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by the Committee for the Study of Hydrology inGreat Britain. The committee call attention to thefact that there is in England little or no provisionmade in medical education, under graduate or post-graduate, for the study of this form of treatment.For more than ten years they have endeavoured tofill this gap by periodical illustrated lectures and byconducting parties of medical men and studentsto the spas. This attempt to make the subject betterunderstood by the medical profession has been madefinancially possible by the British Spas Federation.

This handbook contains a variety of information,geological, historical, topographical, and-more im-

portant-medical indications. The latter are ofchief interest to the practitioner, and might perhapshave taken a more prominent place in the text. The

judicious comparison of a group of spas may be ofvalue. The biological properties of waters and mudsare now much discussed on the continent. Certainobservations are here recorded on the action ofthe Buxton waters on vegetable growth, and on thebactericidal action of the old sulphur water at

Harrogate. It would be interesting to learn whetherthe waters of Bath, which, coming from a depth ofsome 5000 feet, shows signs of any biological propertiesof this nature. From Cheltenham comes a discussionon the general actions of baths ; the aeration and

whirlpool baths, devised in England during the war,are regarded as stimulant remedies in atonic nervousdisorders. No mention is made here or elsewhereof sedative baths in the treatment of cardiovascularand nervous cases. Very little information seems to beavailable about the composition and mode of actionof peats and muds, which are more and more employedin bath establishments in England, especially forrheumatism.

It is regrettable that some British spa authoritiesstill think it necessary to attach foreign names tomost of the baths in common use; it would appearto the uninitiated reader that the Scotch douche isthe only one which belongs to these islands ! Themedical committees have presented a varied and

interesting collection of information. The resourcesof civilisation are evidently by no means exhaustedat the health resorts, and there is still scope for Britishenergy and enterprise. ____

PROBABILITIES IN MODERN WARFARE

SINCE the responsibility for the care of casualtiesin any war falls upon doctors, the medical professionhas a special interest, apart from that of the thinkingcitizen, in the forms which warfare would now take.Last year the Inter-Parliamentary Union publishedthe views of 19 experts belonging to nine differentcountries on the probable characteristics of thenext great war ; this book has just been republishedin a popular edition and deserves far more attentionthan it received on its first publication. To say thatit is a terrible book might give a wrong impression,since it is only by exercise of imagination that thepresentation of the facts, figures, and opinions canbe translated into human terms. The impressionis left that a future war would not merely be anintensified repetition of the last one, but that itwill be of quite a different character. Just as theold wars between barbarian tribes were wars ofextermination so, after passing through the stageof professional armies and of the " nation in arms "as exemplified by the late war, the advent of air and">np.mi..l UT_-r-fça_T’a nçaQ -nla Q+Y’ÇB+.Dít""’t7’ -rD.U"AT’f: 1-:n. fhn

1 What would be the Character of a New War ? London :Gollancz. 1933. Pp. 412. 5s.

primitive idea of extermination ; the nation in armswill be the nation under fire-a very different matter.The results of the use of modern air power wouldbe, in effect, to bring a whole country within range ;chemical agents would be of immense use againstan unprotected civilian population; the destructionof the " nerve centres " of government and industryare almost certain to be the immediate objective.The question remains whether their destruction is

possible. " In the course of manoeuvres 250 aero-

planes took part in a night attack on London.

According to military estimates only 16 of those werediscovered by searchlights, and even under the mostfavourable circumstances it is not certain that eventhese would have been all shot down." As to theresults, Prof. Langerin stated that 100 aeroplanes,each carrying a ton of gas, could cover Paris with agas cloud 20 metres thick in one hour. Besidesgas, thermite bombs weighing only 1 kilogramme eachcan develop a temperature of 3000° C. and burn

through steel, while no extinguishing appliance hasyet been invented. With such weapons used underthe new strategic conception that " to attack thecivilian population is now a basic principle of modernwarfare" (Major Endres) a further war might wellbecome mass murder of the civilian populationrather than a conflict between the fighting forces.The possibility of "

