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THE SUPPRESSION OF QUACKERY.
913 have been working with the Ehrlich-Hata specific for syphilis. Revolutionising discoveries in medical and allied sciences: have succeeded each other with such startling impetuosity during recent years that medical men a,re in danger of losing the faculty of surprise : nevertheless the accounts of apparent. cures-as attested by some of the most eminent authorities in Germany-are of such a nature as to arrest the attention even of the most apathetic. We read of severe cases of syphilis running their course uninfluenced by mercury administered in the most approved fashion, showing marked retrogression of symptoms within a few hours of the introduction of the remedy. We are told that patients whose lesions swarm with spirochsates before the exhibition of the specific fail to yield any of these organisms 24 or 48 hours after its employment. But to my mind the most hopeful record yet published is the account of an experiment performed upon apes by Dr. Neisser, who has such vast experience in this field of research. Syphilitic apes some time after the initial symptoms had disappeared were treated with the Ehrlich-Hata specific. One month later they were reinoculated with human syphilitic material, and after the usual incubation period presented typical primary lesions.1 This wonderful result may be explained away in the course of time ; meanwhile, we may with reason hope that the genius of Ehrlich has conferred a blessing upon mankind which will rank with the greatest achievements of medical I am, Sir, yours faithfully, science. ARTHUR LOXTON. Birmingham, Sept. 12th, 1910.
A WET DAY AT AN AIR AND WATER CURE. To the Editor of THE LANCET.
I
half-moon of damp would be on the other side of the small face the morning after. Then there were ancient grandmotherly restrictions as to eating fruit. Even the ripest was to be taken very gingerly. To drink water when you were hot was considered very dangerous. There was in our family a tradition of an ancestor who, in 1793, had drunk cold water when heated by or thereabouts, exercise, and had at once felt an awesome pain inside his vitals. The procedure was to take two or three sips, or about a teaspoonful at a time, and thus the honest thirst of infancy, a thing to dream of in after life, was never satisfied. Spinal curvatures, irregular teeth, and dirty nails were also much neglected. Of course, with the march of civilisation things are improving, even in ultra-conservative France, but our brilliant neighbours will be long in wholly adopting the standards in matters of personal hygiene which prevail in countries otherwise far behind them. They would think it affectation to do so. I am, Sir, yours faithfully, JOHN BULL, M.D. Sept. 12th, 1910.
THE
SUPPRESSION OF
QUACKERY.
1’0 the Editor of THE LANCET.
SIR,-As a non-advertising unregistered dental practitioner of 16 years’ standing at the one address, and an old and interested reader of THE LANCET, and having received an intimation from Mr. Morton Smale that this vital question might well be ventilated in your columns, and he not making any specification that the reader should be duly qualified either medically or dentally, I beg to take advantage of this courteous intimation to ask you to kindly insert this. On reference to the Dental Directory, 1910, I find Mr. Morton Smale holds what every British dentist ought to hold-the Conjoint qualification in medicine and dentistry. Probably the duly qualified medical practitioner will think these are peculiar utterances from one of the regimental order of quacke. But all existing quackery in the embryo I lay to the door of the late governing medical bodies; had the curriculum prescribed been, as in many countries, that to become a dental practitioner necessitated the holding of a medical and dental qualification, there would not have existed any quackery to-day. But in many civilised countries, as dental science has advanced, provision has had to be made for unregistered practitioners. One of our cleverest physicians’ pet remark was : "There is an antidote to every disease." The present existing antidote no doubt is severe. But the greater the severity of the disease the deeper and longer the incision, and we will hope that the wound will be entirely healed by first intention. And, furthermore, I can assure you that at least 50 per cent. of unregistered dental practitioners would welcome a registration, and entirely submit themselves to your governing bodies. And might I be allowed the presumption to submit to you through the medium of your very well-known journal a few condensed proposals, to be added to or subtracted from by the governing bodies, viz. :1. The existing unregistered dental practitioner that shall produce proof of having practised dentistry for the past three years or more shall, on six months’ attendance (sine curriculum) at the "nearest dental hospital, receive a certificate of the title of Dentist." 2. Should he on receipt of the title of dentist be desirous, he shall pursue the curriculum required by the governing bodies, and after classes and lectures, hospital attendance of two years’ duration, he will be allowed entry to his Final Examination, equivalent to the present L.D.S. (You would find many unregistered taking advantage of the
