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Announcements of further investigations for the current

year will be made at a later date.

THE TUBERCULOSIS CONGRESS AND THERUSH TO AMERICA.

IT is to be hoped that those who propose to attend

the International Congress on Tuberculosis which will meet.at Washington from Sept. 28th to Oct. 3rd have alreadyaecured their berths. The very notable increase in the

cost of the journey has not brought about a decrease inthe number of passengers who annually crowd the westward-bound steamers during the month of September. In conse-

quence of the recent Atlantic Conference no line can make

any reduction on its minimum rate and the rates have been

considerably increased so far at least as the winter season isconcerned. For the return journey there will be no difficulty.Very few Americans come to Europe for their pleasure inwinter so that there is plenty of room on the steamers. Theremay be even more room now as the inducement of lowerfa,res during the dull season is no longer offered, at

least, not on the minimum rates. It is because the

tourist season terminates in September that there is a greatrush homewards on the part of the Americans who flock

over annually to "do Europe." Calling round at the officesof the different companies the same reply was received fromone and all. There were berths still vacant for some of the

ships that sail in August and plenty of room in October ; but,with only a very few exceptions, every berth was alreadybooked for the early September sailings. First on the liststands the Cunard Company which has no less than :fourships starting at dates suitable for members of the Congress.For those who wish to spend a few days at New York orelsewhere on the other side before the Congress or to attendthe Exhibition on Tuberculosis which will begin at

Washington on Sept. 21st, there is the huge, extremely steadyand comfortable ship the Caronia that sails on Sept. 2nd ;then on the 5th there is the record-breaking leviathan theLusitania, while on the 12th her sister ship the Mauretaniawould also carry passengers over the Atlantic in

plenty of time for the Washington Congress andexhibition. The best chance, however, of securing a placeon these ships would at this late date depend on somepassenger altering his plans and giving up his berth. There

only remains the Umbria which is one of the smallest

and oldest boats on the New York Line. She sails on

Sept. 9th and at the commencement of this weekthere were still a few berths vacant. The White Star Line

has the Majestic on Sept. 2nd, the Oceanic on the 9th, and ’,the Teutonic on the 16th, sailing from Southampton andCherbourg, while the Celtic leaves Liverpool on the 10th andthe Baltic on the 17th, but it is very questionable whether aberth could be obtained on any of these ships. In regard tothe great German lines, the Deutschland on Sept. 11th andthe Amerika on the 18th of the Hamburg-Amerika Line mayhave one or two of their more expensive berths vacant, buttheir cheaper ships which take English passengers on boardat Boulogne or Plymouth are all full. At the offices of the

Norddeutscher Lloyd it was the same story. The Kaiser

lYaLheLnz der Grosse on Sept. 9th and the Kror2prin-aessinCecilie on the 16th had only one or two vacancies. Sailingfrom Havre on Sept. 12th and 19th respectively Za. Savoieand La Provence are naturally very full, for these, the

ships of the French Transatlantic Line, are renowned for theexcellence of their French cuisine. The ships of the

American Line from Liverpool are full but there are still a

few berths on its Southampton ships. There is not a berthvacant on the Minneapolis of the Atlantic Transport Line.On the nine-day boats of the Holland-America Line, theRyndam on Sept. 12th and the Potsda-m on the 19th, there

may still be one or two berths, as also on the Red Star Line

ship Vaderland from Dover on Sept. 19th, but this ship is notdue at New York before Sept. 28th and the previous shipis already full except expensive rooms on the promenadedeck. There are ships that sail directly for Boston fromLiverpool but this is somewhat out of the way for

Washington. It means more time and more money to be

spent in railway travelling after landing; besides, theBoston ships are also very crowded. The Anchor Line has

ships that go to New York, and as they start from Glasgowthey may be sufficiently far from the usual tourist route

not to feel so much the September homeward rush.

THE USE OF SILK LIGAMENTS IN INFANTILEPARALYSIS.