bacteriological warfare " hasbeen studied by a commission of the League ofNations on Chemical Warfare,2 and the conclusionis that while there is a possibility of the destructionof crops by parasites distributed by air over a largearea there is no immediate likelihood of any use beingmade of the bacteriological weapon against enemypersonnel. Certainly on a priori grounds it is difficultto imagine conditions which could fulfil the fourobvious postulates for its use : (1) the effects mustbe disabling, at any rate, temporarily; (2) it mustbe communicable in the first instance to the enemy;(3) it must spread rapidly ; (4) the side employingit must be protected either by complete isolationor by some form of preventive or curative agentunknown to the enemy.

THE MEDICO-LEGAL SOCIETY

THE Medico-Legal Society has signalised the

thirty-first year of its existence by issuing a newjournal.3 In future the transactions of the societywill be issued quarterly instead of yearly and willbe combined with book reviews and hithertoinaccessible material such as abstracts of foreignliterature of medico-legal interest. Dr. Gerald Slotand Mr. Everard Dickson are the honorary editors.Lord Riddell, the president of the society, in a fore-word, expresses the hope that the journal will intime provide a complete survey of medico-legaland criminological subjects. The first numberpromises well. The opening paper by Sir JohnCollie on medico-legal practice is in light and anecdotalvein, but Dr. F. J. McCann provides more solidfare in his exhaustive survey of impotence in themale and female, a paper which contains much ofvalue to the practitioner as well as to legal andmedical specialists in the courts dealing with matri-monial causes. In a retrospect of the history ofthe society its founder, Mr. Henslowe Wellington,recalls with justifiable pride the many eminent menwho have filled its offices, including Lord JusticeAtkin, the late Lord Russell, Dr. Stanley Atkinson,

Document A.16 (1924), ix., of the League of Nations.3 The Medico-Legal and Criminological Review. Published

for the Medico-Legal Society by Baillière, Tindall and Cox,London. Vol. i., Part I, January, 1933.

318

and Sir Samuel Evans. He notes that three of the loriginal office-bearers of 1902, Sir William Collins,Sir Walter Schroder, and himself, are still activemembers.There are special reasons why the Medico-Legal

Society should attract influential and widespreadsupport. The varied duties which are includedunder the term " medico-legal " are carried out inEngland with great ability, but under considerablehandicaps. There is no centre for teaching, research,collection and storage of specimens, or the performanceof laboratory tests, such as can be found in the

great cities of almost every other civilised country,including that part of Great Britain which lies northof the Tweed. The society has for long filled at leasta part of the gap, in that it provides a meeting-groundwhere doctors and lawyers can discuss in amity thosethorny problems which too often arouse mutualantagonism in the more heated atmosphere of the courts. Doctors and lawyers have everything to Igain personally by a better understanding of each ’,,others point of view and perhaps the lay public,over whose bodies, live or dead, the forensic battlesrage, stand to gain most of all in the shape of sounderand better informed administration of justice. Acase in point was quoted by a stipendiary magistrate ,,

in the discussion on Dr. McCann’s paper, reportedin the new journal (p. 63). An application for anaffiliation order was made to the court over whichhe presides against a man of 69. The defendantproduced a certificate with which he had been goingabout armed for some time and which he had beensufficiently business-like to have had brought up todate. It was signed by a surgeon who had removedhis prostate gland, and stated that in consequenceit was impossible for him to become the father ofa child. The case might well have ended there butfor the enterprise of the solicitor who represented thechild’s mother. He enlisted the help of the medicalpress and before the adjourned hearing had securedevidence that pregnancy had followed intercoursein at least one known case of prostatectomy. Thelearned magistrate, arguing no doubt that " what manhas done man can do," granted the-order of affiliation,a course which subsequent events proved to havebeen just. The story has several morals, not theleast of these being the great value of transactionsin which such cases are recorded.

