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Spence and H. A. Job contribute articles on the temperanceposition in Canada and Australasia respectively. Sir Auck-land Geddes’s memorandum on American Prohibition isvery interesting, not least because he has tabulated sideby side the statistical conclusions relating to the effect ofthe Volstead Act (passed in October, 1919) from threesources : (1) the Anti-Saloon League, (2) the Associationagainst the Prohibition Amendment, and (3) the FederalProhibition Unit of the United States Treasury. Theenormous discrepancies in these comparative figures explainthe confused echoes which arise in this connexion on ourside of the Atlantic. Thus the number of arrests for drunken-ness on a 100 per cent. basis of the number in a given timeduring the period before prohibition is put at 50 by theLeague, at " fully 100

" by the Association, and at 50 bythe Treasury Unit. The figures of deaths from alcoholism,similarly compared, are given as 20, 250, and 20 per cent.respectively ; and other supposedly carefully-compiledstatistics show similar differences. Sir Auckland Geddesalso notes that since the adoption of prohibition a largeincrease-computed at 40 per cent.-has taken place in theamount of deposits in savings banks ; the claim that prohibi-tion has increased production in the factories and has betteredthe home conditions of the average wage-earner is, perhaps,rather lightly dismissed, with the comment that " so manyother factors have contributed to restore economic con- Iditions in the United States since the war that it is almostimpossible to form any estimate of the extent to whichprohibition has contributed to this recovery, or otherwise."In an article apparently reprinted from the New YorkOtttlook, Mr. Raymond Spears writes of " The Furtivenessof Liquor," and makes the following statement: " I canwalk the streets of my town and not see ten drunks in sixmonths, when in half an hour before prohibition came I sawand counted thirty-odd in 15 minutes. And, with my eyesopen, I drive tens of thousands of miles and see no drunkenmen, and the pitiful dejection or recklessness that is themark of illicit liquor on property and community andindividual appears only at long intervals, and one mustknow it to recognise the sign." Another interesting featureof the Year Book is a series of " pictorial studies in temperanceeconomics," or posters issued by the Alliance in leafletform for propaganda purposes. The full text of theIntoxicating Liquor (Sale to Persons under Eighteen) Act,1923, is also included. The usual full index facilitatesreference.

A USEFUL HYPODERMIC OUTFIT.

Dr. John W. Tomb, medical officer of health, AsansolMines Board of Health, Bengal, sends us the followingdescription of a useful and compact hypodermic outfitwhich he has used in India for over ten years under allconditions of transport. He writes : " The universal use ofhypodermic medication necessitates the possession of anoutfit which will secure the minimum waste of time in itsemployment with the maximum of surgical sterility. Thehypodermic outfits sold by the large manufacturing housesare costly and require very considerable care in transport.I claim for the outfit here described that it is cheap andalways ready for use. It consists primarily of a three-piece50-minim B. & W.’s all glass hypodermic syringe, with aplatino-iridium needle, size No. 27. The syringe whenoriginally assembled is sterilised by boiling in its metal caseand is never afterwards taken apart. The platino-iridiumneedle is also originally sterilised by boiling but on allsubsequent occasions is sterilised by heating in the flameimmediately before and after use. As an additional securityagainst contamination, and to preserve the point againstinjury, the needle is kept in an empty sterilised hypodermictabloid glass phial of suitable size with the point of the needledirected upwards and embedded in the cork, a pledget ofsterilised cotton-wool being placed at the bottom of thephial. The " lamp

" consists of an ordinary 2 oz. glass-stoppered narrow-necked bottle filled with methylated spiritand provided with a separate (locally made) brass or other" burner " with a wick of twisted cotton strands. To washout the syringe after use and at the same time to sterilise itand to maintain it constantly in sterilised condition, and alsoto prevent the glass piston from sticking to the barrel, amixture of equal parts of glycerine, carbolic acid, and rectifiedspirit is provided in a oz. glass-stoppered bottle. Theneedle having been previously sterilised in the flame, fiveto six minims of this mixture are drawn into the barrel of thesyringe on each occasion after use. The piston is thengi7adually withdrawn while holding the nozzle of the syringeupwards, so as to allow the mixture to escape and at thesame time thoroughly to wash it out and lubricate the wholebarrel, the piston being subsequently replaced. A smallteaspoon is included in the outfit in which to dissolve thehypodermic tablets by boiling, and thus secure that nonebut sterilised solutions shall at any time be taken into thebarrel of the syringe. In the tropics it is often desirable toassist the cooling of the sterilised hypodermic solutions by

immersing the tea-spoon to half its depth in a little cold’water in a saucer or other suitable vessel. Not more than60 seconds are required for this operation.The whole outfit is contained in a stout cardboard box,.

