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day is even now no more than half a pint. Therewas an increase of 662 in the number of licences

granted for the production of tuberculin-tested milk ;this is good, but not up to expectation. So far as the

working of the Sale of Food and Drugs Acts is con-cerned adulteration seems to be now negligible,except for the watering of milk and spirits.

Those parts of the report which deal with thesanitary services and housing are satisfactory in so faras they record the purchase of 9059 acres of recreationground, great progress in housing, and belatedattention given to rural water-supplies.An all-round improvement in insurance practice is

indicated. The commissioners seem to have littlecause for grievance with the way doctors carry outtheir side of the contract, for the faults found in theconduct of practitioners were few and in the maintrivial. In 116 cases remuneration amounting in allto E866 was withheld from practitioners. The numberof such cases is higher than usual, though the rate isnot, for 1936 was an unusually busy year with16 million contributors. There were only three casesof fees improperly charged, apparently only two ofimproper treatment and 21 of infringement of certi-ficate rules. In only one instance was removal fromthe medical list considered and this was rendered

unnecessary by an undertaking of the doctor not toengage again in insurance practice. Excessive pre-scribing still troubles the Minister. In the reportthis is treated as a purely financial matter, though

perhaps the chief objection to excessive prescribingis that it is not good practice. The number of doctors

engaged in treating insured persons was about

16,000, an average of one doctor per thousand poten-tial patients. The doctors received 6,868,000 apartfrom mileage fees ; this works out at an averageincome per doctor of 1:429. The cost of drugs andappliances paid to chemists was 2,084,600, and inaddition jEl90,000 was paid to doctors for medicinesdispensed by them in rural areas. The number of

prescriptions issued was over 63 millions, an averageof 4.72 per insured person.

WELSH BOARD OF HEALTH

The last part of the report is devoted to the workof the Welsh Board of Health and follows the sameplan as the parts devoted to England. Good progresswas made in the Welsh services in 1936. The maternal

mortality was 5-17 which, though much higher thanthe rate in England, is the most favourable but onesince 1926, and well below the average of the threepreceding years which was 6.08. The death-rate permillion from tuberculosis was 861, the first year onrecord in which it has been below 900. The KingEdward VII Welsh National Memorial Associationis a voluntary body which carries out the treatmentof tuberculosis on behalf of the local authorities, forwhich the latter paid 259,000 in 1936-37. Under anew agreement this sum will be raised to 305,000after 1940.

GRAINS AND SCRUPLES

Under this heading appear week by week the unfettered thoughts of doctors invarious occupations. Each contributor is responsible for the section for a month ;

his name can be seen later in the half-yearly index.

FROM F.R.C.S. (1936)II

IT was a common teaching to us in the wards tolose no time in developing the senses. If a doctorhad not by nature been endowed with the qualitiesof the hawk, then it was his plain duty constantly todevote himself to the development of the faculties,not omitting the olfactory. Our fellow passengers intube or train were pointed out as excellent materialupon which to practise the powers of observation. Theidea took strongly amongst those who were able torecapture some of the past pleasures of beaver inspotting a Parkinsonian facies or facial palsy. Myown results were disappointing. Complete visualexamination of the clinic took only a few seconds ofthe half-hour journey and the bag was never verystartling. On no occasion had I to worry about mysocial duty regarding the gentleman opposite with alip chancre. More yielding in diverse return was astudy of how fellow devotes of our tuppeny dailyread their news. A three-year statistical study onthe Central London line showed a clear majority forthe lower corner of the back side of the sports page.On that railway I saw no performer of Dr. James’sclass shaping as though the cross-word were a taskto be accomplished during the light-boiling of an

egg. Only two further clear-cut results emergedfrom my observations : the first that on golf daysMr. Bernard Darwin was sure to prevent a large fieldfrom reaching the financial news before the Bank, andthe second that I enjoyed alone my taste for obituariesin the early morning.

* * *

There is a spaciousness in these reviews of pastlives that does for me what Kruschen is said to accom-

plish for the outlook of the costive. In reading themany paragraphs extolling the great capabilities andhigh talents of an oriental Prince and the very shortreference to the capricious nature and violent temperwhich led to his summary ejection from his domain,it is impossible not to feel that this is the broad andbenign view taken by the deity or that this loftyperspective cannot fail to influence the ultimate

judgment. It is said that to obtain the fullest savourfrom this column a certain seniority and a pencil arenecessary, that then can be enjoyed the solid satis-faction of crossing off contemporaries as they showtheir inferior stamina.

* * *

There are those who get their forecast of thefuture from the Personal Column whose livelyimaginations, like Mr. Fleming’s, can from a

vacancy for two guns to share expenses, bestreferences required and given, conjure the pictureof two red-faced men at a bar saying, " What weneed is a couple of suckers each with two hundredquid." Others who regard the Engagement Columnas a list of stud bookings for the coming year mayconsider it a sounder basis for imaginative specula-tions on the future. Nor had I ever thought thatthis column was ever given more than the rapidscansion necessary to detect a familiar name warrant-

ing a congratulatory note. Last week in this innocenceI announced my engagement. Just who are mostinterested in this column was soon apparent. One

photographer must have studied the marriage fore-cast with his breakfast, for his circular arrived beforelunch a mail ahead of a field of three florists, twofurniture stores, and a shoemaker. In forty-eighthours the entry had risen to fifty, at this point there

