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afford even the appearance of an excuse for accusations j ]of dishonesty against perfectly upright and honourable t

men. 1

Politicians too often do not think it necessary, prior to

legislation, to obtain any adequate or accurate informationconcerning the circumstances to which the new legislationis supposed or intended to apply; they are too ready toenact what appears to be least likely to give popularoffence, and to fling it down to be licked into shape bycourts of law and by experts, at the cost, sometimes evenat the ruinous cost, of the classes or individuals whom

it is supposed to benefit or to protect. It was manifest

to every surgeon or physician that questions relating to thereal or supposed connexion between some accident or injuryand the subsequent health of the person sustaining it wouldbe certain to crop up under the Compensation Act, and thatthese questions, which would frequently be insoluble by anydirect evidence, would be among the most difficult and

most perplexing which could be presented to a practitioner.It was equally manifest that every large employer of

labour would be likely to protect himself by the advice of amedical man, whose duty it would be to guard him againstbeing swindled either by malingerers or by persons with whomthe connexion between some real malady and some recentaccident was at best only an after-thought. The attention

of such medical men would quite excusably be directed rathertowards the detection of fraud than towards the recognitionof genuineness. On the other hand, the medical attendantof the patient concerned, assuming that his own suspicions offraud had never been aroused, would be quite likely to defendthe opinion of the case upon which he had acted from the

beginning, and almost to resent the suggestion that he hadhimself been more or less the subject of deception. With

most patients, moreover, there is some tendency towardsan exaggeration of symptoms or of disabilities calculated to

support the view which they are themselves anxious to

maintain ; and we need not look beyond these facts in orderto find a sufficient explanation of differences of opinionconcerning questions which do not admit of demonstration.The real difficulties arise from the frequent incapacity of thetribunal to which such cases are submitted for ultimate

decision, and from the inability of judges, counsel, andjurors to understand the presence of unknown quantitieswhich may render the problems containing them insoluble.It is, in most cases, absolutely impossible for a medical

witness to make a non-medical audience understand the

precise nature of the doubt which restrains him from a

positive expression of opinion ; and any endeavours whichhe may make in this direction are, almost as a rule, baffled

by the desire of counsel to present only a confused issueto the jury.

In these circumstances it is manifestly impossible for

medical witnesses to be too cautious, either for their owncredit or for the credit of the profession to which theybelong; nor can they abstain too carefully from expressinganything like certainty in conditions in which certainty isnot attainable. In the cases arising under the Workmen’sCompensation Act the stakes are usually moderate, and theissues are thrashed out before tribunals which come but little

under the notice of the public, but the hasty words of the

judge of the Clerkenwell county court are only too likelyto be ignorantly re-echoed by some who should know

better.

The Spread of Plague by Ingestion?ONE of the most important items of knowledge concerning

ommunicable diseases is clearly their mode of transmission.A.s soon, for instance, as the transmission of malaria and

yellow fever by mosquitoes was clearly established, medicalscience was able to devise methods for the prevention of

these diseases which have reduced their terrors very greatlyand which could not have been devised without that

knowledge. In some diseases it is more than possible-it is

likely-that more than one mode of transmission exists.

That this may be the case with plague seems to be theoutcome of an observation of Passed Assistant SurgeonGEORGE W. McCoY, of the United States Public Health andMarine Hospital Service,l who has recently studied the data

bearing on the prevalence of plague in Hawaii, where casesof the disease, both in human beings and in rodents,have been occurring since 1900. Dr. McCoY found that on

the north, or Hamakua, coast of the island, out of ten humancases all except one had a bubo in the neck, while not onehad a bubo in the inguinal region. The tenth case was one

of axillary bubo. This finding entirely reverses the condition

usually found in other places (and, indeed, in parts of

Hawaii other than the Hamakua coast) where the usual percentage (86 per cent.) of inguinal buboes obtains. While, of

course, this may be a mere coincidence, Dr. McCoy thinksthat some other explanation for the peculiar condition mustbe sought. In this connexion he points to the fact that when

plague is induced in animals experimentally by feeding themwith infected material, in the great majority of cases a bubo

develops in the neck. He, therefore, suggests that in such

cases in human beings transmission may have been effected,not through the usual medium of flea-bites, but throughingestion. The confirmation of this view would not, of

course, in any way militate against the recognition of the

preponderating intermediacy of the rat and its flea ; it would

simply call attention to another weak spot in the defence thatneeds guarding.While admitting the interesting nature of the cases

reported by Dr. McOoy, it wculd hardly be prudent to baseupon so small a number of instances any conclusions as tothe spread of plague in man by ingestion. Many investiga-tions in this direction have already been made by verycompetent experts without bringing to light any unassailableevidence that this is a method by which plague is trans-

mitted to man and which need be seriously considered inpreventive measures. The commonest article of food amongnative races in the East is grain in one form or another.

Experimentally it has been shown that when grain is

artificially contaminated by cultures of plague bacilli theseorganisms die out in a short time, as soon, in fact, as

they have become well dried. Moreover, grain is almost

universally cooked before being eaten, and this, of course,

necessarily secures destruction of the microbes. Nor is it

1 Public Health Reports, April 5th, 1912. Vol. xxvii,, No. 14.Washington: Government Printing Office.

1142

easy to see how articles of food consumed uncooked

by man can readily become infected by plague bacilli. The

Commission for the Investigation of Plague in India came tothe conclusion, after many feeding experiments, that animalswhich are susceptible to plague by inoculation may beinfected by feeding, but before this can happen an immensedose of highly virulent material has to be administered-acondition, it may be remarked, not likely to occur commonlyin nature. The present position of our knowledge on this

subject may be summarised thus : Specific contamination offood might, theoretically, upon occasion and under certainconditions, lead to man becoming infected by plague; butthe probabilities of plague microbes reaching articles of dietwhich are consumed in an uncooked state, and on which thebacilli could multiply, are extremely slight. The intestinal

tract cannot be regarded as a likely or favourable channelfor infection, as large quantities of virulent plague organismsare needed to give rise to the infection. Finally, it may beasserted that up to the present there is absolutely no

epidemiological evidence pointing to the spread of plaguethrough the agency of food.

