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factor,. The value of heat in particular is everywhereacknowledged. It is, however, to be remarked that

nothing approaching a standard form of physicaltreatment for rheumatism has been established. Forexample, in lumbago the favourite method in GreatBritain is the infra-red ray ; in Amsterdam the ultra-violet ; in Leyden long-wave diathermy; in Denmarkcold packs at one clinic and short-wave diathermy atanother. This is rather a strange position for anyrecognised branch of therapeutics. Why are not thephysiological reactions that take place in rheumaticconditions under physical treatment established bytherapeutic research Why are the numerous centresfor the treatment of rheumatism left, in the main,without the guidance of scientific data No countryis at present taking the lead in this matter.The use of baths at the spas is worldwide and

traditional in the case of rheumatism. Since the lastwar certain hydrotherapeutic methods have been set

up in hospital departments and clinics in the towns.In Copenhagen a method has been developed reminis-cent of Winternitz and his pupils, in which radiantheat is followed by cold packs. In this connexionFerderber of the Pittsburgh school of medicine hascompared the effects of moist with those of dry heat,and finds that moist heat increases the circulatorvvolume more than twice as much as dry heat, andmore than half as much again as short-wave diathermy.With reference to artificial hyperthermia, variouslyproduced, small repeated doses are often used forrheumatoid disease.

Occupational treatment, which has aroused littleinterest until lately in Great Britain, has attractedmuch notice in Scandinavia, and at the Mayo Clinicand elsewhere in America.. Movements and exercisesare more generally and skilfully used than heretofore,and correct posture and postural exercises are power-fully advocated in America. It is evident that theright combination of physical methods is more andmore sought after, as well as the proper regulationof rest and movement. In ankylosing spondylitis, forexample, the active movement cure in Germany maybe compared with the practice of rest in Great Britain,the United States and France.The great part played by the state and the insur-

ance societies at many of the continental spas, someof them provided with magnificent special hospitalsfor rheumatic diseases, should be especially noted.Dr. Tegner aptly remarks on the enlightened policyfollowed at some of these centres. In these greatestablishments it has proved itself in practice benevo-lent and helpful to the patients as well as veryserviceable to science.

NOMENCLATURE

Many physicians in the new world and the old havenow specialised in the research and treatment ofrheumatic disease with a new energy; and largegeneral hospitals have provided rheumatism andphysical treatment departments. But one seriousobstacle stands in the way of their scientific work,and especially in the comparison of results obtainedin different countries. All serious students of rheuma-tism know to their cost that the nomenclature ofrheumatism is chaotic, and also that the records ofclinical conditions and results of the treatment ofrheumatic patients are, as a rule, meagre and unreli-able. In this way a great mass of material is wastedto science. It is reassuring to find that among therecommendations that are made for the better organi-sation of rheumatic centres in Great Britain greatemphasis is laid upon the outstanding need for " fullrecords on an agreed nomenclature."

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

JAMES MACKENZIE INSTITUTE

IN the annual report of the James Mackenzie Insti-tute for Clinical Research, Professor Waterston, thechairman, states that although the activities of theinstitute have been curtailed somewhat since the out-break of war because many of the staff are engagedin national service, it has been possible to carry onmuch of the work. So the valuable informationcollected since the establishment of the institute in1919 will not be wasted. The work of the instituteincludes the investigation of symptoms and of minormaladies which interfere with efficiency or comfortwith the object of determining the mechanism of theirproduction and their bearing upon the future healthof the individual. St. Andrews was selected originallyas a suitable place for this work to be done since itssize permits of knowledge of the circumstances ofeach patient; and, since many of the inhabitants arenon-migratory, individuals can be observed over a

period of many years and long range records kept.The continuous observation of children from birth is avital feature of the work. Figures based on-recordsof children observed from birth for at least five

years reveals a definite decrease of morbidity in thechildren who were breast-fed and an improved nutri-tion in the 2-5 year age-period among the same

group. The influence of bad housing was not soseverely felt by breast-fed as by artificially fedchildren. Bad housing was found to increase theincidence of respiratory disorders and of measles. Itresulted in impaired nutrition in this age-group andalso predisposed to poorly nourished and marasmicbabies. The Medical Research Council have lent theinstitute an experienced statistician to give temporaryassistance with a view to publishing further results.In collaboration with the university pathologicaldepartment at Dundee, plans are being made to estab-lish a blood bank at St. Andrews Cottage Hospital,the supply of blood for which will be taken at theinstitute from suitable donors.

FRANCE

(FROM OUR OWN CORRESPONDENT)

THE REDISTRIBUTION OF DOCTORS

THE grotesque game of musical chairs goes on.

Round and round we go to the tune of the nationalanthem, and on the whole we take our bumps in goodpart. To understand the rules of the game it isnecessary to remember only one cardinal point: everyman Jack of us-and Jill too for that matter-hasbeen put at the service of the state, however dodderingour age. The Minister of Public Health is the masterof the ceremonies, and it is he who tells one to remainwhere he is and another to go packing. Under himare the departmental prefects. In certain departmentsthe local medical societies have made a workingarrangement with the prefects with a view to establish-ing a more or less self-governing rule among thedoctors themselves. The president of the local medicalsociety then becomes a medical registrar and an

administrative dictator rolled into one, fitting squarepegs into square holes with the minimum of fuss andbullying. But hardships are inevitable. There is thecase of the elderly and none too robust general prac-titioner whose practice in the mountains began to seemoverwhelming. Why, he asked himself, should he not

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try to find a more comfy chair next time the musicstopped? What about some comfortable practice ina place where one or more of the doctors have beencalled up ? What more simple than to slide down themountains into the plains ? But this seemingly happylittle plan came to naught with a stern injunctionfrom on high to the old man to remain where he was.

