1701JAPANESE MEDICINE.

In January, 1904, Dr. SABOURAUD was able to give up tothe Assistance Publique 150 beds and as a bed represents a

capital of 10,000 francs 1,500,000 francs were saved. In

another six months Dr. SABOURAUD expects to be able to

hand over another 100 beds. Up to 1903 children affectedwith ringworm lived at the Ecole Lailler for an average oftwo years and the average of cures per annum was 110 ; in1905 the number of cures was 504. Each cure used to cost

2000 francs ; now it costs an average of 260 francs. Dr.

SABOURAUD made the following summary at the conclusionof his address : ’’ With the application of x rays for ring-worm the Assistance Publique will have recovered at the endof this year a capital of 2,500,000 francs ; and, further, itmakes now, and will continue to make, a saving certainlyexceeding 300,000 francs per annum, a sum which will

increase from year to year."

Japanese Medicine.MANY factors have recently drawn attention to the in-

tellectual progress of the Japanese. For their progress re-

lating to medical matters it is fitting that in these columns weshould not withhold that praise which is so richly deserved.Our readers have had an opportunity of studying at leisurethe presentation of one aspect of Japanese medicine in theinteresting lectures recently delivered at St. Thomas’s Hos-

pital by Baron TAKAKI, F.R.C.S., who selected as his subjectthe preservation of health amongst the personnel of the

Japanese navy and army. 1 Baron TAKAKI was himself a

distinguished student at St. Thomas’s Hospital, and in viewof the success that has attended the reforms which he has

introduced in his national navy and army it is natural that

the staff of that hospital should feel a sense of gratificationin inviting him to review these results within the walls wherehe had studied for an English qualification. Before comingto this country in 1875 he had seen several hundreds of

cases of beri-beri at the Naval Hospital in Japan and wastherefore fully acquainted with the danger that it was likelyto present in the event of any serious and prolonged war.Beri-beri occurs only among rice-eating peoples, and its

prevalence and importance may be realised from the factthat formerly it constituted three-fourths of all illnesses inthe Japanese navy. One attack afforded no protection, thesame men were often affected three or four times a year.The control of this disease was the problem which BaronTAKAKI set about solving when he was appointed Vice-Director of the Naval Medical Bureau, and our readers

will have noted the care with which he accumulated the

data from which he was able to prove that the disease

originated in an excess of carbohydrates and a deficiency of

proteids in the dietary. Although the lectures covered awide field of interest, Baron TAKAKI necessarily spoke mostfully of the subject of beri-beri, which is most peculiarlyhis own, and the triumphant demonstration of the wisdomof the reforms which he introduced is shown by the prac-tical elimination of beri-beri from the ranks of the navy and

its enormous diminution in the army, where his recommen-

dations could only in part be carried out. We read that

formerly ’’ the food supplied to the army and navy was

regulated by a monetary system, without any regard for

1 THE LANCET, May 19th and 26th and June 2nd, 1906.

quality or quantity; " and Baron TAKAKI is to be con-

gratulated upon having shown that the truest economylies in the prevention of disease, even though the initial

expense may be somewhat greater.It is unnecessary for us to follow the steps by which

Baron TAKAKI arxived at his conclusions, or to enter intodetails as to the composition of the rations supplied to the

Japanese soldier before and after the time when Baron

TAKAKI’S recommendations had been accepted. These detailsare to be found in the lectures, while they receive confirma-tion from an independent source in the pages of a book whichhas been written by a late surgeon-major of the United Statesarmy,2 who drew upon materials collected during the recentwar as well as upon official statistics with which he was

courteously supplied. Surgeon-Major Louis L. SEAMAN

writes with the authority of one who has already seen activeservice, and his narrative is not weakened by his obviouslysincere conviction that other countries might with advantagecopy the army medical organisation of the Japanese.He has shown that the precautions taken by Japanhave been sufficient to reverse the trustworthy statistics

of war which had been accumulated during the past 200years. While all medical men have been familiar with the

frequent assertions that Japan has assimilated and improvedupon European knowledge, it will probably cause some

surprise to find that whereas the former estimate allowed

for at least four men to perish from disease to every onefrom bullets in the recent Russo Japanese War the propor--tions were precisely reversed. This alteration is attributed

to the general precautionary measures adopted. Diseases

which have hitherto occupied prominent positions in the _statistical reports almost dropped out of consideration duringthe Russo-Japanese war. Surgeon-Major SEAMAN speaks of"the conquest of the silent foe," and the conquest, in his

opinion, has been effected far more by precautionary and

hygienic measures than by any medical or surgical skillin treatment. Due credit is assigned to operative skill, tomedical treatment, and to the admirable provision of hos-

pitals on the lines of communication, but it is abundantlyevident that these alone would not have been so suc-

cessful had they not been preceded by an almost incredibleamount of forethought. The careful examination of the

water-supply, the instruction in the use of " first dressings,"the destruction of flies in the hospitals, and the provisionof nets by which they could be excluded, all betoken an

enlightened application of means to an end. Beyond this,however, Surgeon-Major SEAMAN attributes a large part ofthe success to the harmonious working of all concerned insecuring the general welfare of the army. He states

definitely that, although some of the most eminent Japanesemedical men were called on to help in army hospitals athome, they invariably served as assistants to the men in

charge. These men frequently had been their former pupilsin the University, but the limits of discipline were nevertranscended.