SiR,—Some diseases are said to move in vicious circles. An air-cure in France at a fashionable "bain " forcibly illustrates this, for immemorial Gallic custom militates often against the most approved modern therapeutics and prophylactics in a manner that must prove the despair of enlightened French practitioners. These lines are being written in a hermeticallysealed salon, heavy with the exhalations of seldom-washing humanity and of phthisical patients who do bathe, but who have sat in rows on sofas during hours of a gloomy and rainy day among the mountains. The salon, which has not a ventilator or practicable window anywhere, and is lit by a dim ground-glass skylight, opens into another room, stuffy with the aroma of particularly active children. This drawing-room also llCl’Cr has its windows opened; the parents of the children take good care of that. This hotel, which is the resort of baigne2.rs, many of them consumptive, is certainly built on modern hygienic principles. The bedrooms are austerely clean, and the mania for rounded corners has even spread to the insides of the night-tables. Everything from walls to furniture is made to wash, but, on the other hand, there is no bath-room in the house, and there is no sign of a bath. Closets are on the English principle, but some of them open into unventilated air-shafts. The "w.c. t 1’Anglaise " has had a hard struggle to establish itself in France during the last two decades. It is still the subject of sarcasms from patriotic pens in the newspapers! Indeed, to many French minds English cleanliThe ritual ness is a form of Pharisaism and is not loved. of the mineral-water baths here seems to be interwoven with survivals, such as the 11 bassanoire," or warming-pan, perhaps traceable to a Roman source. It would be interesting to examine into what the French call the provenance of all the bathing customs and beliefs here and elsewhere. How many of the practices at a "bain" are really merely oldworld survivals ? Venerable absurdities and immemorial bad customs in the matter of ventilation and cleanliness do not promise well for the cure of incipient consumption, which in proposal.) France, at least, seems to a great extent to be a self-induced 3. The unregistered dental practitioner of advanced years, disease due to mollycoddling, rich and unwise diet, lack of who could not well take advantage of this proposition, would fresh air, and life-long bathlessness, if I may be allowed to on receipt of the certificate of the title dentist receive the coin a word. In the writer’s early youth the French child same privileges as the registered dentists of 1878, viz. : of a well-bred stock was most perfunctorily cat-licked by his (1) Exemption from juries ; (2) duly qualified medical nurse in the morning. We remember one worthy soul practitioners to be permitted to administer any general who with a slightly-damped sponge made a sort of anaesthetic necessary, when called upon so to do ; (3) the segmentary dab over her little charge’s face at 7 o’clock continuing of the right of administration of N20 and oxygen, It was always a toss-up whether the or any equivalent anaesthetic of a similar nature that in in the morning. I may be used in dentistry; (4) the use of local 1 Berliner Klinische Wochenschrift. anaesthetics, embracing all that are in present and future use
future
914 as local anaesthesia ; (5) in granting this certificate of the title of dentist only will make a distinction between the graduate who through college training can exhibit the title of L.D.S. ; and (6) the applicants shall conform to all ethical regulations as laid down by the governing bodies from time to time. The existing opposing elements you have to contend with are, to say the least-I am bound to put it in the superlative degree -very numerous. There exist at present 40,000 unregistered dental practitioners in the British isles of all descriptions, societies and companies inclusive. Their books will show they are making livings from f:100 to E2000 per annum. Should it necessitate financial enterprise to pass a Bill (Parliament permitting), they can command at a week’s notice £50,000 without any financial inconvenience to themselves whatever. That is the financial side of the question. Taking your professional side of the question, I can safely assert according to the present state of dental affairs that in another three years a registered dentist of any qualification whatever, unless he has a private income, will not be able to live. My argument lies in the fact that ordinary dentistry is composed of minor operations only ; excision of jaws, antrum belong to the region of the hospital cases, growths, &c., surgeon, hence the birth of so many unregistered dentists. And furthermore, in reply to Mr. Morton Smale, who probably has his carriage patients from 10 to 4, he cannot possibly possess any conception of the dental requirements of the middle, and especially the lower classes in the North of England ; so the sooner fresh legislation is issued the better for all concerned in the practice of dentistry. I am, Sir, yours faithfully, SINE IRA ET STUDIO. August 29th, 1910. -
--
EPIDEMIC POLIOMYELITIS IN THE UNITED STATES. (FROM A SPECIAL CORRESPONDENT.) which has prevailed since 1904 in New and since 1907 in New York State, has now reached the capital, and there are estimated to be already nearly 200 cases in the city and surrounding country. So much alarm has been created by the sensationalism of the newspapers that the Medical Association of the District of Columbia met in special session on August 23rd in order to consider the situation and attempt to reach a common understanding from which they might formulate a statement to render uniform the advices which are reaching the public from irresponsible sources. The matter was taken up as follows : Epidemiology, Dr. L. T. Royster of Norfolk, Va., the secretary of the Pediatric Section of the American Medical Association ; Bacteriology and Pathology, Dr. John F. Anderson, director of the Hygienic Laboratory of the United States Public Health and Marine Hospital