1173THE FUTURE OF MEDICAL BENEFIT.

reagent it gives the greenish-yellow precipitate,similar to that given with many other substances,such as alkaloids, amides, all amines, organicammonias, aldehyde, and methylene derivatives.Nessler’s reagent is very sensitive to ketones andparticularly to acetone, but the presence of thelatter may be excluded as being the factor in theprecipitate, for it has no odour, and its precipitateis milky-white instead of greenish-vellow ; moreover,the other reactions for acetone, such as acetol, iodo-form, and nitroprussiate, do not occur. Dr. Pittarelli 1

concludes from the result of his experiments thatthere is a close relation between the odour of theurine, the distillate, and the precipitate, and thatthere is a volatile body in normal urine resemblingketone, but different from ordinary acetone, pre-cipitated by Nessler’s test, and that it is to thissubstance that the characteristic odour of the urineis due.

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RETIREMENT OF SURGEON-GENERAL

SIR GERALD GIFFARD.

AFTER nearly 35 years’ service, Sir Gerald Giffard,Surgeon-General with the Government of Madras,has arrived home on leave, preparatory to netirement.General Giffard’s name will always be associatedwith the reconstruction of the Government MaternityHospital, and the building of the School of

Midwifery in Madras, which last is known as the" Giffard School." During his strenuous years inthe Maternity Hospital and also during his tenureof office as head of the medical department in Madras,he has been the keen champion of the nursing pro-fession. During his term of office the Madras Nurses’Association was formed ; the members of the Associa-tion recently entertained General Giffard at an " AtHome," held in the Y.W.C.A. grounds. In his replyto a tribute of praise paid to him by Mrs. Symons,President of the Association, Surgeon-General Giffardsaid that he had welcomed the formation of theAssociation, but that much yet remained to be donefor the nurses. The Madras Government had recentlypassed an order that only qualified nurses should beemployed in State hospitals ; this meant thatunqualified nurses would no longer be able to rise tothe higher ranks of the nursing profession. TheGovernment was also arranging for pension andprovident funds for their nurses, and the papersconnected with this subject were now before theSecretary of State for India. We congratulateSurgeon-General Giffard on the valuable work formaternal welfare which he has been able to initiate,the results of which are as yet only dimly seen.

BOWEL DISEASE AMONG MINERS IN THE

TROPICS.

WE recently printed an abstract of the researchprogramme of the School of Tropical Medicine atCalcutta, from the pen of Major Robert Knowles,I.M.S., professor of protozoology in the school andits secretary during the critical early days of itsexistence. The annual report for the year 1922 nowreaches us, containing additional information on thework of the school and of the Carmichael Hospital forTropical Diseases, and, amongst other things, an

account of the inquiry into the causes and prevalenceof bowel diseases in colliery districts-an inquirywhich was financed by the Indian Mining Association.The investigation was entrusted to Captain G. C.Maitra, I.M.S., who forthwith started to find out thenumber of bacillary dysentery carriers in hospitalpatients. No success attended his efforts during thehot weather, but with the advent of the cold seasonthe proportion of faecal specimens giving an alkaline,or neutral, reaction became larger, but even thenno dysentery organisms were isolated from fasculent Ispecimens. The cultural results of blood and mucus

1 La Riforma Medica, xxxix., May 14th, 1923.2 THE LANCET, April 7th, p. 728.

I stools were not satisfactory ; 15 samples were

examined and typical organisms, once a Shigabacillus and once a Flexner bacillus, were isolatedfrom two only. Both these were from early cases ofthe disease which had developed locally. Successin recovering dysentery organisms depends mostlyupon the freshness of the sample of stool, even inearly cases of the disease. Sixty blood samples wereexamined for agglutinins by the macroscopic method,and out of these 17 only gave a higher titre than1-40, and mostly with the Flexner organism. Asciticfluid was also examined for antibodies in eight cases,and it was found that this fluid inhibited the growthof the dysentery bacillus ; the reason for this inhibi-tion does not seem to be sufficiently clear. The fieldwork was conducted at Dhanbad, when 1200 samplesof faeces, 11 samples of water, and three batches ofhouse-flies were examined, and it was found that themajority of cases of dysentery among the miners arebacillary in origin. The general conclusion is thatmonsoon prevalence of bowel diseases in the coal-fields is to be attributed to polluted water-supply,while there is also a probable correlation betweenbowel diseases in miners and ankylostomiasis.

THE FUTURE OF MEDICAL BENEFIT.TIME is running out in regard to the panel settle-

ment, for the present compromise lasts only anothersix months. Panel committees have been fullyinstructed in the views and temper of their consti-tuents, and, as we go to press, their representativesare meeting at Westminster to decide on a course ofaction. At this juncture it may be of interest toset down the position of medical benefit as seen bythe National Insurance Gazette, which sums up thusin a recent leading article :-

" A good number of doctors are giving a thoroughly goodservice ; others are overpaid ; still others are giving nothingbetter than the old club practice, and the small residue-well, no respectable ’ ‘ club ’ would have contracted withthem. That is the problem of the panel service, as we seeit. We wish we saw the solution as clearly."No doubt the panel system as it stands does allow

a good deal of latitude to the so-called black sheepfor whom the only effective and speedy remedy isdisciplinary action by the medical profession itself.And this view is spreading, for a prominent officialof a large friendly society is reported as saying :—

" In my opinion the doctors themselves, through theBritish Medical Association, could do far more to improvethe service than it is possible either for the Ministry ofHealth or the insurance committees to do. By their ownCouncil they could bring to book and deal effectively withany doctor who failed in his duty to his panel patients."

There would appear to be appropriate administra-tive machinery in existence for this purpose. Inconjunction with the Insurance Acts Committee thelocal panel and medical committees might be em-powered to deal with irregularities which presumablycome to their knowledge at a very early stage, whilethe Ministry of Health might enlist the services ofpanel committees to a much greater extent than isdone at present. In this way the " thoroughly goodservice " which is the mainstay of medical benefitwould not be overshadowed-quite unjustly and outof all proportion-by the worser service.

MEGALO-URETER.

AT a recent meeting of the American Association ofGenito-Urinary Surgeons, Dr. John R. Caulk,l of St.Louis, remarked that anomalies of the ureter haveceased to be autopsy curiosities and have acquired avery important clinical position since the developmentof scientific urology. His paper, which includes thereport of a personal case, deals with variations in thecalibre of the ureter which hold an intermediateposition between irregularities in number, which arethe commonest, and aberrations of insertion, whichare the rarest. The most frequent type of change in

1 Journal of Urology, April, 1923.