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was no oedema, no congestion of the lungs, no enlarge-ment of the liver, and no dyspnoea on exertion. Onthe other hand, tidal air was much reduced, beingbelow 300 c.cm. instead of 400-500 c.cm. ; thealveolar oxygen tension was only 75 instead of100 mm., the vital capacity was. below 2-6 litres(normal 4-5), and there was reduced oxygen saturationin the capillary blood. The authors believe that aninvestigation of these various factors should be under-taken in cases of cyanosis, because if alveolarunder-ventilation is the cause great benefit is tobe expected from oxygen administration. Here, too,they might have mentioned carbon dioxide, whichis of obvious value in the shallow breathing ofpneumonia, for example. They divide the clinicalstates in which alveolar under-ventilation may occurinto acute and chronic types. The acute include suchconditions as pneumonia, cardiac failure, asthma,pleural effusions, and bilateral pneumothorax, whileunder the chronic types must be considered cases

where the elasticity of the lungs is diminished-e.g.,emphysema and various sclerotic conditions-orwhere the under-ventilation is due to extra-pulmonaryconditions, such as tumours or muscular affections.Most cases in practice in which alveolar under-ventila-tion is the cause of the cyanosis are examples of

emphysema, and the value of oxygen administrationfor them is well understood. In differential diagnosiscyanosis from chronic alveolar under-ventilation hasto be distinguished from cyanosis from cold, fromlocal causes, and from cardiac causes. According toHoussay and Berconsky, examination of the arterialblood and alveolar air is enough to settle the questionwhen in doubt.Diagrams in their paper make the different causes

of cyanosis very clear, and the purely physiologicalapproach to a problem of medicine is refreshing. As

they remark, although " it is always said that thepurely anatomical era in medicine is over, it must berecognised that there are very few clinics whererespiratory problems are studied with the aid ofmodern knowledge and modern methods."

HOSPITALS AND THIRD PARTY RISKS

A BULLETIN lately issued by the Central Bureauof Hospital Information deals with insurance againstthird party risks.1 Patients are occasionally in aposition to make claims against hospitals for suchmatters as burns from hot-water bottles or burns fromX ray or electrical apparatus or for some form ofnegligence in treatment or nursing or other accidentaloccurrence. The bureau has ascertained that in205 hospitals (totalling 17,400 beds) there have been35 effective claims in the past 10 years. The amountpaid in respect of these claims was n 786 (includinglegal costs). One claimant obtained 675 but thisresult was exceptional; the average amount wasabout E51 per claim. Four of the 35 claims weremade by members of the general public ; the remaindercame from patients. Inquiries among representativehospitals indicate that about a third of our hospitalsinsure themselves against these third party liabilities.A good insurance office will cover the risk at a premiumrate of Is. 6d. per bed with a limit of :E1000 for pay-ment on any one accident or event ; if cover isnot required against the risk of " ptomaine poisoningand deleterious substances in food and drink suppliedby the hospital," the premium rate is sixpence less.

1 Insurance against Third Party Risks. Memorandum No. 56.Prepared by W. E. C. Baynes, barrister-at-law, for the CentralBureau of Hospital Information, 12, Grosvenor-crescent, London,S.W.1. 3d. post free.

The bureau suggests that, if enough hospitals availedthemselves of this kind of insurance, the premium ratescould be substantially reduced. The memorandumusefully summarises various points to be borne inmind in arranging for this kind of insurance. If, forinstance, the insurance company is allowed to insertin the policy a condition that the hospital shall take5’ reasonable care," the cover is obviously veryseriously restricted. On the statistics alreadymentioned the risks may not appear substantialbut the trouble is that a hospital may easily incurE100 in costs even when a plaintiff eventually with-draws his claim. If it is worth while for hospitalsto insure against third party risks, it is worth while.to insure to the best advantage. In this connexionthe suggestions contained in the memorandum areworth noting. ____

Sir John Collie and Dr. Henry Robinson have beenappointed deputy lieutenants for the County ofLondon.

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WE regret to announce the death on Tuesday lastat a nursing home in London of the distinguishedophthalmologist, Mr. Edward Treacher Collins, con-sulting surgeon to the Royal London OphthalmicHospital, consulting ophthalmologist to Charing Cross.Hospital, and chairman of the International Ophthal-mological Council. Mr. Treacher Collins was in his7lst year. ------

Sir Arthur Keith’s illness will prevent him fromdelivering Hunterian lectures at the Royal Collegeof Surgeons next month. In his place Mr. HaroldBurrows will lecture on the Production of MalignantTumours in Animals by pure chemical substances, Mr.Arthur Edmunds on Unsuccessful Appendicectomy,Mr. G. A. Mason on the Surgical Significance of theVitelline Duct, Mr. Laurence O’Shaughnessy on

Thoracic Surgery, Mr. Mandall Wardill on the Treat-ment of the Cleft Palate, and Mr. E. R. Flint onPre-operative Procedure. The Arnott museum

demonstrations will be given by Mr. E. K. Martin andMr. Wilfred Shaw.

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A FUND is being raised in memory of Dr. R.Stenhouse Williams, first director of the NationalInstitute for Research in Dairying, who died lastFebruary. The signatories of the appeal, whoinclude Lord Radnor, Lord Iveagh, Lord Daresbury,and Sir John Gilmour, Minister of Agriculture, speakof his continuous and untiring efforts in the causeof science and its practical application to the problems.of the dairy industry. His great hope was that hemight live to see the work of the institute adequatelyprovided for, and the fund, apart from a smallpermanent memorial, will be devoted to the advance-ment of dairy science there. Contributions should besent to Mr. S. R. Whitley, Rookwood, Shinfield-road,Reading.

BIRMINGHAM HOSPITAL SATURDAY FUND.-Mainlyas the result of an increased rate of contributions thecollections this year to date for this fund have reached.8124,507, as compared with .896,200 in the same periodlast year.

QUEEN’S INSTITUTE OF DISTRICT NURSING.-Atthe meeting of the council last week it was reportedthat 14 district nursing associations have recently beenaffiliated, and that the names of 254 nurses have beenplaced on the roll of Queen’s nurses. The season’s openingsof gardens in aid of the funds produced £ 10,527, of which40 per cent. goes to the institute, the remainder to thecounties in which the 1079 gardens are situate.