THE use of silk ligaments was introduced by ProfessorLange of Munich and has now become a well-establishedprocedure. He has shown that the silk causes the formationof a tough tissue which surrounds it and extends from its

origin to its insertion. In other words, a strong natural

tendon is produced throughout the length of the silk. This

not only reinforces the silk. but is sufficiently strong to takeits place. In older methods of transplantation for paralysistransplanted muscles were inserted into paralysed tendonswhich in time stretched. In the Boston Medical and SurgicalJournal of June 4th Dr. Robert Soutter has published animportant paper on the use of silk ligaments. He points outthat in a case of infantile paralysis when all possible gainhas been derived from massage, electricity, and muscle

training, and groups of muscles remain paralysed whileothers are strong, the resulting deformity and paralysis maybe effectively treated by transplantation of muscles to takethe place of those paralysed. The use of silk is advisable :1. When the deformity is great or when the transplantedmuscle cannot be expected to correct the deformity,though it will take up the new motion. 2. When so

few muscles remain unparalysed that the transplantedmuscle is not strong enough to correct the deformity. 3.When the paralysis is so extensive that transplantationcannot be done and the remaining muscles are thrown out ofaction by the deformity. In the last case the deformity maybe corrected by silk ligatures and from half to all the func-

tion of the unparalysed muscles may be utilised. These

cases were formerly treated by arthrodesis. 4. In some

cases of total paralysis silk ligaments are useful ; in othersthe best treatment is arthrodesis. The following are someexamples. A child, aged nine years, had infantile paralysisof the left leg dating from the age of three. All theanterior muscles below the knee were paralysed and therewas a flail ankle in the position of marked equino-valgus.Silk ligaments were inserted from the tibia to the scaphoidand the tibialis posticus was transplanted by means of silkto the internal cuneiform. 15 months later there were goodcorrection of the valgus and good power of dorsal flexion. A

girl, aged ’11 years, had infantile paralysis dating from theage of two. In the right leg was marked equinus with

relaxed ankle-joint, allowing the foot to turn in completevarus or valgus. Complete paralysis of all the muscles

below the knee except those to the tendo Achillis

was present. This required lengthening of the latterand silk ligament from the periosteum of the tibia

to the scaphoid and to the cuboid. Nine monthslater the foot was in good position and there was

no tendency to varus or valgus. A child, aged nine

years, had infantile paralysis dating from the ageof 11 months. The left foot was in marked equino-valgus and could not be raised or adducted. There was no

power of flexion or extension of the toes. The peroneiacted well. The peroneus longus was transplanted to the

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internal cuneiform and a second strand was inserted to the

cuboid by means of silk strands. Silk strands were attached

to the periosteum of the tibia and inserted into the scaphoidto correct the pronation and abduction of the foot. Eightmonths later the foot was in good position and motion ofthe transplanted muscle was beginning. In the treat-

ment of infantile paralysis Dr. Soutter insists on certain

rules. All deformity can be prevented. No opera-tion (except some simple one for deformity) should beundertaken until massage, electricity, and muscle traininghave been used for three or four years. In attaching silkligament to the tibia the periosteum is slit longitudinally ;No. 14 or 16 or 20 silk is quilted up the everted edge on oneside and down the everted edge on the other. This gives astrong attachment. The everted edges of periosteum stretch,like other tissues, with the growth of the child. The doublesilk is then carried down and inserted well under the peri-osteum and superficial portion of the bone by means of ablunt, short curved needle. After the operation a plaster-of-Paris bandage is worn for from eight to ten weeks. Silk

ligaments stiffen the ankle-joint sufficiently to prevent lateralmotion but allow dorsal motion, so necessary in walking.Hence their advantage over arthrodesis.

FIRE ON A TUBE RAILWAY.THE fire which occurred on the City and South London

Tube Railway on July 16th last seems to us to bring onceagain into prominence the fact that the chief danger of

underground electric traction arises out of the short pathwhich the powerful electric current is prone to take, or short-circuiting. The public safety rests in fact on the complete-ness with which the preventive measure of insulation is ’,carried out. In spite of the care which is taken to Iprovide an insulated installation evidence is now and

again forthcoming that the precautions occasionally breakdown. This may some day result in the sacrifice of

human life either by panic or by actual disaster-dealingphenomena. We have frequently expressed apprehensionin these columns as to the horrible consequences of electric

leakage on the tube railways and the public have a rightto expect that to avoid it every effort which it is humanlypossible to take shall be taken. The great conveni-

ence of the tube railways is on all sides admitted, and it isonly fair to add that the record of accidents is marvellouslytrivial considering how enormous is the traffic dealt with on

the London tubes. In the incident referred to the greatestcredit is due to officials and passengers alike who by theircalm, unexcitable conduct averted consequences which mighteasily have been of a serious character. The result of the

Board of Trade inquiry will be awaited with interest as

determining what was the defect in the electrical machineryin this instance.

