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To institute a chair in physical medicine in oneor more of the universities and to establish a post-graduate school.To establish contact with the general practitioner

and to keep him informed of the changes in thesubject.To establish a technical board to act in an advisory

capacity.Dr. MONTAGUE WHITBY, honorary secretary of the

society, elaborated these ideals. The growing import-ance of the subject, particularly in industrial medicine,makes it essential that there should be a united bodythat could protect their interests and support theirclaim to recognition as an organisation of highlytrained workers. There is no official means, he said,of knowing how many specialists there were, becausethere was no register. The general practitioner, thepivot of the profession, knows little or nothing of thesubject and sends his patients to technicians, whohave to bear the responsibility of the treatment.Manufacturers would welcome the cooperation of atechnical board to whom they could submit appliancesfor investigation. It is important, he concluded,that there should be some sort of union between theAssociation and the Society of Physiotherapy, a

recently chartered body that has always worked undermedical supervision.

Sir ROBERT STANTON WOODS criticised certainof the society’s objects. Cooperation with themanufacturers may lead to misunderstanding, unlessthe Association acts in a purely advisory capacity.A university chair seemed very ambitious ; its value

has first to be proved to the rest of the profession.Instead of adding to the medical student’s work,it would surely be more satisfactory to include thesubject in a post-graduate course. Dr. KERR RuSSELLwas in favour of a register as binding the membersto concerted effort. It would help to raise the statusof the physical medicine department in hospitalswhere it is at present regarded merely as a dispensaryof treatment. Dr. D. HowAT suggested that theyought to ensure that the sales of lamps are restrictedto people qualified to use them. In hospitals lightis too often regarded as the last resource when allelse has failed. Mr. MORTON WHITBY, speaking asa genito-urinary surgeon, had found that it is some-times possible to dispense with operative measuresby means of physical medicine. He felt that itshould be one of the objects of the Association tocentralise this new branch of science ; as in a nursing-home or hospital for middle-class patients. Dr. EvAWHITE thought that the Association should includeanyone who was interested in the subject and not belimited to medical members.

It was agreed that associate members should beelected to the membership of the society. A medicaladvisory committee for manufacturers should beset up in conjunction with the National PhysicalResearch Laboratory. It was also agreed to aim atsecuring a university chair and a diploma in physicalmedicine. A register of known physiotherapistsis to be formed, but the elections were left over untilthe next meeting.

CORRESPONDENCE

TRANSFUSION OF LEUKÆMIC ANDERYTHRÆMIC BLOOD

To the Editor of THE LANCETSiR,-In several recent articles the transfusion

of leukemic blood has been advised in cases of

agranulocytosis. As spontaneous leukaemia in animalscan be transferred to other animals of the same species,even by inoculation of a few cells, transfusions ofthis nature seem interesting as experiments ratherthan desirable as therapeutics. In this connexionI should like to ask whether anyone has seen illeffects follow the transfusion of erythraemic blood.Bleeding is a most useful remedy in erythrsemia,and the concentrated blood is very effective whenused for transfusion. Nevertheless erythreamia hassome resemblance to leukaemia, and hitherto Ihave tried to restrict the transfusion of erythraemicblood to patients with incurable diseases.

I am, Sir, yours faithfully,L. J. WITTS.

St. Bartholomew’s Hospital, E.C., Jan. 21st.

INFANTICIDETo the Editor of THE LANCET

SiR,-There can surely be no dissent from yourgeneral conclusion with regard to mothers chargedwith the murder of their children, that a prisonhospital " is scarcely the ideal place " for theirobservation and treatment. While it is true that thehusband or other relatives would nearly always dis-like the certification of the mother or her commitmentto a mental asylum, they dislike and resent far morethe commitment of the mother to a prison hospital.It is really a scandalous thing that mothers, whoseoffence has been committed because of unbalancedmind arising from any cause, should be sent to a

place of punitive detention and forced to consort withoffenders of all degrees of moral culpability. The

stigma and the memory of that experience remainand may be a very real hindrance to complete recoveryand a lasting source of mental suffering.One way out of the difficulty would be provided

by the establishment of properly equipped observationcentres, long advocated by the Howard League forPenal Reform as an essential in the scientific treat-ment of delinquency, where such cases as these couldbe kept in safe custody in surroundings without eitherthe prison or the asylum taint. We are promisedat least one such centre in the new Prison Bill, andtheir rapid extension over the whole country shouldbe pressed for at the earliest possible moment.

It is unfortunate that Lord Dawson’s Bill, so

excellent in intention, should by its wording be solimited in scope. Surely, proof that the offencecommitted was the result of unbalanced mind shouldbe sufficient, whatever the cause of the mental derange-ment and irrespective of whether or not the offencewas committed within twelve months. The Bill,as drafted, would not have applied to more thanone or two of the considerable number of cases inwhich mothers have been subjected to what hasbecome known as "the black cap farce" duringrecent years. It is to be hoped that if it makesprogress in the Lords its scope will be greatly widenedby appropriate amendments.

I am, Sir, yours faithfully,JOHN PATON,

Secretary, National Council for theAbolition of the Death Penalty.

Victoria-street, S.W., Jan. 31st.

THE MEDICAL PROFESSION IN NATIONALEMERGENCY

To the Editor of THE LANCET

SiR,-The " national emergency " form sent out

by the British Medical Association has been the

subject of a good deal of criticism and discussion.

