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To bring the tuberculosis officer and the generalpractitioner into closer touch presupposes mutualconfidence. The tuberculosis officer must be a manof experience whom the practitioner can trust, andnot just a migrant in the public health service.Unless he has the modern equipment of the tuber-culosis specialist, the general practitioner is not

likely to trust his skill. Public health committeeshave not yet come to realise that the treatment oftuberculosis is something more than the facileapplication of rest, fresh air, and good food ; it involvesthe use of technical apparatus with a trained handand mind. The practitioner also has much to give.There is knowledge yet to be gained on conjugaltuberculosis and marital infection; on pregnancyand tuberculosis, on relapses and recrudescences, onearly signs and minor tuberculosis, on the causativefactors in the acute, often fatal, forms of infantiletuberculosis, and the like, which can only be

, acquired in general practice. At the same con-

ference Sir George Newman remarked that theLocal Government Act of last year spells the endof the dual control of tuberculosis. Henceforth the

public health committee which controls the tubercu-losis service, called into being in 1912 as the resultof the Astor Report, and the public assistance com-mittee which now supersedes the guardians whocontrolled the advanced cases in workhouse, infirmary,and special ward and through out-relief, will meetunder the roof of the same State authority. A new

phase of the antituberculosis campaign is openingto which the practitioner has a contribution to makeif he - is allowed

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MEDICAL MEDALS.

THE Brettauer Collection of coins and medals,which is a very famous one, and which is now in thepossession of the University of Vienna, was made byDr. Josef Brettauer of Trieste, who died 25 years ago.The circumstances in which it has since beenhoused, and why the cost of an illustrated cata-

logue has become a question of public appeal, willbe found in a letter from the trustees for the upkeepof the collection which appears in another column

(see p. 117).The collecting of medals and coins is justified by

the value of the tokens in confirming history, whileaffording an opportunity for the display of beautifulart. The coin and the medal have no exact differentia-tion, for the ancient coins, while representing money ofa certain value, have had often, on the reverse, anillustration of some historical event. For example,there is a Byzantine coin whose reverse shows theVirgin Mary supporting the walls of Constantinople,a resume of the history of that date which is verysignificant, while similarly a gold coin of Edward III.(a noble, worth about 8s. 6d.) commemorates on theback a victory over the French. It seems that thecoin having a particular value in currency no longer" features " historic episodes, this rble being left tothe medal, which is struck to commemorate someevent or person, and has no place in the currency.To this class belong the medals struck during theEnglish Civil War, and the Christian token of PopeGregory XIII. recording the festival or massacre ofSt. Bartholomew. The Brettauer Collection containsa complete group, in many subdivisions, of medalsreferring to the art and practice of medicine, and" thefield here is a large one. Those who have seen

Mr. Forrer’s catalogue of the collection of Greek coinsbelonging to the late Sir Hermann Weber, who beganhis fruitful labours through interest in m edical medals,

may recollect how fully medicine was represented.A rare drachma of Epidaurus, for example, has onone side the head of Apollo the father of Asklepios,and on the other Asklepios with his hand extendedover his serpent. while beneath his throne is a dog.Mr. S. W. Grose, writing in THE LANCET with referenceto the Weber catalogue, called attention to coins

showing Epione,the wife of

Asklepios. and theinstrument knownas the cuppingvessel. The cup-ping vessel is onother Greek coins,especially those

deriving fromThessaly, anothercentre of the wor-

ship of Asklepios.This town was the

reputed home ofCheiron, the wisestof the Centaurs,and renowned for his skill in medicine. Un the coins of

Tricca, the legendary birthplace of Asklepios, appearan interesting type of Asklepios feeding his sacredserpent with a bird. Such are the prizes that arousethe antiquarian, but throughout the history ofmedicine great men, large events, and privategenerosity have been represented by numismaticart, and a graceful example of the last is furnishedby the endowment at Corpus Christi College,Cambridge, by Dr. S. A. M. Copeman of an annualmedal for medical research.

It is to be hoped that the trustees of the BrettauerCollection will obtain the practical help they need.

SENILITY AND HIGH BLOOD PRESSURE.

THE aetiology of high blood pressure, excludingcases which can be put down to chronic renal disease,remains obscure. The old belief that the blood

pressure inevitably rises as age increases is a fallacywhich dies hard. C. Laubry and R. Castéran 1

point out the importance of distinguishing betweenold age, a physiological condition, and senility,a pathological state, and recall the dictum of Vaqeuzthat the vascular changes in the aged are due less toage than to the pathological conditions appertainingto age. They cite cases of men as old as 90, in whomthe blood pressure was found to be well below thenormal adult level. They have also observed thatpeople exposed to hypertensive influences duringtheir working years not uncommonly have a loweredblood pressure after retirement. This observationis readily understood if high blood pressure is regardedas a manifestation of cardiovascular hypertrophyin response to continuous or intermittent hyper-tensive influences. If the influence is removedbefore the vascular changes have gone beyondthe stage of physiological hypertrophy, the bloodpressure may fall again ; but once this stage is

passed a permanent rise is necessary to force the bloodthrough the rigid and often narrowed arterialbed. It follows from this that in patients withhigh blood pressure and grossly degeneratedblood vessels attempts to lower the pressure byviolent means, such as purgation, are not merelyillogical, but may cause a dangerous and even fatal

1 Rev. de Méd., April, 1930, p. 251.