In 1914 the rush of casualties filling the Frenchhospitals in the first few weeks of the war found theArmy Medical Service inadequately supplied withdoctors. Criticism was lively and was still ringing inthe ears of the chiefs of the service in 1939. Accord-ingly, the provision made for dealing with casualtiesin the present war was on a gigantic scale, doctorsbeing combed out wholesale from their civilian occupa-tions for the expected massive casualties. When theyfailed to materialise a chorus of protests again wentup, this time because so many thousand doctors weresupposed to be twiddling their thumbs in the armywhile the civilian population was neglected. But thecritics cannot have it both ways, and though the ArmyMedical Service may not be handling war casualtiesby the thousand at the moment, it is doing invaluableservice in sanitation and the training of subordinates.

SCOTCHING THE BOGUS DOCTOR

The last war yielded a small but active crop ofbogus doctors. It was so simple. The army orderlywith much experience of first-aid and more than anodding acquaintance with surgery found himselfdemobilised and his talents wasted. Why not putthem at the service of suffering humanity ? Recent

prosecutions have shown what a place such self-createdhealers can make for themselves in the community,always provided that it is not too inquisitive abouttheir qualifications. To prevent a recurrence of thisprocess, French doctors are urged to register theirmedical qualifications with the local authorities onevery change of address. As recently as 1935,measures were adopted for the establishment of acentral register of all doctors with French medicaldegrees, but it is as well for the prefecture of adepartment to have its own local register. Such alocal register, kept up to date, is also most helpfulin effecting as fair a distribution as possible of medicaltalent.

UNITED STATES OF AMERICA

(FROM OUR OWN CORRESPONDENT)

FREE CHOICE OF DOCTORS

NOT long ago a study was published under theauspices of the Committee on Research in MedicalEconomics 1 of a group of 365 self-supporting familiesof small means living in New York city. The inquirywas directed to discovering to what extent free choiceof physician is exercised by this group and how

intelligently the choice is made. It was found thattwo-thirds of the families had no family physicianand that the remaining third only called on theirphysicians for acute or special needs. Mr. MichaelM. Davis, in an address before the annual meetingof Group Health Association in Washington on Oct.31, said that similar conclusions had been reachedfrom a similar study in a mid-western city of 250,000population. " Free choice of doctor," he said, " bringsconfusions as well as advantages." Mr. Davis pointedout that no real personal relationship between patient1. Swackhamer, Gladys V. Choice and Change of Doctors, study

of the consumer of medical services. Committee onResearch in Medical Economics, 9 Rockefeller Plaza, NewYork. 1939. Pp. 48.

and physician can exist in many eases under. theseconditions and asks how the average unaided indi-vidual in a large city is to obtain reliable informationabout the training, skill and special knowledge ofdoctors or about the fees that they are likely to charge.

DELTA OMEGA

Delta Omega, the honorary fraternity in publichealth, celebrated its fifteenth birthday on Oct. 10,at which time it had 828 members. Its objects are" to encourage research and scholarship among personsundertaking graduate study in the sciences of publichealth and to recognise attainment in the field ofpublic health." Honour societies exist in several pro-fessions in this country: in pure science, in medicine,in law, in theology and in others. Dr. E. E. Humeat Johns Hopkins proposed in 1923 that a similarhonour society should be formed for graduates inpublic health. The idea was immediately approvedby Dr. William H. Welch, at that time dean of theschool of public health of Johns Hopkins University.The first chapter was formed in that university andsubsequently chapters originated in Harvard, Massa-chusetts Institute of Technology, Yale, Michigan andCalifornia. The society has been responsible for therepublication of two public-health classics-Budd’sbook on typhoid fever in 1931, and Dr. Snow’saccount of the cholera epidemic of the Broad StreetPump-and it is now considering the publication ofa third, Panum’s " Observations on the Epidemic ofMeasles in the Faroe Islands."

PSYCHOLOGY OF PEACE AND WAR

Readers of your leading article of Oct. 21 will alsobe interested in a yearbook to be published in 1940by the Society for the Psychological Study of SocialIssues, entitled " The Psychology of Peace and War."This society is an outgrowth of the economic depres-sion. In 1934 psychologists in various academiccentres began to seek a solution for the problem ofwasted professional talent which was resulting fromthe depression. The movement grew into a plan fora learned society which would study psychologicallythe major difficulties facing all Americans. The societywas launched officially in September, 1936, at Dart-mouth College during the annual convention of theAmerican Psychological Association. There are nowsome 400 members, most of them teachers ofpsychology in colleges and universities of the UnitedStates and Canada. The society carries on variouseducational projects besides its yearbook series andpublishes a quarterly bulletin. The secretary is Dr.I. Krechevsky, Box 249, Station G, New York, N.Y.

CONVALESCENCE

A conference was held on Nov. 9 and 10 at theNew York Academy of Medicine under the chairman-ship of Dr. George Baehr on the subject of convales-cent care. It seems that the metropolitan district ofNew York city possesses nearly half of all the homesfor convalescent care in the United States. Muchneedless hospitalisation results from failure to restorepatients fully to health after illness. With moreconvalescent care of the right kind it is likely thatless hospital care will be needed-for example, therewill be fewer " hospital repeaters." Many convalescenthomes are " choosy," and patients just out of the

hospital are sometimes obliged to " trot around " tovarious admission offices and be examined medicallyand " welfarely " at precisely the time they most needconvalescent care. Convalescent day camp care, as

recently demonstrated by the New York city depart-ment of hospitals, can provide the needed care in