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REGULATIONS GOVERNING FOOD PRODUCTS.
1187
correspond to the absence of the plantar flexion ; is there any movement in the antagonists of the recti abdominis to correspond to plantar extension ‘ .0 Ne quid nimis." As far as we know this point has not been investigated. There are other reflexes still-the so-called organic reflexes-whose activity requires the integrity of REGULATIONS GOVERNING FOOD PRODUCTS. reflex arcs involving muscles that are not voluntary THE extensive code of regulations under the Sale of in the usual sense-arcs in which there are components Food and Drugs Act, 1908, New Zealand Department been considerably widened by new belonging to the sympathetic nervous system. The of Health, have which came into force last September. regulations of as these aids to diagnosis is very considerable. value Armed with these weapons, the clinician can reach The requirements which must be complied with are set out in detail, and the conditions which cannot a diagnosis with facility in any case, a diagnosis, be permitted in connexion with most food products however, that is topographical rather than patho- are prescribed with great care. The new regulations logical. This is the limitation of the method. If deal in particular with bakehouses and the sale of the bulbo-cavernosus reflex is abolished, he knows bread and pastry, places for the preparation of meat for a fact that there is impairment of function of the and made meat products, and for their sale in butchers’ and fishmongers’ shops, with the transport arc through the third sacral segment, but not whether he is dealing with tabes dorsalis, sarcomatosis of the of meat and fish, with milk and ice-cream, and their attencauda equina roots, tumour of the conus medullaris, prevention from contamination. The detailed tion paid to made-up meat products is of particular and so on. If there is reflex iridoplegia, he cannot interest, since they go far beyond any powers ipso facto and without further testing say whether possessed in this country, where it is generally recogmesencephalic neurosyphilis, mesencephalic tumour, nised that existing powers are extremely inadequate. New Zealand, for example, it is an offence for any epidemic mesencephalitis, trauma, or which of half a dozen other pathological states is responsible for person to engage in the manufacture, preparation, the phenomenon. The tendency of the beginner to storage, packing, carriage, or delivery for sale of any link the absence of the knee-jerks with tabes, the food or of any article used or likely to be used as a from any communicable disease, food, if he is suffering " presence of the extensor plantar response with lateral or is a " carrier of any infectious disease, or is sclerosis, the Argyll Robertson sign with syphilis, suffering from any condition causing a discharge is venial but none the less regrettable. It should be of pus or serum from head, neck, hands, or arms. the task of the teacher to inculcate principles rather The preparation and storage of food have to be carried than particularities. Rightly employed, the use of out under conditions which prevent contamination the reflexes aids as nothing else can in the analysis by dust, damp, foul odours, or by rats, mice, or of neurological symptoms, but as the examiner taps insects. All receptacles for such foods have to be kept clean. The adequate cleaning of drinking one tendon after another, or stimulates one skin vessels and table appliances in restaurants and other area after another, he should, in his mind’s eye, where food or drink is sold is very fully envisage the corresponding segments of the nervous premises Detailed regulations in regard to the prescribed. system, with their afferent and efferent paths; only structure of bakehouses are enacted and as to the thus will he derive that information which is in truth precautions to be observed in their usage. Places for " " an the mincing, curing, canning, and otherwise preparing insight into neural function. of meat (and this word is given an extended application) have to be approved and licensed by the local MODERN ENGLISH. authority. Such premises must have smooth, imperIT is no easy matter for the father who has spent vious floors, be properly drained, internal walls with the laborious days and nights of his youth in the an impervious surface, roofs dust-proof and painted colour or calcimined, construction and fittings study of Addison to understand the tongue of a light so as to exclude, so far as possible, rats and mice and of these In the shingled daughter post-war years. Equally stringent are the requirements for last decade there has arisen a language, racy and flies. butchers’ and fishmongers’ shops and for the storage descriptive, that is still partly incomprehensible to of meat and fish in connexion therewith. The adoption It must be wholly many of the older generation. of these for meat made food products regulations mysterious to the strangers within our gates. This in this country would mean and the reconstruction of a new speech, born when the principles of war-time material proportion of the buildings now in use and economy seemed to extend even to words, may be a very welcome revolution in practices which are now ignored on the judicial bench or in the scholar’s permitted, and, indeed, cannot legally be prevented. study, but it is a power in the market-place. The The New Zealand regulations in regard to milk are hour has come for the recording and explanation more in line with those adopted in this country, of this language, and with it the book-the Pocket but are more stringent. The powers for dealing with Oxford Dictionary of Current English.l This little the cleanliness and freedom from contamination of F. and H. G. Fowler W. dictionary, compiled by ice-cream or ices are considerable and premises used to Fowler, well justifies the claim of its compilers for this also have to be licensed. No fresh making clear the idiomatic usage of words, although penaltiespurpose are fixed in the new regulations, but there is a tendency to explain colloquial or slang the penalty in Section 87 of the existing in equally unclassical language. For presumably expressions will " apply, and this enacts that the penalty regulations example, to send one to Coventry " is classified into on conviction for a breach of regulations is up to " to combine to cut him,"-possibly a foreigner for a continuing offence not more than would be thus justified in interpreting the phrase as 5 and the continuance of the offence.
