4
1364 able, nevertheless, to capture something of the Harvey atmosphere in the old garden where Dr. George Ent had sought out Harvey and induced him reluctantly to part with his book De Genemtio Animalium. He concluded by thanking Prince Arthur for his good wishes and assuring him that the society would strive to justify the distinction which his name had given to its roll. Sir StClair Thomson, as an honorary member and one of nearly 40 years’ standing, bade the guests welcome. He quoted a saying about Sir Astlev Cooper that he had passed " through the hearts of the poor into the pockets of the rich," adapting it to apply to Prince Arthur who, as treasurer of the Middlesex, had passed " through the pockets of the rich into the hearts of the poor." Prof. W. H. Welch replied for the Harveian Society of New York as one who occupied the chair of medical history at Harvard. " Permit me to say," he kindly remarked, " you do these things extremely well." He described the effect of anniversary celebrations of this kind in stimulating the advancement of medical knowledge. Lord Dawson. who also replied, spoke with feeling of the ties of medical comradeship. In no other field, he said, do we work in such harmony. Dr. D. Elliot Dickson, representing the Harveian Society of Edinburgh, was induced to tell a story. The guests included Dr. R. A. Young (President of the Medical Society of London), Dr. Raymond Crawfurd, the Archdeacon of London, Sir Farquhar Buzzard, the Master of the Apothecaries, Prof. W. Blair Bell (President of the British College of Obstet- I ricians and Gynaecologists), Sir Arthur Gaskell, the Master of Caius College, Sir Dudley Ridout, and Dr. H. B. Brackenbury. PILGRIMAGE TO HEMSTEAD. The centenary celebrations ended auspiciously in a summer day’s pilgrimage on Saturday to Hemp- stead Church where William Harvey and many of his family are buried " lapt in lead " in the Harvey I Chapel. His remains were transferred in 1883 from I the vault beneath the church, at the charge of the Royal College of Physicians. The journey was made by road and the party, which included a large number of ladies, was received by the vicar, the Rev. Conyers Barker, at the church where a short service was held, the address being given by the Right Rev. T. A. Chapman, D.D., Bishop of Colchester, and a collection was taken in aid of the fund for rehanging the bells when the new tower is built to replace the one that collapsed in 1882. Sir Thomas Horder then offered, on behalf of the Harveian Society, a silver paten, which was received and consecrated to the use of the church. The party inspected the Harvey relics contained in the church and its vault, and took luncheon in the vicarage garden. The members then proceeded to Rolls Park, Chigwell, near Loughton, where they were received by Lady Francis Lloyd, and Sir D’Arcy Power gave a short account of William Harvey in his family relationships. CONTRIBUTORY SCHEMES AND PUBLIC ASSISTANCE. The Leeds public assistance committee has adopted a scheme for providing hospital treatment for the contri- butors to the Leeds workpeople’s hospital fund and their dependants. A payment of twopence per week will entitle the beneficiaries to treatment at the hospitals of the public assistance committee or at the public dispensary and nursing societies of the city. The workpeople’s fund will pay to the Leeds corporation 61 5s. for each in-patient within the city-tuberculous, mental, chronic, maternity, and noti- fiable diseases cases excluded. The full rate of maintenance and treatment will be paid for patients outside the city area. ROYAL INSTITUTE OF PUBLIC HEALTH. ANNUAL CONGRESS AT FRANKFORT-ON-MAINE. THIS congress was held from May 19th to 24th. From Frankfort opportunity was taken to visit the spas of Nauheim, Homburg, ZViesbaden, Kreuznach, and Munster a. St., and on the outward journey most of the visitors called at Aachen to see the Quellenhof and the Landesbad with its baths for insured patients. The sessions of the congress were held in the lecture rooms at the Stadtisches Kranken- haus, a hospital of some 3000 beds. Of the numerous papers read at the six sections only a few notes can be given here. Section of State Medicine. DIABETES. Dr. G. SINGER (Vienna) said that the increase in the extent of diabetes and the peculiar difficulties of dealing with this disease have brought it within the sphere of public health activity in Vienna. The discrepancy between our considerable scientific knowledge of the disease and the results of treatment are most marked in the age-group 25-55, the most productive years of man’s life. In Vienna a welfare centre has been set up confined to the very poor; it has been so successful that doctors are anxious to send both private and insured patients to the centre. In 1930 2000 patients attended ; those requiring hospital treatment were recommended to go to hospital ; the bulk were dealt with at the centre. The installation of special kitchens for diabetes is an important advance. Dr. Singer considers that many diabetics can be efficiently treated and more cheaply without insulin. Dr. L. R. GROTE (Frankfort) pointed out that in the German public hospitals the number of patients admitted for diabetes had increased by 80 per cent. from 1924 to 1927 ; the increase is due to treatment by insulin and to the diminution of the mortality in children which can now be reduced to nil. The treatment of diabetics is usually extended over too long a period ; they ought to be treated intensively either in a special clinic or in a special division of a hospital. In the Carl von Noorden Clinic at Frankfort, the severest cases are made fit for work in about 18 days. Subsequent treatment and advice could well be given at special welfare centres. Dr. Grote also advocated the institution of homes for diabetic children where they would be instructed on diet. CANCER. Herr GRUNEISEN, general secretary of the German Society for Combating Cancer, pointed out that owing to better methods of treatment in the last 20 years there had been a lessening of mortality from cancer during the middle period of life. For the diagnosis and treatment of cancer centres should be established in connexion with university clinics and the large hospitals. A concentration of all the cases of cancer in such centres is not desirable or necessary ; the cost of the apparatus and the difficult X ray and radium technique, however, compel a certain amount of concentration. An important duty of the cancer centres would be the following up of all patients treated for at least five years. No effort must be spared to prevent sufferers being treated by quacks. VE, NEREAL DISEASES, Dr. RoESCHMANN, general secretary of the German Society for Combating Venereal Disease, gave an account of the working of the law relating to the prevention of venereal disease passed by the Reichstag in 1927. This requires that anyone knowingly suffering from venereal disease or having reasonable cause to believe themselves to be infected must submit themselves to medical treatment by a qualified