Service ; Symptomatology, Dr. G. N. Acker, visiting physician of the Washington Children’s Hospital; Differential Diagnosis and Treatment, Dr. Tom A. Williams, neurologist to the Epiphany Dispensarv ; Washington Preventive Measures, Dr. W. C. Woodward, health officer of the District of Columbia. Dr. ROYSTER was inclined to believe that the present outbreak was an epidemic analogue of a sporadic disease rather than a new malady. He emphasised the comparative frequency of meningeal and encephalitic incidence of recent epidemics. He believed that until they had clearer knowledge of the manner of contagion it was better to err on the safe side with regard to precautions against infection. No promise was yet afforded by attempts at attenuation of the virus with which to furnish a useful preventive inoculation ; but the labours of the Rockefeller Institute had added a very great deal to their knowledge of the transmissibility of this disease, and the work a was striking illustration of the value of such laboratories. Dr. ANDERSON emphasised the European experiments by which infection had been conveyed by spraying the suspended virus into the nares and by rubbing it on to the bruised nasal mucous membrane. Introduction of the virus
THIS
England
disease,
into the stomach through an oesophageal tube had also infected animals. It was very important to keep in mind the demonstrated fact that the virus, like that of epidemic cerebro-spinal meningitis, was excreted by the nose. It was also excreted by the saliva. From these experimental facts it should follow that the disease might be conveyed clinically in this way, and that precautions against this possibility should be taken, even although the reported facts did not favour this view at present. But as the virus remained active for a long period and was very resistant to most inimical agents except heat, and as in the laboratory of Levaditi the virus had been obtained from the olfactory bulb as the direct result of infection through the nose, too many precautions could not be taken against the nasal avenue and the conveyance of the disease by the inspiration of infected dust. Hence, the disease should be notifiable in order that minute inquiry might be instituted as to the manner of propagation. The fact that normal sheep serum appeared to have a weak neutralising effect upon the virus and that this could be augmented by inoculation might have a bearing upon sero-pathological researches in the future. Dr. ACKER described an epidemic which had occurred in 1889, during ;which he saw about 20 cases in the district. Only sporadic cases then occurred until 1904, when there were 25. He had been much struck by the absence of family infection, never having seen two cases at once in a household. The contagion must therefore be very feeble. He had noticed the frequency of spinal irritation in this epidemic, and he had seen several cases which were mistaken for rheumatism and neuritis, and some for typhoid fever. In some cases the paralysis had occurred only after the subsidence of the fever or after a recurrence. He thought that if all cases were reported the mortality would not exceed 5 per cent. Dr. WILLIAMS alluded to the need of an accurate neurological technique in diagnosing the more difficult cases, which were not numerous. Some resembled Landry’s paralysis ; in some meningeal symptoms predominated; in some it was chiefly the brain stem which was attacked, giving rise to a dysergic syndrome, sometimes unilateral, as in a case he shortly reported. In such cases examination of the reflexes was particularly important, but it was sometimes very difficult in children to obtain the muscular relaxation needed to examine these, especially when the meninges were irritated. The failure to respond under these conditions did not indicate absence of the reflexes but error in the method of eliciting them. There were two sources of pain from poliomyelitis: (1) meningeal, and (2) that due to stretching, dragging, and torsions of muscles, fascife, and ligaments. The latter was permitted by the atonia which resulted from the neuronal degenerations of the disease. The best remedy for it was early galvanism, to exercise muscle contractivityand preserve tonus. But prolonged suspension in water as recommended by the New York committee which reported upon the 1907 epidemic was also of great value, and something could be done by well-applied slings and pads for the patient in bed. ro encourage the voluntary movement which was so important factor in recovery, the child must be induced to play the kind of games which make a demand upon those muscles which were weakened ; and when no visible movement was )therwise attainable, suspension in a bath would often nable the patient to command some otherwise inert nuscle bundle. In conducting these exercises, which must )e persevered with for months, the psychic factor was of the greatest importance, so that the child could participate vith enjoyment and thus make greater and more prolonged efforts. Dr. WOODWARD believed that could they answer the uestion of why these outbreaks were occurring throughout he civilised world at this particular time, they might go far owards finding a means for arresting the spread of poliomyelitis. Did it prevail now because the growth of the rganism was favoured, or was it because their mode of life endered them more susceptible ? At present they must work empirically, although they could be largely guided by aboratory experiments, which had shown the danger of asal and salivary secretions. Disinfection of these and the se of different utensils by the patients should be minimal commendations. But there was always the danger of
ifection
by droplets.
