763 for promotion to the rank of Captain on the completion of three and a half years’ commissioned service, and to the rank of Major on the completion of 12 years’ commissioned service, provided that in each case he has passed the necessary examination and is recomThe recognition of merit mended for such as a factor for progress in the Service runs, it will be seen, throughout, for promotion to the higher ranks is by selection. The occurrence of vacancies must dictate the rate of promotion ; but during the past year, we learn, 23 Majors were promoted to the rank of Lieutenant-Colonel. One feature of the present conditions of service should be specially attractive to newly qualified practitioners. Those who take up a hospital appointment can, under certain conditions, get ante-dates to their commissions. In this way the time spent in acquiring the experience which comes from holding a hospital appointment will count as time in the Army. Hence the value of joining the Corps soon after qualification, so as to be quickly ripe for promotion, has no longer to be set against the value to a young doctor of holding house appointments ; instead of these appointments being an indirect deterrent to advance by postponing entry to the Service, they have become a definite asset, while the ante-dating of the commission secures the young man from loss of seniority. The advantages of joining the Corps while it is short of junior officers are obvious, for it would seem that those who obtain commissions in it now cannot fail to find themselves in really responsible places while still in early middle life. And if they are minded to retire after seven years with the Corps, and while still at an age when many practitioners are just beginning to reap the fruit of their training, they will have earned a gratuity of £ 1000 to assist in their establishment of a civil practice.
Annotations. "
promotion.
A LEADER IN PHYSIOLOGY. THOUGH
currents
of
action in
the heart
were
THE
No
quid nimis.
NEW LIFE-TABLES.
IN this issue and the last we have summarised the contents of a volume containing the new nat onal life-tables and the Government actuary’s report thereon. This report is of particular value because Sir Alfred Watson’s knowledge of and interest in the subject matter of his analysis are such that he has comp etely avoided any temptation to dwell mainly upon those technical aspects of construction and graduation which, interesting and important to professional statisticians and actuaries, are almost unintelligible to the average reader. Indeed, he has not disdained to point out that the real value of life-table constants which enjoy great popular prestige, such as the expectation of life, is restricted and that there are cases where to present the facts of mortality in life-table form at all has little to recommend it. In general, the results of this analysis of post bellum mortality are gratifying. At most ages, especially in el-ii ldhood and early youth, the peope of Eng and die at much lower rates than before the war. It may be that the stagnation-amounting to a slight backward movement in the data for women-between the ages of 20 and 30 is a war effect; in any case it is not very serious. After four years of desolating war and a great pes’ilence, in an epoch of industrial crisis and general disillusionment, judged by the test of mortality, we stand better than at the end of an epoch of peace and prosperity. It may be that there is some illusion in this. Few men in middle life or beyond it can altogether escape the feeling that life as lived now in England has a touch of unreality. It seems hard to reconcile it with the economic facts. How can it be that the citizens of a country supporting a fantastic burden of taxation, with a million workers idle and restricted markets, still on the average maintain life at a higher standard of comfort and even of luxury than a generation ago ? Are we living in the shadow of some great disaster ? The medical analogy to this
I
economic impression would be a doubt whether 1856, their systematic not yet reflected by mortality, is so favourmorbidity, investigation did not come into the field of practical able. Since morbidity cannot be measured with the medicine until 1903 when the string galvanometer unambiguous precision that attaches to mortality, was first used to record them. This advance was due the point must remain speculative. But, without to Prof. BVILLElB1 EINTHOVEN, whose death occurred passing beyond the circle of ascertained experience at Amste’ dam’ on Sept. 29th, and it was only one of of mortality, there are some features brought out by Sir Alfred Watson which are not agreeable. Of these many services rendered to science by this distinguished the most impressive are the regional undoubtedly physiologist and physicist. Born at Samarang, in differences. The comparison of the county boroughs Java, in 1860, he was appointed professor of physio- of Northumberland and Durham with all England logy at Leiden at the early age of 25, and spent the and with the rural districts of the eastern counties is an remainder of his life in this old and quiet city. example. For every 100 of the males who reach 60 Profound learning and elaborate research in time by the Northumberland and Durham experience, in the eastern counties. Nor 141-8 attain that gained him world-wide recognition in various branches is this wholly due age to the unfavourable conditions of of physics, but his fame will chiefly rest on the cardio- life in infancy in the northern towns, for it appears logical work to which his later years were mostly that for every 100 males aged 20 who reach 60 in devoted. The electrocardiograph as it is used to-day Northumberland and Durham, 125-5will do so in the is of his devising, and the notation of its tracings- eastern counties. This is not wholly an occupational since the figures for women also offer a the well-known P. Q. R. "-is that which he suggested. difference, the last test-viz., the proportion contrast ; using The clinical application of his methods, notably by of survivors from 20 to 60-the county boroughs of Sir THOMAs LEWIS in this country, has enormously the north show 100 survivors compared with 115 in enlarged our knowledge of the heart in health and the rural districts of the eastern counties. We may
demonstrated
as
long
ago
as
"
and EINTHOVEN well deserved the Nobel pass over this with the remark : 0 fortunatos nimium, sua si bona nÔrint, Prize for physiology and medicine bestowed on him Agricolas .... for 1924. In the same year he was made an honorary member of the Physiological Society, and the respect but it is hard to believe that in this small country in which he was held by English physiologists became there ought to be so vast a disparity. Favourable as is our mortality experience on the whole, such personal as well as academic when he acted as their contrasts as these-which, by restricting the areas, host on the Society’s visit to Leiden. The latest of might be made still more striking-show that there his English honours was foreign membership of the is still much to be done before the worst districts or occupations are raised to the level of the best. Royal Society, to which he was elected in 1926.
disease,