of 2 /2
1440 these Irish towns, each of which had in 1901 a population below 15,000, the mean rate of infant mortality last year was equal to 106 per 1000, exceeding the rate in London, with an estimated population little short of five millions, by 3 per 1000. The proportion of deaths under one year to births registered affords a fairly trustworthy test of the health condition of a population, and has, at the present time, the additional advantage of not being invalidated by un- certainty as to the local numbers of urban populations. The unsatisfactory health condition of the Irish towns, compared with that of the far larger English and Welsh towns is, indeed, beyond doubt, and it is, moreover, a fact that the death-rate at all ages in these Irish towns shows a far larger proportional excess on the same rate in the English towns, than the rate of infant mortality, although this excess cannot be accurately measured until the results of ,the recent Census are available. EDUCATION "AL FRESCO." "THE visitor to the Forum Romanum (and in these days his name is Legion) may witness," writes an Italian corre- spondent, "an educational method interesting in itself, well worthy of being considered, and, where possible, of being ,adopted in practice. He will see relays of little boys, about the ’ fourth-form age’ in English schools, taken round the monuments and informed as to the events associated in chronological sequence with each. In that great centre of Roman life, Republican and Imperial, the boy is thus made ,to realise, with a vividness not to be derived from books, the evolution of the historic drama, in contact with many of the features, architectural and artistic, among which it was enacted; surrounded, moreover, by the landscape and even the nature ’ present to the old dramatis personae themselves. Another day the said visitor may witness on the much- frequented Pincian Hill-the Valhalla of Rome,’ so called from its assemblage of busts of the national heroes placed . en 6vidence on the initiative of Mazzini in 1849-the same or similar relays of boys conducted by their teachers and examined vivi voce as to the career or the moral character- istics of each personality in succession. Placed before the bust of Marius, for example, the first boy is asked to give from his private reading a brief account of that great plebian soldier, an account supplemented, when necessary, by a second or third boy ; and then, the company having moved to the bust of Sulla, the patrician rival of Marius, a fourth or fifth boy is made, in turn, to describe the career of that mighty captain, the account being also corrected or illustrated by fresh details from another class- fellow. And so, day by day, or week by week, the boys are familiarised with the national history, not only in the , sculptured presence ’ of the chief actors in the same, but in the environment, more or less immediate, in which they lived and moved. All this instruction, be it added, is conveyed in the open air, with walking exercise and with a use of the voice and respiratory system under the freshest, the healthiest, of conditions-in what contrast to those of the traditional school-room with its vitiated atmo- sphere and the physical constraint imposed by bench or form’ 1 The same instruction, at a later stage of the boy’s education, is given as to the social life of his ancestors -in the Colosseum, for instance, with its illustration of Roman amusements, in the Baths of Caracalla, with their evidence of the Roman respect for the body in the elaborate provision for personal cleanliness and physical exercise, culminating in the yet nobler advance in the spiritual sphere as attested by the Catacombs and the gradual decline of paganism before Christianity. Of course, there is the objec- .!ti0n that the instruction, the educational methods, referred to are seen under exceptionally favourable circumstances in Rome, with its concentrated ensemble of monuments and treasure-trove, architectural and artistic-above all, with its steady climate, whose fine, or at least fair, weather may be counted on for days, if not for weeks, in succession. Granted; but may not in other communities an approach to al fresco instruction be made by special accommodation, giving shelter, while not excluding free ventilation, such as is seen in the porticoed hall’ not unfamiliar on the con- tinent ? Even in the British Isles, ’the rain, it rains not every day’; while some such protection from atmospheric vicissitude as the awning that shielded the vast assemblages in the Colosseum from wet or heat ought not to be beyond the resources of twentieth century ingenuity. In these days of rapidly developing hygiene, public and personal, some innova- tion on the traditions of school life is both demanded and expected-innovation directed to the physical well-being:of the growing boy or girl during lesson-time,’ while making the lesson itself more attractive, interesting, and impressive than has hitherto been attainable under the system of learn. ing by rote from the printed page. The Roman Hippocrates’ (as Celsus used to be called by the medical humanist) simply concurred in traditional Roman usage when he pointed out the salutary effect of using the voice under health-giving conditions, as practised in the ’ portiooed halls’ of the Rome of his day, with the clara lectio ’ and the free inflation of the lungs assisted by appropriate gesture and attitude. The practice, too, of expressing oneself in words, as encouraged by calling on the pupil to ’ give an account’ of this or that object en évidenoe, or subject of private reading, and as illustrated in the Roman methods above described, has also its appeal to the con- temporary educationist even in the British Isles, and adds another to the profitable hints that may be gathered from a visit to the Eternal City, now celebrating the fiftieth anniversary of its recovered freedom and proving its title to the sympathy and support of the Present by its wise and opportune resuscitation of some of the best features or methods of the Past." ___ CEREBRAL EPENDYMITIS. IT is a curious fact that while the pathology of the outer membranes of the brain occupies an important place in all the classical text-books, that of the lining membrane, or ependyma, has been almost entirely ignored. Yet the walls of the cerebral cavities may be the seat of acute, subacute, or chronic inflammatory processes of great interest and clinical significance. The establishment of internal hydro- cephalus as a morbid entity seems to have been made by the Edinburgh school as long ago as 1770, but the notion of ependymitis is quite modern ; in fact, to obtain clinical and pathological descriptions of the condition it is necessary, or has hitherto been necessary, to consult the literature under such varying titles as internal or acute hydro- cephalus, cerebral pseudo-tumour, ventricular meningitis, serous meningitis, hydrocephalus from meningitis, cerebral meningeal syndrome without meningitis, &c. It is therefore satisfactory to note the publication of an authoritative "Study of Cerebral Ependymitis," based on material from the Salpêtrière and Bicetre, by Dr. Pierre Merle of Paris.l The student of neuropathology and the clinician alike will find in thisrevue d’ensemble an admirable exposition of the subject, which both from medical and surgical points of view has been too long neglected. The ependymal lining of the cerebral cavities, prolonged into the medulla, may be the seat of various microbial infections, the result being a serous, a sero-purulent, or a purulent ependymitis ; the 1 Etude sur les Ependymites Cérébrales. Par le Docteur Pierre Merle. Thèse de Paris, 1910. Paris: G. Steinheil. Pp.240.