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was a sharp decline, and the mail has steadied totwo or three a day for the last ten days. There isnow nothing that the young couple might ever needwhich has not been illustrated in some elegantbrochure. It has been pleasant to meet again thoseold friends in the photography business whosecongratulations and gratuitous offers first appearedafter the primary and subsequently punctuated myacademic career.The massed batteries of the furnishing trade are

reserved for the female of the species, and no fire iswasted on the male. There was a uniform trust inthe sales value of a coloured picture of a vast doublebed set in a baronial hall. If the store also possesseda lingerie department the nuptial effect would be

heightened by a hovering silk-clad nymph. For therest there are few concessions to the occasion thejewellers concentrate on plain rings of gold and

platinum, food firms on wedding cakes and bewiskeredpictures of the founder of the business, but most relyon a coronation rather than on a special nuptial display.Not all the mail is intended for both parties. One, anelaborate and heavily illustrated document about abreast supporter and corset, made no use of slogansto keep abreast of the times or to use a brassiere thatreally uplifts. It chose to rely on protection affordedagainst " cancer, tumour, inflammation, cysts, mastitisand pain." A devastating picture of a young ladysupporting only one breast with their contrivance andlabelled with and without was given much prominence.For further conviction a quotation, unhappily anony-mous, from one of many Royal letters of thankswas reproduced. At this point orthodox advertisingceases. The contraceptive firms conduct their corre-spondence under a heavy personal seal and many longpreambles about their reluctance to solicit unwillingclients. They beg to be excused this unorthodoxintrusion on the grounds that usual methods ofadvertisement are denied them. Their politeness inthis sphere is unique, although the enclosed accountsare couched in an irritating pseudo-medical jargon.The sound basis of one method advocated was possiblysuggested in the subscription to a picture of theshop. It said " the public would admire the

ingenious method employed to keep the sexes strictlyapart." A more curious manifestation of the com-mercial mind is the attention given by the manu-facturers of energising tablets to the names of thosein the engagement columns. After several of these awayside pulpit text arrived opportunely. It adjuredthe reader to " make it a stern rule of life not tobe too critical."

In early ’35 the blankness of the Europeanhorizon made the prospect of qualification contrastpoorly with the opportunities of the early Georgianera. There seemed no lack amongst us of embryonicdoctors who would welcome a return of the livelydays when a picnic war in the Balkans provided for theenterprising a ready escape from hospital routine.Envy for this particular period was not infrequentlystimulated by the personal reminiscence of a seniorsurgeon who told of rollicking fun with a privateambulance in Albania. The picture evoked was thatof a jolly caravan trip through the Balkans punctuatedby quantities of the most stimulating sort of FrontSurgery work and frequent interludes for high jinksin Zagreb. There seem not a few about to receive theirdiplomas 4who given a similar opportunity would feelwith the poet

Let me like a soldier fallWith my breast expanded to the ball !

True in Manchuria and in Paraguay internecineactivities of the greatest vigour were being conducted.

But they were scarcely the right sort ; remote in thefirst place and quite lacking in any sporting elementin the second. These surprising relapses intounrelieved barbarity required a very rare degree ofidealistic fervour from the prospective doctor beforethey attracted him. There were few of us who

regarded war as the Condy’s fluid of the blood, andin those days there was completely lacking that" state of mind " which, the truism assures us, morethan guns and bombs makes a war. But it did seemthat given the proper opportunity there would stillbe many who would regard war through a cheerfulmiasma of sentiment and heartiness as the most

exciting if the most dangerous of sports. Once theheroic qualities are given their old values it is easy forinexperience to offset the general theme of post GreatWar books and their insistence on its monotony,brutality, and futility, with the reflection that thepersons most sensitive to that aspect of war are themost likely to write of it. Personal conflict tendedto disappear during the Great War and with it thatelement of excitement and even pleasure which is saidto accompany killing in the war " state of mind."Writers on older wars not infrequently used to makemore of it and novelists, writing on the Crimea,had described their hero’s unexpected delight inthe pastime of bayonetting Russians. More recentlythat connoisseur of equestrian delight, Alphonso XIII,is reported as rating the cavalry charge high abovepig-sticking. Experience of neither sport is necessaryto feel that he has got the order right.

* * *

Before any war might be expected to attract eventhe most swashbuckling of medical non-combatants areturn of both the picnic and the accompanyingpersonal conflict elements would seem to be necessary.The wars of the last two years have seen some returnof personal conflict; and although the picnic elementhas been conspicuously lacking, dug-outs and mudhave not occupied much space in the reports. It is

easy, however, to understand Abyssinia not being acompelling magnet to the only casually adventurous.Addis Ababa was given no attractions to compensatefor the penalty of being mistaken for an Italian bya wandering tribesman ; all work and no play in thatcity seemed to alternate unhappily with no work andno play. In Spain, on whichever side of the wobblingboundary line the sick are tended, the relaxation ofthe warrior appears to be given its due importance.Except for Madrid, Spain from the press providesthis year of grace with its equivalent to the Balkanwars of some quarter of a century ago.

* * *

It was with feelings of remorse, repentance, andregret, that the other day I overheard a librarysubscriber ask for books on war wounds, as heintended shortly to leave for Spain. Had two yearsof opportunity for work unobtainable elsewherethan on the battlefield and for a variety of otherlively experiences been let pass I took tally of thosebolder contemporaries who, realising that at anyone time there is only one spot on the globe whereimportant things are happening, had chosen Spain.My acquaintance is not large nor representative, butan exhaustive tot up found me with personal know-ledge of one medical worker in Spain, the journalistbrother of a friend who enlisting to drive ambulanceswas last heard of as medical superintendent of a

base hospital. It seems we are not the stun ourseniors were.