Y2,8 ?RR anug I GTNSHOT WOUNDS OF 'TI RNEE. ULI 23,

irovision had been made-for their treatment "in an institutionwith 105 beds at Golder's Green, and its accommodation wasabout to be increased by 50 beds; other suitable accommodationwas being sought in the neighbourhood -of London. On July21st a hospital for 50 of these cases was opened near Belfast.At Leeds 1Obeds were being provided, and at Leicester another100. Men were also being sent on the recommendation of thespecial board to recuperative work on farms in Essex; He-hoped by these institutions, increased to any extent that mightprove necessary, to carry out with State funds the objects ofthe appeal to private charity referred to in the question.If there were any mental cases or any insane mei as the resultof shell shock or any other cause, they were suibly prvdefor. These institutions might happen to be lunatIc asylmsprovided out of public funds, but these cases were not treatedas pauper patients, but as private patients without taint o£pauperism. They-were paid for at special rates by the Govern-rnent. Allowances were made to wives and children on thewidowand children scale.The lledical Board of the Itdia Office.-Sir William Collins

asked the Secretary of State for India what were the powerssnd -duties and who were the mibers of the Medical Board ofthe India Office. Mr. Meutau replied: The dutied of the IndiaOffic& 'Medical Board are to report on the me4ical fitness orVUiness of such membersol'the India wservices or candidatesfor appointment to Indian services as the Secretiry of Staterequired to come before the board f6r examination. The boardwas- at -present composed of Surgeon-General Sir HavelockCharles,- G.C.V.O., I.M.S. (ret.) (President), and Lieut.-ColonelJ. Anderson, C.I.E., I.M.S. (ret.).Pay for Maeb Medically Re-exarnined.-In the House of

Coimmons on July 20th Mr. Macpherson, replying to Mr.-Watt, said th-at men called up for medical re-examinationreceived a whole day's pay and ration allowances, amountingto 2s. 9d. in all. Special instructions were issued on July 5thcalling attention to the fact that all men Were to receive thisallowance, irrespective of the date on which they were calledap. Mr. Wing asked whether whien men were called up by theexamination form on one day and had to go on a second theywould'have pay for both. Mr. Macpherson thought that a veryreasonable request and promised to convey it.

TREATMENT' OF GUNSHOT WOUNDS OFTHE KNEE.

SPECIALARZT FtR CHIRURGIE DR. HADDAEUS, in describingthe results of treatment in seventy cases of gunshot injuryof the knee-joint, stated that it had been necessary to dis-card the aseptic methods of civil practice. Since allgunshot injuries were to be regarded as infected a returnto the older antiseptic method was inevitable. Haddaeusat first used a 3 per cent. solution of carbolic acid forinjection into the joint; in some cases no suppuration tookplace but in others this treatment failed. In severalcases, moreover, considerable quantities of carbolic solu-tion remained in the joint owing to the small size of thetrocar opening. To meet this difficulty, after injection ofthe joint he made an incision through the trocar openingand thoroughly irrigated the joint. These cases almostalways healed rapidly and without any inflammatory re-action.. He accordingly adopted this as-his regular methQdin severe cases. In slighter cases he usedpuncture withoutincision, using a large trocar and washing out the jointenergetically. He lhad never seen any case- of poisoningfollowing the use of carbolic acid. From the intensehyperaemia set up within the joint by this meth6d-Haddaeus was inclined to attribute the antiseptic effectless to the bactericidal action of the solution than to thehyperaemia.i He therefore attempted to increase thebyperaemic aotion by the addition of other agents. Hefound a- 10 per cent. solution of iodoform ether speciallyactive in this respect, a temporary contraction of thearterioles gradually giving plice to intense congestion. Incertain cases a 2 per cent. solution of collargal was em-ployed with good results. It was employed, on accountof its stimulating influence in the formation and organiza-tion of granulation tissue, for irrigation during the laterstages, and appeared to be of value in promoting theclosure of the upper recess of the knee-joint.

Haddaeus's procedure was* as follows: In apparentlysimple cases of haemarthrosis, where the presence of aforeign body or of wound of the capsule-could be excludedwith some certainty, a large troear was entered at theouter aspect of the joint, the blood allowed to flow out,and the joint distended several times with 3 -per cent.solution of carbolic acid, the patella being raised to permit,the fluid to reach the upper recess. The trocar was with-

drawn before completely emptying the joint, so that t4ifluid subsequently coming away might sterilize a possibleinfection of the puncture from the skin or the joint itselfThe puncture was made under anaesthesia by ethyichloride rather than novocain, since HHaddaes considered that the latter rendered the tissues more snbjeet tbe attacked by a spireading infection. The leg was thenimmobilized in a long Volkmann's splint, with the kneeleft freely under observation.In severe eases, with large contaminated wounds in the

neighbourhoo of the joint, or with-fragrdento hi the j-oilit,or in which punture with the trocar sho*ed that thehaeuiatoma was already suppurating, or in Which thecapsule itself was wounded-in all such cases the joint wasopened on each side by an incision into the upper recess.The wound edges and capsule were then held apart withhooks, and the joint cavity thoroughly irrigated withcarbolic acid -slution, thea inner surface of the join -beingat thee -s-ame time vigorously swabbed-and rubbed., Finally,10 c.cm. of a 10 per cent. solution of iodoform ether wasrun into the joint and allowed to renain -for -a few seconds,and the limb put up in a Volkmann's splint. In-this wayit was often possible X prevent an infection from becomingmanifest or to arrest it. -In 68 of Haddaeus'8 70 cases,many-of-them infections of the severest kiind, recoveryfollowed.Where. the knee-joint was- wounded from behind-

Haddaeus enlarged thie wound in the capsule in order 'togain free-access to the joint.. This generally Aufficed, butin two cases it was necessary also to open the joint bIelowthe patelia, the ligamentum patellae being split longi-tudinally and the apex of the patella excised. Haddaeusdid 'not consider the bacteriological exainiiation of thefluid contents of the joint, at all equal in value, as anindication for operative treatment, to -the clinical evidenceof infection. Suppuration often folloWed in -cases? inihich the aspirated fluid was sterile, the explanationbeing probably that the joint, originally sterile, becamesubsequently infected from the surrounding tissues.Of the cases treated 63 recovered with a movable joint

-that is to say, the joint could be voluntarily moved insome degree, and in many of them there was already goodmovemilent.