OXYGEN AND CARBON DIOXIDE AS

RESPIRATORY STIMULANTS

THE increased use of carbon dioxide as a respiratorystimulant has led to further investigation of its modeof action, and recent work suggests that many of thestandard explanations of the effects not only ofcarbon dioxide but also of oxygen-lack will need tobe revised. Some experiments reported in a paper 1from the department of physiology at the MiddlesexHospital by Dr. S. Selladurai and Prof. Samson

Wright, throw some light on this complicated problem.A new point of view, they say, was reached in

1927, when J. F. Heymans and C. Heymans showedthat chemical changes in the blood might modifyrespiration reflexly, without necessarily acting directlyon the respiratory centre itself. These workers, withtheir collaborators, concluded that acute anoxaemiastimulates breathing reflexly for the most part byacting on the carotid sinus and (to a lesser extent)on the aortic nerve-endings, and that its direct

1 Quart. Jour. Exp. Phys., 1932, xxii., 233.

stimulant action on the respiratory centre is com-

paratively unimportant. Prof. Wright and Dr.Selladurai have now re-examined the action of

oxygen-lack in the cat. Inhalation of various con-centrations of oxygen (4 to 16 per cent.) and of

nitrogen were studied in decerebrate and in chlora-losed animals. With the carotid sinus nerves elimi-nated and the vagi cut it seems to be proved thatlack of oxygen depresses the " isolated " respiratorycentre. The increase in breathing which is oftenobtained in the intact animal appears to be whollyreflex, and depends upon excitatory afferent impulsesin the sinus nerves and the vagi which overcome thedirect depression of the centre. Examination of thispoint in greater detail revealed that the reflex stimu-lation from the sinuses may under certain circum-stances be of greater importance than that producedby the vagi. Apparently the integrity of what Prof.Wright has called the "buffer" nerves enables therespiratory centre to withstand for long periodsdegrees of anogaemia which are lethal to it when ithas been isolated by section of the vagi and denerva-tion of the sinuses. In view of these results, whichconfirm in the main those reached by the Belgianinvestigators in their work on dogs, the classicaltheories in which oxygen-lack is considered a stimu-lant to the respiratory centre can no longer be regardedas tenable. Experiments on the circulatory effectsof the low oxygen mixtures used do not support the-idea that fall in blood pressure is playing anyimportant part in the results obtained.

In a second paper 2 similar detailed studies of themode of action of carbon dioxide have been made,.and here again the classical theories, which assumethat the influence of this gas on breathing depends.entirely on an action on the respiratory centre, willhave to be revised. The results obtained are not,.however, so clear-cut. In the cat it is found thatdenervation of the carotid sinuses usually decreases.the rate of breathing and the minute-volume ofventilation-whether the vagi have been previouslycut or not. It is concluded that the chemical com-position of the blood stimulates the nerve-endingsin the carotid sinus in the resting animal to dischargetonic excitor impulses to the respiratory centre. The-

response to carbon dioxide was usually reduced whenthe sinuses were denervated, and it was concludedthat raised carbon dioxide concentrations stimulatethe respiration in part reflexly from the carotid sinus.The effects of vagotomy varied somewhat in differentexperiments, and it is suggested that carbon dioxidemay act differently on the various sensory components.of the vagus nerve. ____

EPIDEMIOLOGY OF THE COMMON COLD

INVESTIGATIONS made at the Johns HopkinsUniversity, with the support of the John J. Abelfund for research on the common cold, include astudy, by V. A. van Volkenburgh and W. H. Frostyof the prevalence, distribution, and character of theminor respiratory disorders observed over a spaceof two years (November, 1928, to November, 1930)in 114 Baltimore families comprising a mean weeklypopulation of nearly 500. Notification was madeimmediately upon the occurrence in any memberof the family of any respiratory illness whatever,including those which were apparently trivial, andon report of a case a staff physician promptly visitedthe home and obtained a record of the illness byinterrogation of the patient or (in the case of children).

2 Ibid., p. 285.3 Amer. Jour. Hyg., January, 1933, p. 122.