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the time to render the most effective aid. They continued :"It is proposed therefore to establish four central collegesfor training Chinese doctors. One such college alreadyexists in Peking, but it is incomplete, and at least threeothers in three commanding localities are badly needed. Theimportance of this step is not measured by the possibilitiesof these four colleges ; for the time will come-let us hope,speedily-when the Chinese Government must itself take upmedical education; and the presence, as models, of institu-tions on Western lines will then be decisive as to the

scientific principles on which the State action must proceed.The cry in China of China, for the Chinese’ will thus besatisfied in the best possible way." The Appeal Committeeis presided over by Sir Robert Hart, and includes the Vice-Chancellors of Oxford, Cambridge, Edinburgh, and GlasgowUniversities, the Primate, the Bishop of London, the Pre-sident of the Wesleyan Conference, and many other repre-sentative men. We have referred to a second proposal topromote medical education in China, and we must addthat there are indications that it may unfortunatelyclash with that recommended by the Emergency Committee.We hope it will not, for, as outlined by Mr. R. S. Gundry inan earlier letter to the Tames on March 13th, it appearseminently practicable if sufficient support is forthcoming.Mr. Mody, a resident of Hong-Kong, has offered to give.629,000 to build a resident university for which the Govern-ment, subject to Government approval, will provide an

excellent site if .6110,000 can be raised in six months for itsendowment. The two first faculties to be created wouldbe those of medicine and of applied science (engineer-ing). Mr. Gundry points out that the present schemefor establishing a medical college in Hong-Kong could nothope to result in so efficient a training for Chinese studentsas would be provided by the projected University. It has

since been announced that a Chinese gentleman has promiseda substantial sum towards the required endowment, and weshould deplore the wreck of this promising scheme. It

seems very desirable that the Chinese Emergency Committeeshould attempt to fall into line with it, for it has the

blessing of Sir Frederick Lugard, the Governor of Hong-Kong, and an assured measure of local support. If the two

appeals are made in opposition it seems more likely that

people will subscribe towards the fund to further so concretea proposal rather than to that in aid of the more nebulousplans of the Emergency Committee. In this case surelyunion will be strength.

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THE ETIOLOGY OF ENDEMIC GOITRE.

THE question of the mode of production of endemic goitrehas received a large amount of attention and many hypo-theses have been put forward to explain why goitre occurs incertain districts. Nearly all observers are now agreed thatendemic goitre is connected somehow with the water-supply,and it is said that in Switzerland some of the young men

who wish to avoid military service drink of the water ofcertain springs and develop goitre and so obtain remission ofservice. It is still unsettled what constituent of the water

gives rise to goitre, but the chief support has been given tothe mineral salt theory, though the evidence in favour of anyspecial metal or acid is very conflicting, and experimentalattempts to produce the disease by administering saline sub-stances have almost always failed. Klebs is the main

upholder of the theory that goitre is due to micro-organisms,and various bacilli and infusoria have been credited with

the power of producing goitre. At the meeting of

the Royal Society on Nov. 26th, 1908, a communicationwas read from Captain R. McCarrison, I.M.S., who madea number of observations and experiments on the artificialproduction of goitre in Kashmir. At Gilgit in Kashmir

cases of goitre are common and they are attributed to

certain springs, and a research was undertaken to determinewhether the water or its suspended solid constituents wereresponsible for the production of the disease. The goitre-producing water was filtered and a portion of the suspendedmatter was administered to 13 persons, among whom was

Captain McCarrison himself; this was given every morn-

ing before breakfast. Four of them, including CaptainMcCarrison, developed enlargements of the thyroid gland.The experiment was repeated in the case of eight personswith the suspended matter, but it had been boiled for tenminutes before administration, and in no case did any

enlargement of the thyroid gland occur. From the results

of these experiments it was concluded that endemic goitreis due to a living organism present in the water, and

it was suggested that the organism of goitre exists as

an intestinal parasite in goitrous individuals, since theadministration of an intestinal antiseptic appeared to havea marked curative effect. The incubation period of the

experimentally produced goitre was from 13 to 15 days.Some experiments were made on monkeys to test

the possibility of the spread of the disease by the fascesof infected individuals, but the results were negative. In the