WAR NEPHRITIS.PROFESSOR MAGNUS-ALSLEBEN,I. in a paper on acutenephritis, observed among,soldiers between January andOctober, 1916, states that the first twenty were under hisobservation only two to three weeks, the cessation of, thelmost acute symptoms being the signal for drafting themelsewhere. It was then recognized that transport in thisearly stage frequently provoked acute exacerbations, andsubsequently the patients were nursed in one place for twoto three months. An immediate rise in the blood pressuredid not always occur; among at least a third of his casesthere was no appreciable rise. Yet this feature did notdisqualify these cases for inclusion in the category of warnephritis, for the other signs of renal insufficiency-oedema,etc.-were the same as those observed in patients with.high blood pressure. In about half of his cases the bloodpressure was considerably increased (150 to 180 mm. ofmercury). Within one to two weeks the blood pressurealmost invariably fell gradually to normal, -but an ab-normally high blood pressure was still demonstrable after-the other symptoms and the oedema had passed off. Inmost cases disturbances of the circulation and of excretionvanislhed quickly and completely. On the otlher hand, atrace of albumin and a few casts and red cells were oftenfound in the urine for several months in spite of strictrest in -bed. He saw only five cases of uraemia; .itoccurred as a rule in the period of increasing diuresis;-venesection supplemented by saline infusion proved bene-ficial, and no deatlh occurred. He considered that theAnmount of fluid given should correspond with the excretionof urine, and that the old fear that a scanty supply offluid favoured retention of nitrogenous bodies was exag-gerated. The diet should be rich- in calories, poor innitrogenous bodies and salts. Professor Magnus-Alslebenstates that all' recent Germin publications agree~that warnephiritis is not a new disease, but is the well knowrnacute glomerular nephritis wvhich is a common sequel toscarlatina.

l Kench. med. Woc,., December _2h 196

TUMOR ALBUS PYOGENES. I

T lMn¶n NA -I29

Professor Beitzke and Dr'. Seitz 2 have carried out thef6llowing investigations to ascertain whetlher war nephritisis a microbic disease or not. In thirty cases, terminatingfatally, they examined serial sections of the kidneysstained with polychrolue methylene blue and witlh Leva-diti's silver impregnation. In two cases they found smallcoccal emboli, which had apparently originated in puru-lent, bronchopneumonic foci. Thle verv fine Gram-nega-tive rods often seen and the spirochaetal-like structuresobserved in thlree cases were evidently artificial, the resultsof the silver stain. Thus, in the majority of cases, nomicro-organisms were found. In fifteen cases a bacterio-logical examination of the blood and urine was made,always with negative results. Tlle blood examination alsofailed to show eosinophilia. The authors apparentlyattached no imiportance to small Gram-negative rodsstated to have been found in urine-bouillon cultures intwo cases. Intraperitoneal injections of urine -and de-fibrinated blood were made from several cases into miceand guinea-pigs, four mice and two to four guinea-pigsbeiang, as a rule, used for eaclh case. At first half thenumber of these animals were chilled in ice water justbefore inoculation with a view to promoting the develop-ment of nephritis. But this procedure was abandonedwhen it was found that it alone was sufficient to causealbuminuria lasting several weeks. The animals which sur-vived the inoculation were killed eiglht days to eight weeks-later, and the liver and kidneys examined in the samemanner as the kidneys of the patients dying of warnephritis. Most of the animals, particularly the guinea-pigs, showed more or -less definite nephritis, but theclXled animals were not more affected than the others.Sections of the kidneys in several cases showed smallGram-negative rods, but these, again, were regarded asartificial, created by -the stain. The authors concludethat their investigations failed to show an infectiousetiology of war nephritis.

TUMOR ALBUS PYOGENES.PROFESSOR A. TIETZE has described, under tlle name of"tumor albus pyogenes," an unusual form of chronicinflammation which at times affected wounded tissues andcaused delay in healing. It occurred more especially insuppurating gunshot injuries of the bones and joints, andwas characterized by great swelling of the capsule of thejoint, and of the surrounding soft parts, which were con-verted into a gelati4ous, oedematous granulation tissue,traversed by numerous sinuses. Fever was absent, andthe discharge from the sinuses sterile. The appearancesclosely resembled those of the white swelling of tubercle,or the analogous condition more rarely met witlh in syphilis.In the cases in question, however, those diseases wereexcluded, and there seemed to be no doubt tlhat the condi-tion had its origin in the injury and the accompanyinginfection. The following case is an example of thecondition:A comminiuted gunshot injury of the elbow-joint, with suppu-

ration; excision of the joint. Observed a month later theinfection was found to be quiescent, but several unhealthywounds were present, and the whole region of the elbow haduudergone marked swelling, causing a fusiform enlargement ofthe limb from the middle of the arm to themiddle of theforearm.The swellinlg involved the soft parts only, -the bones showing, bythe x rays, merely the changes resulting from the excision, andone or two fragments of the projectile. The ulnar nerve wasparalysed, but was subsequently proved not to liave beeninjured.Tiele explained the origin of the condition on the

supposition thalt while tlle infection ceased to be active,a formative irritation was set up in the damaged soft partsbv small foci of necrosis resulting from the past infection,and by minute fragments of the projectile or bone im-planted into tlle tissues by the explosive action of theinjury. An examination of tlle parts removed in caseswhere excision lhad been performed appeared to supportthis theory.The course of this very chronic process could not be

accelerated to any appreciable degree by operation, sinceit was impossible to locate and remove the numerous fociof irritation present; there was, moreover, the ever-presentdanger of liglhting up the quiescent infection throughoperative interference. It- seemed preferable to limitoperative measures to enl,rging the, existing sinuses wherethebe appeared to afford an insufficient outlet for tlie

2Berl. M in. Wocli.. December 4th, 1916.

discharges. Tietzelad,l owever, found tlat a rapid diminu-tion of the swelling in these cases, with arrest of thechronic process and rapid lhealing of the wounds, followedthe administration of potassium iodide.