ROYAL INSTITUTE OF PUBLIC HEALTH. ANNUAL CONGRESS AT FRANKFORT-ON-MAINE

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able, nevertheless, to capture something of the Harveyatmosphere in the old garden where Dr. George Enthad sought out Harvey and induced him reluctantlyto part with his book De Genemtio Animalium. Heconcluded by thanking Prince Arthur for his goodwishes and assuring him that the society wouldstrive to justify the distinction which his name hadgiven to its roll.

Sir StClair Thomson, as an honorary member andone of nearly 40 years’ standing, bade the guestswelcome. He quoted a saying about Sir AstlevCooper that he had passed " through the hearts ofthe poor into the pockets of the rich," adapting itto apply to Prince Arthur who, as treasurer of theMiddlesex, had passed " through the pockets of therich into the hearts of the poor." Prof. W. H.Welch replied for the Harveian Society of New Yorkas one who occupied the chair of medical historyat Harvard. " Permit me to say," he kindly remarked,"

you do these things extremely well." He describedthe effect of anniversary celebrations of this kind instimulating the advancement of medical knowledge.Lord Dawson. who also replied, spoke with feelingof the ties of medical comradeship. In no other

field, he said, do we work in such harmony. Dr. D.Elliot Dickson, representing the Harveian Societyof Edinburgh, was induced to tell a story.The guests included Dr. R. A. Young (President of

the Medical Society of London), Dr. RaymondCrawfurd, the Archdeacon of London, Sir FarquharBuzzard, the Master of the Apothecaries, Prof. W.Blair Bell (President of the British College of Obstet- Iricians and Gynaecologists), Sir Arthur Gaskell, theMaster of Caius College, Sir Dudley Ridout, and Dr.H. B. Brackenbury.

PILGRIMAGE TO HEMSTEAD.

