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mineral and vitamin content. Insistence on an

adequate diet should form an important part of allpost-operative gastric treatment and should go fartowards preventing the development of ansemia.

CLINICAL RESEARCH IN L.C.C. HOSPITALS

THAT advantage was already being taken of theunrivalled opportunities for research afforded by thehospitals and clinics now under the control of theLondon County Council is clear from the medical

supplement to the report on the hospital services

compiled under the direction of Sir Frederick Menzies.1More than 50 separate articles and reports or analysesof results are included, some by individuals andothers by groups of co-workers. Some of the authorsare full-time medical officers of the Council of varyingseniority ; others are part-time consultants-forexample, Sir Comyns Berkeley, who gives interestingstatistics of the work of the radium centre for carci-noma of the uterus at the North-Western Hospital,and Dr. Macdonald Critchley, who contributes a

.communication on reflex epilepsy made to the ZurichNeurological Society in 1933. Five workers at the

group laboratory, Archway Hospital, report on

biological tests of pregnancy by Friedman’s method.Excepting two " doubtful" results, the test wasaccurate in 81 out of 86 cases (94 per cent.) whichwere available for analysis. The results obtained atCarshalton with " iodine powder " in the treatment.of chronic otitis media appear to justify the con-clusion that this should be the first method tried.The full details of pre- and post-operative treatment- practised at the goitre clinic, New End Hospital,.and the description of the steps of the operation willbe found most useful in other centres. The statisticsof the maternal deaths in the Council’s hospitals forthe year under review demonstrate the value of theroutine supervision of the pregnant woman. Thelate results of treatment at St. Giles’ Hospital of 82.cases of fracture of the neck of the femur in elderlysubjects, as estimated from the replies to a question-naire received from 30 patients, were disappointing.The administration of paraldehyde per rectum as apreliminary to general anaesthesia has found favouralike with patients and medical and nursing staff atSt. Andrew’s Hospital, where it was tried in 200consecutive surgical cases.

These samples of the kind of observations beingrecorded by the medical officers working for theL.C.C. give promise of the great opportunities for- coordinated research which are offered in its generaland special hospitals.

BRITISH HEALTH RESORTS

IN his foreword to the third edition of the OfficialHandbook of the British Health Resorts Association,Sir Hilton Young remarks that even amongst themedical profession the extent and variety of the

health-giving properties and services available atour coastal resorts and inland watering-places are notalways fully appreciated. It is for the expresspurpose of developing a discerning appreciation thatthe Association is bringing out each year a new

edition of a publication which the general secretary,of the Association, Dr. Alfred Cox, believes has noparallel in this or any other country. Last year theprincipal spas and seaside resorts of New Zealand,South Africa, and Canada were included in thehandbook ; next year it is hoped to do the same forthe health resorts of Australia. A new section of

1Annual Report of the Council, 1933. Vol. IV., Part III: PublicHealth. London : P. S. King and Sons, Ltd. 1935. Pp. 223. 5s.

the handbook deals with the role of the winter healthresort. In spite of unpleasant evidence to the

contrary during the last week-end it is neverthelesstrue that the British Isles enjoy a climate 20° F.warmer than would be proper to their latitude.Moreover, the daily range of temperature is low,amounting only to 10-12° F. in the west countrywhere mists or fogs are rare in the winter, and thenights are considerably warmer than in the Riviera.If a winter resort does no more than enable somehouse-bound person to spend several hours daily inthe open air it has already justified its existence.The Association which issues the handbook is the

only organised body which specialises on the valueof our inland and coastal resorts as health resorts.Each year it holds a series of conferences; in 1934,for instance, the objectives were Harrogate, andCromer with Sheringham. These are to be con-

tinued indefinitely, for, as is frankly admitted, muchremains to be done before the science of the healthresort can be said to have been fully explored. Whileno doubt this is true, the handbook in its thirdedition is already a very complete and attractivepublication. It is published by Messrs. J. and A.Churchill Ltd. at 1.9.

SPLANCHNIC SECTION FOR HYPERTENSION

THE term " essential hypertension " implies thatso far as our knowledge yet goes the disorder is notsecondary to renal disease or other focal organiclesion. Its treatment must therefore be tackled onthe assumption that there is no need for the highblood pressure, and since a persistently raised pressuremust eventually bring about degenerative changesin the vessels, it is right and proper to reduce it if wecan. Seeing that essential hypertension seems oftento run in families, and that constitutional characteristicsare held to play an important part in its setiology,local changes in the vasomotor centre have beenpostulated as its underlying cause. And sincethe vasomotor centre acts principally throughthe splanchnic reservoir, many surgeons, both on thecontinent and in America, have tried to lower theblood pressure by section of the splanchnic nerves.Thus Craig and Brown 1 record their observations in5 patients whose major and minor splanchnic nerveswere cut on both sides; but they say that althoughthere was an immediate fall of pressure after theoperation this improvement was not maintained.Adson 2 has carried the procedure a step farther bycutting the anterior spinal nerve-roots from Th. 6 toL. 2 on both sides, thus paralysing the abdominalwall as well as the splanchnic nerves. He found thatthere was a definite fall in blood pressure after the

operation, and that it fell still lower when the patientstood upright; it could be made to rise again slightlyby wearing an abdominal support. This method oftreatment, however, involves a very extensive opera-tion, and the paralysis of the abdominal wall mayprove a serious handicap, if not a source of dangerto the patient.

There seems to be no ground for supposing that thecause of the disease lies in the blood-vessels themselves,and it is therefore natural to look for excess of pressorsubstances, or deficiency of depressor substances,in the blood stream. Though hypertension couldresult from depressed activity of the carotid sinus,or from deficiency of a depressor substance normallyproduced in the pancreas, more attention has been

1 Craig, W. M., and Brown, G. E.: Arch. Internal Med., 1934,liv., 577.

2 Adson, A. W., and Brown, G. E.: Jour. Amer. Med. Assoc.,1934, cii., 1115.