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Many medical practitioners have maintained that itwas reasonable that some attempt should be made tocoordinate the work of the medical profession in timeof war. That this should be done voluntarily accordedwith the best traditions of the profession. Othersconsidered that there was a sinister purport in itall and that the form was inquisitorial. They feltthat the political views of those who for one reasonor another found themselves unable to fill in the

required particulars would be suspect by theauthorities. It was argued too that the GeneralMedical Council, which already links the professionwith the State, would have been the appropriatebody to make the inquiry.Now comes the letter in to-day’s issue of THE

LANCET which discloses an attempt to apply indirectcoercion in a most offensive way, which smacksof Fascism. This anticipation of conscription createsquite the wrong atmosphere and can only arouse thedistrust of those concerned.

It would be well for the British Medical Associationto publish a full explanation and repudiation of thishigh-handed action; otherwise the sympathies of

many members of the profession will be alienatedfrom the scheme.

I am, Sir, yours faithfully,LEONARD F. BROWNE.

TREATMENT OF SCABIES

To the Editor of THE LANCETSiR,—I see that the treatment of scabies with

nascent sulphur receives further commendation inthe report from your Budapest correspondent(Jan. 29th, p. 285), who describes it as " a new quickmethod." As this is the second occasion within the

past few months that this form of treatment hasbeen " discovered," I thought it would be worthwhile putting on record the fact that it was used byat least one Field Ambulance (102nd) during the latewar. Whilst at Franvillers in the Somme area in thesummer of 1916 we had a large number of patientssuffering from scabies and it was found that thedeposition of sulphur, obtained by wetting the skinwith a solution of sodium thiosulphate, followedby the application of a dilute mineral acid, gaveslightly better results than those derived from thetraditional use of sulphur ointment.

I am, Sir, yours faithfully,W. K. FITCH.

CARBOHYDRATE METABOLISM INANOREXIA NERVOSA

To the Editor of THE LANCETSiR,-The article by Dr. Sheldon and Dr. Young

in your last issue raises a number of matters fordiscussion. Most of these I propose to leave fortreatment in a paper on the same topic which I havein preparation; but one or two points call forimmediate comment.A good deal of the reasoning in this paper is based

upon a series of oral glucose tolerance curves whichare considered to reflect changing states of glucosetolerance. Actually they are of types commonlyencountered in debilitating conditions, includingprolonged starvation, which lead to disturbed tonusof the alimentary tract, their occurrence beingapparently due to irregular gastric discharge and toactual changes in the efficiency of intestinal absorption.I have, for instance, a set of three curves obtainedat short intervals from a case of chronic cardiacfailure, which closely mimic the three types includedin this series. It is becoming widely recognised of

late that oral curves alone cannot form a satisfactorybasis for discussion.

Evidently with some feeling of this kind, Sheldonand Young performed an intravenous glucose tolerancetest upon their patient and a

" control " case--

" a surgical convalescent." Unfortunately, thiscontrol curve is very far from normal; in fact at

only one point (70 minutes) does it fall below the

usually accepted renal threshold of 180 mg. per100 c.cm. This mishap has led to the conclusionthat the case of anorexia nervosa showed greatertolerance than usual, whereas in fact her curve isquite abnormally high (its area is more than twicethat of one of my normal curves)-a state of affairswhich is usual in these cases.

Confirmation of the view finally expressed, " thatthere is no need to invoke an endocrine explanation,"may be derived from a study of the insulin sensitivity.Anorexia nervosa seems, in fact, to be purely a

condition of inanition, usually psychogenic at first,presenting the morbid physical and chemical findingsof persistent undernutrition.

I am, Sir, yours faithfully,C. WALLACE ROSS,

Carline Harrold research fellow,University of Birmingham.

SILICOSIS INQUIRY IN SOUTH WALES : ADISCLAIMER

To the Editor of THE LANCETSIR,-During the past week several newspapers

have published inaccurate accounts of the progress ofthe investigation into silicosis in the South Walescoalfield which is being promoted by the MedicalResearch Council with the assistance of their Indus-trial Pulmonary Disease Committee. These includea statement attributed to "a member of the Pul-

monary Diseases Board " (apparently meaning oneof the investigators working under the direction ofthe Committee), to the effect that the results’of theinquiry will make possible an immediate reduction ofover 80 per cent. in the incidence of silicosis in theanthracite coalfield. The facts are that the investi-gation is still in an early stage ; that the resultscannot yet be assessed ; and that no such opinion asthat purporting to be quoted has been formed. Nointerview has been given to the press, and the allegedstatement has not been made by the investigators.

I am, Sir, yours faithfully,E. MELLANBY,

Secretary, Medical Research Council.

CONTROL OF A TYPHOID EPIDEMIC

To the Editor of THE LANCETSIR,-Dr. Richard Taylor suggests in your last

issue that mass inoculation of the Basque childrenprevented a major epidemic. Might I be allowed topoint out that according to Dr. Taylor’s own accountof the camp the fifth and last case of typhoid amongstthe children was diagnosed on June 4th, 1937, andno inoculations were performed until June 6th. Asall the children had arrived at the camp by May 24th,thirteen days before the inoculations were started,and as the most insanitary period of the camp wasduring that thirteen days, why should inoculationbe given any credit for preventing typhoid ? If thechildren’s filthy habits were likely to cause an out-break of typhoid, the disease would have beencontracted during those thirteen days.With regard to the sanitary arrangements, Dr.

Taylor himself wrote as follows (Brit. med. J.1937 2, 760):" The latrines were provided with narrow trenches,

which were disinfected several times daily with