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RESULTS WITH RECENT DEATH-RATES

Snow’s equations were based upon the mortalityexperience of 1910-12 and the complete life tablebased upon it, and their applicability to the lowerdeath-rates of recent years might well be questioned.To assess their validity under modern conditionsthe present numerical test was made.The last English life table (No. 10) was based upon

the death-rates of England and Wales in 1930-32,and an abridged table was therefore constructed,for each sex separately, from the death-rates prevail-ing in those years. The results are given in theaccompanying table. It will be seen that the

abridged method gives results which agree well withthe values given by the full method. With bothsexes the number of survivors at ages up to 55 are

consistently rather too few and at ages 65 and aboverather too many, but the percentage differencesare less than 0’25 per cent. at all ages up to 65.The expectation of life is consistently slightly too

low (except for an equality in males at 55 and femalesat 10), but at every age up to 75 the absolute differenceis never greater than a tenth of a year or the negligibleamount of little more than one month. In short,judged by this test, Snow’s short method of workinggives a perfectly satisfactory result when applied tomodern death-rates.

SUMMARY

Abridged life tables for males and females havebeen constructed by Snow’s method applied to thedeath-rates of England and Wales in 1930-32. The

resulting values agree well with those of EnglishLife Table No. 10 and suggest that the method isstill applicable under modern conditions of mortality.We are indebted to Dr. K. Conrad for checking the

arithmetic.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

PERIPHERAL ARTERIAL DISEASE

AT a meeting of the Edinburgh Medico-ChirurgicalSociety last week Dr. W. Melville Arnott and Mr. J. J.Mason Brown made a communication on the investiga-tion and treatment of obstructive peripheral vasculardisease. After giving a summary of the control andfunctions of the peripheral blood-flow, they pointedbut that, whereas nervous vasomotor control is

predominant in the skin blood-vessels, the controlof the muscle blood-vessels is principally mediatedby the products of muscle metabolism. The resultsof deficiency in the blood-supply to the skin consistin nutritional changes and abnormally low tempera-ture, whereas in the muscles intermittent claudicationis the cardinal disturbance. Where arterial obstruc-tion is present the improvement in circulation follow-ing the release of nervous vasoconstrictor tonusshould be estimated. This is done by warming theblood by immersion of either hands or feet in hot water.Any elevation of temperature in the affected limbfollowing this procedure indicates an increase inblood-flow. It is only in cases showing a substantialrise that sympathectomy should be considered. Inmost well-established cases of obstructive arterialdisease there is no rise of temperature when nervousvasoconstrictor tonus is inhibited.The principles of treatment are (1) try to limit the

cause of the condition ; (2) to increase the circulation ;(3) to care for the ischaemic area. In discussing themethods of increasing the circulation particular

emphasis was placed upon intermittent venous

occlusion, originally introduced by Collens and

Wilensky, and which Arnott and Brown have usedin the treatment of 47 cases. This method consistsin the application of a cuff to the thigh or arm of theischaemic limb and the inflation of this cuff to a pressureof 30-50 mm. Hg for a period of two minutes anddeflation for two minutes. The treatment is appliedfor several hours per day for several weeks. Treat-ment has been found to relieve the resting pain ofischaemia in a day or two, and in intermittentclaudication the walking distance is much increasedif treatment is continued for several weeks. Healingor separation of dry gangrenous areas is hastened.In the type of obstructive arterial disease discussedoperation on the sympathetic has little place, andthe indiscriminate use of periarterial sympathectomyin these cases only brings discredit on an operationwhich is of value in other types of vascular disease.

PARIS

(FROM OUR OWN CORRESPONDENT)

POSTGRADUATE COURSES

THE arrangements for postgraduate courses inParis for 1939, under the auspices of the Faculty ofMedicine, are now so far advanced that it has beenpossible to draft a provisional programme, a copy ofwhich is issued as a supplement to the Presse Médicalefor Jan. 7. Application for attendance must be madeto the secretariat of the Faculty. The courses areclassified according to the hospitals at which they aregiven. At the Salpêtrière Hospital, for example,Prof. Gosset and his assistants will give a course onsurgical technique between June 5 and 24. Thecourse will include 18 lessons in the theory of surgicaltechnique illustrated by films, and demonstrationswill also be given of operations. At the Broca

Hospital a special gynaecological course in Englishhas been arranged from June 19 to July 1. The feefor this course will be 400 francs, and it will be givenonly if at least six students attend. The programmeat the Institute of Hygiene and Epidemiology isimpressively full and those students who satisfy theexaminers will receive a diploma.

EXAMINATIONS FOR MENTAL HOSPITAL

APPOINTMENTS

Some idea of the conditions governing hospitalappointments, which are as greatly coveted in Franceas in England, can be gleaned from the JournalOfficiel for Jan. 1, where particulars are given of adecree governing the examination of candidates forthe higher appointments at the mental hospitals ofthe Seine area. When a vacancy occurs a com-

petitive examination will be held in the offices of themedical director or heads of the mental hospitalservices. Candidates must be under the age of 53and must have had more than five years’ experiencein a mental hospital. Each candidate must submitevidence of clinical work and scientific study,40 points being allotted to the former and 60 to thelatter. The salary for an appointment of this kindranges from 41,000 francs in the fifth class to 58,000francs in the first.

THE FRENCH BIRTH-RATE

The Alliance Nationale contre la Depopulation hasjust issued one more appeal for more babies. Itseems that 1938 yielded only 610,000 births-presumably live-births-the deaths exceeding the