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these Irish towns, each of which had in 1901 a populationbelow 15,000, the mean rate of infant mortality last year wasequal to 106 per 1000, exceeding the rate in London, withan estimated population little short of five millions, by 3 per1000. The proportion of deaths under one year to births

registered affords a fairly trustworthy test of the health

condition of a population, and has, at the present time,the additional advantage of not being invalidated by un-certainty as to the local numbers of urban populations.The unsatisfactory health condition of the Irish towns,compared with that of the far larger English and Welshtowns is, indeed, beyond doubt, and it is, moreover, a factthat the death-rate at all ages in these Irish towns shows a

far larger proportional excess on the same rate in the

English towns, than the rate of infant mortality, althoughthis excess cannot be accurately measured until the results of,the recent Census are available.

EDUCATION "AL FRESCO."

"THE visitor to the Forum Romanum (and in these dayshis name is Legion) may witness," writes an Italian corre-spondent, "an educational method interesting in itself, wellworthy of being considered, and, where possible, of being,adopted in practice. He will see relays of little boys, aboutthe ’ fourth-form age’ in English schools, taken round themonuments and informed as to the events associated in

chronological sequence with each. In that great centre ofRoman life, Republican and Imperial, the boy is thus made,to realise, with a vividness not to be derived from books,the evolution of the historic drama, in contact with many ofthe features, architectural and artistic, among which it was

enacted; surrounded, moreover, by the landscape and eventhe nature ’ present to the old dramatis personae themselves.Another day the said visitor may witness on the much-

frequented Pincian Hill-the Valhalla of Rome,’ so calledfrom its assemblage of busts of the national heroes placed

