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and the mortality from it was very small. Yet in spite ofits merits, and in spite of its results, it is, dead.

In 1890 LAWSON TAIT delivered the Address in Surgeryat Birmingham. The more recent date makes the fact lessobvious in his stirring words that fashions change as

surgery progresses, but none the less some of TAIT’s

most dogmatic teaching is now not acquiesced in. It

is needless to follow Mr. JORDAN LLOYD through the

other examples which he brought forward of operationsand methods no longer in vogue that have had their

day and ceased to be. We may feel sure that in

their turn many of our operations and our methods onwhich we pride ourselves will be superseded and will passinto the realms of the forgotten. Some must survive,and amongst these we may with confidence place the moderntreatment of wounds ; the details will be modified, the

methods will be changed, but the intention of excludinggerms from the wound will still persist. This, however, willbe rather the perpetuation of a principle than the maintenanceof a technique. Few piobably will be the exact methodsnow employed which will be able to withstand the gnawing Itooth of time. Thus a survey of some of the successes Iof the past should arouse in us a feeling of humility and a

feeling of pride. We recognise in the establishment of

unchangeable principles the genius and industry of our

forerunners ; we perceive in the oblivion that has fallen uponthe very exploits with which they were most well pleasedthe fact that some of our own finest technical work will die,or will at any rate be superseded by its legitimate develop-ments. As the world progresses surgery will progress. New

conditions must bring new problems to the surgeon, but newdiscoveries will furnish him with new weapons againstthem.

Annotations." Ne quid nimis."

THE SUN IN POISONOUS DOSE.

IT is not often in this country that sunshine becomes amonotony, but there is little doubt that a good many people,quite apart from any agricultural or industrial avocations,would just now regard with relief a cloudy and rainy day.Insolation has its glories for medical science, inasmuch as not all the carbolic acid in the world can furnish such a

supply of germicidal power as does the sun. Sunlight com-pletely destroys the vitality of most disease producingorganisms. These intense chemical effects of sunshine

cannot, however, be without great influence upon the

human organism, the question of germs apart. Posologymust play its part even with sunshine, and with overdosesbad effects may well be a probability. It is an interestingcoincidence that labour troubles of no mean magnitudehave broken out during an unwonted spell of sunshine.

Of course, we are not regarding the strikes as caused by theheat, as the reasons for the prevailing unrest have manyof them been obvious for many months. But it is

not at all improbable that the heat has played its partin the form which the manifestations have taken. Let us

remember that the failure of the white races to colonise

certain tropical tracts has been attributed to the excess oflight which there prevails, and not to the heat or humidity.The white man in the tropics gradually becomes disinclined

to work under the influence of the actinic agencies of thesun ; he grows neurasthenic, and finally breaks down. The

widespread discontent of the labouring classes reached anacute stage during a period of excessive and intense lightwhich promises to break all existing records. Have theforces of the potent sun, consequent upon a long periodof chemically active sunshine, altered the energies of thebody and mind of the worker, as in the case of thewould-be coloniser in the unsuitable tropics ? In an

admittedly bad state of affairs, has an overdose of sun

proved a poison ? In other words, should sunshine, like somany good things, be doled out on posological lines, lestit poison the individual ? When the dark days of wintercome we shall yearn again for some of this "poison,"knowing, however, full well that then the doses, even whencontinuous, are less potent; but it is quite possible that the-instinct is a sound one which makes many of us, inhabitantsof what should be a temperate zone, almost resent unbrokenheat.

____

THE SCOPE OF A MEDICAL MAN’S AUTHORITY,

IN another column will be found a letter with this title,over the initials "M.D., which describes how the writer,after being called in to attend a footman, treated him at thehouse of his mistress, as the man refused to be moved to the.nearest infirmary. The somewhat unlooked-for circumstance

connected with the case consists in the mistress being nowdisposed to criticise the medical man on the ground that hehas instituted a precedent under which her servants, if theybecome ill, will in future insist upon being nursed in herhouse, to her inconvenience. The point has apparently beensuggested to the lady by her friends, who can hardly haveincluded a lawyer among them, or he would have beencareful to explain to the mistress that the authoritywhich she exercises over her domestics arises out of her