Annotations.

ROYAL HONOUR TO THE PROFESSION.

" Ne quid nimis."

WE are very glad to learn that His Majesty the King, whowill be accompanied by Her Majesty the Queen, will openthe new buildings of the Royal Society of Medicine. The

ceremony will take place on Tuesday, May 21st, at 3.45 P.JB’!.

THE PERCEPTION OF SPACE.

SOME interesting experiments on the functions of the

vestibule as an organ for the perception of space were

reported by Dr. F. L. Golla in a paper read before the

Neurological Section of the Royal Society of Medicine. 1

The method adopted was to place the subject of the experi-ment with closed eyes before a screen ruled in millimetre

squares and to get him to indicate on the screen his idea of apoint exactly opposite to a point on his own body touched bythe experimenter. When the degree of accuracy attainedhad been thus noted, the subject was seated in a rotatingchair with his head fixed and the screen held in the samerelative position. After undergoing 30 revolutions at a speedof one revolution in five seconds, he was again made toindicate the points touched, and it was found that hetended to place the point in space before him a con-

siderable distance towards the side of the screen away from- which rotation had been made. If the subject’s head were.fixed so that the line passing between the two ears was

vertkal, a vertical displacement of the point touched wasobserved. A curious case bearing on the same subject was re-corded in our own columns by Mr. Macleod Yearsley,2in whicha patient who had suffered loss of one labyrinth by diseaseand had had the other destroyed as a remedy for the resultingvertigo, was found to be quite unable to guide his movementsor realise his position in the dark. Thus, if he got out of

bed in the night he remained collapsed and helpless on thefloor till help arrived. Dr. Golla adopts Cyon’s explanation

1 Proceedings of the Royal Society of Medicine, vol. v., No. 5, 1912,Neurological Section, p. 123.

2 THE LANCET, Sept. 19th, 1908, p. 871.

of our ideas of space-viz., that there is a continuous streamof sensations of space derived from the internal ear whichblends with and qualifies all other sensations. It is interest-

ing to speculate as to whether a similar organ will some daybe discovered to account for the remaining great metaphysicalproblem-our idea of time.

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THE METROPOLITAN WATER-SUPPLY.

WE publish in another column a brief review of the recentreports-namely, the fifth annual report and the seventhresearch report which have been made to the MetropolitanWater Board by the director of water examination, Dr.A. C. Houston. The reports contain a record of most

interesting and important scientific work which must be ofvery great use to the Metropolitan Water Board and tothe vast community whose interests are watched over bythat Board. These records of investigations of the metro-politan water will be of the utmost value in guidingthe Board in the lines along which the processes of waterpurification must go in the immediate future. It is verysatisfactory to know that the scientific work of Dr. Houstonfully demonstrates the fact that the purity of London’s

drinking-water is being adequately maintained, and under thevaluable guidance and help afforded to the Board by hisresearches there is every reason to believe that this puritywill be adequately safeguarded in the future. Those whoknow the magnitude of the problems involved, and the diffi-culty of their solution, and who remember the sinister fore-bodings of many shrewd observers, will see the satisfactorynature of such statements.

____

PHYSICAL FITNESS OF THE TERRITORIAL

FORCE.

As a nation we are accustomed to regard our nationaldefenders, whether naval or military, as a body of men ableto go anywhere and do anything-that is, properly trained intheir duties and in a condition of health and fitness forservice in any part of the world. Probably this belief is

justifiable, and at any rate we need not be ashamed of ourpast record, although there have been occasions when thetraining, both of mind and body, has been less than couldhave been desired. As regards the Territorial Force, how-ever, the position is not all that could be wished. It is

generally allowed that the material is good, but it is to agreat extent raw. The question has on several occasions beenunder the consideration of the military authorities, and weinvite our readers’ attention to a recent discussion (p. 1133)at the United Services Medical Society, opened by MajorH. E. M. Douglas, V.C., D.S.O., of the Royal Army MedicalCorps, on the Special Weaknesses, from a Medical Aspect, ofVolunteer Troops. The dangers attending concentration oflarge bodies of men in camps have been abundantly illus-trated in the experience of the United States army, both inthe Civil War and in the more recent volunteer camps in

1898; enteric outbreaks can be guarded against by pre-ventive inoculation, and small-pox by revaccination; theformer can be carried out on mobilisation, but the lattershould be seen to during peace time. Systematic physicaltraining, to produce a condition of fitness and avoid risk ofheart strain, should also be undertaken beforehand ; alsoinstruction in personal hygiene, care of the feet, and theexigencies of camp life-all matters easily comprehended, ifundertaken in time, and with opportunity for the developmentof healthy habits and a sanitary conscience. Such habitsbecome second nature if allowed time to get ingrained into aman ; but time is essential. Such training should be under-taken beforehand at leisure, not deferred to the hour of

mobilisation, when urgent military necessities will inevitably