majority of the cases of goitre examined a marked amoebicinfection of the intestine was found, but nothing is known asto any relation between the amoebae and the disease. Theseobservations of Captain McCarrison are of great interest, andthey deserve to be continued. The absence of goitre in thesubjects who took the suspended matter after it had been

boiled does not prove conclusively that the cause of goitrewas a living organism, for the number of cases was so small.Even in the first series only four were affected out of 13cases on whom the experiment was tried. We would suggestthat a full microscopic and bacteriological analysis of thesuspended matter should be made, and the effect of theadministration of some of the constituents separately shouldbe observed. The enterprise of Captain McCarrison and thoseassociated with him in experiments upon themselves mustcommand the particular respect of all medical men.

PARÆSTHESIÆ.

OF the multitude of minor nervous complaints met with inprivate and hospital practice alike, one of the commonest isthat of acroparsesthesia, so-called. The patient, who is

usually a woman, complains of more or less continuous

tingling or numbness in the fingers, sometimes in all of them,more frequently in those on the ulnar side. The tingling,which may amount to actual pain, impresses itself on herattention more particularly during the night, and in the

morning ; it is often more intense when the hands are warm,and then a feeling of burning may be remarked ; sometimesthere is a feeling of coldness. While the condition is usuallybilateral, it is much more frequent in the upper than in thelower extremities, and in the former it rarely spreads as faras the elbow. The skin of the fingers may be bluish or red ;sometimes the finger tips are peculiarly pink, and look fulland swollen. In other cases no obvious-that is, visible-

change in the hands can be found. It is very common for the

patient to complain at the same time of a certain weaknessand stiffness in the fingers, a certain difficulty in the perform-ance of finer movements, a certain general tiredness of thelimbs, a vague and indefinable feeling of uselessness. This

parasstbesia and dyskinesia may continue unaltered for years,and careful examination may not lead to the discovery of anyorganic signs beyond some slight hypsesthesia in the ulnar orother distribution. In a recent number of the Miinc2eaerMedizinisalte Woaltensorift Dr. O. Wandel has collected 32cases of this condition, 19 of which occurred in women.That occupation is of some importance in determining the

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incidence of the disease on the upper extremities is clear; Dr.Wandel has noticed its frequency in washerwomen, scrubbers,and milkers; persons occupied daily in ordinary housework,in sewing, dusting, cleaning, &c., are very liable to it. In

some of the cases the symptoms are intermittent and par-oxysmal ; the formication becomes acutely painful and isaccompanied by involuntary flexion of the fingers. In none

of Dr. Wandel’s cases were the indications those of brachial

neuritis ; they were, on the contrary, suggestive of imperfectblood-supply to the peripheral nerves, and the view is ad-

vanced that they are associated with arterio-sclerosis, anendarteritis obliterans of the vasa nutricia nervorum. In

some cases this. change has been demonstrated histologi-cally. Treatment based on this pathological conception islikely to prove helpful.

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CONDUCT IN THE LIGHT OF DISEASE.

Sir Henry Montagu, first Earl of Manchester, in his littletreatise entitled ° Ma-nchester al Mondo" has the followingpithy sentence, typical alike in its pathology and its anti-

theses of the seventeenth century. He says: ’’ Everyhumour in us engenders diseases enow to kill us, so that ourbodies are but living graves, and we die, not because we aresicke, but because we live." Few things in the practice ofmedicine are more striking than the way in which somepatients will go on leading their ordinary life the while theycarry about with them conditions enough to make a seriousbreakdown not only possible but eminently probable. And

yet from various causes they do not complain. In

Vol. XII. of the Arehaves of the lIIiddlesex Hospital whichwe deal with at length in another column is a case in whichDr. R. J. Gladstone describes an aneurysm of the arch of the

aorta, multiple tuberculous lesions, including a perforatedulcer of the intestine, and hernial sac coexisting in a manwho ultimately died from acute lobar pneumonia. These

various lesions were found in a dissecting-room subjectwho had only complained of symptoms three months beforedeath. As if these lesions were not enough he also had aleft pleural empyema and a thrombus of the thoracic ductwhich completely blocked it. The really sick patient whodoes not seek medical advice or complain may be dividedinto four classes. Firstly, there is the patient who suspectssome very serious or fatal disorder-for instance, a womanwho suspects she has a cancer. We say suspects, but she

