715 during the corresponding periods, owing to the ease with which the effectiverays are absorbed. A second series of experiments designed to test th...

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during the corresponding periods, owing to the ease with which the effectiverays are absorbed. A second series of experiments designed to test the relative values of direct sunshine and of sky-shine " demonstrated that the scattered rays were from a half to two-thirds as effective as the direct sunshine, a point of practical importance as indicating a means of applying an efficient dose of ultra-violet rays in cases where radiant heat is undesirable. Animals exposed to light were not only protected from rickets, but also showed an increased resistance to deliberate infection, twice as many of the irradiated rats surviving an intraperitoneal injection of pathogenic bacteria as did controls kept in the dark. The intestinal contents of the irradiated rats were found to be more acid than those of the controls, indicating a better digestion in the former. Tests carried out with various special glasses transparent to ultra-violet rays convinced the writers that for glazing ordinary windows they were of little value, owing to the small amount of sky-shine that is available. To be effective these glasses should be University College, Gower-street, on Tuesday and ’, used in the construction of special solaria, where both Wednesday mornings, 10.30 to 12.30, at which, along ’, direct and diffuse light can be made use of. Sunlight with demonstrations of recent additions to our know- ’, filtered through Corning glass, Vioray, and Vitaglass ledge of the circulation, will be shown a film specially was shown to have from 25 cent. to 50 per cent. of I for the occasion by the College, displaying the antirachitic value of per prepared unfiltered sunlight. Drs. a reproduction of Harvey’s original experiments. Brown and Tisdall conclude that special glass screens, Members and Licentiates are advised to make early of the are of value as a protection considered, type application, as tickets will be allotted to both London from the cold during exposure to the early spring and provincial applicants as far as practicable in the sunshine in places with a climate like that of Toronto. order of application. Letters should be addressed to the Registrar, Royal College of Physicians, Pall Mall East, London, S.W.I. THE G.M.C. AND INCOME-TAX. THE claim of the General Medical Council to have SEASONAL VARIATIONS IN THE ANTIRACHITIC its income exempted from tax, on the ground that it VALUE OF SUNLIGHT. First the Special is a charity, has again failed. SINCE the existence of a dietetic antirachitic factor Commissioners decided against it, then Mr. Justice Rowlatt confirmed that decision last November, and was demonstrated by Mellanby more than ten years now the Court of Appeal has agreed with him. The the of rickets and of the the of elucidation aetiology ago photosynthesis of vitamin D has been the object of argument for the Council was briefly this : The systematic research in all parts of the world. The preamble of the Medical Act says that it is expedient r6le of sunlight in the production of vitamin D is now that persons requiring medical aid should be able to generally recognised, but the antirachitic value of distinguish qualified from unqualified practitioners ; light at different times of year and at different it is the duty of the Council to keep a register of latitudes has only recently been studied. In an qualified practitioners and also to supervise medical address recently delivered at Kansas City before the studies and education as well as to edit and issue the Inter-State Post-Graduate Medical Association, Dr. British Pharmacopoeia ; these objects are of general Alan Brown and Dr. F. F. Tisdall make a valuable con- public benefit ; therefore the Council is a charity and tribution to our knowledge. After tracing briefly the entitled to income-tax exemption under Section 37 steps in the investigation of the aetiology and specific of the Income-Tax Act. Up to a certain point the Court of Appeal agreed. The Master of the Rolls said cure of rickets, they emphasise the practical value of the available data, as illustrated by their own experi- that the Council’s objects and duties were all for the ments on the value of sunlight in Toronto. The ultra- public benefit. Those objects and duties, however, violet rays constitute only about 1 per cent. of the are also of benefit to the medical profession. The total solar radiation at the latitude of Toronto, and of public interest is served, but the professional interest these only a small band of rays (3130-2900 A.U.) are is served also. Lord Hanworth asked himself if the known to have antirachitic value. Since the wave- Council was formed for the promotion of objects length 2900 A.U. is the shortest recorded under beneficial to the medical profession ; he found himself optimal conditions, it is obvious that for a great part obliged to answer in the affirmative and he also found of the year the antirachitic band is still further himself unable to say that the Council’s income was restricted ; the more so as it is just this extreme region applicable, and had been applied, to charitable of the solar spectrum that is most readily absorbed by purposes only. There are two previous decisions which illustrate the smoke and moisture in the atmosphere. After menIn the case of the Institute of Civil Engineers of on the Dorno observations point. tioning important seasonal variations of sunlight in the high Alps, the it was held that the main purpose of the body was the authors proceed to describe their own experiments. promotion of science. There might be some subsidiary Rats fed on a rachitogenic diet were placed out of purposes or objects, but the property of the institudoors from 11 A.M. to 1 P.M. daily, control animals on tion, having to be applied and being applied for the the same diet being kept in the dark during the experi- purposes of the institution, was legally appropriated mental period. Eack week throughout the year and applied for the promotion of science within the batches of rats were started under these conditions, meaning of the income-tax law as it then stood. On and after a month each batch was killed and examined the other hand, in 1886 the Society of Writers to the for signs of rickets. The results showed that in Toronto Signet in Scotland was held not to be exempt from tax because its objects were not substantially chariteven winter sunshine had slight antirachitic value, but from the end of February onwards this value able ; the body, it was said, was mainly one of several increased sharply, corresponding with an increase in portals to a profession. Similarly the income of the the shorter rays of the solar spectrum. It is worthy Royal College of Surgeons of England was held liable of note that the biological test bears very little to income-tax in 1899 because, though one of the of the Royal College was the promotion of the relationship to meteorological records of sunshine objects science of surgery, another (perhaps equally important) 1 was the promotion of the interests of those practising THE LANCET, March 24th, 1928, p. 621. THE

