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of the frequency of ulceration of the gastric mucous mem-brane m such cases. Chemical examination of gastricCtmtemts has given conflicting results ; but radioscopy afteriin.[a.tion. of the stomach is of the greatest service in diagnosis.Operative treatment has been undertaken in 61 cases ; in 47of these a more or less extensive and complete removal waspracticable, with results that are encouraging when thedesperate nature of the disease is considered, the immediatemortality being about 35 per cent. Several of the patientsare known to have survived for years.

CHINESE MEDICINE.

CHINESE medicine may be regarded to some extent as asurvival of the dark ages, much of it being based upon abelief that all diseases are due to supernatural causes and aremainly occasioned by offended evil spirits which the nativepractitioner seeks to propitiate or drive off by charms,incantations, or other devices. Even at the present day, insome localities, the natives may still be found burning largeqnantities of gold and silver paper along with incense in thehope of averting, for example, a threatened invasion of theirhomes by cholera, plague, or small-pox ; or firing guns andbeating gongs or cymbals in order to frighten away themalignant spirits likely to give rise to mischief, When thenative practitioner attempts to treat -disease with medicinalremedies these are often derived from strange sources andsometimes they are even of a disgusting description.Hitherto great difficulties have been encountered byEuropeans when trying to obtain trustworthy informa-

tion regarding the incidence of disease and mortalityin different parts of China, there being no arrangements forthe certification and registration of the causes of death. The

only way, we understand, in which any undue mortality in alocality can be estimated is by ascertaining from the localundertakers how many coffins they have sold within a givenperiod and comparing that with the number vended in

normal times. But this method may be found far from

accurate, since it is known that the jealous coffin-

maker upon occasion, fearing that his craft is in danger,purposely falsifies his figures in order to mislead the foreigner.Epidemics of dangerous infectious disease have not in thepast been without injury to countries having close commercialrelations with China, to which country, also, the originof some pandemics has been traced. As instances of this

we may cite the two great pandemics of influenza and plaguewhich have so recently swept over the whole world, startingin Central China and travelling from east to west. It need

&&rd!.y be added that notification of communicable diseasesand public provision for their isolation are entirely lacking inChina ; proper sanitary administration by local or centralauthorities has yet to be established. Sometimes the first

intimation that the foreigner in China receives of the

presence of epidemic small-pox in his locality is by meetingconvalescents in the streets with the marks of their recentillness still visible upon their faces.. But there are indica-tions at the present moment that sweeping changes are

about to take place, and the great awakening of the Chinesenation now in process is likely to be followed by markedimprovements in the medical treatment of the sick as wellas in the prevention of disease generally. The educatedChinese are fully aware of the great superiority of Westernmedical and surgical methods, and during the recent

revolutionary riots some of the lower classes had alsooccasion to view very favourably the surgical assistance

given to them by the foreign medical men. The number of

qualified medical men in China with European or Americantraining as on the increase. Several medical schools with

foreign professors have been set up in various places for thepurpose of educating suitable natives in the science and

- j practice of modern medicine and surgery. Much valuablec information respecting diseases in China has been given byr the medical missionaries, who have done admirable work in. their hospitals and in the homes of the people. 1 Apart from7 the official reports from the medical officials at such placess as Hong- Kong and Shanghai, a great deal of our knowledge as; to the incidence of illness on the foreigner and on the nativea has been derived from the half-yearly medical reports of the9 Chinese Imperial Maritime Customs. These reports were

initiated by Sir Robert Hart, the Inspector-General, in 1870,and with the exception of a recent break, they have beencontinued since that time up to the present day. Chinese

medicine at this moment seems to be undergoing a transition,but we may mention as interesting a few facts taken fromthe last issued group of reports 2 by the medical officers

s attached to the Chinese Customs establishments at the free

ports on the sea coast, in the interior of the country, alongthe banks of the great navigable rivers like the Yangtse

, Kiang, or at towns on the land transport routes near the: frontiers of India and Thibet. Although these reports show: an increasing native appreciation of the Western methods of, medical treatment, it is to be observed that consultation of

. the foreign medical man is commonly delayed until the

: native practitioner has exhausted his own repertory,and in this way valuable time is lost and the patientis then too far advanced in his illness to derivebenefit from any rational treatment. This delay is

. more particularly disastrous in midwifery cases. In Yunnan,the second largest province in China, the parturient woman,