practically knows, and yet she dreads to be told the fact,with the result that she hesitates to submit herself to a

medical verdict until she is past the reach of effective aid.Secondly, there is that class composed of people who takea somewhat fatalistic view of life or death and who tell

themselves that it is no use worrying and that they Iwill just go on as long as they can. Thirdly, thereis the class composed of persons suffering from some

very chronic complaint, such as, for instance, the

business man suffering from granular kidney. He isconscious of feeling vaguely unwell, but having so much toattend to, and never " bothering much about himself," as heexpresses it, he goes on with his daily occupation until oneday a cerebral haemorrhage or an acute pleural effusionstrikes him unexpectedly down, or perhaps one morning hewakes to find himself partially blind. And lastly, there arethose brave souls who, knowing that they are doomedwithin a few years at the most, take up their burden for thesake of those near and dear to them, or for very love oflabour, and work with undiminished courage to the end.Robert Louis Stevenson was the type of this class of sufferers,and our own profession can afford other shining examples.The nam(of John Hunter comes at once to mind. Contrastwith these that large class of persons who with nothing what-ever definite the matter with them, or with nothing

but some illness which is due to their own self-

induigence, fly from one medical man to another, whilein the intervals of orthodox treatment they dose them-

selves with all the various quack remedies which figure solargely in the advertisement columns of the daily press andthe popular monthly magazines. They are always com.plaining, never satisfied, and are a nuisance to themselves,to their friends, and to their medical man for the time being.The type of this class is the man who habitually over-distends his stomach and who translates the resulting fre-quent attacks of cardiac palpitation into the warnings ofapproaching death proceeding from a heart in a condition ofhopeless disease. The contrast is a remarkable illustration

of the complexity of human nature, and can only beparalleled by the way in which the really poor suffer in

heroic silence, while the loafer parades the streets withbanners inscribed 6 Curse your Charity " at one end of theprocession and a collecting-box at the other.

THE MEDICAL TREATMENT OF SCHOOLCHILDREN IN LONDON.

AT the meeting of the London County Council on

Tuesday last the Council had under consideration an

important report from its Education Committee present-ing a report of a special subcommittee appointed in

July, 1907, to consider the desirability of providingmedical treatment for the Council’s school children. A

comment upon this report by the Finance Committee wasalso presented. The treatment of diseases of the teeth and

eyes, of ringworm, favus, suppurating ears, adenoids,debility, and tuberculosis has been especially considered

by the subcommittee, whose chief terms of reference wereto inquire into the present provision for treating schoolchildren in London, into the desirability of providing addi-tional facilities for that object, and into the best method ofproviding any further facilities that may be desirable. Thedebate upon the report was adjourned and we shall refer toit at greater length when we are able to record the con-clusion of the Council’s deliberations. In the meantime we

will say that the report recommends the provision of treat-ment of the diseases specified in existing hospitals and dis-pensaries under a suitable financial arrangement betweentheir managers and the Council in preference to the establish-ment of a system of school clinics in London.

LINIMENTUM IODI IN THE TREATMENT OFTUBERCULOUS SINUSES.

Mr. W. Arthur Tatchell of Hankow, Central China, hassent us an account of the success which he has had

in the treatment of chronic tuberculous sinuses. The

slowness with which these sinuses tend to heal is known

to all surgeons, and Mr. Tatchell had in 1908 under

his care a large number of cases of tuberculosis of

joints, bones, and glands, and it occurred to him to

employ a strong solution of iodine. He chose the linimentum

iodi, or, as it is now called, the liquor iodi fortis, which con-tains 1 part of iodine in about 10. The results were very

satisfactory, for the discharge ceased almost immediatelyand healing was rapid. The application of this strongsolution of iodine, he tells us, is painless, except whensome specially tender surface is treated. The iodine is

applied daily and the wound is lightly plugged at the

time of operation. A few years ago some surgeons

employed a weak solution of iodine as an antiseptic forinstruments and as an application for wounds and the

results were good. The effect on the part to which it is

applied is not merely superficial, but the drug penetratessome little distance into the tissues, though toxic symptoms