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any increase in consumption of oxygen and thereforewith greater economy and efficiency.

All isolated hearts eventually fail, and the failurecan be shown to be due to inability of the heart tocope with the work demanded of it. Such failure isassociated with rising pressure in the auricles andwith dilatation of all chambers. Running parallelwith the dilatation there is increased consumption ofoxygen and diminished efficiency. If the work askedof the failing heart be reduced, the degree of dilatationand the consumption of oxygen are lessened, and the

heart becomes more able to carry out its task. If,on the other hand, the load be increased, increasedwork may be obtained but only at the expense offurther dilatation, greater consumption of oxygen, andfurther lowering of efficiency. Indeed the currentview is that cardiac insufficiency means reducedmechanical efficiency, with a smaller fraction of theenergy consumed being converted into work.Katz and other workers have, however, suggested

that in the failing heart there may be a diminishedchemical change rather than a lessened output of

work, and that the efficiency may not be reduced.This work was done with the internal method ofmeasuring the metabolism, the coronary-sinus fractionof the coronary blood flow being analysed. Fisherhas shown that, if both the coronary sinus and theright ventricular (thebesian vein) fractions be collectedand analysed, a rising consumption of oxygen and afalling efficiency can be demonstrated when theheart fails.The addition of digitalis to the perfusing blood of

the failing heart diminishes the diastolic volume andthe consumption of oxygen and increases the efficiency.The administration of adrenaline to the denervatedheart may increase the work done but at greaterexpense and lowered efficiency, and long-continuedadrenaline eventually produces failure and death.GoIlwitzer-Meier, however, has shown that on theheart in situ adrenaline acts by different mechanisms.Direct stimulation causes increased rate and con-

sumption of oxygen. Nervous control of the rateby increasing the vagal tone reduces the increasedmetabolism, while the central effect also increasesvagal tone and lessens metabolism. The total result,according to him, is a reduction in consumption ofoxygen and in rate and an increase in work doneand in coronary flow, along with improved utilisationof oxygen.

Prof. Lovatt Evans concluded his lecture with afilm illustrating the technique developed by him forthe study of the living heart with an artificialaeration chamber instead of the lungs. With thispreparation it is possible to measure the metabolismof the heart without the complication of the lungmetabolism.

IRELAND

(FROM OUR OWN CORRESPONDENTS)

A CENTENARY CELEBRATION

THE annual meeting of the Irish Free State MedicalUnion, held last week in Dublin, was made theoccasion of a celebration of the centenary of thefoundation of the Irish Medical Association, one ofthe constituent bodies which joined to form thepresent Union at the beginning of 1936. The usualprogramme of the annual meeting, which consists ofa scientific session, a business meeting, and a

dinner, was extended this year to include a

commemorative session, a golf competition, and a

medical trades exhibition. The meeting was givenmuch publicity in the Irish newspapers, and theIrish Press issued a special supplement of 24 pages,including articles on the public aspects of medicine.At the commemorative session on June 8 an

address on the history of medical organisation inIreland from 1839 to 1939 was given by Prof.Robert J. Rowlette and followed by a descriptionof the position of the medical profession in ancientIreland by Prof. T. P. C. Kirkpatrick, who showed aclose parallelism between the principles of the ancientlegal codes, in so far as they concerned the medicalprofession, and those of the Hippocratic oath. In

many respects the practice of medicine was more

efficiently controlled in Ireland at the beginning ofthe Christian era than at present. Prof. T. G.Moorhead spoke on the foundation and recent historyof the Medical Union.The business meeting dealt with many items in a

short time, owing largely to the capacity of thepresident, Dr. Patrick MacCarvill, as chairman. He waselected to a further year of office. He recounted indetail the events which compelled the Union to" black-list " the army medical service of Irelandbecause of unsatisfactory pay and pensions. Anaccount was also given of a recent conversationbetween representatives of the Union and the Ministerfor Local Government and Public Health concerningfees for immunisation against diphtheria, and thecentral council was authorised to continue discussionson the same lines.The annual dinner, held on the same evening at

the Shelbourne Hotel, was attended by over a hundredmembers and their guests. The heads of UniversityCollege, Dublin, and of the two royal colleges wereamong the guests, as was also Dr. Leonard Kidd, whowas president of the Irish Medical Association in 1903.On June 9, at the scientific session, a discussion on

the developments of modern chemotherapy was

introduced by Prof. Henry Moore, who was followedby Prof. Moorhead, Prof. J. M. O’Donovan, Prof.E. N. MacDermott, and others.

A BELFAST HOSPITAL

The new extension of the Hospital for Diseases ofthe Nervous System, Paralysis, and Epilepsy, Belfast,was opened by the Duchess of Abercorn on May 24.The hospital was founded in 1897 and for the pastforty-three years has carried on its work in a largedouble-fronted house in Claremont Street. About adozen years ago a convalescent home was establishedat Killowen, a large house surrounded by opengrounds and gardens in the country near Lisburn,co. Antrim. The old building in Claremont Streetwas not, of course, designed to meet the needs of amodern hospital, and the board felt that it would bedifficult, if not impossible, to alter it sufficiently tocope with the requirements of today. The openingof the new hospital, which adjoins the old, completesthe first stage of their plans. The intention is, whensufficient funds are available, to knock down the oldbuilding and to substitute modern premises, whichwill then complete the new hospital.The building just opened is designed on modern

lines and has two floors. On the ground floor is theoutpatient department, facing Abercorn Street. Thereis a large reception room for patients, and the dis-pensary and physiotherapeutic department lead off it.The examination-room for outpatients is well lightedand affords accommodation for students. Dressing-rooms for patients adjoin it. On a separate corridorrooms have been appointed for the establishment laterof an operating-theatre and radiographic apparatus,and there is a small clinical laboratory with a mortuary

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attached. On the second floor two main wards, onefor either sex, each accommodating eight patients,are connectedwitha broad sun-balcony, which overlooksthe hospital garden, and on to which the beds maybe wheeled in fine weather. Off the corridor betweenthe wards are two single rooms and one two-bedroom for paying patients and a large day-room forpatients able to be out of bed.The new building was designed by Mr. R. Frater,

A.R.I.B.A., chartered architect, of Belfast, in con-junction with the honorary visiting staff. The costhas been j613,000, including equipment, and of this98000 has already been subscribed. The walls, builtof rustic brick, are finished in white plaster on theinside. The floors of the wards and outpatient-roomare made of wood blocks, and cork-tiling is used inthe corridors to deaden sound.