HONOURS.A SUPPLEMENT to the London Gazette dated July 18thcontains a further list of awards to officers, non-com-missioned officers, and men for conspicuous gallantry anddevotion to duty in the field. The list includes thefollowing medical officers:

D.S.O.Temporary Captain James Harding Barry, M.C., R.A.M.C.,

attached London Regiment.For conspicuous gallantry and devotion to duty in attending to the

wounded under exceptionally tryring conditions. Under very heavyohell fire he dug out five men who were buried, and amputated twomen's legs on the spot. He showed utter disregard of any personalrisk, and his examiplewas splendid.

Major Lionel WilfredBv3hd, A.A.M.C.When in charge of advanced Ctllecting and forwarding posts his

total disregard of danger under a terrific hail of gas shells, H.E.,and shrapnel fire gainedhim-the confidence of all ranks and greatlyassisted the evacuation of the wounded. Later, although woundedand partly gassed, he refused to leave his post, and his bravery anddevotion saved a very critical situation.

Major Herbert Percival Brownell, A.A.M.C.For conspicuous gallantry and devotion to duty whilst attending to

the wounded under heavy fire. His coolness in organizing mattersamnidst the greatest confusion enabled the wounded to be expedi-tiously treated, and he personally treated some hundreds of casesunder heavy shell fire.

Major Horatio Victor Patrick Conrick, A.A.M.C.For conspicuous gallantry and devotion to duty in attending to the

wounded. He proceeded to the scene of an explosion under veryheavy shell fite, and personally directed the removal of the wo'unded.His fearlessness and disregard for his personal safety has beenmarked on all occasions.

Temporhry Captain James Henry Fletcher, M.C., R.A.M.C.He showed the utmost bravery and coolness when commanding

the bearers. He worked continuously under artillery and machine-gun fire. It was largely due to his gallant conduct spat somanywounded were safely evacuated.

Temporary Surgeon William Jamed'McCracken, M.C., R.N..For conspicuous gallantry and resource during operations, when.

after attending wounded in captured dug-outs, he pushed forwardinto a village which was being heavily shelled, compelled a capturedenemy MO.. to show the' best enemy R.A.P., and then kept him, withtwelve enemy Red Cross men, busy all day bringing in and dressingover 150 of our wounded, who otherwise could not lhave beentreated, and then sending themi down. He also searched the frontline under a heavy fire for.wounded.

Bar to ,Iilitary Cross.Temporary Captain Charles Bromley Davies, M.C., R.A.M.C.

He was in command of the bearer division when evacuation wasmost difficult. He showed great ga-lantry and resource in pushingforward under heavy fire and rescuing several wounded men.(Military Cross gazetted August 25th, 1916.)

Temporary Captain James Churchill Dunn, M.C., M.D.,R.A.M.C., attached Royal Welsh Fusiliers.

For conspicuous gallantry and devotion to duty in,-attending tothe wounded. He crawled close up to the enemy's wire, accom-panied- by another officer, and brought- in a wounded mllan on awaterproof sheet. (Military Cross gazetted August 25th, 1916.)

Temporary Captain Harold Garnett Janion, M.C., R.A.M.C.attached R.H.A.

-He was assisting to remove the pilot from a wrecked aeroplanewhlen the spot came under heavy fie from a' hostile battery.Several of the bearers were wounded, but by his courage andexample this officer collected fresh bearers and conveyed thewounded mien to safety. This task was carried out under continuousshell fire. (Military Cross gazetted June 23rd, 1915.)

Captain Maurice Baylis King, M.C., M.B., R.A.M.C.(S.R.).For conspicuous gallantry and devotion to duty in rescuing

wounded under very heavy shell fire. His fearlessness get a splendidexample to the stretcher-bearers, who were then much shaken bythe heavy shelling. (M1ilitary Cross gazetted January 1st, 1917.)

Captain George Seabourne Robinson, M.C., A.A.M.C.He displayed great courage and determination in attending

wounded under heavy fire. On one occasion lhe personally led aparty out in front of our line for the purpose of searching andattending the wounded not yet collected. (Military Cross gazettedJune 4th, 1917.)

Temporary Captain James Lennox Stewart, M.C., M.B.,R.A.M.C., attached Gordon Highialnders.

He behaved with the utmost gallantry in removing the woundedunder shell fire. He continuled to work in the open exposed tosevere shell and miiachine-gun fire until every wounded man hadbeen brought in. (Military Cross gazetted May 16th, 1916.)

M,lilitary Cioss.Temporary Captaini Frederick Carson, M.B., R.A.iM.C., attached

Royal West Kenit Regiment.He behaved with the greatest gallantry in attending wounded

under pontinuous heavy shelling. His total disregard for personalsafety set a fine example to those around him.

Temporary Captain Henry Joseph Cotter, R.A.M.C., attachedLincolnshire Regiment.

Although wounded on -tle previous day, he declined tobe-relieved,-and e6ntinued to dress wounded in the open tunder heavy fire, goingthrough heavy barrage to reach some men lyiing out in an exposedposition.