contract with them. They are not the servants of the.medical practitioner whom she calls in to attend them, orwhom they may employ, and his authority over them islimited to recommendations which, so far as he is concerned,they are at liberty to disregard. In the case put forward by" M.D." we have no doubt that he gave sound advice to thefootman when he told him that he "must" go into thenearest infirmary, and when he declined, as we understand,to sanction his taking a journey of 150 miles. The man,however, could have insisted upon going home, provided thathe were capable of taking the necessary steps to do so, andhis medical attendant could not have prevented himfrom going any more than he could lawfully haveforced the infirmary upon him. The servant’s employeris in a different position. As to the precise extent of themistress’s authority upon such an occasion we have no

intention to advise, but, except that it should always beexercised with due regard to the dictates of humanity, wehave no doubt that the lady could not be compelledto keep her footman in the house owing to the mere

fact of his preferring to remain there. The absolutelyforcible removal of a sick servant might be a stepfrom which a master or mistress would shrink, but

there are degrees of insistence open to them which

go beyond any pressure that a medical attendant can

exert or can be asked to attempt. The case describedwould seem to have been one for more or less authori-tative persuasion on the part of the employer, and if

we assume that the medical man was ready to take theresponsibility of saying that treatment in the infirmaryreferred to would be adequate, and that removal to it wouldnot entail risk or undue suffering to the patient, there is noreason why such persuasion should not have been exercised.After all, however, the prolonged illness of a servant such as

534 T

that described is not an incident of frequent occurrence evenin large establishments, and the mistress referred to will

probably have ample time to consider a course of procedure.to meet the next occasion before it arises. Let us hope thatthe footman was duly grateful for the consideration accordedto him and that his mistress will have no reason to regret..her kind treatment of him.

__

ARTERIAL LESIONS IN ANCIENT MAN ANDTHEIR LESSONS.

FEW pathological conditions have given rise, perhaps, to more diverse views as to their etiology and significance-

.a,nd, as a consequence, to more conflicting rules of conduct-than arterio-sclerosis and allied arterial degenerations. This

condition has been held up as the pathological "horrible, example " by antitobacconists, total abstainers, diet faddistsof all kinds, contemners of athletics and of the wear and tearof modern life. Apart, therefore, from its antiquarian interest,a paper by Dr. Marc Armand Ruffer describing his examina-tions of the Arterial Lesions found in Egyptian Mummies 1deserves thoughtful consideration for the sidelight it throwson ultra-dogmatism in support of preconceived -centro-

versial theories. Dr. Ruffer first describes the procedure of,dissection and the preparation of the specimens for the

microscope- It appears that the embalmers of the twenty-first.Dynasty removed not only the viscera but the aorta and

most of the muscles of the body, packing the spaces thuscreated with mud, sand, or rags. Sometimes sawdust mixedwith a resinous material of unknown nature (but certainlynot bitumen) was used. It was only rarely that a portionof the aorta or one of the large arteries was left

behind, but fortunately the posterior peroneal artery,owing to its deep situation, often escaped the embalmer.The isolating of the arteries is a very disagreeable process,for the hard black material lining the walls of the cavitiesafter removal of the packing is not removable by water, buthas to be taken away mechanically, thus creating an

irritating dust. The packing does not appear to contain

pathogenic microbes, for no inflammation ever followed thenumerous cuts and scratches. The arteries, when dissectedout, are placed for’24 hours in a solution containing carbonateof soda 1 per cent. and formol 0’ 5 to 1 per cent. They arethen immersed for some weeks in glycerine, to which a fewdrops of formol have been added. Calcified artery is decalcifiedin Marchi’s solution for 24 hours and cut in the usual

manner. Dr. Ruffer gives a description of specimens from24 subjects, consisting of aorta, brachial, anterior and pos-terior tibials, posterior peroneal, femoral, profunda, radial,ulnar, and palmar arch. The results of the examinationare given and points of interest noted as follows : (1) thatthe muscular coat may be changed almost wholly by calci-fication, following on degeneration of the muscle fibre, intoa magma of no particular structure; (2) that the diseasevery often seems to pick out the point of origin of the