They
must have more
light; and
A WET DAY AT AN AIR AND WATER CURE. To the Editor of THE LANCET.
I
half-moon of damp would be on the other side of the small face the morning after. Then there were ancient grandmotherly restrictions as to eating fruit. Even the ripest was to be taken very gingerly. To drink water when you were hot was considered very dangerous. There was in our family a tradition of an ancestor who, in 1793, had drunk cold water when heated by or thereabouts, exercise, and had at once felt an awesome pain inside his vitals. The procedure was to take two or three sips, or about a teaspoonful at a time, and thus the honest thirst of infancy, a thing to dream of in after life, was never satisfied. Spinal curvatures, irregular teeth, and dirty nails were also much neglected. Of course, with the march of civilisation things are improving, even in ultra-conservative France, but our brilliant neighbours will be long in wholly adopting the standards in matters of personal hygiene which prevail in countries otherwise far behind them. They would think it affectation to do so. I am, Sir, yours faithfully, JOHN BULL, M.D. Sept. 12th, 1910.
THE
SUPPRESSION OF
QUACKERY.
1’0 the Editor of THE LANCET.
SIR,-As a non-advertising unregistered dental practitioner of 16 years’ standing at the one address, and an old and interested reader of THE LANCET, and having received an intimation from Mr. Morton Smale that this vital question might well be ventilated in your columns, and he not making any specification that the reader should be duly qualified either medically or dentally, I beg to take advantage of this courteous intimation to ask you to kindly insert this. On reference to the Dental Directory, 1910, I find Mr. Morton Smale holds what every British dentist ought to hold-the Conjoint qualification in medicine and dentistry. Probably the duly qualified medical practitioner will think these are peculiar utterances from one of the regimental order of quacke. But all existing quackery in the embryo I lay to the door of the late governing medical bodies; had the curriculum prescribed been, as in many countries, that to become a dental practitioner necessitated the holding of a medical and dental qualification, there would not have existed any quackery to-day. But in many civilised countries, as dental science has advanced, provision has had to be made for unregistered practitioners. One of our cleverest physicians’ pet remark was : "There is an antidote to every disease." The present existing antidote no doubt is severe. But the greater the severity of the disease the deeper and longer the incision, and we will hope that the wound will be entirely healed by first intention. And, furthermore, I can assure you that at least 50 per cent. of unregistered dental practitioners would welcome a registration, and entirely submit themselves to your governing bodies. And might I be allowed the presumption to submit to you through the medium of your very well-known journal a few condensed proposals, to be added to or subtracted from by the governing bodies, viz. :1. The existing unregistered dental practitioner that shall produce proof of having practised dentistry for the past three years or more shall, on six months’ attendance (sine curriculum) at the "nearest dental hospital, receive a certificate of the title of Dentist." 2. Should he on receipt of the title of dentist be desirous, he shall pursue the curriculum required by the governing bodies, and after classes and lectures, hospital attendance of two years’ duration, he will be allowed entry to his Final Examination, equivalent to the present L.D.S. (You would find many unregistered taking advantage of the
SiR,—Some diseases are said to move in vicious circles. An air-cure in France at a fashionable "bain " forcibly illustrates this, for immemorial Gallic custom militates often against the most approved modern therapeutics and prophylactics in a manner that must prove the despair of enlightened French practitioners. These lines are being written in a hermeticallysealed salon, heavy with the exhalations of seldom-washing humanity and of phthisical patients who do bathe, but who have sat in rows on sofas during hours of a gloomy and rainy day among the mountains. The salon, which has not a ventilator or practicable window anywhere, and is lit by a dim ground-glass skylight, opens into another room, stuffy with the aroma of particularly active children. This drawing-room also llCl’Cr has its windows opened; the parents of the children take good care of that. This hotel, which is the resort of baigne2.rs, many of them consumptive, is certainly built on modern hygienic principles. The bedrooms are austerely clean, and the mania for rounded corners has even spread to the insides of the night-tables. Everything from walls to furniture is made to wash, but, on the other hand, there is no bath-room in the house, and there is no sign of a bath. Closets are on the English principle, but some of them open into unventilated air-shafts. The "w.c. t 1’Anglaise " has had a hard struggle to establish itself in France during the last two decades. It is still the subject of sarcasms from