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though the guarding may be less efficient. But in theabsence of statistics it is impossible to be at allcertain. The relation, if any, between speed andaccident-rate deserves a great deal more attention andscientific investigation than it has yet received.

The Need for More and Better P1’eventive Measuresagainst Accidents.

The next best thing to preventing accidents is tohave the means at hand for treating them promptlyand properly. It is only in the last few years that theimportance of first-aid equipment has been realised,and especially its value in preventing all sorts of smallwounds from becoming septic, a frequent cause ofunnecessary suffering and loss of time. First-aid hasbeen for years past a requirement in the regulations forhalf a dozen " dangerous trades," but the dangerguarded against in most cases was specific poisoning orinfection-e.g., by chromates used in dyeing or byanthrax spores ; apart from that, first-aid equip- ment, although not compulsory, has been generallysupplied in docks and shipyards, at least in thelargest centres. Under that Act it was made a

requirement in a number of welfare Orders, covering,amongst other trades, all work at blast furnaces andin foundries, in iron and copper mills, and in othermetal works. The new Workmen’s CompensationAct makes the provision of a first-aid box compulsoryin every factory, and it must be in the charge of aresponsible person. Insistence on the need for theimmediate treatment of even trivial injuries is alsoan important part of the Safety First Association’spropaganda. They issue posters for display in works,with pictures of germs as large as lobsters, much in thestyle of infant welfare diagrams.The general impression derived from a study, both

of such statistics as are available and also of themeasures taken for the prevention of accidents, is thatnothing like the progress has been made in thisdirection which has been made in the prevention ofdisease. A good deal has been done to lessen thenumber of machinery accidents, but by far the greaternumber of accidents are not directly due to machinery.The most that can be said at present is that attentionis again being focused on the very high accident-rate,and that measures are being taken, both under Stateregulation and as the result of private initiative andpropaganda, which it is to be hoped will bring aboutin the next few years a marked diminution in thenumber of accidents.

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

" Jfensce Medicm."

THE appalling need which all the brain workers inGermany are experiencing, say Profs. Bier, Bumm,Czerny, His, Goldscheider, and other well-knownmembers of the medical profession in Germany, in anappeal which they have just published in the Tageblatt,is being felt in an overwhelming measure by doctors.Large numbers of people are no longer calling inmedical aid on account of their inability to pay thefees. This dwindling number of their patients hasbrought thousands of doctors to such a dire state ofneed that they have been obliged to seek other waysof earning a livelihood, and the majority of them arein a pitiable condition. Some have even been drivento commit suicide. This need might be mitigated if ’,in the already-existing, or planned, community ’,kitchens in Berlin meals for the doctors-" mensæmedicæ "-could be established. For these meals Ithey should pay a small sum of money, or in certainexceptionally unfortunate cases they might be given I,free. Dr. Eugenie Schwarzwald has placed at the Idisposal of the profession the kitchens which werecreated and are conducted by the Austrian " Friendly Help." What is now wanted is money for carrying Ion the work in the kitchens and for buying the ood. Appeal is made to everyone who has cause for

gratitude to the medical profession to send contribu-tions to the credit of the " Friendly Help " (Departftment Mensæ Medicae) at the Bank of Mendelssohnand Co., Berlin W. 8, Jagerstrasse 51 ; and by thismeans assist in maintaining the public health.

Bayer " 205 " in Sleeping Sickness.Speaking before the Berlin Medical Society, Prof.F.K.