HARVEY TERCENTENARY. THE Royal College of Physicians of London is celebrating the tercentenary of Harvey’s great publication from May 14th-18th. We have already set outa provisional programme of arrangements, and we are asked to make it known that the College has reserved a proportion of tickets for such Members and Licentiates of the College as may wish to be present One hundred at certain parts of the celebrations. tickets are available for the conversazione at the Hall of the Merchant Taylors Company at 9 P.M. on Tuesday, May 15th ; each ticket-holder is invited to bring a lady with him. A similar reservation for Members and Licentiates, without ladies, has been i made for the banquet at the Guildhall at 7 P.M. on Wednesday, May 16th. There will be an inclusive’ charge of 2 guineas for each dinner ticket, which should be sent as soon as the applicant receives notice that a ticket has been allotted. Some tickets will also be allotted to Members and Licentiates for the I demonstrations in the Physiological Department of



716 or about to practise surgery, including the examination appearances of Kienbock’s disease. After the condition of students and candidates for qualifications and had lasted for six months without any improvement This second object was not charitable. under conservative treatment the semilunar bone was honours. After analysing the property of the Royal College to removed under ether anaesthesia, after which steady see how far its income could be regarded as applied to improvement took place, the final result being that the first object only, the Court refused to exempt from extension and flexion were approximately one-half tax the offices in Lincoln’s Inn-fields, the examination that of the normal wrist. hall, and even the libraries. It seems reasonable to say that, if the General Medical Council has been A CORONER ON ANÆSTHETICS. created by Parliament for the main purpose of supervising medical education and ensuring a supply of AT a recent inquest in the City Dr. r. J. Waldo qualified practitioners, its other functions are ancillary 1 remarked on the increasing number of cases coming But at present the law is’ and supplementary. before him in which death has occurred during the committed to searching for signs of dualism-on the administration of ether, as opposed to his experience one hand the protection of the public, on the other of the past in which chloroform figured much more the protection of the practitioner ; while this practice in these fatalities. The first obvious fact in prevails, it seems difficult to regard any professional largely of this that the use of ether has connexion organisation as, in the technical legal sense, a charity. increased and is,that course, of chloroform has decreased

Dr. Waldo cannot, we think, justly that the proportional death-rate of ether has risen while that of chloroform has fallen. Nor can his apparent deduction that the deaths under ether havee been due to the use of an impure drug be accepted generally without fuller accounts of the cases and fuller skilled investigation of the facts. Impurity has been shown to be the probable source of the trouble. in that particular kind of case characterised by convulsions, but we believe this symptom did not figure prominently in the fatalities recorded ’ before the coroner. With Dr. Waldo’s reiterated plea for research in connexion with anaesthetics and their administration we are in full accord, and we are happy to know that valuable work of the kind is going on under the joint committee set up by the Medical Research Council and the Section of Anaesthetics of the Royal Society of Medicine.