I

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W 7 e m p o lalv ~~~~IO OT R~[apta i 28,el!itr G r i , h I17R.. . .

ITrim BR1Tisn 1

13 MEDICAL JOURNAL J

Tattporarv Captain Albert Victor Craig, M..B., R.A.M.C.,attached Royal Field Artillery. a I

Though -suffering himself from the effect of gas shells, he displayedthe greatest bravery and the most untiring energy in attending tothe wouinded under fireof heavy guins and gas shells. He risked hislife day and night without the slightest hesitation.

'Temporarv Captain John Nissen Deacon, M.B., R.A.M.C.,attached East Yorks, Regiment.

He showed exceptional bravery and resource on several occasionsin attending to the wounded under very heavy shell fire, vith com-plete disregard for his own personal safety.

Temporary Lieutenant Cyril Duncan, M.B., R.A.M.C.For conspicuous bravery ald devotion in attending wounded

close to a large ammunition dump which was on fire, with splintersand shrapnel shells flying about, and later, although partiallygassed, attending wounded under heavyT gas shell fire.

Captain Hugh Hart, C.A.M.C.He displayed the utmost gallantry and courage In attending

wounded continuously under heavy shell fire.

Temporary Captain James Dunican Hart, M.B., R.A.M.C.,-attached London Regiment.

He com-manded an aid post close to a piece of heavily shelled road-way. He continually went out into the open road and attendedwoundedmen under heavy fire, with a total disregard for his ownpersonal safety.

Temporary Captain Charles Reginald Ralston Huxtable, M.B.,R.A.M.C., attached Lancashire Fusiliers.

He sho-wed the uitmost skill and bravery in attending to andevacuating wounded. Wheen seven of his bearers were buried by ashell he at once, despite the intense hostile bombardment, organizeda party and dug them out.

Temporary Captain Charles CloustonIrvine, R.A.M.C., attachedEast Yorkshire Regiment.

He took his stretcher-bearers out under heavy barrage fire andbrought the woutnded back safely, carrying one imian back on hisshoulders. Hiscomnplete disregard for his own personal safety was.most marked.

Captaini Cyril Jacobs, M.B., R.A.M.C.(S.R.), attached Lincoln-shire Regimenit.

After an assault he went out over the whole ground in daylight,cleared as many of the wounded as possible, and, having located thewounded who were in the enemy wire and close to it, ¢ompletedhis task by nightfall. He succeeded in evacuiating all woundedmen.

Temporary Captain RichlardDrthin Hilton Jones, R.A.M.C.For miiany hours he had to occupy a most exposed position under

heavy fire, where he dressed and attended wounded at great personalrisk.

Captain Douglas Ballantyne Kennedy, C.A.M.C.He directed the work of the stetcher-bearers for forty-eight hours

without rest, ald repeatedly aided the wounded under very heavyshell fire.

Temporary Captain Franicis Kenneth Kerr, M.B., R.A.M.C.,attached Royal Scottish Fusiliers.

During heavy and accurate hostile fire he continued to dress-wounded. although the building was hit several times. His fineexample was of the utmost value to those around him.

Cuptain Charles Herbert Leedman, A.A.M.C.Although he and several of his staff were wQunded by the heavy

shelling of his post by the enemy, he continued, with the greatestgallatntry, to attend the Wounded, remaining at his post until itbecame untenable.

,Captain (now temporary Major) Ronald Hugh Macdonald,C.A.M.C.

-One of our aeroplanes was shot down, the observer was wounded"and pinned beneath the wreck. This officer and a bearer went outin full view of the enemy, who wereshlelling the machine, and,extricated the wounded man and removed him to safety. He-himself was severely wounded while doing so.

Temporary Lieutenant Joseph Randolph Morell Mackenzie,M.B. R.A.I.C., attached South Staffordshire Regiment.

For conspicuous bravery-and devotion on numerousoccasionswhen attending wounided and leading stretcher-bearer parties nuder,every kind of heavy and continuous fire, and invariably exhibitinggreat skill, coolness, and contempt of danger.

Temporary Captain Randal Vivian McDonnell, R.A.M.C.,'attached Bedfordsliire Regiment.

For over -forty-eight hours he attended miiore than 200 wounded,many having to be dressed in the open underheavy fire. His totaldisregard of personal danger was beyond praise.

Captain Malcolm McGillivray, M.B., R.A.M.C.(S.R.), attachedSouth Wales Borderers.

Althoughl his dressing station was twice blown in, and himselfextricated with great difficulty, he continued to attend woundedunder heavy shell fire.

Temporary Captain Daniel McKelvey, M.B., R.A.M.C., attachedGordon Highlanders.

Duiring an attack by his battalion hefollowed them closely andattended to the wounded in the open under very heavy fire. Hisfearlessness and gallant conduct throughout the operations wasmost marked.

Temporary Captain Mlurdo Mc6Kenzie McRae, M.B., R.A.M.C.,attached Northumberland Fusiliers.

Owing to the shortage of bearers this officer carried in during thenight seven or eight wounded m-en who otherwise would have diedin the snow. He has performed consistent good work throughout.

Captaisi Robert James Maiion, C.A.M.C.While going forward through a heavy hostile barrage to establish

an aidI)ost he at greatDersonal risk stopped and dressed alone ninewounded men.

Temporary, Captain Arthur Gilbert Michelsen !Middletoi,R.A.M.C.

He showed great gallantry and bravery in carrying in two woundedmen under heavy hostile shelling. He displayed the utmost disregardfor danger throughout in carrying out his duties.

Captain Cyril Charles Minty, A.A.M.C.He showed the greatest courage and fearlessness in attending

wounded whilst exposed to heavy shell fire and gas fumes, andassisting to carry them to the collecting post. The stretcher-bearers had suffered severe casualties, and it was owing to hismuagnificent example that they maintained their courage andendurance.

