296

Annotations.

EASTER MEDICAL TOURS IN FRANCE.

" Ne quid nimis." "

THE eighteenth Voyage d’Etudes A16dica-les will takeplace at the Easter season of this year. These toursare organised by a central bureau in Paris, and areunder the scientific direction of Dr. Paul Carnot,professor of therapeutics in the University of Paris,assisted by his professeur agrege, Dr. Rathery. For14 years before the war the V.E.1VI., as the organisationis known to French medical men, conducted toursdesigned to make better known to French and foreigndoctors the various spas of France. After an interrup-tion of six years the tours were resumed in 1921, andhave grown increasingly popular in this country. Eachyear a different district is chosen for study ; in 1922 avisit was paid to the sulphur springs of the WesternPyrenees, of which a full and illustrated account

appeared in THE LANCET.l In the autumn of 1923 adelightful journey was taken through Savoy, theDauphiné, and the Jura, where the claims ofseveral well-known spas were studied. Thisyear the projected tour embraces the spas of theMediterranean, and in consequence the usual datehas been altered, for late summer does not offer theideal climatic conditions from the therapeutic point ofview. Easter has therefore been selected as the mostadvantageous season, but as the holiday time at thedisposal of doctors at this period of the year is generallylimited, the eighteenth V.E.M. will consist of threeindependent tours. The principal tour will includethe resorts in Provence and on the Cote d’Azur, andwill extend from April 17th to 23rd. The starting-point is Aix-en-Provence, and members will disbandat Nice. The number of participants is limited to 180and the cost of the tour is 450 francs.A preliminary tour of the resorts of Cerdagne and

the Pyrénées orientales is under consideration.Members are due to arrive at Carcassonne individuallyon April 13th, and after visiting the town will leave onthe following day by motor cars for the Valley of theAude, Usson-les-Bains, Mont-Louis, Font Romeu, lesEscaldes, Thues-les-Bains, Vernet-les-Bains, Le Boulou,Amelie-les-Bains, Banyuls, and Montpellier; joiningthe principal tour at Aix-en-Provence on the morningof the 17th. The maximum number of participantsis 60, and the approximate cost 350 francs. Lastly,a tour is contemplated in Corsica for the period fromApril 23rd to 27th, crossing from Nice to Bastia, andproceeding to Orezza, Corte, Vizzavona, Piana, andAjaccio, The return journey to Nice, or, if possible,Marseilles, will probably be made on the evening of the27th. This tour is also confined to the maximumnumber of 60 members and will cost 400 francs.As in former years, a reduction of 50 per cent. will begranted by the French railways to doctors and medicalstudents (from place of residence or from the frontierstation to the place of concentration and vice versa).It must be noted, however, that the committee of theprincipal railways have decided to cease the extensionof this facility to the wives or daughters of doctors.Any members of the medical profession desirous

of participating in the eighteenth V.E.M. are asked to Icommunicate as soon as possible with Madame M. C.Juppe-Blaise, representative of the French Spas, atthe Office Frangais du Tourisme, 56, Haymarket,S.W. 1. They are requested to state whether, in Iaddition to the principal tour of the Cote d’Azur, theywish to take part also in the tour of either Cerdagneor Corsica, or both. Participants who wish to beaccompanied by their wives or daughters, shouldcircumstances permit of suitable arrangements beingmade, are asked to state whether they would be pre-pared to go alone in case such arrangements could notbe carried out.

1 THE LANCET, 1922, ii., 824, 880.

MUSCULAR ABNORMALITIES.

I IN a paper on this subject in our present issue Prof.Gordon Harrower mentions four or five interestingabnormalities which have come under his notice inthe dissecting room at Singapore. Two of thesemuscular anomalies, at least, have the added interestthat they might conceivably possess a clinical bearing.The rectus sternalis is a well-known variant. Prof.Harrower figures a very well-developed bilateralspecimen..It must be recognised, however, that themuscle is usually unilateral, but when it is double itmay have different shapes and directions of its fibres,and during life, if contracting, may produce verycurious effects, quite inexplicable to those that areignorant of the structure. The careful studies of nervesupply mentioned by Prof. Harrower are of greatinterest to the morphologist in view of the presenttendency in viewing the muscle. His division of thespecimens into two classes appears to be acceptable,but this does not exclude a mixed class more or lessanalogous with the fibres of the " achselbogen." Theabnormal additional origin of the gastrocnemius is onewhich might cause confusion in operative measuresundertaken in this region. Such slips, arising like thisone or from some adjacent part, are not excessivelyrare, and on that account perhaps deserve notice.Without definitely adopting the views of Testut andothers, that these structures are always atavistic, itmight perhaps be conceded that such extra-poplitealorigins of the gastrocnemius are remnants of a moreextensive or conjoined area of origin, pierced by theenlarging anastomosis which forms the poplitealartery. ____

CLINICAL RONTGENOLOGY.

THE phrase is ungainly, but it describes accuratelyenough the subject-matter of a much needed workfrom the Mount Sinai Hospital, New York, on all

aspects of the radiology of the chest. z Drs. Wesslerand Jackes make no extravagant claims and have nothesitated to point out the limitations of X rays inrespect of diagnosis. The reader is warned againstmaking a hasty diagnosis from the plate, for the blood-vessels and bronchi throw shadows which vary indifferent normal lungs and which should not be con-fused with shadows resulting from disease. Especiallydifficult to interpret are the shadows of the lung roots,and we agree with the authors that it is

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particularlyunfortunate that the shadows at the roots of thelungs have so often been made the basis for thediagnosis of pulmonary tuberculosis by roentgenolo-gists." The authors are of the opinion that the earliestlesions in pulmonary tuberculosis appear in theinfraclavicular region near the apex of the lung, andare nearly always unilateral. Hilum tuberculosis theybelieve to be very rare, and the so-called peribronchialphthisis to be the result of shadows of dilated blood-vessels and lymphatics. For the early diagnosis ofpulmonary tuberculosis fluoroscopy is important as itwill show deficiency of aeration at an apex and alsoabnormalities in the movement of the diaphragm, butshadows due to areas of disease are more easily seenon the plate. The authors state that an area of infil-tration situated near the surface of the lung must beat least 4 mm. in diameter to cast a shadow, and thedeeper the disease is situated the less clearly will itbe seen. There are numerous plates showing pulmonarytuberculosis in all its stages, and of special interest arethe three plates illustrating a case of acute pulmonarytuberculosis in its early, middle, and late stage.Undoubtedly X rays are of great value in the earlydiagnosis of pulmonary tuberculosis, but the historyand condition of the patient must be taken intoaccount, for similar shadows may be cast by non-tuberculous conditions. The question as to whethera lesion is active or arrested should, we are told, be

1 Clinical Roentgenology of Diseases of the Chest. By H.Wessler, M.D., Adjunct Physician and Associate Roentgenologist,Mt. Sinai Hospital, New York; and Leopold Jackes, M.D.,Roentgenologist to the hospital. Troy, N.Y.: The SouthworthCompany. 1923. With 430 plates. Pp. 560.