The centenary celebrations ended auspiciously ina summer day’s pilgrimage on Saturday to Hemp-stead Church where William Harvey and many ofhis family are buried " lapt in lead " in the Harvey IChapel. His remains were transferred in 1883 from Ithe vault beneath the church, at the charge of theRoyal College of Physicians. The journey was madeby road and the party, which included a large numberof ladies, was received by the vicar, the Rev. ConyersBarker, at the church where a short service washeld, the address being given by the Right Rev.T. A. Chapman, D.D., Bishop of Colchester, and acollection was taken in aid of the fund for rehangingthe bells when the new tower is built to replace theone that collapsed in 1882. Sir Thomas Horder thenoffered, on behalf of the Harveian Society, a silverpaten, which was received and consecrated to theuse of the church. The party inspected the Harveyrelics contained in the church and its vault, and tookluncheon in the vicarage garden. The members thenproceeded to Rolls Park, Chigwell, near Loughton,where they were received by Lady Francis Lloyd, andSir D’Arcy Power gave a short account of WilliamHarvey in his family relationships.

CONTRIBUTORY SCHEMES AND PUBLIC ASSISTANCE.The Leeds public assistance committee has adopted a

scheme for providing hospital treatment for the contri-butors to the Leeds workpeople’s hospital fund and theirdependants. A payment of twopence per week will entitlethe beneficiaries to treatment at the hospitals of the publicassistance committee or at the public dispensary and nursingsocieties of the city. The workpeople’s fund will pay tothe Leeds corporation 61 5s. for each in-patient within thecity-tuberculous, mental, chronic, maternity, and noti-fiable diseases cases excluded. The full rate of maintenanceand treatment will be paid for patients outside the cityarea.

ROYAL INSTITUTE OF PUBLIC HEALTH.

ANNUAL CONGRESS AT FRANKFORT-ON-MAINE.

THIS congress was held from May 19th to 24th.From Frankfort opportunity was taken to visitthe spas of Nauheim, Homburg, ZViesbaden,Kreuznach, and Munster a. St., and on the outwardjourney most of the visitors called at Aachen to seethe Quellenhof and the Landesbad with its baths forinsured patients. The sessions of the congress wereheld in the lecture rooms at the Stadtisches Kranken-haus, a hospital of some 3000 beds. Of the numerous

papers read at the six sections only a few notes canbe given here.

Section of State Medicine.

DIABETES.

Dr. G. SINGER (Vienna) said that the increase inthe extent of diabetes and the peculiar difficultiesof dealing with this disease have brought it withinthe sphere of public health activity in Vienna. Thediscrepancy between our considerable scientificknowledge of the disease and the results of treatmentare most marked in the age-group 25-55, the mostproductive years of man’s life. In Vienna a welfarecentre has been set up confined to the very poor;it has been so successful that doctors are anxiousto send both private and insured patients to thecentre. In 1930 2000 patients attended ; thoserequiring hospital treatment were recommended togo to hospital ; the bulk were dealt with at the centre.The installation of special kitchens for diabetes is animportant advance. Dr. Singer considers that manydiabetics can be efficiently treated and more cheaplywithout insulin.

Dr. L. R. GROTE (Frankfort) pointed out that in theGerman public hospitals the number of patientsadmitted for diabetes had increased by 80 per cent.from 1924 to 1927 ; the increase is due to treatmentby insulin and to the diminution of the mortality inchildren which can now be reduced to nil. Thetreatment of diabetics is usually extended over toolong a period ; they ought to be treated intensivelyeither in a special clinic or in a special division of ahospital. In the Carl von Noorden Clinic at Frankfort,the severest cases are made fit for work in about 18days. Subsequent treatment and advice could wellbe given at special welfare centres. Dr. Grote alsoadvocated the institution of homes for diabeticchildren where they would be instructed on diet.

CANCER.

Herr GRUNEISEN, general secretary of the GermanSociety for Combating Cancer, pointed out thatowing to better methods of treatment in the last20 years there had been a lessening of mortality fromcancer during the middle period of life. For thediagnosis and treatment of cancer centres shouldbe established in connexion with university clinicsand the large hospitals. A concentration of all thecases of cancer in such centres is not desirable ornecessary ; the cost of the apparatus and the difficultX ray and radium technique, however, compel acertain amount of concentration. An importantduty of the cancer centres would be the following upof all patients treated for at least five years. Noeffort must be spared to prevent sufferers beingtreated by quacks.