. en 6vidence on the initiative of Mazzini in 1849-the same orsimilar relays of boys conducted by their teachers and

examined vivi voce as to the career or the moral character-istics of each personality in succession. Placed before thebust of Marius, for example, the first boy is askedto give from his private reading a brief account of that

great plebian soldier, an account supplemented, when

necessary, by a second or third boy ; and then, the companyhaving moved to the bust of Sulla, the patrician rival ofMarius, a fourth or fifth boy is made, in turn, to describe thecareer of that mighty captain, the account being also

corrected or illustrated by fresh details from another class-fellow. And so, day by day, or week by week, the boys arefamiliarised with the national history, not only in the, sculptured presence ’ of the chief actors in the same, butin the environment, more or less immediate, in which theylived and moved. All this instruction, be it added, is

conveyed in the open air, with walking exercise and

with a use of the voice and respiratory system under thefreshest, the healthiest, of conditions-in what contrast to

those of the traditional school-room with its vitiated atmo-

sphere and the physical constraint imposed by bench or

’ form’ 1 The same instruction, at a later stage of the

boy’s education, is given as to the social life of his ancestors-in the Colosseum, for instance, with its illustration of

Roman amusements, in the Baths of Caracalla, with theirevidence of the Roman respect for the body in the elaborateprovision for personal cleanliness and physical exercise,culminating in the yet nobler advance in the spiritualsphere as attested by the Catacombs and the gradual declineof paganism before Christianity. Of course, there is the objec-.!ti0n that the instruction, the educational methods, referred to

are seen under exceptionally favourable circumstances inRome, with its concentrated ensemble of monuments and

treasure-trove, architectural and artistic-above all, with its

steady climate, whose fine, or at least fair, weather maybe counted on for days, if not for weeks, in succession.

Granted; but may not in other communities an approachto al fresco instruction be made by special accommodation,giving shelter, while not excluding free ventilation, such asis seen in the porticoed hall’ not unfamiliar on the con-tinent ? Even in the British Isles, ’the rain, it rains not

every day’; while some such protection from atmosphericvicissitude as the awning that shielded the vast assemblagesin the Colosseum from wet or heat ought not to be beyond theresources of twentieth century ingenuity. In these days ofrapidly developing hygiene, public and personal, some innova-tion on the traditions of school life is both demanded and

expected-innovation directed to the physical well-being:ofthe growing boy or girl during lesson-time,’ while makingthe lesson itself more attractive, interesting, and impressivethan has hitherto been attainable under the system of learn.ing by rote from the printed page. The Roman

Hippocrates’ (as Celsus used to be called by themedical humanist) simply concurred in traditional Roman

usage when he pointed out the salutary effect of usingthe voice under health-giving conditions, as practised in the’ portiooed halls’ of the Rome of his day, with the claralectio ’ and the free inflation of the lungs assisted byappropriate gesture and attitude. The practice, too, of

expressing oneself in words, as encouraged by calling on thepupil to ’ give an account’ of this or that object en évidenoe,or subject of private reading, and as illustrated in the Romanmethods above described, has also its appeal to the con-

temporary educationist even in the British Isles, and addsanother to the profitable hints that may be gathered from avisit to the Eternal City, now celebrating the fiftieth

anniversary of its recovered freedom and proving its title to

the sympathy and support of the Present by its wise andopportune resuscitation of some of the best features or

methods of the Past." ___

CEREBRAL EPENDYMITIS.

