493

elevation of the diaphragm and a more satisfactorypulmonary collapse. Pneumoperitoneum is also

suggested in support of artificial pneumothorax whenbasal adhesions are preventing an adequate collapseof a lower lobe.The graver complications of pulmonary tuberculosis

are so distressing that no method of treatment,however strange, should be lightly dismissed as

worthless, but though operations of this nature maybring a measure of relief to some incurable con-

sumptives, euthanasia might be more surely and morecomfortably attained by simpler means. Though inskilled hands a pneumoperitoneum may be inducedwithout serious danger in selected cases, its generalemployment would entail risks and might add to

sufferings already sufficiently great.

GAIN IN WEIGHT ASSOCIATED WITH

MENSTRUATION

WATER enters so intimately into every activity of 1

the cell that alteration of almost any physiologicalvariable is accompanied by either gain or loss of bodyfluid. It appears from a paper by J. S. Sweeney 1 that menstruation offers no exception to this generalrule. He noticed that an obese patient who waslosing weight steadily on a reducing diet suddenlygained 7 lb. in 48 hours shortly before the onsetof menstruation. As soon as the menstrual flow

appeared the extra weight was equally quickly lost.Sweeney proceeded to make observations on the

body-weight in 42 normal adult girls and found thatsome 30 per cent. gained 3 lb. or more in weightbefore or during menstruation. The gain in weightwas in some cases associated with thirst and withperceptible diminution in the output of urine, andthere is little doubt that water retention was respon-sible. This phenomenon apparently accounts for thefeeling of tightness in the extremities which oftenaccompanies menstruation, and in a few cases pittingoedema has actually been demonstrated. The causeof these interesting fluctuations in water balanceis at present unknown. The problem may be relatedin some way to the obscure oedema which appearsin otherwise healthy adolescent girls, and possiblyalso to the pre-eclamptic toxaemias of pregnancy.

THE BLOOD ALCOHOL IN ACCIDENT VICTIMS

LEGISLATION has been passed enabling courts todeal severely with motorists who over-indulge in

alcohol, but the possibility of an accident beingcaused by the drunkenness of the injured party is

rarely mentioned. Nevertheless, anyone who hashad charge of a casualty department knows thatit is not uncommon for accident victims to be suf-

fering from alcoholic excess, and it seems fair thatthis cause of accident should be given proper weight.Inquiry has been made into this subject in Swedenespecially, and Drs. James Hindmarsh and PaulLinde have lately given an account 2 of an investiga-tion of all the accident cases admitted to the surgicaldivision of the Maria Hospital in Stockholm over ayear. They used Widmark’s method of estimatingthe alcohol content of the blood-one which hasshown itself to be accurate within limits of ±0-03per 1000-and they tested only cases brought to

hospital within five hours of the accident. Thenumbers were 283 men and 103 women ; of these,41 per cent. of the men and 10 per cent. of the womengave positive reactions. Most of the women hadvery small percentages of alcohol in the blood, but

1 Jour. Amer. Med. Assoc., July 28th, 1934, p. 234.2 Acta Chir. Scand., 1934, lxxv., 198.

the bulk of the men had over 1 in 1000. The inci-dence was greatest on Saturdays, but nearly as largeon Wednesdays and Fridays. The bulk of the acci-dents were made up of collisions between motor-carsand pedestrians and of motor-cycle accidents. Halfthe lorry drivers and pedestrians injured, but onlya third of the motorists and motor-cyclists, hadalcohol in their blood. These figures bear out whatmany observers have suspected-that the pedestrianis by no means always a blameless victim of themotorist. The law of this country does not yet allowto a defendant motorist "discovery" of the bloodalcohol of a plaintiff pedestrian at the time of theaccident ; but, if it did, less might be heard of thewrongs of injured foot-passengers.

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MELBOURNE MEETING OF THE B.M.A.

IT is now announced that Sir Richard Stawell,consulting physician to the Melbourne Hospital andthe Melbourne Children’s Hospital, will preside overthe annual meeting of the British Medical Associationwhich commenes on Sept. 9h, 1935. Thect presidentsof sections are : medicine, Lord Horder ; surgery(including urology), Sir Thomas Dunhill; obstetricsand gynaecology, Dr. J. S. Fairbaim ; radiology andradiotherapeutics, Dr. A. E. Barclay; diseases of

children, Dr. ’Robert Hutchison ; neurology and

psychological medicine, Prof. Edwin Bramwell;orthopaedics. Prof. E. W. Hey Groves ; oto-rhino-

laryngology, Mr. Francis Muecke ; pathology andbacteriology, Prof. A. Murray Drennan ; dermatology,Dr. J. M. H. Macleod ; medical sociology, Dr. E. K.Le Fleming ; ophthalmology, Dr. A. J. Ballantyne ;pharmacology, therapeutics, and anaesthesia. SirWilliam Willcox ; public medicine, Sir HenryGauvain, who will also preside over the section whichconcerns itself with the development of medicinein Australia-an interesting history.

THE CHINESE PLAN OF PAYING THE DOCTOR

IT is often said that the Chinese method of payingthe doctor is to remunerate him beforehand, whenhe works to preserve the health of the subject, while,if he fails to preserve it, he deals with events gratui-tously, i.e., he regards the consequent treatment asthe work for which he has already been paid. Thisstatement is frequently made, and happens to havebeen made prominently this week ; it is sometimesendorsed and sometimes contradicted, while latterly,with fuller comprehension of what contract serviceimplies, it has been asked whether such a plan doesnot constitute a form of insurance. When the matterwas last being discussed we turned for informationto Dr. Wu Lien Teh, part author of a recent andvoluminous history of Chinese medicine and thewell-known director of the National QuarantineService of China. His reply shows that a categoricalanswer on all points is not quite easy. He writes :" I have tried to obtain something definite fromancient books like Chou-li.’ The only certain

thing I find is that during the Chou-li dynasty stateexaminations were held regularly for medical practi-tioners and that grades were given to four classesaccording to the percentage of cures effected bythem. Since then medical practice in China hasvaried in many directions, but although, differentconditions prevail it may be said with fair accuracythat many families pay their doctors regular sumsannually for their services ; and this may be takento mean that the doctors are paid to keep the familieswell, for no extra payment is made for attendanceupon the sick. In some cases the practitioners are