Annotations.
In
store-house2 I The
a surgical consuitation." As a of modern terms-we hesitate to call some of them English-it" is remarkably up to date, "Bradbury," "
meaning " Fisher,"
jazz," and "Pussyfoot " all find a place. One or two medical terms are very loosely definedfor example, as a urinary disease." diabetes "
But the book is
"
one
"
of the most serviceable of
Oxford : At the Clarendon Press.
1924.
Pp. 1000.
I regulations
Ifrequently Iour small
dictionaries, and a useful feature is the work of the compilers in collecting words that form a series and letting the reader know where to find them. 1
for every day during detailed and explicit character of all these contrast sharply with the bulk of the requirements in force in this country, which are couched in vague terms. No one can read English food enactments without being struck with what would appear to be almost deliberate looseness of phraseology. Cowsheds are to be " thoroughly cleansed from time to time as often as may be necessary," they have to be sufficiently lighted with windows," sufficiently ventilated with a "sufficient number of openings" to keep the
3s. 6d.
"
"
1188 " No air in the dairy in a wholesome condition. ANÆSTHETICS IN ANIMAL OPERATIONS. person shall sell to the prejudice of the purchaser IN the course of a communication on the selecany article of food or any drug which is not of the tion and administration of anaesthetics to animals, nature, substance, and quality of the article demanded delivered recently to the Section of Anaesthetics of by such purchaser." It is worthy of serious considera- the Royal Society of Medicine, Prof. F. Hobday tion whether this loose wording should not be abanout the curious fact that animal patients, doned and replaced by a carefully thought out series pointed have the misfortune to require surgical of definite enactments setting out exactly what is when they are the laws of the better
attention,
protected by
revired. Clearly defined requirements are better than those of human origin. By the amended for the administrator, more effective for the con- land Animals Ansesthetics Act, passed in 1919, a long list sumer, and fairer to the trader, who knows exactly of operations performed in veterinary surgery were where he stands and is not at the mercy of a terminoscheduled for anaesthetisation. officially logy liable to be differently interpreted in different For the performance ofcompulsory some of these a general areas. i anaesthetic is essential ; with others a local anaesthetic may be used at the discretion of the operator. In the PASTEUR.1 former class are included, for horses, dogs, cats, and THE pious labours of Dr. Vallery-Radot in producing bovines, operations for ovariotomy and laparotomy, a complete edition of Pasteur’s writings have now amputations of penis, mamma, or uterus, scrotal and reached the third volume, which contains his works on inguinal hernia. Moreover, horses must be given a vinegar and on wine. His books and papers are repro- general anaesthetic for operations for quittor, stripping duced with the interesting original illustrations, and the wall or sole of the hoof, poll evil, fistulous withers, there are as well a number of short notes and letters to extraction of permanent molar teeth, scirrhous cord, journals in which Pasteur emphasises the correctness and extensive tumours; dogs and cats for castration of his views and the propriety of giving him credit for when they are over six months old, and bovines for them. In these days of reckless and snippetty prooperations for actinomycosis and dishorning if they duction, a short course of Pasteur’s larger papers are over 3 months old. A local anaesthetic at least would do any scientific worker good, and wecan imagine must be used for enucleation of the eyeball, umbilical no better discipline, when the edition is complete in and urethrotomy in all these animals, and the hernia, seven volumes, than to take it away to a lonely place same ruling applies in horses to neurectomy, applicafor the long vacation and read it steadily through. tion of the actual cautery, docking, and trephining It would have been helpful if the edition could have in dogs and cats to docking of the tail, and in bovines had a commentary indicating the relation of Pasteur’s to rumenotomy and trephining. In regard to work to the present state of knowledge on the subjects castration, he pointed out that the horse, ass, and he dealt with; such a design would certainly have mule are specially exempted, not on the ground been difficult to execute, but there has been so much that there is less pain when their testicles are specialisation since his day that few people can removed, but because of the powerful and successful adequately appreciate the nuances of all his work. opposition raised at the time and backed up by influential agriculturists and owners of valuable horses. Their chief reason was that, had the Act DIABETIC COMA WITHOUT KETONURIA. become law as it was, the travelling gelder (who is in IT is usually accepted as a clinical axiom that coma many districts of England the man who does most of with glycosuria but no ketonuria is not due to diabetes. the castrations) would have been unable to have The converse picture, however, of