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Nowadays great importance was attached to publichygiene. Bad environment and conditions of livingled to low racial vitality and decreased resistance todisease. A striking example of the result of suchconditions was that of Russia since the Revolution.Such a flood of epidemic was started that at one timeit threatened to overwhelm all Europe. If there hadnot been such vast steps in the science of hygienethe war would have been stopped in a short timeby the devastating effects of epidemics, which up tillcomparatively modern times took greater toll oflives in wars than the fighting itself. Great Britainin some ways was protected by the fact that it is anisland, but nevertheless there was a vast amount ofwork to be done in improving our national healthand hygiene. The Ministry of Health was doing agreat service, but the lack of public scientific know-ledge was a drawback to its activities. When it wasrealised that money spent on research was moneysaved, while that spent on treating patients was moneyspent once and for all, we should have made a longstep towards the best possible conditions of nationalhealth.

DEVON AND EXETER MEDICO-CHIRURGICALSOCIETY.

EXHIBITION OF CASES AND SPECIMENS.

A MEETING of this Society was held at the RoyalDevon and Exeter Hospital on Nov. 23rd, Dr. G. P. D.HAWKER, the President, being in the chair.

Dr. W. GORDON showed specimen of mediastinalnew growth (sarcoma) in which there was involvementof the heart.

Mr. B. DYBALL showed an appendix, the seat ofTnucocele.

Mr. NORMAN LocK showed a goitre which hadcaused pressure on the trachea and was found adherentthereto.

Mr. DYBALL showed radiograms illustrating (1) con-genital deficiency of femur, (2) separation of symphysispubis, (3) plating of old fracture of leg.

Mr. A. L. CANDLER and Dr. MILLER MuiR showedcases of (1) sarcoma of femur (inoperable) undertreatment with X ray, and (2) sarcoma of neck,apparently cured by one large dose of X ray.

Mr. R. A. WORTHINGTON showed with Dr. MUIRcases of (1) sarcoma of tonsil with enlarged sub-maxillary lymphatic gland which had subsided with allappearance of cure after treatment with radium ;and (2) endothelioma of palate where wide sweepingremoval had been successfully accomplished with thegalvano-écraseur.

Dr. GORDON showed a man with paralysis of thelong thoracic nerve in which radiogram suggested anabnormal transverse process of the seventh cervicalvertebra as a possible cause of the condition. Dr.Gordon also reported upon two cases of gastric ulcer.

Dr. F. A. ROPER showed: 1. Boy with rat-bitefever together with temperature chart illustrating thetypical relapsing character of the fever. Up to thepresent the spirochæte had not been found in filmsprepared from the peripheral blood. The case wasimproving under treatment’ with injections of nov-arsenobillon. 2. Young married woman in whomthere was ascites with a hard enlargement of theliver. There was a history of a stillborn birth and amiscarriage. Wassermann had been repeatedlynegative but no alternative causal origin could beassigned with any certainty.

Mr. DYBALL showed with Dr. C. N. LOVELY a case ofulcerative necrosis of the face following upon aninjury. The extensive sloughing had destroyed thewhole framework of the nose and caused considerablescarring of the skin for some distance on either sideof the disfigured and flattened-out nostrils. Theinterest of the case lay in the fact that, in spite ofany known family history, the boy gave a positiveWassermann reaction and responded to treatment.The case was also of importance from the medico-

legal aspect, damages having been claimed in connexionwith the accident.

Mr. CANDLER showed a case of ulcerative necrosisof the hand with loss of little finger together with itsmetacarpal. The infective agency was very obscureand the disease had showed itself most intractable totreatment, but arrest had followed promptly on

injections of antidiphtheritic serum.Dr. G. L. THORNTON showed a man, aged 35,

ex-soldier, in whom V.D.H. had first been noted onservice. The heart was enlarged moderately right andleft with good compensation. The peculiarity of thiscase was that in the aortic area there were heard well-intervalled systolic and diastolic murmurs, whilst inthe second and third left interspaces for one inch fromsternal margin there was a continuous rumble audibleduring the whole of the cardiac cycle. The separatedmurmurs could be distinguished at the apex. Theaortic second sound was heard at the base and in theneck, and the pulse was not true Corrigan, althoughpulsation could be seen in the brachials and carotids.

In discussing the case Dr. GORDON considered thatthe findings as a whole, coupled with the quality ofthe murmurs, were consistent with a patent ductusarteriosus rather than with aortic regurgitation.

YORKSHIRE TUBERCULOSIS SOCIETY.

A MEETING of this society was held on Nov. 25that the Central Tuberculosis Dispensary, Sheffield,Dr. J. RENNIE, the President, being in the chair.

Dr. R. HALLAM lectured on the

Use of X Rays in the Diagnosis of Chest Diseases,defining a satisfactory apparatus as one with anexposure of at most one-tenth second-soon theroutine would be one-hundredth-and with whichassistance could be had from a " maker’s technician."Appreciation of the wide variability of the normalchest was necessary, especially in juvenile patients ;he agreed with the radiological report on normalappearances recently issued in America. As to therelative value of clinical and of radio graphical exam-ination, most often the two agreed. When they didnot, at the tuberculosis dispensary it was thepractice to review the case after a lapse of time.With the X ray (though one should remember thatit magnified lesions) there were more extensivefindings : but in early phthisis clinical methods mightbeat the skiagram. Diagnosis of active from passivedisease was often impossible radiologically. Severalcases of primary malignant disease had been encoun-tered at the dispensary during the last 18 months.Such showed uniform shadows often arising in themediastinum. It was necessary sometimes to screen

the patient and tilt, in order to distinguish from fluidIn suspected syphilis of lung, the lesion showed littlefibrosis, but ? gummatous deposit-a heavy stellateshadow situated in the middle lobe on the right side.One such shadow increased much after a 606 injection,which produced strong reaction, and finally wanedand grew less dense. In bronchiectasis it was oftensurprising how little was revealed. Pneumoconiosisgave larger shadows in steel-grinders than in silica-workers. A typical " snowstorm " appearance mightfail to show with inferior apparatus. The super-adding of tuberculosis to silicosis was often impossibleto determine.

Drs. BARNES, FERNANDEZ, KEATING, MARK,RiVERS, and the PRESIDENT spoke. It was emphasisedthat whereas post-mortem experiments quoted intext-books showed that lesions of less than 4 c.cm.bulk could be missed by the X rays, yet the PensionsMinistry often pronounced patients non-tuberculous,against the tuberculosis officer’s report, mainly on thestrength of a negative X ray report. It was agreedthat the appearance of much local fibrosis by nomeans characterised pulmonary syphilis, and that it

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would be well to resort more often to radiologicalexamination with a view to excluding pulmonarycancer.