patriotic pens in the newspapers! Indeed, to many French minds English cleanliThe ritual ness is a form of Pharisaism and is not loved. of the mineral-water baths here seems to be interwoven with survivals, such as the 11 bassanoire," or warming-pan, perhaps traceable to a Roman source. It would be interesting to examine into what the French call the provenance of all the bathing customs and beliefs here and elsewhere. How many of the practices at a "bain" are really merely oldworld survivals ? Venerable absurdities and immemorial bad customs in the matter of ventilation and cleanliness do not promise well for the cure of incipient consumption, which in proposal.) France, at least, seems to a great extent to be a self-induced 3. The unregistered dental practitioner of advanced years, disease due to mollycoddling, rich and unwise diet, lack of who could not well take advantage of this proposition, would fresh air, and life-long bathlessness, if I may be allowed to on receipt of the certificate of the title dentist receive the coin a word. In the writer’s early youth the French child same privileges as the registered dentists of 1878, viz. : of a well-bred stock was most perfunctorily cat-licked by his (1) Exemption from juries ; (2) duly qualified medical nurse in the morning. We remember one worthy soul practitioners to be permitted to administer any general who with a slightly-damped sponge made a sort of anaesthetic necessary, when called upon so to do ; (3) the segmentary dab over her little charge’s face at 7 o’clock continuing of the right of administration of N20 and oxygen, It was always a toss-up whether the or any equivalent anaesthetic of a similar nature that in in the morning. I may be used in dentistry; (4) the use of local 1 Berliner Klinische Wochenschrift. anaesthetics, embracing all that are in present and future use
future
914 as local anaesthesia ; (5) in granting this certificate of the title of dentist only will make a distinction between the graduate who through college training can exhibit the title of L.D.S. ; and (6) the applicants shall conform to all ethical regulations as laid down by the governing bodies from time to time. The existing opposing elements you have to contend with are, to say the least-I am bound to put it in the superlative degree -very numerous. There exist at present 40,000 unregistered dental practitioners in the British isles of all descriptions, societies and companies inclusive. Their books will show they are making livings from f:100 to E2000 per annum. Should it necessitate financial enterprise to pass a Bill (Parliament permitting), they can command at a week’s notice £50,000 without any financial inconvenience to themselves whatever. That is the financial side of the question. Taking your professional side of the question, I can safely assert according to the present state of dental affairs that in another three years a registered dentist of any qualification whatever, unless he has a private income, will not be able to live. My argument lies in the fact that ordinary dentistry is composed of minor operations only ; excision of jaws, antrum belong to the region of the hospital cases, growths, &c., surgeon, hence the birth of so many unregistered dentists. And furthermore, in reply to Mr. Morton Smale, who probably has his carriage patients from 10 to 4, he cannot possibly possess any conception of the dental requirements of the middle, and especially the lower classes in the North of England ; so the sooner fresh legislation is issued the better for all concerned in the practice of dentistry. I am, Sir, yours faithfully, SINE IRA ET STUDIO. August 29th, 1910. -
--
EPIDEMIC POLIOMYELITIS IN THE UNITED STATES. (FROM A SPECIAL CORRESPONDENT.) which has prevailed since 1904 in New and since 1907 in New York State, has now reached the capital, and there are estimated to be already nearly 200 cases in the city and surrounding country. So much alarm has been created by the sensationalism of the newspapers that the Medical Association of the District of Columbia met in special session on August 23rd in order to consider the situation and attempt to reach a common understanding from which they might formulate a statement to render uniform the advices which are reaching the public from irresponsible sources. The matter was taken up as follows : Epidemiology, Dr. L. T. Royster of Norfolk, Va., the secretary of the Pediatric Section of the American Medical Association ; Bacteriology and Pathology, Dr. John F. Anderson, director of the Hygienic Laboratory of the United States Public Health and Marine Hospital Service ; Symptomatology, Dr. G. N. Acker, visiting physician of the Washington Children’s Hospital; Differential Diagnosis and Treatment, Dr. Tom A. Williams, neurologist to the Epiphany Dispensarv ; Washington Preventive Measures, Dr. W. C. Woodward, health officer of the District of Columbia. Dr. ROYSTER was inclined to believe that the present outbreak was an epidemic analogue of a sporadic disease rather than a new malady. He emphasised the comparative frequency of meningeal and encephalitic incidence of recent epidemics. He believed that until they had clearer knowledge of the manner of contagion it was better to err on the safe side with regard to precautions against infection. No promise was yet afforded by attempts at attenuation of the virus with which to furnish a useful preventive inoculation ; but the labours of the Rockefeller Institute had added a very great deal to their knowledge of the transmissibility of this disease, and the work a was striking illustration of the value of such laboratories. Dr. ANDERSON emphasised the European experiments by which infection had been conveyed by spraying the suspended virus into the nares and by rubbing it on to the bruised nasal mucous membrane. Introduction of the virus