a comatose patient carried on his job-partly because of his ignorance of with considerable ketonuria but no glycosuria is the method of administration of anaesthetics proper occasionally met with in cases of diabetes. This is and the risks to be incurred, and partly because of the usually the result of some stringent measure, such as difficulty (for him) of obtaining chloroform, and the starvation, which has been adopted in order to render added expense in time and money. Many thousands the patient’s urine sugar-free. A few cases of diabetic of horses are operated upon in the standing position coma without ketonuria have been recorded, and the Prof. Hobday said that when done every year. October number of the Archives of Internal Medicine the whole operation from start to finish did expertly contains an account of one in which the ketonuria not exceed two minutes at most, the colt showing so was insignificant. 2 Unfortunately, the tests used for the little evidence of after-pain or discomfort that he detection of ketone bodies in the urine are not given, usually walks right up to the manger and commences nor is there any record of a post-mortem examination. to feed at once. Hera was a concrete illustration of The example quoted is that of a child, aged 9, who was the part played by the brain of the human in the admitted to hospital in a state of coma. The breath this operation, at all events, of anticipation smelt strongly of acetone. The urine contained the animal had things-in no preliminary dread or anticipation3 per cent. of sugar and showed a faint trace of and here the veterinary surgeon scored over his human acetone, but no diacetic acid. The blood-sugar was colleagues. 333 mg. per 100 c.cm., and the CO2 combining power The paradox that animals are better protected from of the plasma, according to the method of van Slyke unnecessary pain than human beings is substantially and Cullen, was 14-3 per cent. by volume, and so very true. could not to inarticulate Lawyers considerably reduced. Further noteworthy points in creatures the ancient maxim, apply Volenti non fit injuria the case were the failure of the blood-sugar to fall or the idea that the patient’s consent may be a defence after the administration intravenously of 110 units to a claim for On the contrary, public damages. of insulin (H. insulin-Lilly) within 12 hours, and the has driven Parliament into vigorous protective opinion fact that the cerebro-spinal fluid, removed imme- measures. Vivisection is carefully restricted under a diately after death, showed a very large amount of system of licences. The Protection of Animals Act of acetone as judged by the reaction to Legal’s test. 1911 made it an offence to cause an animal to be Death from coma occurred 15 hours after admission operated upon " without due care and humanity." to hospital. Despite the large amount of acetone The Animals (Anaesthetics) Act of 1919 went further, found in the cerebro-spinal fluid immediately after as Prof. out. The Act covers every Hobday pointed the to death showed no acetone blood death, just prior person who operates, whether qualified or unqualified ; and the urine contained only a trace. The case is one the owner of an animal has, of course, some means of of exceptional interest and its pathogenesis remains distinguishing qualified from unqualified practitioners somewhat obscure. by means of the familiar system of registration set up Parliament has 1 Œuvres de Pasteur. Edited by Pasteur Vallery-Radot. by the Veterinary Surgeons Acts. never gone so far in protecting human beings from the Paris: Masson et Cie. 1924. Pp. 519. Fr.100. Vol. III. 2 Report of a Fatal Case of Juvenile Diabetic Coma with pain of operations, though professional standards of Insignificant Ketonuria and a Large Amount of Acetone in the Cerebro-spinal Fluid. By Henry M. Feinblatt, M.D. Archives practice in hospitals and elsewhere (which in part of Internal Medicine, Oct. 15th, 1924. receive official confirmation in the working of a State ____
correspond to the absence of the plantar flexion ; is there any movement in the antagonists of the recti abdominis to correspond to plantar extension ‘ .0 Ne quid nimis." As far as we know this point has not been investigated. There are other reflexes still-the so-called organic reflexes-whose activity requires the integrity of REGULATIONS GOVERNING FOOD PRODUCTS. reflex arcs involving muscles that are not voluntary THE extensive code of regulations under the Sale of in the usual sense-arcs in which there are components Food and Drugs Act, 1908, New Zealand Department been considerably widened by new belonging to the sympathetic nervous system. The of Health, have which came into force last September. regulations of as these aids to diagnosis is very considerable. value Armed with these weapons, the clinician can reach The requirements which must be complied with are set out in detail, and the conditions which cannot a diagnosis with facility in any case, a diagnosis, be permitted in connexion with most food products however, that is topographical rather than patho- are prescribed with great care. The new regulations logical. This is the limitation of the method. If deal in particular with bakehouses and the sale of