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No difficulty, we believe, will be found in obtainingParliamentary endorsement of Sir W. JOYNSON-HicKs’s offer. The Panel Conference has decided torefuse a prolonged period in which controversymight cease and during which a Royal Commissioncould decide what is in the best interest of the nationalhealth. A settlement for a period of five yearswould have had its points, giving ample timefor the service to settle down again, while the Com-mission was affording opportunity for full investiga-tion both of the immediate and potential value of theinsurance service to the community. However, theConference has decided on the bolder course, and

courage commands esteem. We trust that no furtherattempt will be put forward to make health insuranceentirely self-supporting. Properly developed andcoordinated, the scheme of medical services under theInsurance Acts should become, as years go by, themost important of the agents of the Ministry ofHealth for improving the health and safeguardingthe lives of the industrial workers.

A STUDY OF OSTEITIS FIBROSA.THOUGH our knowledge of morbid histology still

leaves much to be desired and authorities differ

among themselves on the interpretation of factswhich are accepted by all, our conceptions of themorbid processes of the body rest, on the whole,upon a fairly sound structural basis. The skeletalsystem is, however, a glaring exception to this

generalisation. While in most pathological labora-tories histological examinations are made every dayof the digestive, respiratory, circulatory, or genito-urinary organs, bones are but rarely microscoped,and because of this we know very much less aboutdiseases of bone than we do about diseases of othertissues. The explanation lies, of course, in thetechnical difficulties which must be overcome, and ’,the amount of time and labour involved in the pre-paration of satisfactory histological material from theskeleton. To examine a diseased bone with anythinglike the same thoroughness which is commonlydevoted to a sclerotic kidney or an interesting tumourwould occupy so long that in the routine of a busylaboratory the task is seldom attempted, and thisaspect of morbid histology is poorly represented inthe current literature.

In view of these considerations, pathologists willwelcome the appearance of the October number ofthe Edinburgh Medical Journql, for it is devotedentirely to a long paper by Dr. JAMES W. DAWSONand Mr. JOHN W. STRUTHERS on Generalised OsteitisFibrosa with Parathyroid Tumour and MetastaticCalcification. These authors describe the remarkablecase of a man, 49 years of age, who first came underobservation in January, 1921, on account of delayedunion of a fracture of the humerus. X ray andmicroscopic examination of the humerus showed acondition of fibrosis and decalcification suggestingan early stage of osteitis deformans, and similar

changes could be detected in the cranial bones. Aftera very brief period in hospital the patient’s condition,both local and general, showed extraordinary improve-ment, and X rays demonstrated the redeposition oflime salts in the humerus. He left hospital, butreturned within a few weeks with a second fractureof the bone which healed in about five weeks. Aftera period of good health he was seized with a suddenheart attack, and was again admitted to hospital,hut died a few hours afterwards. Post-mortemexamination revealed an extensive condition ofosteitis fibrosa of the left humerus, femur, and of the

bones of the skull. The left lower parathyroid body wasconverted into a papillary adenoma, and practicallyall the organs showed calcareous infiltration. Theauthors describe in detail, illuminating their text bymany admirable illustrations, the histological changesin the affected bones. The general conclusions arrivedat are that the fixation of calcium and the metabolicactivities of bone are controlled by the bone cells,which, in turn, are themselves under the influence ofhormones derived from the parathyroid glands. Theparathyroid adenoma in this case is regarded as anindication of an abnormal physiological state, an

anatomical hyperplasia reflecting a functional hyper-activity called for by the needs of the bone cellswhich had been injured and rendered physiologicallyimpotent by some unknown agent.

These views may or may not receive generalacceptance, but this complete record of a case formsa most valuable addition to the literature of the sub-

ject. The paper contains, however, more than therecord of a single case : it is a clear and critical

presentation of current knowledge and teaching ofthe pathological processes involved in bone dys-trophies. Such debatable processes as halisteresis andmetastatic calcification are discussed very fairly andwith full references to the literature, and the variousneoplastic giant-cell formations are analysed indetail. In short, the authors are to be congratulatedupon a piece of work which will be of actual assistanceto most workers in this field, and cf interest to all

PSYCHOPATHIC SYMPTOMS IN MINERS’

NYSTAGMUS.WHILE the mechanism which produces nystagmus

in miners may be in doubt two things are certain.Nystagmus may be present without causing subjectivesymptoms, while psychopathic symptoms, such as

tremor, disordered action of the heart, and sleepless-ness, occur in miners with or without oscillations oithe eyeball. To these facts we called attention in

discussing not long ago a new theory of coal-miners’nystagmus. In a letter which appears on p. 1110,Mr. W. INMAN returns to this important issue. Thesecond report of the Miners’ Nystagmus Committee ofthe Medical Research Council makes clear that it isnot the nystagmus alone that demands compensation.Compensation is paid largely for the associated psycho-neurotic symptoms, and the Committee suggest theadoption of a stricter standard of physical signs. Butwhat physical signs exist beyond the nystagmus ?The standardising value of photophobia and blinkingof the eyelids is discounted by the observation thatthey occur commonly in shell shock, for in that associa-tion they are unhesitatingly regarded as hysterical.Mr. INMAN suggests that the oscillation of the eyeballsmay itself be only a part of a psycho-neurotic state.He really offers two possibilities : that the nystagmusis a harmless physical eccentricity, upon which itchances that psycho-neurotic symptoms are hung, asupon a peg ; or that it is only one symptom, and nota constant one, of a psycho-neurosis which, thoughit occurs in miners, differs in no other way fromdisorders with which we are already familiar. Anobvious objection to the latter possibility is that

nystagmus occurs generally as part of certain organicdisorders and can only very exceptionally be imitated.But non-volitional manifestations, such as tachycardiaor tremulous eyelids, are common in the psycho-neuroses, and, though they are valuable diagnosticindications, yet they may be absent in patients withdisabling mental symptoms, or, on the other hand