VE, NEREAL DISEASES,

Dr. RoESCHMANN, general secretary of the GermanSociety for Combating Venereal Disease, gave anaccount of the working of the law relating to theprevention of venereal disease passed by the Reichstagin 1927. This requires that anyone knowinglysuffering from venereal disease or having reasonablecause to believe themselves to be infected must submitthemselves to medical treatment by a qualified

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medical practitioner. Parents and guardians mustsimilarly see that children under their care so sufferingare treated. The competent sanitary authoritymay require persons whom they have reason to believeare suffering from and disseminating venereal diseaseto produce a medical certificate as to their health.Persons suffering from and suspected of disseminatingvenereal disease may be subjected to curative treat-ment and may be detained in a hospital if suchdetention appears to be necessary to check the spreadof the disease. Medical treatment involving seriousdanger to life shall only be undertaken with the consentof the patient. Any person cohabiting while know-ingly suffering from contagious venereal disease or

having reasonable cause to believe himself infectedshall be liable to imprisonment: a similar penaltycan be enforced if any such person marries withoutinforming the other party to the marriage of suchinfection. Only qualified medical practitioners maytreat venereal diseases and diseases of the genitalorgans: the treatment given must be more or lessorthodox. This section also requires examinationof the patient by the doctor; there must be notreatment by correspondence (absentee treatment).The giving of advice by lectures and so forth on self-treatment is also prohibited. Anyone who medicallyexamines or treats a patient with venereal diseasemust inform him of the nature of the disease and thedanger of spread and give him a copy of the officialmemorandum on the danger of venereal disease.Any patient under observation or treatment whofails to attend or who in consequence of his occupationor other circumstances is especially dangerous to otherpersons must be notified by the doctor in attendanceto the sanitary authority. Secrecy is ensured by theinfliction of a legal penalty on any employee of asanitary authority or venereal disease centre whodiscloses information acquired in the course of hisduty as to the existence of venereal disease in anyperson or its source. Such disclosure may, however,be made by a medical practitioner in the service of thesanitary authority or venereal disease centre or withthe consent of such medical practitioner to a publicauthoritv or to any person who is entitled to suchinformation in the interests of his own health. Theadvertising or recommending to the laity of anydrugs or treatment for venereal diseases is forbiddenunder a penalty. The Government may test drugsintended for use as preventives of venereal diseaseand. if necessary, may stop their sale. Regulationsmay also be made as to the display, advertising,and recommendation of any approved drug. Thelaw also deals with the prevention of spread to or bybabies and children.

In the course of discussion Dr. Roeschmann saidthat in Germany brothels were being gradually closed.He thought that accosting could be controlled by thepolice ; this had been effected in Hamburg where,shortly after the war, it became so intolerable thatthe public complained, also in Carlsruhe where theMinister concerned had investigated the matterpersonally and ordered the police to take action.

CRIMINAL ABORTION.

Dr. V. BORLANII and Councillor BE1TNFTT (BethnalGreen) in a joint paper stated that the traffic in" female remedies " is very considerable ; practicallyevery pharmaceutical chemist stocked one or otherof these preparations as a, regular line : they wereeven more prominently displayed by the herbalistand " hygienic store." An ergotin and aloescompound pill sold virtually to secure abortioncould be freely obtained from any wholesale patentmedicine house : the cost was high-2s. 6d.. 3s. 6d..or even more a, box. "

Orange pills," in regulardemand in the East End of London. were sold byunqualified drug stores at Is. for six pills ; theycontained aloes, liquorice, and colocvnth, and are nomore than a strong laxative. These fraudulentpreparations are sold to women who are in a stateof the direst poverty. During 1 Ç)BO 66 cases ofabortion occurred in Bethnal Green, five of the

women died. Nineteen deaths from childbirthoccurred in the last two years, seven of these beingdue to septicaemia, following abortion. The takingof pills and drugs was definitely ascertained in twocases ; in three other cases there was reason tosuspect instrumental interference.

SCOLIOSIS.