Kleine, of the Institute for Infectious Diseases, gavea report of his expedition to Rhodesia and the BelgianCongo to prove the new trypanocidal compound incattle disease and sleeping sickness. The members ofthe expedition numbered tour, including a bacterio-logist and a veterinary surgeon. Cattle disease, asProf. Kleine explained, is produced by Trypanosoma7-hodieiise conveyed to cattle by Glossina morsitans,while sleeping sickness is caused by Trypanosomagambiense and conveyed by Glossina palpalis. Someweeks are necessary to develop the virulence oftrypanosoma within the glossina. In Rhodesiaexperiments were made with monkeys, some of whom,however, died from snake-bites. By injections of thecompound the experimenters succeeded in keepinginfected cattle alive and in a good state of nutritioneven when bitten by numerous glossinas. Theyascertained that Bayer " 205 " did not preventinfection, but that by reducing the potency of thevirus it greatly modified the disease, so that theanimals did not lose weight. In November, 1922, theexpedition set out for the Congo where sleepingsickness is endemic. Prof. Kleine explained that therewere three stages in sleeping sickness. First the stageof infection, then maniacal symptoms were manifested,and lastly a comatose stage set in. By injections ofBayer " 205 " the blood was nearly always renderedfree from trypanosomes, but sometimes in apparentlyhealthy persons trypanosomes were found in the spinalfluid. In Rhodesia 35 patients were given a sub-cutaneous injection of 1 g. on the first, the tenth, andthe twenty-eighth day, the maximum being fiveinjections. In the Congo 105 patients were givenintravenous injections of 1 g. on the first, the third,and the thirteenth day respectively. In two patientsonly was the trypanosome found in the blood aftertreatment, and even very grave cases could be cured.Transitory albuminuria sometimes occurred. Thepercentage of definite cures cannot yet be given,but apparently an infected district may be madehealthy by the destruction of trypanosomes in theblood.

Sterilisation of the Unfit.Dr. G. E. Boeters, a district medical officer of health

in Saxony, writing to the Aerztliches Vereinsblatt, theofficial organ of the Aerztevereins-Bund, draws theattention of the profession to the present degenerationof the German race, and in the interests of posterityhe proposes the sterilisation of habitual criminals,psychopaths, and feeble-minded people by castration.He contends that already under the present laws thisoperation is permitted, provided the degenerate hasbeen placed under a guardian and that the guardianhas consented to the operation. Dr. Boeters hadalready made provision for such operations in theState Hospital of Zwickau, Saxony, which is underthe direction of the well-known Prof. Braun, Presidentof the German Surgical Association. Hitherto theoperation had been performed on men only, andconsisted in a resection of the spermatic cords ; inthe female a resection of the Fallopian tubes wouldbe necessary. In the interest of the improvement ofthe German race Dr. Boeters advocates that childrenof school age who are blind, deaf-mute, or imbecileshould undergo a sterilising operation. The cost ofthe operation would be met by the State. Permissionto sterilise ought also to lie in the hands of guardiansas well as of parents. Defective, epileptic, or insaneadolescents who have been confined in an asylumought, in Dr. Boeters’s opinion, to be operated uponbefore discharge, and permission to marry should begiven only after an operation has been performed.This penalty should be imposed on all persons whohave committed crimes against public morality and

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also on females with more than two illegitimatechildren. Criminals submitting voluntarily to theoperation might be rewarded by the shortening of thetime of imprisonment. These very radical proposalshave been the subject of discussion in the abovejournal in which Dr. Juliusberger, a well-knownalienist and advocate of abstinence, stated thatsimilar principles had. already been put into practice inSwitzerland. Prof. Forel, in particular, had advocatedthe sterilisation of criminals and imbeciles. He alsowished the method extended to habitual drunkards.Another correspondent, however, points out that thelegality of such operations, even with the consent ofthe parents or the guardian, is not yet clear and thatit is, moreover, very doubtful whether such eugenicoperations would have any measurable influence on therace while economic conditions remain unchanged.

SWITZERLAND.

(FROM OUR OWN CORRESPONDENT.)

Unqualified Practice.I RECENTLY wrote of Appenzell as the only Swiss

canton where no medical degree is required for medicalpractice. In the canton of Glarus, where up till 1920the same freedom existed as in Appenzell, a popularmovement has recently been started with the objectof returning to the former practice. An amendmentto this effect, however, was vetoed by the cantonalcouncil, the minority consisting of Socialists. Withthis the question is not settled as it will be broughtbefore the referendum of the electorate. Behind themovement are chiefly herbalists and hydrothera-peutists. The canton of Glarushad good reasons torestrict medical practice to qualified men. Among theunqualified practitioners doubtful elements were

frequent, and in the debate in the cantonal councilthe case of an ex-convict was mentioned. That thesequacks have a very flourishing trade, which consistschiefly in postal treatment, is shown by a newspaperadvertisement in which one of them put his practiceon sale. " Daily income 300 francs, professionalknowledge not strictly necessary," it ran in theadvertisement.