the bulbo-cavernosus reflex is abolished, he knows bread and pastry, places for the preparation of meat for a fact that there is impairment of function of the and made meat products, and for their sale in butchers’ and fishmongers’ shops, with the transport arc through the third sacral segment, but not whether he is dealing with tabes dorsalis, sarcomatosis of the of meat and fish, with milk and ice-cream, and their attencauda equina roots, tumour of the conus medullaris, prevention from contamination. The detailed tion paid to made-up meat products is of particular and so on. If there is reflex iridoplegia, he cannot interest, since they go far beyond any powers ipso facto and without further testing say whether possessed in this country, where it is generally recogmesencephalic neurosyphilis, mesencephalic tumour, nised that existing powers are extremely inadequate. New Zealand, for example, it is an offence for any epidemic mesencephalitis, trauma, or which of half a dozen other pathological states is responsible for person to engage in the manufacture, preparation, the phenomenon. The tendency of the beginner to storage, packing, carriage, or delivery for sale of any link the absence of the knee-jerks with tabes, the food or of any article used or likely to be used as a from any communicable disease, food, if he is suffering " presence of the extensor plantar response with lateral or is a " carrier of any infectious disease, or is sclerosis, the Argyll Robertson sign with syphilis, suffering from any condition causing a discharge is venial but none the less regrettable. It should be of pus or serum from head, neck, hands, or arms. the task of the teacher to inculcate principles rather The preparation and storage of food have to be carried than particularities. Rightly employed, the use of out under conditions which prevent contamination the reflexes aids as nothing else can in the analysis by dust, damp, foul odours, or by rats, mice, or of neurological symptoms, but as the examiner taps insects. All receptacles for such foods have to be kept clean. The adequate cleaning of drinking one tendon after another, or stimulates one skin vessels and table appliances in restaurants and other area after another, he should, in his mind’s eye, where food or drink is sold is very fully envisage the corresponding segments of the nervous premises Detailed regulations in regard to the prescribed. system, with their afferent and efferent paths; only structure of bakehouses are enacted and as to the thus will he derive that information which is in truth precautions to be observed in their usage. Places for " " an the mincing, curing, canning, and otherwise preparing insight into neural function. of meat (and this word is given an extended application) have to be approved and licensed by the local MODERN ENGLISH. authority. Such premises must have smooth, imperIT is no easy matter for the father who has spent vious floors, be properly drained, internal walls with the laborious days and nights of his youth in the an impervious surface, roofs dust-proof and painted colour or calcimined, construction and fittings study of Addison to understand the tongue of a light so as to exclude, so far as possible, rats and mice and of these In the shingled daughter post-war years. Equally stringent are the requirements for last decade there has arisen a language, racy and flies. butchers’ and fishmongers’ shops and for the storage descriptive, that is still partly incomprehensible to of meat and fish in connexion therewith. The adoption It must be wholly many of the older generation. of these for meat made food products regulations mysterious to the strangers within our gates. This in this country would mean and the reconstruction of a new speech, born when the principles of war-time material proportion of the buildings now in use and economy seemed to extend even to words, may be a very welcome revolution in practices which are now ignored on the judicial bench or in the scholar’s permitted, and, indeed, cannot legally be prevented. study, but it is a power in the market-place. The The New Zealand regulations in regard to milk are hour has come for the recording and explanation more in line with those adopted in this country, of this language, and with it the book-the Pocket but are more stringent. The powers for dealing with Oxford Dictionary of Current English.l This little the cleanliness and freedom from contamination of F. and H. G. Fowler W. dictionary, compiled by ice-cream or ices are considerable and premises used to Fowler, well justifies the claim of its compilers for this also have to be licensed. No fresh making clear the idiomatic usage of words, although penaltiespurpose are fixed in the new regulations, but there is a tendency to explain colloquial or slang the penalty in Section 87 of the existing in equally unclassical language. For presumably expressions will " apply, and this enacts that the penalty regulations example, to send one to Coventry " is classified into on conviction for a breach of regulations is up to " to combine to cut him,"-possibly a foreigner for a continuing offence not more than would be thus justified in interpreting the phrase as 5 and the continuance of the offence.