In the medical records of the late war, as detailed in this

book and in the lectures of Baron TAKAKI, is to be found

ample justification for the compliment paid to the Empireof Japan by the General Medical Council in giving

2 The Real Triumph of Japan, by Louis L. Seaman London:Sidney Appleton, 1906.

1702 THE ACCURACY OF THE MEDICAL REGISTER.

courteous consideration to the representations addressed tothe Foreign Office from the Japanese Legation. It had been

recognised that Japanese medical graduates under existingconditions would be precluded from practising amongsttheir compatriots in some British Crown colonies in the

Far East, and the General Medical Council was desired bythe Japanese Government to remedy this anomaly. In his

presidential address Dr. DONALD MACALISTER referred tothe prolonged course of preparatory and professional studyand examinations required for the medical degrees of the

Imperial University of Tokio and added that the surgeonsand sanitary officers of the Japanese forces had provedthemselves capable of teaching many wholesome practicallessons to the nations of the West. A memorandum on

the subject had been prepared for the Council by the Pre-sident on the conditions required for medical qualificationin the Japanese Empire and this appeared as an appendixto the minutes of the Council. It deals purely with the con-ditions for university graduation in Japan and demonstratesthat they are amply sufficient to guarantee the efficiencyof its medical graduates. On these grounds, therefore, theCouncil readily acceded to the request to grant recognitionof the degrees of the University of Tokio. This recognitionis particularly honourable to both countries because of itsimmediate origin. The discovery of the causation of beri-beriby Baron TAKAKi, and the success of the measures that he in-

troduced, might possibly be attributed to the education whichhe received in England. No such explanation can attach tothe general results of the medical administration during thewar. One of the lessons learnt by Surgeon-Major SEAMANwas that a medical man at the front, like a sentinel on duty,could prevent the entrance of danger; he was therebyworth 20 men stationed at the rear to treat sickness when

it had obtained a foothold, wherefore Surgeon-Major SEAMANplaces the medical preparations for war as equal, if not

superior, to those undertaken by the non-medical militaryauthorities. That this lesson should have been learnt from

observation is sufficient evidence of the practical nature ofthe medical education of the Japanese.

Annotations.

THE ACCURACY OF THE MEDICAL REGISTER.

11 Ne quid nimis."

THE official roll ot the medical profession can only be keptcorrectly by the regular cooperation of its members. Itis to the interest of the profession that the roll shouldbe accurate. Some of our correspondents when theydetect any errors use a very hurt tone towards theauthorities of the General Medical Council, forgetting thatfor the most part mistakes in the roll are due to theslackness of the profession at large. Changes of addressand alterations in style or title are not communi-cated to the Registrar and the proper proceedingsare not taken to remove the names of dead persons.We have occasionally had to point out in THE LANCETreasons for thinking that the precautions taken by theCouncil to insure an accurate list are not faultless,but a great deal of hard work has been expended upon theRegister lately and with good result. All that is nowneeded is the systematic assistance of those whose names

make up the roll and this they should give in their owninterests and that of the profession. At the presentmoment, in view of the approaching election of Direct

Representatives, it is most important that all practitionersshould assure themselves that they have their correct

address inserted, otherwise not only will they possibly losetheir votes but they will run a considerable risk of havingtheir names erased from the Register. If the Registrar ofthe Council in sending out the voting papers is unable toget into communication with anyone the person in question isliable to be removed temporarily from the list. We under-stand that no circulars of inquiry are being issued this yearfrom the central office because the sending out of votingpapers will in itself form a means of correcting the roll,while the proofs of the Register are likely to go to pressearly in the summer. We therefore urge upon all ourreaders the necessity of seeing at once that the Registraris supplied with their correct addresses. Not only hasthe General Medical Council the right to expect thatmembers of the profession should lend their assistance inkeeping the roll accurate but the public has the same right.The Medical Register is published by. Act of Parliament forthe definite purpose of allowing the public to ascertain whois and who is not a qualified medical man, and we should alltry to keep the public rightly informed upon a matter ofvital importance.

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MEAT FOR THE SOLDIER.

ON May 30th, in the House of Commons, Mr. Barrieasked the Secretary for War whether any alteration had beenmade in the form of tender for contracts to the army ;whether such forms until recently stipulated for the supplyof "home-fed" " meat ; and whether the new forms had beenadopted in order to enable "foreign-fed"meat to be suppliedto the army. Mr. Haldane said the reply to the first twoquestions was in the affirmative. The object of the altera-tion in the contract was not that suggested by the honour-able Member but to get the "best fresh" meat at the"lowest price for the soldier. It may be of interest froma health point of view to consider whether, by this new formof tender, the soldier will get the " best fresh " meat, thoughcertainly it can be obtained at a lower price. In the new formof contract the term " home-fed " has been replaced by theterm " home-killed " ; this, of course, allows the contractor

to supply any American or Argentine meat so long as it iskilled in England. The health of the soldier is a most

important study and so should be his food, and it is statedin the Daily Telegraph of May 30th that the meat supplied toour soldiers and sailors costs something like .62,000,000 perannum. And it is well, now that the public are hearingdaily some new details regarding American meat, to thinkwhat the terms of Mr. Haldane’s new contract form may leadto. That the meat-supply for our army has not been what itought to have been, even under the old contracts, was thesubject of a series of letters in the Meat Trades’ Journal

during the early months of this year. And the two chief

subjects for complaint were : (1) the letting out of contractsto subcontractors ; and (21 inadequate supervision of themeat by officers who had not made meat inspection a study.Into the last of these complaints we need not enter now forclasses are being held at the Metropolitan Cattle Marketand elsewhere at which officers of the army can obtainefficient instruction in the inspection of meat; and officersof the Army Service Corps have to pass an examination inthis subject. But with regard to the first, that is even

stronger than before ; if under the old contract English firmswere able to sublet their contracts what security can therebe, if these contracts are obtained by American firms, thatthese will not also sublet their contracts and feed the poorsoldier on inferior American beef? The contract need not