Cancer Figures.As in other countries the cancer problem in

Switzerland presents a serious aspect. Dr. A. Renaud,of Lausanne, has lately dealt with it from the statisticalpoint of view. In the last ten years 12-8 death casesof cancer to 10,000 inhabitants were recorded per year,or 1 death of cancer to 780 inhabitants. The cancermortality is 8-9 per cent. of the general mortality and14-1 per cent. of the mortality of persons above40 years of age. In Switzerland both sexes have aboutan equal share in this mortality with a slight preponder-ance of the male sex. Dr. Renaud’s explanation of thisfact is that with women cancer of external organs,more easily accessible for diagnostic means, is morecommon. In Switzerland 73 per cent. of cancer inmen belongs to the gastro-intestinal tract, and 50 per cent. in women. Dr. Renaud shows that the increase iis confined to cancer of deep organs ; he is therefore ’,,inclined to attribute the increase to more perfectdiagnosis. Sarcoma and carcinoma bear the same relation in both sexes, cancer being 16 times morefrequent than sarcoma. In Switzerland the absolutenumber of deaths from cancer is 4700 per year, fromsarcoma 300.

Epidemic Disease.For a considerable time small-pox of a very mild

character has prevailed; no fatal cases have yetbeen reported. The cantons with compulsory vaccina- Ition are signally free from the disease. In order to stamp out the small-pox the Federal Council has issued an emergency order. After notification of asmall-pox case all persons inhabiting the same dwellingsor who have been in contact with the patient must bevaccinated. If the first small-pox case in a parishis followed within 14 days by another, vaccination of

the whole parish or district must be performed. TheFederal Government is paying half of the cost of thesemeasures ; responsibility for carrying them throughrests with the cantonal authorities. In Zurich about600 persons have been brought before the police courtson account of refusal to submit to compulsoryvaccination. The average fine was 50 francs.

Last July the beginning of a rather serious outbreakof poliomyelitis anterior acuta was recorded. InAugust the total number of notified cases was 41, inSeptember 33, in October 70, in November 47, inDecember 20. This marked the end of the epidemic,for in the New Year so far only four cases have beenbrought to notice.

Public Health Services.MENTAL HOSPITALS SERVICE.

THE annual report of the West Riding PauperLunatic Asylum, Wakefield, for 1922 contains matter ofconsiderable general interest, which is enhanced by thefrankness and decision with which the medical super-intendent, Dr. Shaw Bolton, states his opinions oncertain points connected with asylum administration.Wakefield Asylum, which retains the old style titlein spite of the present vogue for " Mental Hospital,"accommodates 2000 patients, and is staffed by sixmedical officers, all of whom hold a diploma inpsychological medicine, a circumstance for which thereis probably no exact parallel. The whole of thenursing staff undergo compulsory training for thecertificate of the Medico-Psychological Association.Unfortunately, however, only a small proportion ofthe nurses thus trained have entered for theexamination. " This result is most discouraging forthe medical and lay officers who are responsible forthe lectures and demonstrations, and makes the wholepresent method of training, examination, and certifica-tion little better than a farce. I am personally satisfiedthat this result is due to the fact that the monetarybenefit resulting from training and certification, com-pared with the increasing wage paid to anyone whosucceeds in remaining on the staff, is not sufficient.I recommend that the difference in pay betweentrained and untrained members of the staff be increasedby an arrangement whereby no member of the staffwho has not passed the various examinations at theproper time receives any annual increment in wagewhatever. At present, after five years of mere service,the wage increment is more than double the monetarybenefit gained by a serious worker who has obtainedthe medico-psychological certificate." This informa-tion is of particular interest at a time when thetraining and status of mental nurses are under con-sideration, and it is to be hoped that some measuremay be adopted which will induce mental nursesthroughout the country to seek official qualification.A summary is given of the pathological work done

during the year. More than half of the examinationscarried out were Widal reactions. This is explained bythe fact that every new patient and every new memberof the staff are submitted to this test : agglutina-tion is obtained in from 10 to 20 per cent. of cases.and these individuals are regarded as possible carriersand treated as such. Stanley Hall, where mentallydefective children continue to be accommodated, hasobtained encouraging results, a number of the childrenhaving been taught to do farm and other work. Thenumber of new cases at the out-patient departmentshows a decrease, a fact which Dr. Bolton attributesin part to hostile and unwarranted criticisms of theasylums which have been made of late, " which haveprobably caused many cases to seek treatment elsewhereat the hands of the numerous professional and quackpsychotherapeutists who are at present flooding thecountry."The annual report of the Crichtoii Royal Institution,

Dumfries, for 1923 records extensive structural

changes, including the erection of new female staff