Mr. G. R. GIRDLESTONE (Oxford), in an account ofthe English orthopaedic schemes, referred to theinsidiousness of scoliosis which when once establishedcannot be completely cured and which is oftenprogressive throughout childhood and again aftermiddle life, yet no parent is prepared to take a childto a distant hospital even once for a defect which isso intangible until well established ; only when thereis an orthopaedic clinic nearby with its consequentautomatic instruction of the mothers in the vicinitywill such defects, easily cured in their early stages byremedial exercises, be prevented.

DISINFECTION.

Dr. ROSENHAUPT (Mainz) regretted that the disin-festation of dwellings by hydrocyanic gas liberatedfrom zyklon was not allowed in Germany ; its useis permitted in Scandinavia, Austria, and Hungary.In Germany, however, zyldon may be used for premisesother than occupied dwellings. He described a

hydrocyanic gas chamber which can be charged andemptied without anyone having to enter it. Forthe disinfestation of dwellings he recommended theuse of diametan, a mixture of sulphur with an oxidisingagent ; this liberates sulphur trioxide at high pressure.

Section of Industrial Hygiene.ENGINEERING RISKS.

Dr. A. MASSEY (Coventry), dealing with the healthof workers in the engineering industry, said that some50,000 persons in the city of Coventry were engagedin the engineering trades. The health of workersin an industry depends not a little on the health ofthe industry itself ; good trade means regular employ-ment, decent earnings, and relief from mental anxietyattendant upon economic stress. Home conditionsare of basic importance ; it is very little use to workin a hygienic factory if the worker has to live in aslum. Many engineering processes tend to eliminatethe physical misfits at an early stage ; at a laterstage there is also a selective transfer from engineeringto other vocations when advancing age finds engineer-ing too exacting ; the proportion of workers over50 years of age in this trade is considerably less thanthat of workers in all occupations collectively. Inengineering shops heat is often a detrimental factor ;this has to be countered by the cooling powers ofadequate ventilation. The dangers to health fromsand-blasting, the process used for cleaning thesurfaces of castings and heat-treated machine detailsby impinging sand under high pressure, are somewhatdifficult to counter. Some of the fine particles ofsilica penetrate the fabric of the helmet or gainaccess under the cape attachment ; although themaintenance of a positive air pressure inside thehelmet is of service, the use of shot instead of sandshould be considered ; the shot do not fracture orbecome pulverised. Even then the danger fromsilica is not entirely removed ; the rough castingsbefore treatment are coated with sand burnt onduring the moulding ; shot-blasting breaks off theseparticles producing a fine silica dust which must beguarded against. Respirators are unfortunately notordinarily employed during the sieving of used mouldsand. Chromium plating has been increasingly usedof late to render bright motor-car and cycle fittingsuntarnishable. The worker is very apt to inhalechromic acid fumes ; the respirators supplied are

often only used when the men are under directsupervision. In cellulose spraying the emanationsin the spraying chamber and its immediate vicinityare very pungent; they contain certain benzenederivatives which are occasionally the source of

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benzene poisoning and at times include amyl nitriteas a decomposition product ; the inhalation of thissubstance may conceivably bring about cardio-vascular changes. Oil dermatitis and boils cause

much trouble among operators of turret and automaticmachines ; for cooling these during metal-cuttingoperations large quantities of a special expensiveoil are used. It is used over and over again andsoon swarms with micro-organisms especially strepto-cocci ; other impurities and metallic particles are

present. The addition of a bactericidal fluid misciblewith oil serves to prevent boils, but oil dermatitiscaused by the action of the metallic particles andother impurities continues to be not uncommon.

Dr. H. L. GARSON (Port Sunlight) set out his nineyears’ experience of the medical examination ofemployees at a food factory employing some 500workpeople. The employees are examined beforebeing accepted for work ; in order to be certain ofexcluding workers with septic cuts or sores on thehands and arms it is made a condition of employ-ment that the employees shall submit to re-examina-tion if so required. Of 475 girls examined betweenthe ages of 14 and 18, 54 were rejected ; 49 of theseowing to lack of personal cleanliness, but only 5on account of physical defect. Any defects foundin those passed as fit for work are noted and treat-ment secured ; girls under 18 who have dentalcaries or a defect of vision must submit to treatment.Smaller employers by combining among themselvescould do much to reduce the cost of medical treat-ment, some of which can be given under the panelsystem. In answer to a question Dr. Garson statedthat during nine years’ work in the food factory hehad not come across a single case of enteric fever ordysentery among the employees.