Temporary Captain George Lynn Pillans, R.A.M.C.He showed great determination and courage in -leading bearor

squiads through heavy barrage. This he did several tim-es, andthroughout superintended the evacuation under heavy shell fire.

Temporary Lieutenant Joseph Rickards, M.B., R.A.M.C.,attached Royal Scot.

He attended a large numiber of wounded in a barn- which wasunder heavy shell fire. During. the night he organized a partywhich brought in many wounded from an exposed position on thebattlefield.

Temporary Surgeon James Ness MeBeain Ross, R.N.For conspicuous gallantry and devotion on mnany occasions in

organizing and leading stretcher-bearers in search for wounded, andattending them under very heavy fire.

Temporary Captain John Finlayson McGill Sloan, R.A.M.C.His dressing station being blown in on the top, he dressed over

200 cases under very difficult conditions. He had to twice changehis dressing station.

Temporary Lieutenanit (temporary Captain) Harry NevilleStafford, R.A.M.C.

Having received a message that many wounded were on heavily-shelled ground, he organized rescue parties, and brought them allin, although he was severely wounded in this gallant work.

Temporary Captain Charles Gordon Timms, R.A.M.C., attachedRoyal Fusiliers.

For two days he attended the wounded in the open under heavyand incessant shell fire, quite regardless of personal danger, and hiscoolness and energy alleviatedmuch suffering.

Temporary Captain William Annandale Troup, M.B., R.A.M.C.,attached Wiltshire Regiment.

He displayed the utmost skill and endurance in clearing thewounded between the lines after the attack. Through the day hecarried out his task under continuous shell fire, and was thusinstrumental in saving m-iany lives.

Captain Alexander Guthrie Semple Wallace, M.B., R.A.M.C.(S.R.), attaclhed Royal Lancaster Regiment.

He continued to attend wounded men in the, front line trenchdespite hostile bomiibardment. His total disregard for personaldanger set a fine example to those around him.

Temporary Captain Robert Bruce Wallace, MI.B., R.A.M.C.,attachedLeicestershire Regiment.

For conspicuous bravery and devotion on many occasions, andnotably when suffering from a painful wound he not only continuedto dress wounded but went out with stretcher-bearers under heavyfire and dressed and brought inmen unable to move.

Temporary Captain Donald Alexander Warren,, R.A.M.C.,attached Royal Warwickshire Regiment (LieutenantC.A.M.C.).

He continued to attend wounded for over an hour under heavyartillery and machine-gun fire and in full view of the enemy, Later-he established an aid post, and carried on for forty-eight hourswithout rest under continuous fire.

Temporary Captain Philip James Watkin, R.A.M.C., attachedBedfordshire Regiment.

For two days he dressed wounded under heavy shell fire, and,when- the captured trenches had been cleared, he commenced tosearch the shell holes in No Mans Land," in spite of heavy saipingfire, until ordered to desist.A bar to the Military Medal has been awarded to one

non-commissioned officer of the R.A.M.C., and two non-commi<ssioned officers and two privates of the A.A.M.C. TheMilitary Medal for bravery in the field has been awarded toSister L. E. James (Queen Alexandra's Imperial NursingService), Actinig Sister E. Maude (Queen Alexandra ImperialMilitary Nursing Service Reserve), twenty-fournon-commis-sioned officers and seventy-two privates of the R.A.M.C., thirteennon-commissioned officers and twenty privates of the A.A.M.C.,two non-commissioned officersandtwo privates of the(.A.M.C.,and five privates of the S.A.M.C. Tie Distinguished ConductMedal is awarded to two non-commissioned officers aiml oneprivate of the R.A.M.C.

MENTIONED IN DISPATCHES.-A supplement to the Lonidont Gazette, issued oii July 21st,containis a list of officers, warraiit and non-commissioiie,

officers, men, and nursing staff of tlhe Blritisli Salonica Forcebrought to notice by Lieutenant-Genieral G. F. Miie for(lis-tingaLished service duriiig the past six montlhs. 'Ile followvingmedical officers aremenltioned in the list:

SALONICA.ArmiyMIIcedical Sen- -ice.

Temporary Coloniel F. D. Birtl, C.B.

Royal Awimy ille(liC(illh)p..Lieut.-Colouels (temporary ColQuels): J. C. ColillO:, C.'1'. .Maurice, C.M.G., P. MacKessa,ck.Lieut.-Colonel J. R.Wbait, M.B.'Majors (temporarry Lieut.-Coloinels): L. L. Fishel, ,A. E. KiAd,

J. Matthews.

[SUt'r 28,HONOUIRS.

JULY 28, 10I7J CASUALTIES IN TIM MEDICAt 8ERVICEd. rMEDCALI JOUNA 131

Majors: F. J. Garland, P. H. Henderson, D.S.O., E. B.Waggett, W. J. Weston, R. K. White.Temporary Majors: K. W. Monsarrat, H. Wiltshire.Captains (acting Lieut.-Colone}s): P. G. M. Elvery, Al.C.,h. Johnson, A. D. O'Carroll, G. H. Stevenson.-Captains (temporary Majors): C. M. Fegen, W. D. Sturrock.Captains: D. V. M. Adarms (Res. of Off.), J. H. Beverland,

T. Carnwath, C. Clarke, D. M. Corbett, R. 0. Eades, E. G.Gauntlett, J. P. Litt, J. Mair, G. P. Mills, M.B., W. L. Murphy,L. G. Parsons, F. Scroggie, R. G. Shaw, C. S. Staddon (S.R.),A. L. Urquhart, V. I. Wardle.Temporary Captains: D. Bird, J. H. Box, C. A. Boyd,

St. J. De Buxton, J. H. Cuthbert, R. S. Dewar, W. H. Fleetwood,S. H. Hay, W. A. L. H. Henderson, G. B. Holroyde, A. G. Howson,J. F. W. Leech, J. Al. Maefie, F. Paine, T.. E.- Parker.Temporary Lieutenant J. M. Hammond, D.S.O., ALB. (died

of wounids).Honorary Lieutenants and Quartermasters: P. A. Baynes,

T. E. Coggon, M.C., A. T. Hasler, M.C.Temporary honorary Lieutenant and Quartermaster A. J.

Wiseman.Caanadian. Army Medical Corps.