- smaller arteries. Dr. Ruffer considers that there can be nodoubt that the condition is exactly the same as is seen at thepresent day-namely, calcification following on atheroma,and that, in spite of the 3000 years that have elapsed sincedeath, the lesions are still recognisable by their positionand microscopical structure. "The earliest signs," he says,"of the disease are always seen in or close below thefenestrated membrane-that is, just in the position where

- early lesions are seen at the present time. ’The disease is,.characterised by a marked degeneration of the muscularcoat and of the endothelium. These diseased patches,discrete at first, fuse together later, and finally form

1 Arterial Lesions found in Egyptian Mummies (1580 B.C.-525 A.D.),by Marc Armand Ruffer, Journal of Pathology and Bacteriology,vol. xv., 1911.

comparatively large areas of degenerated tissue, which

may reach the surface and open out into the lumen

of the tube." The correspondence of the disease

to that recognised at the present time is obvious. In

Dr. Ruffer’s opinion, therefore, "the old Egyptians sufferedas much as we do now from arterial lesions identical

with those found in the present time. Moreover, when weconsider that few of the arteries were quite healthy, it

would appear that such lesions were as frequent 3000 yearsago as they are to-day." As to causation, Dr. Ruffer

considers that tobacco can certainly be eliminated, as thisdrug was not used in ancient Egypt. While alcoholic

beverages played a part in Egyptian social life, Dr.

Ruffer holds that it is clear that the Egyptians, as a

race, are not, and never have been, habitual drunkards.

Moreover, Dr. Ruffer has found the disease just as commonin over 800 post mortems of Mussulmans who had certainlynever touched alcohol in their lives. This fact has led him

to call in question the importance of alcohol as a cause ofarterial disease. As to the "increased wear-and-tear" "

theory of modern life, there is no evidence that old Egyptiansworked too hard, either mentally or physically; the time

tables of workmen which have been discovered show thatthe Egyptian navvies of ancient times toiled practicallythe same hours as the Egyptians do now. In Dr.Ruffer’s opinion, too, the theory that the wear and tear

of human life has increased is a myth, the fact being, hesays, that our life is easier and that we work less thanour ancestors did. Meat, too, is something of a luxury inEgypt, and Dr. Ruffer’s experience in Egypt and the Easthas not strengthened the opinion that meat eating is a causeof arterial disease. Finally, he holds that strenuous muscularexercise can also be excluded as a cause, for there is noevidence that ancient Egyptians were greatly addicted to

athletic sports, though they liked watching professionalacrobats and dancers. In the case of the priests and

priestesses of Dair-el-Bahari, which formed the greater pro-portion of those whose mummies were examined, it is highlyimprobable that they were addicted to much muscular

exercise. ____

THE CONDITIONING OF WINE.

ONE of the most delicate wines is claret, and it is its

delicacy which, justly we think, has brought it the sobraqwetof a temperance wine. It contains least alcohol, acidity, andsugar amongst wines, but it easily spoils, and according torecent researches the element which spoils it is oxygen. Thequicker it spoils by this agency the more delicate as a rule isthe wine, and a good claret is not a wine to be left more thanmany minutes exposed to the air before it is consumed. Thereare some people who do not understand this, or do not

appreciate the horrid result of their action, for they willre-cork an unfinished bottle. If this were done under an

atmosphere of nitrogen there would be no complaint, for ifoxygen is carefully excluded the wine remains sound andpalatable. When wine, in fact, is left in an inert atmo-

sphere, and for choice nitrogen appears to be the best

atmosphere for the purpose, clarification rapidly takes

place and the wine soon begins to assume a characterwith which good bottling and long keeping endow it.Fermentation ceases, the organisms die and retire to thebottom with a sediment which is desirably eliminated. Itis not improbable that the maturing process of a wine inbottle is due to the small quantity of oxygen in the air firstbeing absorbed, leaving only inert nitrogen which fails tosupport the vitalities of the organisms normally present inthe wine. When the activities of the organisms thus ceasethe wine assumes in a quite short time all the qualities of amatured sound article. This view is expressed with such