COMBINED TARSAL CYST KNIFE AND CURETTE.

174 incomes than medical

men.

As

a

class medical

men are

not

New Inventions.

rich, those with the largest incomes having often unduly heavy expenses as well as very little leisure to think of their own concerns, so that it may be replied to those who criticise

A PELVIC LEVEL FOR COMPARING THE STANDING HEIGHT OF THE LEGS IN LATERAL CURVATURE OF THE SPINE, ETC. IN examining a case of lateral curvature of the spine it is important that the standing height of the legs For this purpose the instrument shall be compared. figured here, which has been made to my design by Messrs. Hawksley and Son, 357, Oxford-street, London, W., is simple in use and accurate in its results. It consists

methods with regard to our savings, that the do not in the aggregate amount to much. themselves savings But to read such a book as this is to learn that the art of sound investing is not beyond either those whose time is very much occupied or those who have little to invest. our unbusinesslike

London : G. Bell The Chained Titan. By W. G. HOLE. and Sons. 1910. Pp. 104. Price 4s. 6d. net.-Mr. W. G. Hole has produced in the " Chained Titan" what to our mind is a rather remarkable poem. A modern pilgrim, a social worker at home, who is familiar with all the terrible defaults of our present economic conditions, finds himself at a little seaport on the Greek coast and rows out alone to watch the sunset. He is conducted by Hermes to a valley where Chaos is discoursing on the signs of the times to the other gods, finding the resistance of man to the forces of pestilence, plague, and famine growing stronger and the influence of the gods waning. The pilgrim then comes across Prometheus undergoing his perpetual torture and the chained Titan protests against the way in which mundane affairs, asbe has learned of them, are conducted He himself had suffered in order to place in the hands of men the opportunities of advancing in the arts of civilisation, but it seemed that as men grew powerful against the paralysing influences of the old gods they became tyrants themselves, the strong grinding down the weak. The representatives of those on whose behalf he speaks debate the subject before him, when Chaos returns ; but at this moment the "Eternal Sacrificeis revealed, and as the descends the mountains he passes through forests which thrill with the mysteries of birth and growth. This is a mere outline, mainly in tne author’s own words, of the tremendous subject-matter of this short poem. In the main it is written in dignified blank verse, but the strand is broken with many graceful stanzas. The book has a peculiar interest to us because it is dedicated to the memory of our late assistant editor, Dr. J. Bart Rous, of whose " rare insight as a critic and perfect loyalty as a friend"the author speaks in acknowledgment of a personal debt.

pilgrim

JOURNALS AND MAGAZINES.

The British Journal of Tuberculosis. Edited by T. N. KELYNACK, M.D. Vict. Vol. V., No. 1, January. London : Bailli6re, Tindall, and Cox. Single copies, Is. 6d.annual subscription, 5s. post free.-This number contains the following articles : 1. A Popular Crusade against Consumption, by Mr. C. H. Garland, giving a brief account of the special appeal of the National Association for the Prevention of Consumption. 2. The Conquest of Tuberculosis, by Dr. David B. Lees, in which reference is made to the method of treatment by inhalation recommended by him. 3. Directions for Living and Sleeping in the Open Air, by Dr. Thomas Spees Carrington, a paper which is full of useful practical hints. 4. Local Effort in the Anti-tuberculosis Campaign, by Mr. Reginald E. Stidolph, giving a short account of the methods employed in the town of Brooklyn to arouse interest in this question by advertising and other means. 5. Some Effects of the Constant Current upon Tubercle Bacilli in Fluids, by Dr. Charles Russ. 6. Impressions of the International Tuberculosis Conference, by Dr. Nathan Raw. Two " critical reviewsare also included, one by Dr. F. Rufenacht Walters on Sanatorium Treatment in Pulmonary Tuberculosis, and another by Dr. Hugh A. Macewen on Milk and Tuberculosis, as well as some general information in regard to institutions for the tuberculous, books, preparations, and appliances.

Brussels, 1910,

’,

I

of a thin plate of hard wood, 15 inches long, 2 inches deep in the middle, and tapering to 1 inch either at end, curved to suit the prominence of the abdomen, and having a straight upper edge. It is fitted at the centre of its convex face with a small platform terminating in a convenient handle and bearing a spiritlevel. To use the apparatus the patient, with boots off and with the hips exposed, is required to stand erect. A dot is placed over each anterior superior iliac spine with a dermatographic pencil. The instrument is then applied so that the upper edge passes though both dots. If the spirit-level then indicates horizontal the two legs are equal as regards their standing height. If it does not indicate horizontal then slabs of wood of known thickness are placed beneath the foot of the shorter side until the horizontal is gained. The sum of the slabs used gives the difference between the two legs. This method of measurement assumes only one thing -viz., that the pelvis is symmetrical as regards the height of the anterior superior iliac spine above the acetabulum. Any vertical measurement taken from the anterior superior spines themselves with the patient standing on unequal legs requires correction by a very complex and constantly varying formula before it can be accepted as exact, because in the first place, the distance between the anterior superior spines is greater than the distance between the mid points of the heads of the femora (9½ inches to 6t inches, average measurements), and therefore any difference in the levels of the latter will be exaggerated in the levels of the former; and, in the second place, when the pelvis is tilted sideways the anterior superior spines move up or down, as the case may be, not in straight lines but in curves, owing to the ball-and-socket action of the hip-joint. The usual method of building up the short leg by placing slabs beneath the foot overcomes these objections, and the use of the pelvic level here described does away with the uncertainty of trusting to the eye in judging the restoration of the pelvis to the horizontal. J. S. KELLETT SMITH, F.R.C.S. Eng. Eastbourne. _____