, we are informed, receives no assistance, the course of the. confinement being left entirely to nature. If the European,

medical man is summoned it is only after the woman has,

been in labour for three or four days, and when she isobviously in a dangerous condition. It is not uncommon,

indeed, for the medical man on his way to see such a case tobe met by a messenger announcing that the woman has justdied undelivered. The practice of midwifery is said to beheld in low esteem, and those attending confinements arelooked upon as dirty and despicable individuals. In Yunnan,if a woman fails to make a good recovery after the birth ofher child, her friends, we are told, make her drink dailyfor a week or more some urine that has been passed by ayoung boy, this being considered an excellent tonic I Somenative practitioners impose upon their patients with worth-less medicines having high-sounding names. An example ofthis is given in which the practitioner’s whole pharmacopœiaconsisted of a single small phial labelled The Remedy of Im-mortality," which was prescribed for every variety of com-plaint. Tuberculosis is reported to be increasing in China, andthis is partly attributed to the unwholesome conditions, suchas overcrowding and lack of ventilation, under which many ofthe people live. The filthy habit is common of expectoratingindoors upon the walls or floors, in the corners of rooms, orbehind the doors. In some hospitals the maj ority of the surgicalcases are due to tuberculous disease of bones, joints, or glands.Personal hygiene is often greatly neglected ; in some districtsmost of the population suffer from itch, eczema, ringworm, orother communicable complaints, while their long finger-nailsharbour all sorts of germs. The dangers arising from theChinese method of manuring vegetable crops is mentioned,as also the filthy conditions under which milk is produced forsale to Europeans. Leprosy seems to be not uncommon insome provinces : Kwangsi, for example, where practicallynothing is done to control the lepers, and these poor unhappyhalf-starved wretches are allowed to wander up and down

the country in search of food, constituting a grave danger to

1 See THE LANCET, March 9th, 1912, p. 685.2 Chinese Imperial Maritime Customs Medical Reports. II. Special

series No. 2. Published by order of the Inspector-General. Shanghai,1911.

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other persons. We think we have said enough to show thatthere is pressing need for improvement in the methods oftreating sickness and of preventing disease in the ChineseEmpire, in which only a fraction of the 430 millions of itspopulation have any chance of receiving when ill the benefitsconferred by modern scientific medicine.

THE CURABILITY OF IDIOPATHIC EPILEPSY.

Dr. L. Pierce Clark, consulting neurologist to the OraigColony for Epileptics, New York, has published in the Archivesof Internal Medicine for January an account of 29 cases of

idiopathic epilepsy personally observed where a cure hasresulted, no fits having occurred after a given number ofyears. As Dr. Pierce Clark’s figures are in advance of thoseattained by any other physician his paper deserves the

attention of the profession, apart from the fact that his

position as a specialist in epilepsy is acknowledged by allneurological workers in America. What constitutes a

cure in epilepsy is a matter as difficult to settle

as the definition of idiopathic epilepsy itself. The

establishment of a time-limit as a criterion is un-

satisfactory, for it may vary from two to 20 years,or more. Dr. Pierce Clark does not commit himself to

any definite interval of years as constituting a cure,

and, faced by the obvious difficulty of explaining thecorrect attitude to adopt to the patient’s friends, when theprognosis is asked for, prefers to use the term" arrest." It

is clear that no time-limit can be entirely without possibledefect, for we have seen an epileptic woman who remainedfree from fits during the whole of her reproductive life, fromthe age of 14 to the age of 44, an interval of no less than 30years; but both before and after these ages she was subjectto typical idiopathic fits. While, therefore, such a casecannot be bailed as a cure, in the strict sense, to describe thedisease as arrested is eminently justifiable. It is in the sense

of "arrest" that Dr. Pierce Clark talks of "cure." Nodoubt spontaneous cures have been reported from time totime, but such cases are difficult of interpretation.Academic discussion of terminological questions, how-

ever, is of less importance than a consideration of the

therapeutic methods adopted by the American observer. If

a patient remains free of fits for years, it matters little

whether one considers the disease cured or merely arrested.Some self-applied plan of hygienic treatment is of funda-mental value-a broad, rational plan of living which may bepursued by the patient under occasional medical super-vision. This is essentially a non-sedative method-i.e,, amethod in which the accepted sedatives find little or no