IT is a curious fact that while the pathology of the outermembranes of the brain occupies an important place in allthe classical text-books, that of the lining membrane, orependyma, has been almost entirely ignored. Yet the walls

of the cerebral cavities may be the seat of acute, subacute,or chronic inflammatory processes of great interest andclinical significance. The establishment of internal hydro-cephalus as a morbid entity seems to have been made by theEdinburgh school as long ago as 1770, but the notion ofependymitis is quite modern ; in fact, to obtain clinical andpathological descriptions of the condition it is necessary,or has hitherto been necessary, to consult the literatureunder such varying titles as internal or acute hydro-cephalus, cerebral pseudo-tumour, ventricular meningitis,serous meningitis, hydrocephalus from meningitis, cerebral

meningeal syndrome without meningitis, &c. It is therefore

satisfactory to note the publication of an authoritative

"Study of Cerebral Ependymitis," based on material fromthe Salpêtrière and Bicetre, by Dr. Pierre Merle of Paris.lThe student of neuropathology and the clinician alike willfind in thisrevue d’ensemble an admirable exposition of the

subject, which both from medical and surgical points ofview has been too long neglected. The ependymal lining ofthe cerebral cavities, prolonged into the medulla, may bethe seat of various microbial infections, the result being aserous, a sero-purulent, or a purulent ependymitis ; the

1 Etude sur les Ependymites Cérébrales. Par le Docteur PierreMerle. Thèse de Paris, 1910. Paris: G. Steinheil. Pp.240.

Page 2: CEREBRAL EPENDYMITIS

1441

ventricular effusion may be clear, opaque, heamorrhagic, and Imore or less rich in cells and in pathogenic organisms.Histologically, the lesions are confined to the ependymalsurface and the layers immediately under it, and consistin desquamation and other degenerations of the epithe-lium, active vegetations, perivascular infiltration, and haemor-rhages. The choroid plexuses may be involved in the

inflammatory process, but they do not appear to play anyspecial role. Ependymitis of this sort is comparable to

inflammation of any similar cavity, such, for instance, as thepericardium. Cerebral ependymitis may be, and frequentlyis, associated with generalised meningitis, sometimes onlywith meningitis of the base; it may occur without any

meningitis whatever. Clinically the ventricular syndrome "

consists of the clinical phenomena of acquired hydrocephalus-signs of increased intracranial tension, optic neuritis, interatia; in acute cases the symptoms usually resemble those ofmeningitis; in more chronic cases they resemble those ofcerebral tumour. Ependymitis localised to the fourth

ventricle may give rise to bulbar symptoms, tachycardia,respiratory disturbances, polyuria. There can be no doubt thatependymitis is the predominant factor in many differing con-ditions reported as serous meningitis or hydrocephalus. It is

intimately associated with certain forms of encephalitis ; inparticular, the haemorrhagic encephalitis of Wernicke islimited to the peri-ependymal grey matter of the pons in astriking way. Tuberculous and syphilitic ependymitis canbe distinguished readily enough ; the former occurs in thecourse of tuberculous meningitis, the latter may be congenitalor acquired; in the acute cases the syndrome is always one ofincreased intracranial tension, and is curable, at least in thesyphilitic cases, by suitable treatment. Chronic ependym-itis, granular or reticular, is very commonly found in thesenile brain. Dr. Merle has discovered by experiment thatthe ependyma can be infected either from the meninges ordirectly from the general circulation, but in itself it is a poorbarrier to the passage of pathogenic agents circulating in theventricles. The subependymal tissues are always severelyaffected in an ependymitis. In a great number of casesevacuation of the intraventricular fluid is indicated. Intra-ventricular injections, too, as for instance of antimeningo-craccic serum, are often of great value, for the medicamentis disseminated rapidly by this means.

THE MEDICAL DEFENCE UNION.