THIS
England
disease,
into the stomach through an oesophageal tube had also infected animals. It was very important to keep in mind the demonstrated fact that the virus, like that of epidemic cerebro-spinal meningitis, was excreted by the nose. It was also excreted by the saliva. From these experimental facts it should follow that the disease might be conveyed clinically in this way, and that precautions against this possibility should be taken, even although the reported facts did not favour this view at present. But as the virus remained active for a long period and was very resistant to most inimical agents except heat, and as in the laboratory of Levaditi the virus had been obtained from the olfactory bulb as the direct result of infection through the nose, too many precautions could not be taken against the nasal avenue and the conveyance of the disease by the inspiration of infected dust. Hence, the disease should be notifiable in order that minute inquiry might be instituted as to the manner of propagation. The fact that normal sheep serum appeared to have a weak neutralising effect upon the virus and that this could be augmented by inoculation might have a bearing upon sero-pathological researches in the future. Dr. ACKER described an epidemic which had occurred in 1889, during ;which he saw about 20 cases in the district. Only sporadic cases then occurred until 1904, when there were 25. He had been much struck by the absence of family infection, never having seen two cases at once in a household. The contagion must therefore be very feeble. He had noticed the frequency of spinal irritation in this epidemic, and he had seen several cases which were mistaken for rheumatism and neuritis, and some for typhoid fever. In some cases the paralysis had occurred only after the subsidence of the fever or after a recurrence. He thought that if all cases were reported the mortality would not exceed 5 per cent. Dr. WILLIAMS alluded to the need of an accurate neurological technique in diagnosing the more difficult cases, which were not numerous. Some resembled Landry’s paralysis ; in some meningeal symptoms predominated; in some it was chiefly the brain stem which was attacked, giving rise to a dysergic syndrome, sometimes unilateral, as in a case he shortly reported. In such cases examination of the reflexes was particularly important, but it was sometimes very difficult in children to obtain the muscular relaxation needed to examine these, especially when the meninges were irritated. The failure to respond under these conditions did not indicate absence of the reflexes but error in the method of eliciting them. There were two sources of pain from poliomyelitis: (1) meningeal, and (2) that due to stretching, dragging, and torsions of muscles, fascife, and ligaments. The latter was permitted by the atonia which resulted from the neuronal degenerations of the disease. The best remedy for it was early galvanism, to exercise muscle contractivityand preserve tonus. But prolonged suspension in water as recommended by the New York committee which reported upon the 1907 epidemic was also of great value, and something could be done by well-applied slings and pads for the patient in bed. ro encourage the voluntary movement which was so important factor in recovery, the child must be induced to play the kind of games which make a demand upon those muscles which were weakened ; and when no visible movement was )therwise attainable, suspension in a bath would often nable the patient to command some otherwise inert nuscle bundle. In conducting these exercises, which must )e persevered with for months, the psychic factor was of the greatest importance, so that the child could participate vith enjoyment and thus make greater and more prolonged efforts. Dr. WOODWARD believed that could they answer the uestion of why these outbreaks were occurring throughout he civilised world at this particular time, they might go far owards finding a means for arresting the spread of poliomyelitis. Did it prevail now because the growth of the rganism was favoured, or was it because their mode of life endered them more susceptible ? At present they must work empirically, although they could be largely guided by aboratory experiments, which had shown the danger of asal and salivary secretions. Disinfection of these and the se of different utensils by the patients should be minimal commendations. But there was always the danger of
ifection
by droplets.
They
must have more
light; and