IN THE EYE. A CASE which illustrates the need for care in using silver nitrate to prevent ophthalmia is recorded by Dr. J. G. F. Heal in a recent number of the British Journal of Ophthalmology. As the mother was believed to have gonorrhoea, the doctor ordered nitrate of silver in a strength of 1-5 per cent. to be dropped into each eye three times a day, and at least five instillations had been done before Dr. Heal was He found the child with conjunctival called in. haemorrhage and steamy cornea on both sides, and on one side the haemorrhage proved so persistent that on the fourth day the infant had to be put under chloroform so that the bleeding-points could be touched with a cautery. Five weeks later the eyes As a prophylactic nitrate of silver were normal. drops should not be used in a strength greater than 1 per cent., and caution is needed where they are used more than once or twice. SILVER


KIENBOCK’S DISEASE. Dr. F. W. Van Valkenburg,l who records an illustrative case, defines this condition as a chronic slowly progressive type of osteitis of the semilunar bone. ’The following three forms have been described by W. Miiller, the classification being based on their aetiology : (1) an anatomical form due to abnormal pressure lines from anatomical abnormalities ; (2) an occupational form due to repeated minimal trauma ; and (3) a traumatic form due to a single violent injury. The patient’s first complaint is that of a lame wrist which may or may not have been preceded by a history of trauma. The disease does not usually become well developed until after the lapse of six or eight months, when examination reveals definite tenderness over the .semilunar bone, limitation of flexion, and extension of .the wrist, and localisation of pain over the semilunar bone on tapping the head of the third metacarpal with the fist closed and the hand in ulnar adduction. The head of the third metacarpal will also be found to be on the same level as those of the second and fourth, whereas normally it is more prominent. X ray examination at an early stage is usually negative, but after seven to nine months the semilunar bone appears whiter and more dense, and later still shows fragmentation and atrophy. Kienbock’s disease must be distinguished from tuberculosis, syphilis, and chronic arthritis of the wrist due to other causes. In the early stage conservative treatment in the form of immobilisation for one or two months with massage and electricity is indicated, but operation is required in long-standing cases and those in which conservative treatment has failed. In Dr. Van Valkenburg’s case, which occurred in a man aged 39, a cabinet-maker by occupation, the condition developed without any history of injury to the wrist. The Wassermann reaction in the blood was negative. In spite of a wrist support the joint became much more painful and in the course of a few months X rays showed the typical 1

Minnesota Medicine, March, 1928.



MAXIMA CHARTA. Senator Copeland introduced into Congress last month a Bill which would give the same rights and privileges to the degree of doctor of osteopathy as to that of medicine. This information has to be set against other news from America, printed in another column, which suggests that chiropractic has suffered something of a set-back. According to the Journal of the American Medical Association the Copeland Bill is framed upon remarkably generous and comprehensive lines. It contains, for instance, a definition of drugless healing which is to cover " any system of healing that teaches that disease may be prevented, relieved, or cured without the use of drugs, medicine, or operative surgery." Any five or more adherents of any so-called drugless method of healing can present a petition (if the Bill should become law) demanding the appointment of an official and permanent board of examiners, and thereupon their particular cult will apparently be recognised as on an equal footing with the orthodox practice of medicine and surgery. The only limitation, we are told, upon the official recognition of any particular drugless cult is the requirement that the petitioners should somehow differentiate it from the unrestricted practice of the healing art. It is difficult to comment further upon Senator Copeland’s proposals without a study of their exact text; but it is understood that they include the licensing of osteopaths to practise surgery and to prescribe drugs, the issuing of licences with reciprocal effect, and the general authorisation of diagnosis and treatment either





means, or

by hygienic, dietetic,

domestic remedies without any insistence upon evidence of age, character, or professional ability. What may perhaps be described as freak legislation is by no means confined to America, but for the present the sheet-anchor of the qualified medical practitioner in this country-namely, Section 32 of the Medical Act of 1858-looks like holding fast. Statutory or

provisions for professional organisation are matters of slow growth among us. Midwives, nurses, and nursing homes are regulated under comparatively recent Acts of Parliament, but the Bills dealing with


and surveyors have made little progress and