MOUNTAIN SICKNESS.

Prof. KOELSCH (Munich) addressed visitors to

mountainous resorts. He considers that when climb-ing mountains, possibly carrying a load-in otherwords, a rucksack—persons especially sensitivemay be attacked by mountain sickness even at aheight of 1000 to 2000 metres. When the ascentis passive -i.e., riding a horse or mule or by mountainrailway-the critical altitude is about 3000 metres.The rapidity with which height is attained comes intoplay ; the longer the time taken the longer havethe body mechanisms to accommodate themselvesto the altered conditions. The Austrian Zugspitzerailway takes only 20 minutes to ascend about 1900metres, whereas the Bavarian electric railway requiresan hour to reach the same altitude. The authoritiesof mountain railways going up to great heights shouldbe required to put up a notice at the starting stationgiving advice to elderly and delicate persons, especiallyto invalids with heart or lung complaints or withhigh blood pressure, marked anaemia, and possiblyear troubles. Notices should also be posted in thecarriages and at the various stations advisingpassengers, especially elderly and delicate persons,on alighting to rest in order to become acclimatised.It is also advisable that the rate of ascent should befixed at 20--30 mins. per 1000 metres difference inaltitude. An acclimatisation station between thesecond and third part of the journey would be useful ; -,persons feeling discomfort on the way up couldalight in time.

EXHAUST GASES.

Prof. GROSS (Ludwigshafen) did his best to dispelany fear of the danger of exhaust gases from motortramc in streets. He found that when the enginesare running at full speed the exhaust gases containonly a small percentage of carbon monoxide, 01 percent. by volume as opposed to 6-8 per cent. whenrunning light; similarly unburnt motor spirit ismuch more abundant when the engine is runninglight. But much dilution of the exhaust gases occurs

even at a distance of one metre from the car ; withincrease of the velocity of the motor-car furtherdilution takes place. In a car standing still there was

3 per cent. of carbon monoxide in the exhaust andless than 0-1 per cent. at a distance of a metre.Travelling at the rate of 10 kilometres an hour therewas 6-5 per cent. of carbon monoxide in the exhaustand less than 0-1 per cent. at a distance of one metre ;when the speed was increased to 20 kilometres therewas 9-6 per cent. of carbon monoxide in the exhaustand less than 0’1 per cent. at the distance of one metre.No danger is to be apprehended from the air in well-ventilated tunnels; in the tunnel under the Elbeat Hamburg, which is provided with adequate naturalventilation, the percentage of carbon monoxide wasfound to vary from 0-005 to 0-023. The results of101 analyses of air collected in streets mostly duringrush hours under varying conditions of temperatureand meteorological conditions at the level of the headof a policeman on six occasions only gave a percentageexceeding 0-015, the highest being 0-023 ; the airexamined at the same spot a few minutes later con-tained far less carbon monoxide. Seeing that dangeronly arises from breathing 0-02 per cent. of the gasfor several hours even persons stationed on dutyin streets run no danger of carbon monoxide poison-ing. There is also no danger from unburnt motorspirit in the exhaust gases liberated in the streets ;experiments on animals showed that 10 to 15 timesthe amount present in exhaust gases must be reachedbefcre such unburnt spirit could cause trouble.

Section of Women and Children.