Annotations.
In
store-house2 I The
a surgical consuitation." As a of modern terms-we hesitate to call some of them English-it" is remarkably up to date, "Bradbury," "
meaning " Fisher,"
jazz," and "Pussyfoot " all find a place. One or two medical terms are very loosely definedfor example, as a urinary disease." diabetes "
But the book is
"
one
"
of the most serviceable of
Oxford : At the Clarendon Press.
1924.
Pp. 1000.
I regulations
Ifrequently Iour small
dictionaries, and a useful feature is the work of the compilers in collecting words that form a series and letting the reader know where to find them. 1
for every day during detailed and explicit character of all these contrast sharply with the bulk of the requirements in force in this country, which are couched in vague terms. No one can read English food enactments without being struck with what would appear to be almost deliberate looseness of phraseology. Cowsheds are to be " thoroughly cleansed from time to time as often as may be necessary," they have to be sufficiently lighted with windows," sufficiently ventilated with a "sufficient number of openings" to keep the
3s. 6d.
"
"
1188 " No air in the dairy in a wholesome condition. ANÆSTHETICS IN ANIMAL OPERATIONS. person shall sell to the prejudice of the purchaser IN the course of a communication on the selecany article of food or any drug which is not of the tion and administration of anaesthetics to animals, nature, substance, and quality of the article demanded delivered recently to the Section of Anaesthetics of by such purchaser." It is worthy of serious considera- the Royal Society of Medicine, Prof. F. Hobday tion whether this loose wording should not be abanout the curious fact that animal patients, doned and replaced by a carefully thought out series pointed have the misfortune to require surgical of definite enactments setting out exactly what is when they are the laws of the better
attention,
protected by
revired. Clearly defined requirements are better than those of human origin. By the amended for the administrator, more effective for the con- land Animals Ansesthetics Act, passed in 1919, a long list sumer, and fairer to the trader, who knows exactly of operations performed in veterinary surgery were where he stands and is not at the mercy of a terminoscheduled for anaesthetisation. officially logy liable to be differently interpreted in different For the performance ofcompulsory some of these a general areas. i anaesthetic is essential ; with others a local anaesthetic may be used at the discretion of the operator. In the PASTEUR.1 former class are included, for horses, dogs, cats, and THE pious labours of Dr. Vallery-Radot in producing bovines, operations for ovariotomy and laparotomy, a complete edition of Pasteur’s writings have now amputations of penis, mamma, or uterus, scrotal and reached the third volume, which contains his works on inguinal hernia. Moreover, horses must be given a vinegar and on wine. His books and papers are repro- general anaesthetic for operations for quittor, stripping duced with the interesting original illustrations, and the wall or sole of the hoof, poll evil, fistulous withers, there are as well a number of short notes and letters to extraction of permanent molar teeth, scirrhous cord, journals in which Pasteur emphasises the correctness and extensive tumours; dogs and cats for castration of his views and the propriety of giving him credit for when they are over six months old, and bovines for them. In these days of reckless and snippetty prooperations for actinomycosis and dishorning if they duction, a short course of Pasteur’s larger papers are over 3 months old. A local anaesthetic at least would do any scientific worker good, and wecan imagine must be used for enucleation of the eyeball, umbilical no better discipline, when the edition is complete in and urethrotomy in all these animals, and the hernia, seven volumes, than to take it away to a lonely place same ruling applies in horses to neurectomy, applicafor the long vacation and read it steadily through. tion of the actual cautery, docking, and trephining It would have been helpful if the edition could have in dogs and cats to docking of the tail, and in bovines had a commentary indicating the relation of Pasteur’s to rumenotomy and trephining. In regard to work to the present state of knowledge on the subjects castration, he pointed out that the horse, ass, and he dealt with; such a design would certainly have mule are specially exempted, not on the ground been difficult to execute, but there has been so much that there is less pain when their testicles are