188 made in these two cases may be carried of urban districts, the only effective method of presingle case. In view of the manifesta- venting danger f...

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188 made in these two cases may be carried of urban districts, the only effective method of presingle case. In view of the manifesta- venting danger from leakage was to fix a limit which tions of the disease here met with-a perivascular the carbon monoxide should not exceed. When the Gas Act, 1920, became law last July the Board of lymphatic and embolic infection-it might, perhaps, Regulation Trade was instructed to hold a special public inquiry be well to speak of the condition described as into the question, and a committee, consisting of Sir chronic farcy. It is interesting to note that of 21 William Pearce, M.P. (chairman), Dr. T. Carnwath, Mr. chronic cases of farcy in man recorded by HOWARD William Doig Gibb, and Mr. T. Gray, D.Sc., will proBENDALL as early as 1882, 15 recovered or were ceed in the immediate future to take evidence with a at a decision which, under the propartially cured, the six that died succumbing in view to arriving of the Act, will have statutory effect. In view periods between 50 days and 14 months. In one visions of those that recovered the disease lasted as long of the importance of the decision from the hygienic we trust that this committee will give due A disconcerting feature about the standpoint, as 2 years. to the need of limiting the carbon monoxide weight Nottingham case, but one that in future must be proportion. Health must come first in such a matter, borne in mind, is that the tissues of the udder of and due consideration for health will prove in the long a milch cow may become the temporary nidus of run to be justified economically. the B. mallei and that a condition of mild chronic farcy may there be set up from which the milker VOLUNTARY HOSPITAL FINANCE; A LAY may become infected. It then becomes possible COMMITTEE. for a glanders infection to be contracted by those IT will be remembered that when the Ministry of who partake of the milk, even though in its passage Health (Miscellaneous Provisions) Bill was before the the has bovine carrier host through organism become greatly attenuated in virulence. The mild Standing Committee a debate ensued over Clause 11, which was intended to regularise the taking over or disease process thus set up may through its very founding of general hospitals by municipalities. It modification be difficult of diagnosis, and yet from was, and is, an obvious responsibility of the Ministry this mild infection centre a much more virulent of Health to further a general scheme for the country under which all classes of the population may obtain type may be developed by passage. the benefits which can only follow upon institutional treatment, but the particular clause of the Bill was challenged from so many directions that Dr. Addison withdrew its criticised portion and offered to appoint forthwith a Committee " to inquire into and report upon the financial position of





Annotations. "Ne quid nimis.


voluntary hospitals throughout the country," adding that the Committee would consist of ftve members only, none of them being medical men or connected with hospital arrangements in any way.






CARBON monoxide has been described by Brouardel holding first place amongst the toxic gases-he was speaking of accidental poisoning and not of the deliberate use of respiratory noxae ; and the Registrar-General attributes 704 deaths in 1919 to the absorption of deleterious gases. It is, therefore, not merely a question of fuel value what proportion of carbon monoxide should be contained in the coal-gas supplied to us; it is a matter on which medicine is entitled to raise its voice. The number of cases in which coal-gas has been employed for suicidal purpose have shown some signs of increasing lately; such acute poisoning would be difficult in any case to prevent, but it is well known that carbon monoxide, by its peculiar power of monopolising haemoglobin, is a cumulative poison, and it is important to limit its possibilities of harm. The question of the post-war basis upon which gas shall be sold, as well as the standard of quality to be applied to it, have both been the subject of considerable inquiry and discussion. The matter originated within the gas industry itself during the war, when it was found that the total yield of gas from a ton of coal could be greatly increased by combining the usual process of carbonising in retorts with the simultaneous as

of water-gas by passing super-heated steam incandescent coke. Unfortunately, the resulting mixture of coal- and water-gas is not only of considerably lower heating power (a matter which can be adjusted by grading the price) but also contains much more of the poisonous carbon monoxide. The whole subject was taken up and reported upon by the Fuel Research Board; and, finally, the British Association Fuel Economy Committee, of which Professor W. A. Bone, F.R.S., is chairman, considered it and made certain recommendations. One of these recommendations was that in no circumstances should it be permissible for a public gas undertaking to supply to its consumers a product containing more than 20 per cent. of carbon monoxide. This recommendation was in harmony with the findings of a Home Office inquiry held in 1899, at which Dr. J. S. Haldane took part. It was then agreed that, in view of the imperfect state of the fittings in the poorer houses

production over


The Committee has now been constituted as follows: Viscount Cave (Chairman), Sir Clarendon Hyde, Mr. R. C. Norman, and Mr. Vernon Hartshorn. A fifth member, who will be a representative for Scotland, remains for appointment, while it has also been decided to include a chartered accountant of high standing, a very welcome addition. -

HEREDITY IN CONGENITAL HIP DISLOCATION. a recent bulletin of the Paris Academy of Medicine’1 I L.INDubreuil-Chambardel discusses the hereditary factor the incidence of congenital dislocation of the hip, and traces the later histories of five cases operated upon for this deformity. Judging by this and two previous papers by the same author, heredity is


evidently regarded by him as playing a larger part the production of this deformity than most surgeons would be ready to admit. Tubbycertainly in


" heredity



marked feature "


this de-

formity, and he quotes Marath3 as finding a history of heredity in 40 per cent. of his cases and Vogel in 30 per cent. of his. On the other hand, Whitman5 says " hereditary influence can be established in6 few instances" only, while Bradford and Lovett and Taylor7 would seem to - agree with him. Fairbank found signs of hereditary H. A. T. It is probable influence in only 8 of 200 cases. that more extensive investigation into the family histories of these cases would have added to this figure, but the percentage could not have approached those given by Vogel and Marath. There does not appear to be any reason for regarding congenital dis-’ location of the hip as being the result of hereditary influences to a greater extent than other congenital a

1 Bull. de 1’Acad. de Med., 3e Série, vol. lxxxiv., p. 281. A. H. Tubby : Deformities, vol. i., p. 129. Macmillan and Co. 1912. 3 Marath: Quoted by Tubby, ibid. 4 Karl Vogel: Zeitsch. f. Orth. Clin., 1905, p. 132. 5 Royal Whitman: Orthopædic Surgery, p. 533. Lea and Febiger, New York. 1917. 6 E. H. Bradford and R. W. Lovett: Orthopedic Surgery, p. 318. Baillière, Tindall, and Cox, London. 1912. 7 H. L. Taylor: Orthopædie Surgery for Practitioners, p. 247. D. Appleton and Co., New York. 1909.