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the symptoms go away as soon as the patientgets out into the open air, and after working hoursno feeling of discomfort remains.In this country so far workers in fluor-spar

(calcium fluoride), enamel, and glass, have beenfound free from fluorosis of the bones in thosecases in which the chest has been radiographed inthe search for pneumoconiosis.

ANNOTATIONS

DOCTORS’ HOBBIES

AN exhibition held in the anatomical school of

Trinity College during the meeting of the BritishMedical Association in Dublin deserves special mention.Dr. F. S. Bourke had collected there for the amuse-ment and instruction of the visitors what was describedin the catalogue as a motley collection representingthe diverse interests which from time to time haveoccupied the leisure of men when they relaxed fromthe arduous toils of an exacting profession. Beingan artist and collector himself, Dr. Bourke was ableeffectively to comb the four provinces of Ireland inhis search for material and to form an exhibit probablyunique in the annals of the Association.

" Here "-to quote from the very scholarly catalogue-" aretrophies won on the hazardous field of war and inthe clean conflict of sport, not least amongst themthose of an Olympic athlete (Sean Lavan) who hasbrought honour alike to his country and to hisprofession. Here are antiquities from the prehistoricIrish elk to the rushlight that once shed its infantbeam on Shannon’s shore. Here is cunning of castand sculpture, of work in metal and in wood, beautyof jewel and enamel, showing a craftsmanship as keenas any that has come from Tutankamen’s tomb.Here is melody of measured word, reflect of our Irishbards of old." Hobbies, Dr. W. Doolin reminds us

in a prologue, is an apt term for the collection, forthe hobby was a small horse of Irish breed, trainedto an easy gait, whose rider never need fear fatigue.For the majority of medical men compelled by theexigencies of service insensibly to work in an ever-narrowing groove, walking of evenings in the shadowof the clinic even after they have left it, the exhibitionwas a valuable object lesson in one of the best formsof release. There were in all 251 exhibits by 51

.exhibitors, many of intrinsic interest: fishes such asan enormous Porbeagle shark caught off AchillIsland last autumn or a trout caught on dry fly ontwo successive days ; models of sailing boats ; collec-tions of useful articles made in leisure moments fromold bits of scrap or used to while away the time inthe trenches ; and a surprising number of pleasingpictures in water colour, oil, pen or drypoint. The- catalogue itself contains curious bits of information-e.g., that the song " Robin Adair " was written abouta Dublin surgeon who left his country under distressfulcircumstances to become surgeon to Chelsea Hospitaland later surgeon-general. The writer was LadyCaroline Keppel to whom Robert Adair was betrothed.And again, the reason why the remains of the Irish’elk are nearly always of males is because the maleson account of their huge antlers, could not swim andwere easily drowned. The exhibition was visitedthroughout the meeting by a constant flow of members.and their friends, to the pleasure of whose stay inDublin it undoubtedly contributed in no small degree.

TESTS OF CIRCULATORY EFFICIENCY

MANY laboratory tests of circulatory function havebeen investigated ; among others there are thedetermination of circulation-rate, circulating bloodvolume, oxygen content of venous and arterial blood,vital capacity, and oxygen consumption before and

after exercise. A paper by G. Nylin gives hisresults chiefly with the last named. He determined,before and at fixed times after graduated work (whichconsisted in walking on stairs), -the oxygen consump-tion, minute volume of the heart, blood pressureand pulse-rate, both in normal people and those withvarious grades of heart disease. It was found thatthe increase in oxygen consumption after work,expressed as a percentage of the resting value, varieswithin fairly narrow limits in healthy persons, andis independent of body-weight, provided that thelatter is within physiological limits. In patientswith heart failure with congestion there is a

consistently greater increase after work ; in borderlinecases of heart failure the increase is more doubtfuland the figures overlap those given by normal people.Similarly, values for basal metabolism and minutevolume obtained in failure cases at rest, and for increasein ventilation after work, are not reliable for diagnosis,since they partly overlap those for healthy subjects.

These results confirm the general view that inthe diagnosis of circulatory inefficiency laboratorymethods at present add little or nothing to clinicalobservation. Where heart failure is severe theclinical diagnosis is easy and can be made with

certainty without further tests. It is in ’the earlystages of circulatory failure where the clinical signsare equivocal or lacking that further tests are requiredfor the interpretation of symptoms suggesting a

possible cardiac origin, and unfortunately it is just insuch cases that the methods reported fail in their aim.

MELIOIDOSIS

RECOGNISED as occurring sporadically in the MalayStates and in Burma since 1912, melioidosis has ofrecent years been encountered elsewhere, and whenthe condition becomes more widely known and bettermethods for an early diagnosis are devised it isprobable that the distribution will be found to be farwider than was hitherto imagined. In a publication 2from the Institute of Medical Research of theFederated Malay States, Dr. A. T. Stanton and Dr.W. Fletcher have incorporated the bulk of their

experience of this disease together with much of thework that has been done by other investigators. Thedisease occurs naturally in small animals as well asin man, rodents in particular being susceptible tonatural infection. It has been assumed but not provedthat rats constitute the normal reservoir of infection ;few instances of melioidosis infection have in factbeen found when large numbers of rats have beenexamined in plague surveys. Normally the diseaseappears as single isolated cases, but upon one occasionit occurred in true epizootic form when heavy losseswere encountered amongst small laboratory animalsat Kuala Lumpur. On this occasion infection wastraced to the food-supply. The alimentary tract hasbeen regarded as the normal portal of entry of

infection-again on scanty experimental evidence.The causal organism named after Whitmore has beenclassified in the Pfeifferella group by Topley and

1 Acta Med. Scand., 1933, Suppl. lii.2 Study No. 21: Melioidosis. London: John Bale, Son and

Danielsson, Ltd. 37 plates. Pp. 59.