THE annual general meeting of the Medical Defence Unionwas held at Brighton on May 18th, Mr. Stamford Felce, thePresident, being in the chair. The President pointed out inhis opening address the disadvantages to the medical

profession foreshadowed in the National Insurance Bill, andhoped that resistance to the measure would be strenuousand united. We have received a copy of the annual

report and statement of accounts of the Union, whichshow that the society is in a very good financial conditionand that the progress made has been steady and consistent.The additions of new members have been persistent. Weagain point out that no medical man, in whatever

department of medicine he may practise, can claim forhimself absolute security from attack, however skilfullyand conscientiously he carries out his professional duties ;but if he be a member of one of the Defence Societies hecan be assured that he will be protected with the best

weapon and with the greatest possible chance of success.

It must be satisfactory to the council of the MedicalDefence Union to know that the society stands highin the estimation of the leaders of the Bar, and that it is

recognised by such that the cases in which they are desiredto appear on behalf of the Union are "clean," and that themedical member can be defended without reservation or

misgiving. Another important matter to which attention

may be drawn is the opportunity now accorded to membersof availing themselves of the additional protection byinsuring against damages and costs of the other side.Some two years ago, owing to representations made on

behalf of the members, the council inaugurated a systemof insurance which members are allowed to avail themselvesof at a nominal premium with the Yorkshire Insurance

Company, and by which they are indemnified against lossshould a case be decided against the Union. We once more

heartily congratulate the general secretary of the Union,Dr. A. G. Bateman, on another successful and most usefulyear of work.

-

THE PORTRAIT OF A PRIMITIVE MAN.

THE influence of Christianity in the so-called Dark Ageswas entirely opposed to anything in the nature of phallicworship. So severe was the pressure put by the earlymissionaries of Christianity upon their converts that thelatter would seem to have utterly abandoned even the

traditions of any kind of phallic ritual and to have purgedtheir very dialects of phallic allusions. Thus Freya and hermale counterpart Friggo are handed down to us as respec-tively the goddess and the god of fertility, spring, vege-tation, and so forth, whereas in reality they may very wellhave been the Astarte and Priapus of our Saxon and

Scandinavian forefathers. It is curious, therefore, in viewof this huge process of elimination, to come across anysurvival of what once was a prevalent pre-occupation ofthe mind of early man. Such a survival would seem to

exist on the side of a steep down near the ancient townshipof Cerne Abbas in Dorset, where a huge male figure appearsincised in the turf somewhat after the manner of the LongMan of Wilmington and the White Horses in Berkshire andelsewhere. This figure, locally known as " the giant," wouldseem to date from a hoar antiquity, though its origin is

disputed. We are strongly tempted, indeed, to regard thegiant as of the neolithic or bronze age. He is certainly pre-Christian in conception and attributes. Thus he is naked,disproportionately long-armed, and yet well-drawn in the

manner familiar to students of the drawings on bone foundin Aquitaine and elsewhere. He strides briskly along inpursuit of prey or adventure and in his right hand graspsthe handle of an enormous club. The ensemble of the

figure suggests a type not far removed from the simian.The face has been only roughly sketched in, but it

leers cheerfully, and the head presents a low typeof development and appears to be sunk between theshoulders. The mammae are strongly marked, and the

huge sexual organ, which is conventionally outlined, sug-gests a phallic origin. It is curious to reflect that any-

thing so gross should have been allowed to remain in fullview of the rustic public during the ages, but the mere

fact of this survival points to an immense antiquity.

Originally an object of veneration, the figure was probablyregarded as bringing good luck during the Celtic and earlyEnglish epochs. On this account it may have been carefullytended or scoured during the ages of superstition, and

it probably continues to be tended now on account of itsquaintness and age. Though the figure, which is on the browof a steep down, one of a series covered with barrows, isnecessarily foreshortened, yet the thighs are actuallysomewhat short, and, with the vigorous-looking legs, havea typically archaic and savage aspect. It is this barbaric

drawing of the legs, as well as of the phallus and arms,that seems to prove the great antiquity of the design. We

may compare it indeed with the man of the aurochs-hunt,engraved on bone, and discovered by M. Massénat in LaugerieBasse in 1869. This aurochs-hunter is armed with a javelin,