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still she could not hold her water when standing, anda third operation to diminish the calibre of the urethragave no improvement. At the fourth operation thegracilis was incised between the two areas of nerve-supply and its proximal portion was wrapped roundthe urethra, sutured back on to itself, and fastenedto the under surface of the pubic arch with finedouble zero chromic sutures. The wound healedby first intention and the patient could walk aboutthe ward after the third week without any dribblingof urine. The muscle tone was always good and wasstrengthened by exercises and by electrical treat-ment. A year later she was able to walk for two hoursand to enjoy dancing and social life for the first time.The bladder remained under complete control.The results of other methods of operation, as reviewedby Dr. Deming, have not been very encouraging.He states that among the 30 cases recorded byNove-Jusserand and Gotte only three patients werecontinent after operation, and there was no appreciableimprovement in any of Steiner’s series. The regionof the perineum provides no muscles with normalsphincter action that can be transplanted into theneck of the bladder, nor are there any straight musclesthat can be arranged around the urethra, as therectus is arranged around a colostomy opening.The pyramidalis, he states, has been used unsuccess-fully by Stetinger and Rubsamen, and Rubsamenand Bryosowsky have used the levator ani withsome degree of success. One case has been recordedby Novwy of the successful transfer of the adductorand biceps muscles. Perhaps Dr. Deming’s procedurewill give more satisfactory results. The gracilisseems to be peculiarly suitable for transplanting;its easy accessibility, its double nerve-supply, and thehigh entrance of the nutrient vessels make the opera-tion an easy one, and it is to be hoped that othersurgeons will publish the results of cases treated bythis method.

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COLLIP’S PARATHYROID HORMONE.

IN the Therapeutic Gazette of March 15th O. H. Petty,W. H. Stoner, and H. W. Schaffer describe clinicalapplication of the recent work of J. B. Collip. It willbe remembered that Collip announced some time agothat he had succeeded in preparing an active substancefrom the parathyroid gland, which on injection causedmarked rise in the blood calcium content of normalanimals, also administration of this extract was foundto cure the tetany of thyro-parathyroidectomisedanimals. He also noted that by repeated injectionsit was possible to kill the animals from hypercalcsemia,one of the symptoms being vomiting. In his originalpublications Collip described very briefly a fewclinical tests with his material, but, as he stated, thevalue of the preparation could not be judged fromthese. It is very interesting, therefore, to turn to thefirst published account of a fairly extensive series ofcases treated with this preparation. The authorsuse material made by the Eli Lilly Company. Afterreviewing the literature very briefly, they proceedto a description of the cases treated, composedmainly of infantile tetany, diabetes, and obesity.They conclude that administration of the hormone isof value in the treatment of infantile tetany, and insome cases of diabetes it is possible to reduce theinsulin dosage when the parathyroid hormone isadministered. They emphasise the fact that thepreparation can never be used without very adequatecontrol by means of frequent blood calcium estima-tions. As they point out, the estimation requiresskill, and they recommend that all workers shouldemploy the same technique since the various methodsfor the estimation do not yield strictly comparableresults. In the same number of the TherapeuticGazette there is an editorial comment on a paper byLisser and Shepardson which appeared in Endo-crinology, the authors having treated a case oftetania parathyreopriva with Collip’s hormone. Thecase was a woman of 30 whose thyroid was removedfor adenomatous goitre, and unfortunately three

parathyroid glands were removed. Shortly after the

operation the patient developed typical tetany. Thepatient was treated by injections of the hormone, andher blood calcium, which previously was low, returnedto normal and the objective and subjective symptomsdisappeared. They conclude that the material isa true specific.

POST-VACCINAL NERVOUS DISEASE.

THE international conference on small-pox, arrangedby the Health Committee of the League of Nationsat The Hague at the turn of the present year, decidedto give close attention to the affections of the centralnervous system reported in some countries to havefollowed vaccination. Dr. Levaditi had presented tothe Paris Academy of Medicine some months earlieran account by three Dutch observers of 34 cases ofpost-vaccinal encephalitis (14 of them fatal) whichhad occurred in Holland over a period of 18 months.The Departmental Committee on Vaccination,appointed by the Ministry of Health, now invitesthe assistance of all members of the medical professionwho are in active practice in this country in theelucidation of this question. The Committee hasdecided to make a special study during the next12 months of all cases in which the occurrence ofacute disease of the central nervous system (such asmeningitis of any kind or origin, encephalitis, polio-encephalitis) has been " post-vaccinal "-using thisterm in the sense that the first symptoms haveoccurred within four weeks of vaccination. Theobject of the Committee is to obtain a collection ofdata sufficient to enable them to ascertain whetherthere are any features which distinguish cases of acutenervous disease which happen to be

"

post-vaccinal" "

(as defined above) from those which are not. Theevidence so far available points to certain cases ashaving been due to encephalitis virus carried by thepatient, the effect of vaccination being to activate avirus already present. The request which is there-fore made to all practising members of the medicalprofession is that when called in to any case of diseaseof the central nervous system with an acute onsetthey will not fail to inform the Committee as

soon as possible of every case in which they haveascertained that vaccination has preceded the onsetof the symptoms within a period of four weeks. Theintimation should be sent as speedily as possible tothe Secretary of the Departmental Committee onVaccination (Dr. J. R. Hutchinson), Ministry ofHealth, Whitehall, London, S.W. 1.

MULE-SPINNERS’ DISEASE.1

EpiTHEMOMA associated with mule-spinning incotton mills has only been recognised generallywithin a very recent period, although in THE LANCETof Dec. 2nd, 1911, Mr. John Morley, the demonstratorof anatomy at Manchester, drew attention to thefrequency with which a certain class of operativessuffered in this way. The aetiology of the conditionwas established by the work of Mr. S. R. Wilson, whoin the course of an investigation into epithelioma ofthe scrotum collected a series of 40 cases from therecords of the Manchester Royal Infirmary and theChristie Cancer Hospital which had occurred duringthe ten years previous to the publication of Mr.Morley’s notes. The importance of the matter isnow widely recognised, and in March of last yearSir William Joynson-Hicks appointed a committeeof inquiry, with Sir Gerald Bellhouse as chairman,the other members being Prof. A. H. Gibson, Mr. F.Holroyd, Mr. E. Judson, Sir Thomas Legge, Dr.Archibald Leitch, and Lieut.-Colonel A. B. Smallman.Dr. S. A. Henry acting as secretary. The report ofthis committee has now been published and a leaflethas been issued from the Home Office simultaneouslywhich sets out the facts for the consideration of all

1 Report of the Departmental Committee appointed to con-sider Evidence as to the Occurrence of Epitheliomatous Ulcera-tion among Mule-spinners. H.M. Stationery Office. 1s.