7" long by 4" broad by 2" deep, with a cover of the samematerial. The box is half filled with cotton-wool to absorbshocks and to protect the contents from injury. As anadditional protection a layer of corrugated cardboard is also’fitted around the inside of the box on all sides, and atthe top."

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THE GLASGOW ROYAL INFIRMARY.

AT the annual general Court of Contributors of the GlasgowRoyal Infirmary, held on Feb. llth, the report by themanagers for 1923 was submitted. The work of the infir-mary has increased considerably during the past year.Beginning the year with 653 in-patients, the total treatedin the wards during the 12 months numbered 12,759, beingan increase of 1397 on the previous year. There were onoccasion no fewer than 789 patients in the house at onetime, the daily average number resident being 7229, andthe average period of residence 20-7 days. In view of the-large numbers waiting admission, some overcrowding wasunavoidable. The number remaining on Dec. 31st was 672.Similarly an increased volume of work was carried on inthe out-patient department, where 48,693 patients, being-4004 in excess of the number in 1922, attended for adviceand treatment, while the total number of attendances was-220,193, as compared with 188,532. At the ophthalmicinstitution 855 in-patients and 13,541 out-patients were-

treated. At the Schaw Home, Bearsden, 1041 persons werereceived as convalescent patients. One outstanding featurehas been the introduction to the infirmary of the treatmentof diabetes by insulin. Since February last diabetes hasbeen treated with insulin at the infirmary with satisfactoryresults, but the investigations are not complete, and arebeing continued. The Royal Infirmary has not a bio-chemical laboratory, and special arrangements were made-to supply the need, but with the help of some friends the-necessary funds were raised so that the infirmary funds-were not called upon to defray any of the expenses of this-investigation. As soon, however, as the experimentalstage was past, the managers decided that the cost of insulinshould be borne by the infirmary. The managers appre-hend that another addition to expenses must soon be madeby establishing a bio-chemical department, to aid not onlyin the actual treatment of the patients, but also in theinvestigation of those diseases which are due to faultymetabolism. In view of the widespread stagnation oftrade and increased difficulties due to unemployment and.other causes, it is matter for congratulation, the reportstates, that the financial year terminated satisfactorily.The total amount received from all sources exceeded thesum for the previous year. On the other hand, expenditure-rather increased. To equip the infirmary adequately tomeet modern demands and developments in all departmentsof medicine and surgery, a large fresh expenditure will alsobe necessary. Subscriptions from employees and otherswere generous, though slightly less than in the previousyear. The widening of the scheme for organised weeklycontributions in works, warehouses, &c., continues to

bring in new and increased subscriptions. The ordinaryexpenditure of £107,686 was £2873 more than in the previousyear, and the ordinary revenue amounted to the sum of£82,976—a deficiency of £24,710. There were receivedduring the year the sums of £21,224 in legacies, and £11,200by way of donations. These sums were drawn upon forextraordinary expenditure of £1301 and to meet the above-deficiency of £24,710 on ordinary revenue account. In thefinal result there is a surplus of £6413.

One Who Believes, &c.-A letter has been received on thesubject of an Osteopathic Directory, which can only beinserted if the author entrusts us with his or her name andaddress.

THE LANCET: SUBSCRIPTION RATES.

Subscriptions not paid in advance are charged out at thepublished price of ls. per copy, plus postage. Cheques andP.O.’s (crossed " Westminster Bank, Ltd., Covent GardenBranch ") should be made payable to THE MEAGER,THE LANCET Offices, 423, Strand, London, W.C. 2.