1294

of 24 hours, 20 units of insulin are given, and repeatedevery hour until the clinical improvement and sugarin the urine and blood is approaching normal. Ifthe patient’s expectation is 12 hours, 40 units wouldbe used, and if death appears to be imminent, 40 unitsof insulin can be given every 15 minutes. The othercomplications of diabetes which must be attacked-for it is a well-known clinical fact that very fewdiabetics die of uncomplicated diabetes-includecardio-renal affections, gangrene, tuberculosis, andcarbuncles, and in all of these cases Dr. Joslin hopesfor a reduction of the death-rate when accuratedietetic treatment and the necessary medical andsurgical cooperation in certain of the conditions aresatisfactorily established, which state of affairs, hehints, has not yet been attained.

RESIDENCE AND DISEASE.

AN inquiry of some interest carried on amongUniversity students in America has just been pub-lished.l It was undertaken to obtain some measureof the value of urban health practices. The measureused is the past history of diseases among the students,classified according to the size of the community inwhich childhood was spent. Every care was taken toensure that the information gathered was as accurateas possible. The communities were grouped as (a)rural, (b) villages of 50 to 1000 population, (c) smalltowns of 1000 to 5000, (d) small cities of 10,000 to50,000, and (e) large cities of 50,000 and over. Ina previous communication2 the authors reportedfinding physical defects high in (a), (b) and (d), lowin (c), but lowest in (e). Apparently classification ofmortality and morbidity records may be vitiated ifall populations below 25,000 are considered rural andall above as urban. Records were obtained of 5031students, of whom 3478 were men and 1553 werewomen.- Seventeen diseases, including all the infectiousfevers of childhood, were prevalent enough to classifyin the table here reproduced :-Table shoiting Percentages, according to Residence

Groups, of 3478 University Men, gÌ1:ing Historiesof Certain DiselJSe8.

* The figures in brackets indicate the number of students ineach group.The figures in italic represent the highest percentage for each

disease.

The female records, although rather few for analysis,support the tendencies of the male records. The orderfor all diseases, or for the infectious diseases alone,is the same : cities best, followed by rural, towns,and small cities, with villages worst. Thus cities standout favourably both for histories of diseases and

1 A Comparison of Past Diseases in University Students. ByW. P. Shepard and H. S. Diehl. Journal of Industrial Hygiene,November, 1925. See THE LANCET, Dec. 5th, 1925, p. 1176.

2 A Comparison of Physical Defects in University Students.By the same authors. Jour. Amer. Med. Assn., 1924, lxxxiii.,1117

physical defects, and small cities come out unfavour-ably by bcth measures. The order of importance ofthe diseases is interesting with measles leading easily,and mumps a good second. In this country typhoidand small-pox would probably not appear in suchhistories. The percentage which is highest for eachdisease is italicised in the table. Pneumonia iscuriously high in rural, with great cities a close second.Villages claim far too many firsts, but are lowest forpneumonia. Some evidence may be found in thesestudies to support the thought that, at any rate inAmerica, modern hygiene is capable of making thepopulations of great cities the most healthy andvigorous part of the community, even in advance ofthe oft and frequently extolled rural yeoman class.The records, however, on which the evidence is based,refer only to a favoured portion of the population ineach residence group, and not to the total populations ;they are evidence of what might be done for thewhole, rather than of what is being done.

THE MEDICAL DIRECTORY.THE eighty-second annual issue of the Medical

Directory, which has just appeared,’ does not differmaterially from its predecessor except that it hasbeen brought scrupulously up to date. A singlemisprint of a Swiss health resort has escaped thewatchful eye of the press-reader on both occasions-that is the only blemish we have noticed. Thenumerical summary of the medical profession showsan increase of 1802 on the previous year in the totalnumber of names contained in the Directory, beingan addition of 3-6 per cent., well in excess of theannual increment in the population of the BritishIsles. This increase is distributed fairly evenly oversix sections of the Directory, only the Services showinga small diminution. In the section of useful informa-tion preceding the Directory appears a monographon the spas and climatic health resorts of GreatBritain and Ireland. The whole section has beenrecast and partly rewritten, and is accompanied bya number of illustrations. The list of certifiedmasseurs belonging to the British Association,introduced last year, has increased in length, and thelists of personnel of the Ministry of Health, MedicalResearch Council, and Central Midwives Board havebeen shifted into the middle of the volume betweenLondon and the Provinces. The new issue will takeits place on the shelf as an indispensable book ofreference. ____

MASSAGE IN THE TREATMENT OFMIDDLE-EAR DEAFNESS.

IT would seem reasonable to expect good resultsfrom massage in certain diseases of the middle ear,especially in cases of recent exudation and of chronicadhesions and thickening of the drum membrane andeven, it might be, in the earliest stages of otosclerosis.Many years ago Delstanche, of Brussels, designedan apparatus for this purpose, consisting of a smallhand pump with a length of flexible tubing attachedto a terminal fitting into the external auditory meatus;by alternately rarefying and compressing the air inthe meatus the membrana tympani is moved outwardsand inwards. For this work he was awarded theLenval Prize for having designed the best instrumentfor the relief of deafness. This method, called pneumo-massage, has been modified by attaching the pump toan electric motor, or to a geared-up machine workedby hand, so that the rapidity of the movement maybe greatly increased and, judging by the numerousinstruments of this kind on the market, this formof treatment has been very extensively used. But,unfortunately, the movement may only affect themore mobile portions of the drum membrane, whilehaving no effect on adhesions, and there is no proofthat any motion is conveyed to the chain of ossicles,especially when unduly rigid or fixed by pathologicalchanges. Sometimes tinnitus is diminished, the

1 London : J. and A. Churchill. 1926. 30s.