place. Most observers who have any wide experience ofepilepsy will agree with Dr. Pierce Clark that many patientstreated by sedatives steadily advance in physical, mental,and moral deterioration, notwithstanding a definite cessationof fits. The bromides cannot be held to be curative

agents ; their utilisation as diagnostic - and therapeuticadjuvants is their only merit. There can be littledoubt that true epilepsy is a cortical disorder, ofwhich the fits are but one of the psychic incidents;we should speak, therefore, not of "epilepsy" but of "theepilepsies," as Hughlings Jackson used to do, and we shouldnot allow the visible discharging phenomena to usurp ourwhole attention. The training and dietetic régime employedby Dr. Pierce Clark is of great practical value, and we mayquote some sentences from his programme for a typical caseof the disease occurring in an otherwise healthy young manof 20. "The patient is placed with a nurse-trainer in acongenial but quiet country environment, away from thefamily by preference. The patient rises at 6 A.M., and takes10 or 15 minutes of active calisthenic exercise....... He then

takes a glass of hot water, a cold shower-bath and a briskrub-down, and breakfasts on an egg, small amount of cookedcereal, a glass of milk and some stewed fruit. After brs&k-fast he takes a walk of 6 to 8 miles....... He then takes a

glass of milk, and one or two strips of zwieback.....mm Heworks at some useful occupation till 12.30. He then lies

down without undressing, sleeps or not for half an hour,and is then given dinner of fish and milk, vegetables,cereals, and stewed fruit....... He is then allowed to sleepfor an hour....... Then follows work as in the morning, thenrest, reading, or study from 5 to 6 P.M. Supper of milk,eggs, cereals, and stewed fruit is given at 6 30. The patientis then allowed games, recreation, &c., until 8.30. He thentakes the special treatment of a warm bath, general massage,&c., and is in bed for the night at 9.30. No alcohol, tobacco,tea, or coffee is allowed. He is encouraged to drink at leasttwo quarts of water daily. High colon irrigations are givenevery other night, and every ten days castor oil or calomel individed doses is given. The articles of food ...... are changedevery fortnight, and the occupation too if desired." Dr.

Pierce Clark says he has never known a patient notbenefited more or less permanently by this plan-surely anexcellent testimonial to its abiding value.

FREQUENCY OF TUBERCULOUS INFECTION IN

CHILDREN.

ALTHOUGH some 30 years have passed since the dis-covery of the bacillus of tuberculosis, no absolute certaintyexists as to the exact way in which infection is most com-

monly produced. Koch’s original opinion, that inh&Ia.tS&m of

organisms derived from human disease is the imp&ytantfactor, still commands pretty general assent, but anotherschool has arisen which holds that infection starts :n infancyby consumption of tuberculous milk, the bacilli lying latentuntil some depression of vitality in after life gives them achance to multiply and cause serious disease. In view of

the existing doubt it is important to obtain trustworthyinformation as to the frequency of tuberculous infection

in- infants and children and as to the apparent portalof entry of the germs. As to the frequent occurrence oftuberculous foci in children authorities are agreed, statis-tics derived from post-mortem examinations giving apercentage of infected cases varying from 35 in London(Still) to 42’ 5 in Christiania (Harbitz). Attempts to obtainfurther information by the employment of the tuberculin

test have also been made, the results confirming the view asto the frequency of infection in children. A recent investi-

gation on these lines has been carried out by Dr. CharlesM’Neal and recorded in the Edinb-tcrgh Medical Journal forApril. The investigation concerned a series of 541 cases, 371of these being children in the Royal Edinburgh Hospital forSick Children and the others 170 boys in an industrial school,The method of employing the tuberculin was a modifi-cation of von Pirquet’s procedure, undiluted " old " t-nber-culin being rubbed into an abraded point of skin.

The results obtained showed, even within the first yearof life, a percentage of infection of 14.1, the ratio

rising till it attained a height of 46’6 in the fourth)

and fifth years of life. Among the boys of the

industrial school, drawn from the most necessitous classes,the percentage of infection actually reached a figure of 64. 7in boys aged 15 years. It was remarkable, in comparing thefigures with those recorded by von Pirquet and others in.Austria, that whereas the general mortality from tuberculosisin the latter country is much higher than in Scotland(36 - 25 compared with 12-53), in Edinburgh the percentageof infection among children was actually greater 7he-

more frequent occurrence of abdominal tuberculosis amamg