The additional accommodation (the hospital can nowtake some 30 inpatients) will be a valuable extensionof the hospital services of Belfast and an improve-ment in the teaching facilities already available forstudents of nervous diseases.

BIRTHDAY HONOURS

THE honours list issued on June 8 contains thenames of the following members of the medicalprofession :-

Baronet

Robert Hutchison, M.D., D.Sc., LL.D.President of the Royal College of Physicians; con-

sulting physician to the London Hospital.G.C.V.O.

Sir John Weir, K.C.V.O., M.B.Physician to H.M. the King; senior physician to theLondon Homoeopathic Hospital.

K.C.B.

Lieut.-General William Porter MacArthur, C.B.E.,D.S.O., O.B.E., F.R.C.P., K.H.P.

Director-general of Army Medical Services.

Surgeon Vice-Admiral Percival Thomas Nicholls, C.B.,M.R.C.S., K.H.P.Medical director-general of the Navy.

K.B.E.

Air Vice-Marshal Albert Victor John Richardson,C.B., O.B.E., M.B., K.H.S.

Director of medical services, Air Ministry.

Knights Bachelor

Rupert Briercliffe, C.M.G., O.B.E., M.D.Director of medical services, Nigeria.

Edwin John Butler, C.M.G., C.LE., M.B., F.R.S.Secretary to the Agricultural Research Council.

Robert Ernest Kelly, C.B., F.R.C.S.Professor of surgery in the University of Liverpool.

Thomas Drummond Shiels, M.C., M.B.Medical secretary, British Social Hygiene Council.

C.B. (Military)Major-General H. H. A. Emerson, D.S.O., M.B.

Late director of hygiene, the War Office.

Alaj or- General 1. M. Macrae, C. I.E., O.B .E.,M.B .,K. H.P.D.D.M.S., Eastern Command, India.

C.M.G.

Ralph Roylance Scott, M.C., M.B.Director of medical services, Tanganyika Territory.

Christopher James Wilson, M.C., M.D.Of Naivasha, Kenya Colony.

C.I.E.

Lieut.-Colonel F. J. Anderson, M.C., F.R.C.S., I.M.S.Professor of surgery, Medical College, Calcutta.

Lieut.-Colonel R. F. D. MacGregor, M.C., M.B., I.M.S.Residency surgeon, Hyderabad, Deccan.

C.B.E. (Military)Colonel E. M. Cowell, D.S.O., T.D., F.R.C.S.

A.D.M.S., 44th Division, T.A.

Surgeon Captain Leonard Darby, M.B.Senior naval medical officer, Sydney.

Colonel Roger Errington, M.C., T.D., M.D.A.D.M.S., 50th Division, T.A.

Brevet Colonel Alexander Hood, M.D.Deputy director of medical services, British Forces inPalestine and Trans-Jordan.

C.B.E. (Civil)Arthur Marcellus De Silva, F.R.C.S.

Senior surgeon, General Hospital, Colombo.

O.B.E. (Civil)

Major Bijeta Chaudhuri, F.R.C.S., I.M.S.Senior medical officer, Port Blair.

Kenneth Hutchinson Digby, F.R.C.S.Professor of surgery, University of Hong.Kong.

George Alexander Clarence Douglas, M.S.Orthopaedic surgeon to Brisbane Hospital, Australia. ’

Hugh Arrowsmith Grierson, M.C., M.B.Senior medical officer, H.M. Prison, Brixton.

Alexander Sydney Joske, M.D.President of the medical board, Victoria.

Henry Richard Rishworth, F.R.C.S.P.M.O., Great Indian Peninsula Railway.

Reginald Hunt Tootill, M.B.Of Urmston, near Manchester.

Donald Percy Wailling, M.R.C.S.Commissioner and med. officer, British Virgin Islands.

Ernest Watt, M.D., D.Sc., D.P.H.Medical officer, Department of Health for Scotland.

Montague Harold Way, M.R.C.S., J.P.Med. officer, St. John Ambulance Assn., Portsmouth.

> M.B.E. (Military)Lieutenant E. A. Cotton, D.C.M., I.M.D.

Major Donald Ross, T.D., M.B., J.P.Med. supt., Argyll and Bute Dist. Mental Hospital.

Captain Walter Stewart, M.B., R.A.M.C.

M.B.E. (Civil)Rai Bahadur Rabindra Nath Banerji, M.B.

Medical practitioner, Allahabad.Alan Leslie Greenway, M.R.C.S., I.M.D.

Medical officer, Kuwait, Persian Gulf.Radha Krishna, M.B., D.P.H.

Med. supt., Silver Jubilee Tuberculosis Hosp., Delhi.

Una Frances Marie Morton, M.D.Principal, Women’s Medical School, Agra.

Kaisar-I-Hind Medal

Grace Stapleton, M.D., F.R.C.O.G.Professor of obstetrics and gynaecology. LadyHardinge Medical College, Delhi.