Lieut.Colonels: W. B. Hendry, E. J. Williams.Majors: C. S. McVicar, H. C. Parsons.Captainis: J. E. Campbell, W. A. Clarke, J. G. W. Johnson.Honorary Captain and Quarternmaster H. J. Middleton.

Indian Mlledical Service. <Major E. Bisset.

FRANCE.A supplement to the London Gazette published on July 23rd

contains an additional list of officers, non-commissioned officers,and men recommended for distinguished and gallant conductand devotion to duty in Sir Douglas Haig's dispatch ofApril 9th. The following medical officers are included in thelist:--Lieut.-Colonel G. H. Goddard, R.A.M.C..Temporary Captain (acting Lieut.-Colonel) L. D. Shaw, M.B.,

R.A.M.C.'Captain G. E. Cole, A.A.M.C.

CASUALTIES IN THE MIEDICAL SERVICES.

ARMY.Died onz Service.

CAPTAIN F. A. DERAVIN, Australian A.M.C.

CAPTAIN IAN MACFARLANE, R.A.M.C.Captain Ian Macfarlane, R.A.M.C., died at the Military

Hospital, Cairo, at July 18tlh. He was -the elder son ofthe Rev. Norman C. Macfarlane, of Juniper Green, Mid-lothian, and was educated at Edinburgh University, wherehe graduated M.B. and Ch.B. in 1911. He worked forsome time as medical missionary at Nazareth, but had toleave Palestine when Turkey entered tlhe war. He took atemporary comnrmissioln in the R.A.M.C. as lieutenant onApril 14th, 1915, and was promoted to captain after ayear's service. He was recently in charge of a militaryhospital near Gaza.

LIEUTENANT J. E. FOREMAN, R.A.M.C.Lieutenant John Eugene Foreian, R.A.M.C., was re-

ported as having died on service in the casualty. listpublished on July 21st. He was educated at the LondonHospital, took the diplomas of M.R.C.S. and L.R.C.P.Lond.in 1936, and, after acting as house-surgeon of the RoyalVictoria and Vest Hants Hospital at Bournemouth, wentinto practice at West Southbourne. He had only recentlytaken a temporary commission in the R.A.M.C. and wassenior resident medical officer of Boscombe MilitaryHospital.

Died2of Wounds.LIEUTENANT B. COHEN, R.A.M.C.

A Correctiont.In the casualty list published on July 13th the death

frolmi wounds of Lieutenant B. Cohlen, R.A.M.C., wasannounlced, and it was erroneously assumed that thereference was to Dr. Bertram Cohen of Sidmouth.We regret the error, and are glad to learn that thisofficer is in good healtlh, and serving on thestaff of the Royal Naval Hospital, Plymouth. The officer

who died would appear to be Dr. Benjamin Colhen, for.merly of Cape Town, who received his commission -aslieutenant in the R.A.IC. in Novembeir, 1916. Dr.Benjamin Colhen was educated -ut the -University ofGlasg,ow and St. Bartholomew's Hospital, and took thedegrees of M.B., Ch.B.Glas. in 1913. He was honorarymedical regiptrar at the New SQmerset H<,pital, CapeTown, and additional medical officer and anaesthietist tothe Free Dispensary, Cape Town.

LIEUTENANT J. S. MUNRO, R.AM.G.Lieutenant James Sutherland Munro, R.A.M.:C., died. of

gastritis at the Officers' Hospital, Baghdad, on July 16th.He was the youngest son of Mr. Munro, of Dornoch,Sutherlandshire, and was educated at Edinburgh Uni-versity, whlere he graduated M.B. and Ch.B. in 1900. Hehad only recently taken a temporary commission in theR.A.M.C., having previously been in practice.at Pendleton,Mancliester.

Wounded.Captain J. G. A. Campbell, Canadian A.M.C.Captain W. E. David, M.C., R.A.M.C. (te.mporary).Captain G. D. Eccles, R.A.M.C. (temporary).W.Captain A. T. Hawes, R.A.M.C. (temporary).Captain E. H. Helby, R.A.M.C. (temporary).Captain F. G. McNauglhten, R.A.M.C. (temporary).Captain G. M. Miller, R.A.M.C. (temporary).Captain E. M. B. Payne, R.A.M.C. (temporary).Captain C. P. Rosenthal, Anstralian A.M.C.Captain and Quartermaster A. Morrison, R.A.M.C.Captain H. D. Smart, M.C., R.A.M.C. (temporary).Lieutenant FPCorner, R.A.M.C. (temporary).Sister R. Pratt, Australian Nursing Service.

Wounded anzd Missing.Captain H. H. Ward, M.C.,R.A.M.C.(S.R.).

Erroneously Reported Wounded.Captain E. A. Walker, R.A.M.C. (temiporary), previously

reported as wounded (BRITISH MEDICAL J OURNAL, July 14tll)was reported as not wounded in the-casualty list publislhedon July 19tlh.

