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true fitness implying an absence of enlargement ofthe heart with exertion. According to this view,hypertrophy of the heart in an athlete suggestsover-strenuous exercise of an " unfit " subject, butLaw, after his own rowing career, finds definiteenlargement of his heart which by all clinical and.subjective signs is perfectly healthy, and concludesthat physiological enlargement of a healthy heartmay result from hard and prolonged exercise. Deutsch.says that approximately one-quarter of rowers heexamined had enlarged hearts, the proportion beingmuch greater than among men going in for any othersport. Whether the " sports heart " is always a heartwhich was already unhealthy before athletics werebegun is still a matter for discussion, but it will begenerally agreed that lasting damage to the heart fromover-exertion is exceedingly rare in a previously healthyperson; the figures of Morgan, quoted by Law,-concerning the after-histories of the 255 survivorsof the Oxford and Cambridge boat-race crews from1829 to 1869 bear out this opinion. The practitioner’stask of detecting people in whom harm may resultis thus all the more important, and the decision maybe one of the most difficult of those he is called on tomake. A careful clinical history, a detailed physicalexamination, a judicious consideration of the results.of functional efficiency tests, combined with a studyof the urine and if possible of radiological and electro-.cardiographic records are his guides. First andforemost, however, he must be given the chanceof examining his patients properly. The necessity formedical examination-if possible at suitable intervals-,of all those who undertake strenuous exercise can:hardly be too strongly emphasised.

THE COCKTAIL HABIT,ALCOHOLISM has for several generations been

regarded as a disease of the poorer classes. It is,however, becoming increasingly obvious that thebalance is shifting, and some authorities considerthat before long the incidence will preponderate.among persons of wealth and leisure. The reason forhis change lies in the increase of the " cocktailhabit." Before the war cocktails were regarded asan American innovation ; they have now become apart of the social life of every European country.They are taken primarily as appetisers, but tend todegenerate easily into a pastime. Their attractionis partly due to their endless variety, and theirchief danger lies in the powerful effect which theyexert by reason of their aromatic constituents.The alcohol in a cocktail, which composes 15 to30 per cent. of its volume, may be contained in gin,whisky, or brandy, the vermouth, angostura, andliqueurs, which are added as flavourings to the- different varieties, contain essential oils with a

strongly exciting action on the central nervous

system. The reason why the alcohol in a cocktailproduces an effect in the central nervous systemmore than four times as great as that of the same I.amount of alcohol taken in beer is explained by IProf. W. E. Dixon in the British Journal of Inebriety I

for January. The spirit is absorbed very rapidlyfrom the empty stomach, its absorption beingfacilitated by the irritant oils. During its passagefrom the blood into the nerve-cells it producesa great and sudden increase of tension on the outsideof the membranes, thus causing a powerful stimulantaction which continues until the tension becomesequal in the nerve-cells and the blood. This action,which lasts for about a quarter of an hour, is differentfrom, and much more potent than, the subsequentordinary effect of the dose of alcohol. According toProf. Dixon, the persons who take a cocktail to=diminish nervous strain and stimulate the appetiteare not the true cocktail addicts. The most dele-terious effects are produced in young men andwomen who drink to remove their shyness and toproduce excitement. The continuous use of cocktailsinjures the stomach and lays the foundation for thedrinking habit, which is easily acquired by the young.

They supply for a moment the new sensations,strong emotions, and varied interests which youthdesires, and tend more surely and rapidly, inProf. Dixon’s opinion, to become a habit than do anyother kinds of beverage. Prof. Georges Guillain, ina recent lecture before the Academy of Medicine, 1which we noticed in our issue of May 25the takes aserious view of the increase of cocktail drinking inFrance. Cocktail parties, he says, have replacedtea parties in many modern drawing-rooms. Theminiature bar has become an article of householdfurniture, and is part of the equipment of thefurnished flat and the motor-car. The cult is notconfined to Paris, but pervades country houses,watering-places and even spas. He gives recipesfor ten of the commonest cocktails, to show the largequantity of alcohol they contain, and remarks thatyoung persons never used to take whisky or ginbefore their meals, but that nowadays they drinkseveral of these mixtures every day. He maintainsthat he is constantly observing most serious symptomsamong the young people who indulge in this habit.Their ailments include all kinds of digestive trouble,permanent tachycardia and attacks of syncope,insomnia, neurasthenia, anxiety, and failure toconcentrate. Many divorces, motor accidents, andruined careers are, he holds, due directly to habitualindulgence in cocktails, but it is possible that cause andeffect are here rather difficult to disentangle. Prof.Guillain claims to have witnessed a dramatic transfer ofthe incidence of alcoholic polyneuritis which formerlypredominated among the working classes, especially,it seems, those suffering from tuberculosis, to youngmen and women of the wealthy classes. He draws a,picture which has fortunately not yet been equalled inthis country, but the evil, even here, is none the lesswell established and demands the determined opposi-tion of every medical practitioner. The rigid ruleslaid down by all physicians for cases of suspected orestablished juxta-pyloric ulcer concern the avoidanceof alcohol on an empty stomach, and the universalapplication of the precept would prevent much chronicdyspepsia and be found in the long run not to detractfrom the gaiety of social life.

REALITY.IT is not so long ago that what were called "functional

diseases " were treated with a mixture of contemptand brutality by all except a few medical men inadvance of their times. It was a period when to be" real" was to be concrete ; diseases had to have atangible morbid anatomy and the deepest probings ofthe chemists and physicists into the structure ofexperience found their most complete satisfaction inthe production of models made of billiard balls ormachinery. Biologists in general, and those involvedin medicine in particular, often felt dissatisfied,especially when they were assured (as they frequentlywere) that the only road of progress was the " real "path carved by the " exact sciences." It is thereforeparticularly impressive that it should be a physicistin Prof. A. S. Eddington’s unrivalled position whocomes to tell us that the physical explanation of theworld is no more concrete than anything else, and thatit is quite incomplete in that it fails to include largeparts of our experience. He restated his positionrecently in the Swarthmore Lecture before the Societyof Friends.3 s The modern physicist has given up hisold objective of models ; he aims instead at a set ofsymbols and mathematical equations which they willsatisfy. And, strangest change of all, he no longercares what the symbols stand for : he seeks to knowhow reality behaves, not what it is. In consequencehe no longer wants to condemn the spiritual side ofour experience as illusory because it is not concrete." Mind," he says, is the first and most direct thingin our experience ; all else is remote inference."

1 Académie de Médecine, 1929, p. 538.2 THE LANCET, May 25th, p. 1113.

3 Science and the Unseen World. George Allen and Unwin.1s. 6d.