Prof. GEOTJ-A-1-1--BT (Berlin) pointed out that in thelast decade the birth-rate has fallen to 16 per 1000in England and 18 in Germany ; half of what it hasbeen. Unless steps are taken the birth-rate will fallfurther. States which depend on commerce and

industry require a certain density of population andmust guard against dwindling. A diminution mustoccur if families are to consist of two children only ;for maintenance of the number each family musthave on the average three children, and as this willnot occur in each individual family it is essential forthe State that there should be manv families withmore than three children. Dr. Grotjahn considersthat the time has come for an appeal to parents tobeget children ; the burden should be adjustedby making family allowances to those drawingregular wages and by compulsory insurance -for

parenthood for others.Prof. E. ScHLESixGER (Frankfort) said that during

the last few months a retrogression had occurred inthe state of nutrition of the children of the workingclasses. Too little milk and milk foods were consumedand in the winter months too little vegetables ; thecheaper kinds of meat and sausages were being used.Very valuable is the milk breakfast with its 260calories and the dinner with its 500-600 calories andabundant vegetables provided by the schools.

Section of Tuberculosis.

THE GERSON DIET.

Discussion on the influence of diet on tuberculosiswas stimulated by the presence of Dr. Gerson, oneof the originators of the salt-free diet. Opinionamong those present was, on ’the whole, averse to itsuse-at least, for cases of pulmonary tuberculosis.Dr. G. SCHR6DFR (Schomberg) considered such a dietdangerous to some patients. Dr. 0. AMREiN (Arosa)held that patients treated for tuberculosis could notall be given the same diet ; differences in nationaldietaries stood in the way. Although he had seenastonishing results obtained by Prof. Sauerbruchat Munich in cases of surgical tuberculosis, andespecially in patients with lupus given a salt-freediet, he had given it up himself in pulmonary tubercu-losis. Prof. L. BRAUER (Hamburg) had causedconsecutive patients admitted to his institution tobe sent alternately to one pavilion when they weregiven salt-free diet, and to another when they weregiven the ordinary full diet; no difference could bedetected in the results. Prof. F. VOLHARD (Frankfort)

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explained that in the treatment of pulmonary tuberculosis by a salt-free diet Gerson holds that the Ifdiet should be largely vegetarian with but little meat, I,and the body should be saturated with vitamins,whereas Herrmannsdorfer allows food rich in protein liand not so restricted as to meat. Both have

prescribed a so-called " Mineralogen," a mixture of if

calcium salts and phosphorus with cod-liver oil ; ’

this is, however, apparently no longer consideredan essential part of the treatment. Common to bothdiets is the increasing restriction of sodium chloride.Although he had found no benefit to tuberculous ’,patients by giving them a salt-free diet he was certainthat such a diet was of benefit to patients sufferingfrom other diseases. The salt in the food should belimited so that the chloride excretion in 24 hoursdoes not exceed 1 g. The kidneys are saved work,the quantity of circulating blood is lessened ; bloodpressure often falls, and attacks of angina pectoriscease.

EARLY SIGNS.

Dr. J. STRASBURGER (Frankfort) reported thatexaminations of contacts with tuberculous patientscarried out at the University polyclinic at Frankfort,in which X rays had been largely employed, showedthat in 2-6 per cent. there was a manifest lesion ofthe lungs. All these contacts were apparently healthy i,and would not have sought medical advice. Control Iexaminations of about 1400 students and nurses

resulted in the discovery of only one case oftuberculosis. The form taken by the disease in thecontacts was the Frilh-,inftltrat, which usually canonly be detected by X ray examination.

Dr. T. RENNIE (Sheffield) emphasised the importanceof dealing with cases of pulmonary tuberculosis beforethey became sputum-positive. In Birmingham,London, and Sheffield a rough comparison of the per-centage of sputum-negative cases treated in sanatoriumsis 30.3, 20-5, and 81-7 respectively ; these figuresindicate that in Sheffield for every infectious caseof pulmonary tuberculosis treated in sanatorium fournon-infectious cases are so treated. The positionto-day is that no physician can guarantee a completecure to an infectious case of pulmonary tuberculosishowever localised the initial lesions may be. Of7231 sputum-positive cases recorded in Sheffieldsince 1911, 80-4 per cent. have died of pulmonarytuberculosis; 2 per cent. have died of other causes.In no area can the death-rate be appreciably loweredby curing infectious cases of pulmonary tuberculosis ;to effect this it is necessary to diagnose and treat thedisease before the sputum-positive stage- He holdsthat where definite infiltration is shown by radio-graphic examination physical signs are present.Whether such patients are in the active stage of thedisease or not can only be determined by admittingthem for observation.