DEATHS AMONG SONS OF MEDICAL MEN.Cooke, Christopher A. G., Midshipman R.N., eldest son of

Lieut.-Colonel A. Cooke, R.A.M.C.(T.F.), of Cambridge, killedin the blowing up of H.M.S. Vanguard on July 9th. He wasborn in 1899, entered Osborne in 1912, and -was mobilized at theend of his first term at Dartmoutlh. He was serving on H.M.S.Abouwkir when she was torpedoed on September- 22nd, 1314-, andon H.M.S. Vangitard in the battle of Jutland-on May 31st, 1916.De Segundo, William, Midshipman R.N., second son of Major

C. S. de Segundo, R.A.M.C.(T.F.), killed in the blowing up ofH.M.S. Vanguard onl July 9th, aged 17.Duke, Alan C. H., Lieutenant Commander R.N., eldest son of

the late Colonel A. W. Duike, R.A.M.C., died oni July 11th, ofinjuries received in the blowinig up of H.M.S. Vanpguard onJuly 9tih.

Garlike, George Popham, Somerset Light Infantry, secondson of the late Dr. Garlike of Sutton Benger, Wiltshiire, died inhospital abroad on July 5th, aged 35.Green, Charles Arthur, M.C., Second Lieuteinan-t Royal

Garrison Artillery, son of the late Dr. Arthur Green of Gates-head, killed on July 13th, aged 20.Robertson, James, Second Lieutenant Highiland Light In.

fantry, son of the late Dr. James John Robertson of Oakfield,Montgomery, Wales, died of wounds on July-9th, aged 19. He waseducated at Merchiston, where he was in the O.T.C., and hadbegun to work as a farming pupil, when he took a commissionin November, 1916.Woodforde, Hector Sidney Ridout, Australian Imperial

Force, fourth son of William Sidney Ridout Woodforde ofGoondiwindi, Queensland, killed February 25th, 1917.Woodforde, Philip Sidney Soane, Major Australiani Imperial

Force, eldest soIn of the late Alfred Ernest Woodforde, L.R.C.P.,of Uralla, New South Wales, died of wounids oni May 6th. , Hewas a first cousini of Hector Woodforde, both being grandsons ofthe late Dr. W. T. G. Woodforde, of Spencer's Wood, Reading.Ziani-de-Ferraniti, Basil, M.C., Major Royal GarrisonArtillery, eldest son of Dr. S. Ziani-de-Ferranti, of the Hall,Baslow, Derbyshire, died of wounds on July 12th.

MEDICAL STUDENT.Drewe, Adrian, Major Royal Garrison Artillery, killedl on

July 12th. He was the eldest son" of Mr. J. C. Drewe, of W0a-hurst Hall, Sussex, and was educated at Etonl, at TrinityCollege, Cambridge, where he graduated as B.A., with first-class honlours inl psychology, andl had passed his first anld second(MI.B., and at St. Bartholomew's Hospital. He was a wellknown rowing man at Etonl and at Cambridge, where he rowedtharee years in the third Trinity light foar, which was thien head

CORRECTIONS.*The following are among the corrections printed in regard to

the names of those mentionied in Sir Douglas Haig's dispatchprinted in the supplement to the Lowdon Gazette of May 29thRoyal ArmAy Ie(ldical Corps: For temporary Captain J. Davidson,M.B., read Captain J. Davidson, M.B.(S.R.); for Captain G. T.Vasn Der Vyver, M.B.(S.R.), read Captain G. T. Van der, Wyver,M.B.(S.R.).

T-lamaran, SCOTLAND. 1917

of the river, and won the University trial pairs in 1913. He gota commission in the R.G.A. on November 2nd, 1914, and wentto the front in the spring of 1915.

[fTJe shall be indebted to relatives of those wvho are killed inaction or die in tthe wvar for infornation which wvill etable us toniake these notes as comaplete and accutrate as possible.]

NOTES.INVESTITURE:

AT the investiture by the-K-ing at Buckingliam Palace on July21st-.the recipients were in two categories-the men them'selveswho had won distinction, and the near relatives of those whobagd died. In the latter category, unfortunately, occurred thename of Lieutenant Donald Mackintosh, Seaforth Highlanders,who won the Victoria Cross by an act of heroism recorded inour issue of June 23rd, but which cost his life. The cross wasreceived by his parents, Dr. Donald Mackintosh, C.B., medicalsuperintendent of the Western Infirmary, Glasgow, and Mrs.Mackintosh.

IRISH COUNTIES WAR HOSPITAL.THE Irish-Counties War Hospital was formally opened onJuly 18th' by Lady Wimborne.. Her' Excellency saidthat the hospital was the crystallization of a desire on the'part of the counties of' Ireland to pro'vide? by' 'their'' own''efforts and by theii own self-sacrifice some means of' reliefand help for wounded s'oldiers. The idea had originatedwith some' of 'the directors of thee county Rted Crossorganizations, who desired local institutions oor theiIwounded. But it' liad 'been pointe-d 'oit to' them+! tientral hospital in -Coun-ty6 Dublinb` w.ou.db reain'pr&

prioductive of good, hnd it reditafe,tore'op rgaiiza-ations that they had a-t- once sun.k thou'indiridu fliigsand thrown tliemselves s)lheartily and- completely intbthe organization `of a great- central ilospital, where thebiggest and- best results might be -had for the money:that'had been subscribed. The buildng, so well situated, insuch good air, was going to 'be a real help tot the braveIrishmen who would be there. Of the many supportersand founders of the institution, she mentioned Mr. Hely,to whose efforts on behalf of lhe hospital were due somany generous subscribers, and Dr. Lumsden who, in hiscapacity as head of the V.A.D.'s, had done most wonderfulwork in connexion with it.

CRAIGAVON NEURASTHENIC HOSPITAL FOR SOLDIERS,BELFAST.

