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result. The discredit attached to ovarian therapy 7in the past was due to ignorance of a reliable method iof testing the activity of the preparations employed. (

Whether the use of standardised preparations willrestore faith in this method of treatment depends on i

clinical results, which are not easy to assess. Mr. 6WILFRID SHAW in this country and Dr. E. L. ’

SEVRINGHAM and Dr, J. S. EVANS2 in America have 1been trying respectively the oily and water-solublepreparations on a group of cases and have publishedtheir experiences which are encouraging though notconclusive. This is not surprising, for there is littleanalogy between the oestrus of the laboratory rodents,coincident as it is with the period of sexual activity,and menstruation in man and the higher primates ;the difference is held to be connected at least in partwith the functions of the corpus luteum. It is clearthat in those patients in whom the deficiency, whilstit may be hormonal, is not primarily one of the oestrus-producing hormone of the ovary no effect can beanticipated. Moreover, the problem of dosage is notyet solved. If the correct dose is proportional to thebody-weight, a woman with complete ovariandeficiency will require a dose of some 1500 rat units,an almost impracticable quantity. With the smalldoses available at present too much must not beexpected. The distribution of the dose, however,can be controlled. The preparations used are oftwo kinds : oily and water-soluble. The earlier oilypreparations suffer from the disadvantage that theyare liable to give pain on injection, and SHAW refersto the severity of the local reaction produced. Thefact that they are slowly absorbed, however, may be anadvantage, since the effect of the dose is spread overan appreciable time. In animals a single injection ofthe aqueous preparation is much less effective thanthat of the same total amount of material given atfrequent intervals. Aqueous preparations such as

those used by SEVRINGHAM and EvANS are notfollowed by any local reaction, but they have to begiven frequently, probably daily, to get the bestresults.The hysterical tendencies associated with some of

the conditions studied tend to increase the difficultiesof the clinical work. In view of the fact that one ofthe most striking properties of cestrin is its action inpromoting uterine growth in experimental animalsMr. SHAW examined the effect of the hormone in15 cases of spasmodic dysmenorrhoea, with thetypical ill-developed uterus associated with thiscondition. In six of these no improvement wasobserved, even when 50 units were given at weeklyintervals ; all were severe cases. In nine others thetreatment was successful either in completely freeingthe patients from pain or in alleviating it. The sizeof the uterus, however was increased only in twocases and in all the symptoms returned when theinjections were stopped. The author recommendstrial of the treatment in young women and wheredilatation of the cervix is not successful. Not all casesrespond, and if after eight weeks there is no improve-ment the injections should be discontinued. Infive cases of primary amenorrhoea no definite effectwas observed and menstruation was not establishedin any of the subjects. Two cases of amenorrhoeaof secondary type also gave negative results. Bothof these were combined with adiposity, and in eachof six further patients who were not adipose menstrua-tion followed the administration of oestrin. Theresults indicate that the treatment may be of valuewhen the symptoms are of recent date. Other casesin which good results have been observed includewomen with irregular menstrual periods. Accordingto SEVRiNGHAM and EvANS, relief is also given inmenopausal disturbances, particularly those asso-

ciated with vasomotor phenomena, in which goodresults are reported in 10 or 11 out of 15 cases treated.

1 Wilfrid Shaw : Observations on the Therapeutic Value ofthe Œstrus-producing Hormone of the Ovary, Quart. Jour.Pharmacy and Pharmacol., 1929, ii., 373.

2 Sevringham, Elmer L., and Evans, Joseph S.: ClinicalObservations on Use of an Ovarian Hormone : Amniotin,Amer. Jour. Med. Sci., November, 1929, p. 638.

Both the English and American investigators referto the handicap of the lack of an objective index ofovarian activity in the human subject, a circumstancewhich together with the spontaneous improvementwell known to occur in young patients, makes thescientific evaluation of any drug extremely difficult.The workers themselves consider the results obtainedto be in many ways encouraging.

Annotations.

HOSPITAL ASSESSMENT.

"Ne quid nimis."

WHY is it that the attempt to lighten the burdenof rates borne by the voluntary hospitals has achievedso little success ? The hope of total de-rating has beenfrustrated because it spoilt the symmetry of recentenactments framed by reformers who forgot thehospitals. The Central Valuation Committee’sadvisory functions have failed to achieve theuniformity in valuation which it is that body’sstatutory duty to promote. The Committee mosthelpfully suggested an equitable basis for assessinghospitals ; it would have meant an advantage onlyless valuable than total de-rating ; but the suggestionhas been largely ignored and the utmost diversityof practice flourishes. The hospitals’ prospect ofswollen demands for rates is deplorable. The recentreport on the Voluntary Hospitals in Great Britain 1(excluding London) contains a memorandum on thepresent situation which makes gloomy reading.The revision of assessments consequent upon theRating and Valuation Act of 1925 means that theprovincial voluntary hospitals in England and Waleswill have to pay .866,000 annually in rates whereformerly they paid 44,000. It is a crushingimposition, unjust in its haphazard and anomalousincidence. Stated in terms of assessment per patientbed, the amounts vary from nothing at all in oneplace to 220 in another. Only 19 per cent. of thenew assessments are less than 21 per patient bed ;more than 12 per cent. are 25 and over. The BritishHospitals Association has done its best. It has triedto obtain general support for a uniform and preferentialassessment which would not exceed 91 per patient bed,such assessment to cover all those parts of the hospitalthat are necessary to enable it to carry out the purposefor which it is established. Unanimity in supportof this reasonable proposal has been lacking. Manyhospitals are willing to uphold it ; a few favourindependent action and other remedies. Meanwhilethe financial prospect is uncertain and dark. Somelocal authorities are making contributions under thePublic Health Act-that is to say, they take withone hand and give back with the other ; this processmay be satisfactory locally but it does nothing tosolve the problem as a whole. If hospitals elsewherehave a greatly increased bill for rates, is the deficitto be met by a contraction of the hospital’s facilitiesor by begging from generous donors whose charitabledonations may be diminished in view of impendingnew taxation ? There is general sympathy for thevoluntary hospitals; nobody wants to see themunfairly harassed. Cannot some sensible formulabe framed which will give them equitable treatmentand which can be submitted to the valuationauthorities with unanimous support ?

THE BLOOD COUNT IN RHEUMATIC FEVER.IT has long been recognised that rheumatic fever

in children is associated with a mild leucocytosis, and. the work of Swift and his collaborators2 seemed to show that its degree bears some rough relationship to

1 Tenth Annual Report for the Year 1928. Published by theCentral Bureau of Hospital Information, 19, Berkeley-street,London, W. 1s., post free 1s. 5d.

2 Swift, H. F., Miller, C. P., and Roots, R. H.: Jour. Clin.Invest., 1924, i., 197.