COLLIERS AND SILICOSIS.

Prof. S. LYLE CUMMINS (Cardiff), speaking on coal-miners and tuberculosis, said that coal-miners,although so constantly exposed to the inhalation ofboth coal dust and stone dust, are’notoriously lessliable to pulmonary tuberculosis than the rest of theadult male population in Great Britain. There is,however, a high death-rate of colliers from bronchitis.A large proportion of elderly coal-miners are affectedwith a degree of silicosis which though not sufficientto prevent them from working is sufficiently advancedto give rise to the radiological appearances char8cter-istic of lung fibrosis ; such men tend to be short ofbreath on exertion and are liable to have a cough andbring up rather copious sputum, often black in colour ;they are also subject to fairly frequent attacks ofcatarrh. Apart from the stone dust used to preventexplosions there is also present in the air of coal-mines stone dust from the ripping of the roof, therepairing of the walls and road, and from the coalface when the seam has to be reached by drilling" hard headings." Prof. Cummins believes thatfine particles of silica are taken up by alveolar

phagocytes and cariied into the intercellular spacesof the alveolar walls. Thence the dust-laden cellsenter the lymphatic vessels ; the silica particlesundergo slow solution and the silica sol thus producedcauses a fibrosis to be set up. The dust cellsagglutinate in the lymph channels obstructing thecirculation, ultimately causing local stasis ; aroundthese accumulations of cells fibrosis also occurs. Thepresence of coal dust in the lungs of experimentalanimals has been found to have a definite protectiveeffect against tuberculosis ; its anti-tuberculousproperties may depend upon its well-known powersas an adsorptive agent.

MEDICINE AND THE LAW.

Cooperative Drug-supply : UnsuccessfulAction against the Minister of Health.

THE difficulty of obtaining any remedy againsta Minister of the Crown was shown last month by anunsuccessful action against the Minister of Health.The third schedule of the Medical Benefit Regulationsgoverns the supply of drugs and appliances underthe national health insurance system ; its provisionsare part of the terms of service agreed a few yearsago with representatives of the pharmacists. Ifthe Attorney-General is correctly reported, he statedthat " it was understood or agreed that the termsshould apply for a period of six years." In theschedule it is stipulated that no chemist shall giveor offer to any person any gift or reward " whetherby way of a share of or dividend on the profits of thebusiness or by way of discount or rebate or otherwise "as an inducement towards, or in consideration of,such person presenting an order for drugs or applianceson a prescription form under the regulations. Itis easy to imagine the kind of abuse at which thestipulation was aimed. But the result was to makea cooperative society unable to pay dividends onhealth insurance prescriptions dispensed in coöpera-tive drug stores. The societies not being entirelydevoid of influence, the Minister of Health proposedto cancel the obnoxious stipulation. The proposedchange affected the prospects of some 10,000 retailpharmacists throughout the country who objectedto the deletion. They applied to the ChanceryDivision for a declaration that the Minister was notentitled thus to alter the terms of their contractswith the insurance committees, and for an injunctionto restrain him from carrying out his intention.The Minister, of course, has large powers of makingand altering regulations under the National HealthInsurance Acts, but the plaintiffs argued that his

present proposal was not a bona-fide exercise of suchpowers. Appearing on behalf of the Minister, theAttorney-General contended that the plaintiffs’ actionwas misconceived, that it disclosed no considerationfor the alleged agreement, and that the bargain waslegally invalid. He applied to strike out the claim onthe ground that it did not disclose any reasonablecause of action ; the proper remedy, if any, was byway of petition of right. The court agreed ; itwould be a waste of time and money for the plaintiffsto continue their action in the present form ; theaction was therefore dismissed with costs.The Crown is notoriously a well-equipped and

relentless opponent. The almost archaic procedureby petition of right, which the Pharmacists’ Unionhas now been told is its only method of attacks issomething of a scandal. It is slow and costly. Thelegal advisers of the Crown can hamper the petitioners