Lieut.-Colonel James Craig, M.P., and Mrs. Craig havelent their large house and grounds to the Ulster VolunteerForce Hospital Board of Management to be used as ahospital for discharged soldiers and sailors suffering fromneurasthenic slhell shock and kindred affections. Thehouse is situated on the rising ground of the CastlereaghHills, on tlhe south side of Belfast Loughl, and commandsa view of the lough and much of the adjoining beautifuland wooded country; it is about three to four miles fromthe city. The grounds are over 30 acres, and the ownerhas also given permission to make all necessary altera-tions. The committee has arranged to erect a temporary-ward in line with the loggia and large billiard room, and itis expected that the hospital will ultimatelv accommodate100 patients. There will be numerous one-bedded roomsand small wards. The kitchen is enlarged, and a largedining-room is being built adjoining. The billiard room isfor the present to be used as a ward,'but in the near futureit will be converted into a recreation room for concerts,lectures, and through the day for reading, etc. There willbe a nursing staff of one matron, three sisters, and abouttwelve V.A.D. nurses, and accommodation for them isbeing provided upstairs. The Board of Management ofthe Ulster Volunteer Force Hospitals have appointed Dr.H. L. McKisack medical officer in chiarge, and he andDr. W. Calwell and Dr. R. W. L3slie will form thevisiting staff. Dr. J. Adamson, lately h1ouse-physicianin the Royal Victoria Hospital, Belfast, is the residentmnedical officer and superintendent.The opening ceremony was performed on July 21st in

tlhe beautiful grounds in front of the house. The LordMlayor of Belfast occupied the clhair, and called upon Mrs.James Craig, who declared the hospital open, and handedit over to Sir Edward Carson for the Ulster Volunteer

Force Hospit.al' Board. Sir Edward moved a heartyvote of thanks to the donors for their magnificent gift,The Right Hon. G. N. Barnes, Minister for Pensions,, inseconding the vote of' thanks, said the countr'y must nobe content with giving a man a pension; it m'ust build himup and return him a self-supporting and self-respectingunit to the community.

Sir- Arthur Griffith-Boscawen moved a vote of thanks tqthe Lord Mayor for presiding, and expressed his pleasureat being present and his high appreciation of the gift.This, was seconded by Mr. R., V. Williams, Chlirmapn of;the Belfast Branch of the War' Pensions Committee.' Thisis the second war neurasthenic hospital to be opened, andthe sixtlh war hospital Whiclh thiis energetic board hasestablished and is working.- ,It.follows 'on, 'the' lines ofGolders Green, London, and will be under the guidance otLieut.-Colonel Sir John Collie, director of neurasthentiainstitutes.

REPORT OF THE CENTRAL MIDWIVES BOARD FORSCOTLAND.

THE appearance of the report on the work done by theCenttial Midwives Board SftTh4or' for the year endedMarch 31st, 1917, shows that the Midwives (Scotland) Act,which1 was pssed on December 23rd, 1915, is now i4operation. ,The oarW was conqstitheed in February, 1916,b ,ut, until thle two members to ~be; selectedl from .the midi-wives on the roll coulrd beadded, it was eot '& full size;c6h~qii~nty~he'fn wrisiconsoithe rules wbtasy 1e9aye

~~+~ienthe1 ~ n

'anad he41tili :JQard r&eoied tha-tthe currieulum 'etc.,

prves'cribe the'lculddbedaede'd,~~it, asn'th ie ul-si

Thnse ru',shreceiyed the :a{uprovad of tlfe Privy Council onA,ugust ~thl. O)tdr matters .which were att,of_ea tourlig th,e; yeaw,e.largetvofnthe .nature' of. adiustnentqand 'recipro-cal recogiiitio'n 'regarding 'cu'rriculum 'an'&examination between the twro boards. In thle meantime,however, r,cipr,ocal recognition of examinations is incomplete, for midwive.s passing an examination in Scotlandcannot be enrolled in Enlgla'nd without passing also theexamination of the Englishl Board. The first exam'ination'of the Scottish Board was 'held'in October, 1916, wenseventy-seven *candidates entered, of whom; sixty-ninepassed; the examination was conducted simultaneously atEdinburglh, Glasgow, Dundee, anld Aberdeen. iFor the periodto March 31st, 1917, the number of midwives enrolledpwas2,026, including the sixty-nine above mentioned by- exanmi-nation. To the report, which is signed by Sir HallidayCroom, chairman, and D. L. Eadie, secretary, there areappended lists of teaching institutions anld teachlers recog-nized, of certified midwives approved to sign certificatesand of. the examiners. The institutions are' the RoyaMaternity Hospitals in Edinburgh and Glasgow, theMaternity Hospitals in Aberdeen' and Dunde, the Hospiceof the Edinburgh Hospital forWvomen, the Quee VictoriaJubilee Institute, and the Churcw of. Scotland DeaconessHospital, Edinburlgh; the Nurses Training Home, Govan,and the Glasgol Eastern (Poor Law) Hospital, Glasgow.PUBLIC HEALTH OF EDINBURGH.

The annual report of the publichealthr departmentaof tineCity of Edinburgh for 1916, whilst much smaller than inthe tpre-war years, contains a great many facts ansdfigures of outstanding importance. Dr. Maxwell William-son, too, continues to makme his statistics interesting.A remarklabie sign of the times is thne bprominentposition given to the birth-rate; it is actually moreimportant than thendeath-rate. Thus, whilst theenaturalincrease inthse population of Edinburgh-thlat is to saythe excess of births over deaths for 1916 is 936, as cornpared with '432 in 1915-that greater increase is not due toa rise in the number of births but to a fall in the numberof deaths, and, as a matter of fact, to the comparatiyefreedom of tpe city from measles and whooping-cough.Indeed, the birth-rate has fallen-from 17.8 in 1915 to17.4 in 1916, a figure, says Dr. Wailliamson, which is thelowest yet recorded; and he adds:It is to be kept in mind regarding the low birth-rates whichare now ruling that thesei do not mark a specilly sudden fallin