THE SCOTTISH BOARD OF HEALTH.

28 this country in prosthetic matters before the war and since 1914. He divides types of artificial limbs into two classes, American and European, but his descriptions of the European types are in many cases inapplicable to the limbs made in Great Britain. He is therefore not a very trustworthy guide here, and the British reader is more likely to profit by his survey of continental practice. The opinions expressed as to sites of amputations and the general principles of limb-fitting are sound, but we think that Dr. MARTIN is unduly pessimistic as regards certain end-bearing stumps. The light metal limb, which has become so popular in Britain, appears to be little known on the Continent, and its advantages and disadvantages not to be understood. The later results of cinematisation of stumps would appear to have been disappointing in France, Italy, and Belgium, as they have been here, where it may safely be said that the practice has been given up altogether. Information is lacking as to the true position of this procedure in Germany, where SAUERBRUCH continues to vaunt its success, but where most other surgeons are significantly silent Neither is KRUKENBERG’S procedure on the subject. of splitting a forearm stump in order to form " tongs " recommended by Dr. MARTIN, whose references to German methods of limb-fitting are not copious. With his views on artificial hands we are in general agreement, though he is inclined to magnify their practical value. Appliances-the simpler the better-have proved of much greater practical worth than hands, though these have greater sesthetic value. His remarks about the problems arising from loss of both hands are suggestive, but he appears to be unacquainted with the ingenious table invented by Mr. GEORGE THOMSON, of Edinburgh, which our Ministry of Pensions has supplied to handless men, and he reproduces 30 illustrations from a brochure by the English limb-maker, F. G. ERNST, on the equipment of such an amputee without mention of the author’s name. This is not an isolated instance ; although various American and other limb-makers are mentioned by name, none of the most successful British makers are named, although their work may be referred to. We have nothing but praise for the public spirit and energy of the International Labour Office as shown in the production of this report, as well as in many other ways. It is to be feared, however, that interesting as it may be to surgeons and limb-makers, the British amputee will not gain much by a study of it.

THE RELIEF OF ASTHENOPIA. BINOCULAR single vision depends upon the muscles of the two eyes being so coordinated that their combined action always maintains the parallelism of the two eyes. Its maintenance depends upon the reflex muscular response to the stimulation of light in the maculae of the two eyes. When this stimulus is by the occlusion of one eye, the parallelism is still maintained, at any rate approximately, but in most cases only approximately. There is, as a rule, slight divergence, but there may be slight convergence or a slight vertical deviation from parallelism. The importance of slight lateral deviation is generally considered to be negligible so far as the necessity of treatment goes, but the occurrence of vertical deviation is found to be a not very uncommon cause of asthenopia which may call for treatment by appropriate prisms. This is the generally received view. Prof. F. W. MA]EtLOW,l in an essay recently published, goes far beyond this. He finds that by

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1 The Relative Position of Rest of the Eyes and the Prolonged Occlusion Test. By F. W. Marlow, M.D., Professor of Ophthalmology in the College of Medicine, Syracuse University. Philadelphia : F. A. Davis Company. 1924. Pp. 96.

one eye for a long period-say, a weekamount of latent deviation, both lateral and vertical, is disclosed far in excess of what the ordinary Maddox rod test without any preliminary occlusion reveals. As is well known, latent errors of refraction can in many cases only be made evident after the paralysis of the ciliary muscle by means of atropine. Similarly, if we had a drug capable of paralysing the external muscles of the eye we might in that way discover the position of rest. As we have not, it is necessary to use the method of occlusion which attains the same object. According to Dr. A. DUANE, such prolonged occlusion tends to make the eyes revert to their infantile state in which, not being controlled by coordinative influence, they exhibit a varying imbalance. Prof. MARLOw disagrees and cites cases in which a week’s occlusion has produced an exaggeration of the pre-existing heterophoria which does not vary. This position of rest, he says, affords relief to the strain on the extra-ocular muscles just as the correction of a refractive error may afford relief to an over-strained ciliary muscle, and according to him the prescription of appropriate prisms determined by the post-occlusion tests may relieve cases of asthenopia in which there may be no refractive error at all and in which the ordinary tests for heterophoria give negative results. The cases to which this method is applicable must necessarily be rare. The author, however, claims to have treated successfully cases of obscure asthenopia in which refraction and the muscle balance without occlusion were both normal, or in which the refractive error had already been corrected. The treatment advocated is the constant wearing of prisms where this is possible, and when not, operative treatment which, again, resolves itself into " partial tenotomy," an operation hitherto much more in vogue in America than in

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England.

THE SCOTTISH BOARD OF HEALTH. THE fifth annual report of the Scottish Board of Health has just reached us. In a brief introduction it is noted that the general death-rate per 1000 of population reached the record figure of 12-9, and that the infantile mortality has dropped to 78.9 compared with 101-4 in 1922, a retrogressive year, and 90-3 in 1921. Even the present figure can hardly be regarded as satisfactory, though it shows considerable progress. The infantile mortality rates for England and Wales for the years 1922 and 1923 are 77 and 69.2 respectively. While climatic conditions are, on the whole, more favourable in England for rearing infants, it is acknowledged that the climate of every country generates its own methods of protection, and that special precautions in severer climates may, to a certain extent, counteract atmospheric conditions. In Norway and Sweden, for example, the infantile mortality is low. To the school health service is allotted more space than in former reports of the Board. Since out of 208,706 children examined during the school year, 100,980, or 48.3 per cent., were found to be suffering from physical defects, all must share the hope expressed in the report that the development of this service, curtailed by economic conditions, may soon be extended to its full capacity. The last section of the report includes a survey of the effects of unemployment on the physical welfare of the population, on the technical skill of trained and partly-trained workers, and on morale, which deserves careful study. The conclusion is reached that, thanks mainly to comprehensive relief measures, the period of serious unemployment which has now extended over three years, is not likely to leave a serious mark on the physique of the Scottish people. But there can be little doubt that young people growing up in a world that makes no call on their capacities for service are likely to suffer mentally and morally from such unstimulating conditions, and it is obvious that a revival of trade will result in the more energetic cooperation of young people in schemes designed for the improvement of the public health. ,