, while naturally careful about theaccommodation of their passengers, are in the’habitof giving their men the minimum of sanitary accom.modation, as we have pointed out on many occasionsin these columns. It is therefore the more satisfac-tory to note the improved quality of accommodationwhich is being provided in the standard ships under ,

the direction of the Controller of Auxiliary Shipping.In these ships the crews are berthed in the poop,instead of as heretofore in the forecastle, with specialarrangements for steam heating. The floor and cubicspace now provided are considerably in excess of theBoard of Trade requirements. The messing arrange-ments for firemen and seamen are separate fromthe sleeping accommodation, and a smoke room isbeing provided for the general use of the men.

Separate cubicles or rooms are provided, eachfitted with two berths and a folding table, andsituated along the side of the vessel. Thefiremen’s and seamen’s washplaces are fittedwith lockers for dirty clothes, one for each man.Three spare cabins, with a separate bath and w.c.,situated under the after end of the bridge, can beused for isolation purposes if necessary. In an

interesting letter which we print elsewhere MajorW. E. Home gives his personal experiencesof the old conditions and points out to whoseefforts the improvement is principally due. TheNational Seamen and Firemen’s Union may be

congratulated on the success of their efforts inthus securing for their men many of the improve-ments which we have long been demanding for

them. ____

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INFECTION OF SIMPLE FRACTURES.

IN the Boston Medical and Surgical JournalDr. J. B. Blake has described a very unusualphenomenon which does not appear to have beenpreviously recorded-infection of simple fracturesparalleling in intensity and duration the infectionwhich is still too common in compound fractures.Among the large number of fractures treated atthe Boston City Hospital he has seen 10 or 12 suchcases in the past 20 years. They occurred princi-pally in the working class, among whom conditions favouring sepsis are common. The following areexamples. A thin, feeble, elderly man was crushedin an elevator accident. The right humerus wasbroken and much comminuted and the arm wascontused and scratched. On the day afteradmission his temperature began to rise, and onthe third day there were obvious signs of infectionof the arm. On incision a large amount of pus wasEound. He died on the sixth day. A - labourer,iged 50 years, sustained fracture of both bones of