COMBINED TARSAL CYST KNIFE AND CURETTE. THE removal of tarsal cysts (chalazia) from the eyelids is an operation of some difficulty on account of the smallness of the hold on the eyelids and the slipperiness which ensues when bleeding commences. The difficulty is not lessened by having to change instruments, one to incise and another to scrape out the cyst. To obviate the disadvantages of two independent instruments, I have devised a combination in which both are contained in a metal tube. The knife blade is wedge-shaped, thus enabling the cyst to be opened by one

cut, and instead of the usual sharp spoon, which becomes

sharp ring curette is used. As one instrument is from the tube the other is withdrawn into it, thus tending to prevent injury either to the operator or the patient. The action can be controlled by the fingers of one hand. Messrs. Weiss of Oxford-street, London,’W., have embodied my ideas in a perfectly satisfactory manner, and the instrument can be obtained from them at a moderate cost. A. A. BRADBURNE, Manchester. BRADBURNB, F.R.C.S. Edin. blocked,

a

protruded

THE EVOLUTION OF THE MEDICAL OFFICER OF HEALTH.

175

’y taking the official appointments will leave the field for uch practice more open ; and secondly, those holding the official appointments, not being their rivals in practice,

THE LANCET. LONDON: SATURDAY, JANUARY 21, 1911.

The Evolution of the Medical Officer of Health. public health service of Great Britain has afforded an example of sanitary administration which has been closely followed by foreign nations and by our own colonies and dependencies, and although there are not wanting critics who are opposed to local government in sanitary matters, THE

and who would have the conditions of ment Board is not

our

follow methods

us

Indian

likely

Empire,

more

the

suitable to

Local Govern-

to be deaucted from its ideals

We may be well resolved to of local administration. resist the needless encroachments of bureaucracy, and yet perceive that public health conditions cannot always await a settlement by a Parliament entangled in party The path towards the attainment of sanitary warfare. ideals is a long and difficult one, and it is mainly by periodic stimuli put forth by the central body that advances in detailed local administration are made, more

particularly

in the

case

in the rural districts

of the smaller urban districts and

where,

as a

rule, part-time medical

diagnosis and kept informed on sanitary professional friction. It must be remembered that the appointment of a whole-time medical officer of health for a very large comoined district is not always a success. This fact is evidently ;a.n

be consulted in

natters without risk of

appreciated in a Memorandum which has been issued by the Local Government Board in connexion with the new

Order.

tain

some

This Order and Memorandum combined very

important

and

far-reaching modifications,

the full force of which is only apparent to those who are sufficiently familiar with the subject to enable to read between the lines. Although the Local Government Board is strongly opposed to the medical officer of health being at the same time a general

them

practitioner, it is clearly in favour, at any rate at present, of the medical officer of health embracing as many appointments of a public nature as will enable him to devote his whole time to public work of one or another description. Indeed, it seems within the realms of possibility that the not far distant future may see a medical officer of health for a relatively small area possessed of a diploma of public health and holding, in addition, one or another, or conceivably all, of the following appointments : school medical officer, superintendent of the isolation hospital, certifying factory surgeon, police surgeon, public vaccinator, district medical officer,

still in power. These part-time officers have in very many instances done excellent work, and a great deal of the sanitary progress which has been effected

and medical officer of the workhouse.

large part due to their efforts which, it may be added, have been altogether out of proportion to the paltry recompense which they have received. But these part-time officers would be, some of them, the first to admit that there are many drawbacks to their employment, and it is clear by an Order recently issued that the Local Government Board considers these drawbacks to outweigh the advantages obtained by leaving the preventive service in the hands of the general practitioner. The future of the general practitioner, which has been of late seriously threatened by so many new social factors, may not at first sight seem to be improved by the new Order, but having regard to the miserable stipends received by so many of the part-time medical officers the pecuniary damage will not perhaps be very great. Moreover, the

authorities.

officers

are

is in

process of conversion will take very many years to accomplish, so much so that many men of 40 who are now still

con-

qualified and that

to do so, act

as

Moreover, he may, if consultant in infectious diseases

bacteriologist to his own and perhaps other local It is evidently by some such means as theserelatively small areas will in the future provide them-

as

the

selves with

medical officer of health who shall not engage practice, and it will be found by an examination.

in

a

private appointments how easily a sum of money sufficient to support a whole-time officer may be procured by the

of local

fusion of

here

The

revolution must be

appointments in the sense coming into operation of such a spread over many years, and should spoliation of the general practitioner so

contemplated.

not be

much

regarded

as

as a

rearrangement of duties among medical men whereby there will be more who receive public salaries and less who practise under

existing conditions. profession runs at

medical

The

the

particular present

insufficient salaries should be offered and

discharge

of

accepted

that

for tha

duties.

amalgamated or suggestion

No statement

before

risk which the moment is

is ventured upon in the circular

to what the Local Government Board would be

holding part-time appointments may die, holding them, at a ripe old age. The Order must be taken as little likely to regard as a minimum salary, but as the observation other than an indication of the tendency of central is made that the medical officer of health should not be administration. Nor, as we view it, will there be any placed in a position of inferiority in the matter of salary to loss of prestige to the medical profession, but rather the other medical men in the district, it is difficult to see how reverse, for at present many who hold these appoint- anything under E500 per annum net as an initial salary ments, owing to the insecurity, of their tenure and the could be entertained, the expenses of administration being conditions of their service, do not regard them with much defrayed. We areglad to see, too, that the Board complacency. The loss of emolument to those in general definitely expresses the opinion that it is " not sufficient practice will be to a great extent made up in two ways : merely that a medical man is found who is prepared to firstly, those who would be their rivals in general practice accept the salary offered, it is more important that the us as