____

THE VALUE OF EUPHORBIA IN ASTHMA ANDBRONCHIAL CATARRH.

IN Nouveaux Renaedes of June 24th Dr. M. Artaultcontributes an article on the value of euphorbia in the

treatment of asthma and bronchial catarrh. Euphorbiapilulifera has been used to some extent in these conditionsand in paroxysmal dyspnoea, laryngeal spasm, whooping-cough, angina pectoris, coryza, and hay fever. It appears toact directly on the respiratory and cardiac centres. Dr.

Artault suggests that the relatively small popularity whichthis drug has enjoyed is due to the fact that it is not generallyrecognised in the pharmacopoeias. He states that all

species of euphorbia have a similar anti-asthmatic effect andthat the most active is euphorbia peplus, or devil’s milk.It is recommended in all cases of dyspnoea whether ofpulmonary or pneumogastric origin. When given in asthma

the secretions are modified and the attacks are rapidlysuppressed. It exerts a reflex irritating action on certainbranches of the pneumogastric nerve, especially in the naso-pharyngeal region. It has been said to have a hypnoticeffect but Dr. Artault considers that the narcosis is indirect,the sleep following the administration of the drug being dueto fatigue and therefore natural. The drug is administered inthe form of extract, decoction, and tincture. The dose of theextract is 7½ to 30 grains during the day and of the tinc-ture 30 to 60 minims. The decoction is made by boiling45 grains of the dried, entire plant in one pint of water andmaking the volume of the finished product up to one pint.It is administered in doses of one teacupful three or four

times a day, preferably between meals. In twice these dose;

the decoction produces irritation, vomiting, and other un-pleasant symptoms. In cases where the administration of

the proper dose of the decoction causes irritation in the

throat it should be diluted with water until the acrid taste is

suitably reduced. ____

THE MEDICAL INSURANCE AGENCY.

As a result of eight months’ working of this agency theMedical Insurance Committee has received a satisfactoryreport from the secretary and agent. The work has been hard

and as yet the returns are not large but a satisfactory starthas been made and a profit secured from the beginning-mainly owing to the economy of management. The agencyhas now some 1650 insurers under the Employers’ LiabilityAct. As separate policies are issued for any form of medicalassistance outside domestic service the agency has sent out

probably 3000 policies in all. Other insurances represent :-life, 10; personal accident, 18; burglary, 31 ; fire, 40 ;motors, fidelity, and other individual policies, 8.

LIQUID HELION.

THE telegram published in the Times of July 20th to theeffect that Professor Onnes of Leyden had succeeded inobtaining a substantial quantity of liquid helion is of the

greatest scientific interest. It appears that about 60 cubiccentimetres of the liquid have been obtained, which mustmean that Professor Onnes had a relatively large quantity ofhelion gas at his disposal for the purpose. It is remarkable

that the boiling point of helion is 4’ 30 only above absolutezero, but no attempt to obtain the solid state seems to havesucceeded even under high exhaustion and when reduced toa temperature within 30 of absolute zero. The questionremains whether there exists another element with a boilingpoint nearer to the absolute zero than this. We referredto Professor Onnes’s researches in a leading article in

THE LANCET of March 14th, p. 798.

Dr. Adolf Meyer has been appointed director of the

recently founded Henry Phipps department for the study andtreatment of insanity at the Johns Hopkins Hospital, Balti-more, and professor of psychiatry at that University. He isa native of Switzerland and has been director of the Patho-

logical Institute of the State Hospital of New York, atWards Island, since 1902, and professor of psychiatry atCornell University since 1904, and has made severalcontributions to the literature of psychological medicine.He has for long been an advocate of I I psychopathiahospitals," such as the projected institution of which he-

will have charge and of which an account was publishedin THE LANCET of July 4th, p. 38. Dr. Meyer is to proceedto Europe with Mr. Atterbury, the chosen architect, to studythe construction of similar institutions on the continent.

Dr. F. C. Gayton, who has for the last 25 years been seniorassistant medical officer of the Surrey County Lunatic Asylum