specialisation since his day that few people can removed, but because of the powerful and successful adequately appreciate the nuances of all his work. opposition raised at the time and backed up by influential agriculturists and owners of valuable horses. Their chief reason was that, had the Act DIABETIC COMA WITHOUT KETONURIA. become law as it was, the travelling gelder (who is in IT is usually accepted as a clinical axiom that coma many districts of England the man who does most of with glycosuria but no ketonuria is not due to diabetes. the castrations) would have been unable to have The converse picture, however, of a comatose patient carried on his job-partly because of his ignorance of with considerable ketonuria but no glycosuria is the method of administration of anaesthetics proper occasionally met with in cases of diabetes. This is and the risks to be incurred, and partly because of the usually the result of some stringent measure, such as difficulty (for him) of obtaining chloroform, and the starvation, which has been adopted in order to render added expense in time and money. Many thousands the patient’s urine sugar-free. A few cases of diabetic of horses are operated upon in the standing position coma without ketonuria have been recorded, and the Prof. Hobday said that when done every year. October number of the Archives of Internal Medicine the whole operation from start to finish did expertly contains an account of one in which the ketonuria not exceed two minutes at most, the colt showing so was insignificant. 2 Unfortunately, the tests used for the little evidence of after-pain or discomfort that he detection of ketone bodies in the urine are not given, usually walks right up to the manger and commences nor is there any record of a post-mortem examination. to feed at once. Hera was a concrete illustration of The example quoted is that of a child, aged 9, who was the part played by the brain of the human in the admitted to hospital in a state of coma. The breath this operation, at all events, of anticipation smelt strongly of acetone. The urine contained the animal had things-in no preliminary dread or anticipation3 per cent. of sugar and showed a faint trace of and here the veterinary surgeon scored over his human acetone, but no diacetic acid. The blood-sugar was colleagues. 333 mg. per 100 c.cm., and the CO2 combining power The paradox that animals are better protected from of the plasma, according to the method of van Slyke unnecessary pain than human beings is substantially and Cullen, was 14-3 per cent. by volume, and so very true. could not to inarticulate Lawyers considerably reduced. Further noteworthy points in creatures the ancient maxim, apply Volenti non fit injuria the case were the failure of the blood-sugar to fall or the idea that the patient’s consent may be a defence after the administration intravenously of 110 units to a claim for On the contrary, public damages. of insulin (H. insulin-Lilly) within 12 hours, and the has driven Parliament into vigorous protective opinion fact that the cerebro-spinal fluid, removed imme- measures. Vivisection is carefully restricted under a diately after death, showed a very large amount of system of licences. The Protection of Animals Act of acetone as judged by the reaction to Legal’s test. 1911 made it an offence to cause an animal to be Death from coma occurred 15 hours after admission operated upon " without due care and humanity." to hospital. Despite the large amount of acetone The Animals (Anaesthetics) Act of 1919 went further, found in the cerebro-spinal fluid immediately after as Prof. out. The Act covers every Hobday pointed the to death showed no acetone blood death, just prior person who operates, whether qualified or unqualified ; and the urine contained only a trace. The case is one the owner of an animal has, of course, some means of of exceptional interest and its pathogenesis remains distinguishing qualified from unqualified practitioners somewhat obscure. by means of the familiar system of registration set up Parliament has 1 Œuvres de Pasteur. Edited by Pasteur Vallery-Radot. by the Veterinary Surgeons Acts. never gone so far in protecting human beings from the Paris: Masson et Cie. 1924. Pp. 519. Fr.100. Vol. III. 2 Report of a Fatal Case of Juvenile Diabetic Coma with pain of operations, though professional standards of Insignificant Ketonuria and a Large Amount of Acetone in the Cerebro-spinal Fluid. By Henry M. Feinblatt, M.D. Archives practice in hospitals and elsewhere (which in part of Internal Medicine, Oct. 15th, 1924. receive official confirmation in the working of a State ____