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experienced by the members of the medical pro- fession, both as to the need for additional medicalmen in the Royal Army Medical Corps and thepracticability of the method chosen by the CentralMedical War Committee for meeting that need.

The Enrolment Scheme, if entered into by a largemajority of the constituency concerned, should

ensure an equitable distribution of the burden asit affects the medical profession; and in order toavoid the alternatives of haphazard recruitmentor arbitrary demand, the War Office has officiallydecided to rely upon the Central Medical War

Committee, and the corresponding Committees inScotland and Ireland, to meet the shortage in

the Royal Army Medical Corps as it occurs. Theextent of that shortage is not suggested, in so

many words, by either the navy ’or the army; butit is clear that it must depend upon the course ofthe war and the rapidity with which additions aremade to our fighting formations.The Central Medical War Committee has been

subjected to an extraordinary amount of criticism.Distrust of its policy, its actions, and indeed of itsmorals, has been widely suggested, and the numberof times is very great that questions have beenasked in Parliament having as their aim theextraction from the Government of some admissionthat may be damaging to the status of the Com-mittee. As far as can be ascertained, the Committeehas worked steadily for the good alike of themedical profession and the community. We are

glad, therefore, to see the Committee and itsScottish and Irish similars described in the WarOffice statement in the following terms :-These Committees include representatives of the Royal

Colleges of Physicians and the Royal Colleges of Surgeons,of the Universities and Medical Schools, and of the BritishMedical Association, and have associated with themselvesin their work representatives of the Government Depart-ments mainly concerned. The Committees have an organisa-tion of representative local committees in all parts of thethree countries, from which they obtain local information andadvice, and they work in daily contact with the variousGovernment Departments concerned. Furthermore, for thepurpose of considering and advising, through the CentralCommittee, on cases in England and Wales having suchspecial features as exist, for instance, in regard to the staffsof the metropolitan hospitals, a Committee of Reference has,with the approval of the War Office, been now established bythe Royal College of Physicians of London and the RoyalCollege of Surgeons of England, acting jointly.

May we hope now that all medical men will workto assist the Central Medical War Committee in

promoting the Enrolment Scheme and in finding thefittest civilian medical men to serve in the navy and

army? The Enrolment Scheme becomes an essen- r’

tially fair one, seeing that the Central Medical War Committee has decided to call up no practitionersunder it unless and until 75 per cent. of those medical men, who on Jan. 5th, 1916, were of military age, have enrolled or received a commission. j- j

THE LATE MR. W. B. RICHARDSON.-William B.Richardson, late senior surgeon to the Victoria Hospital,

]

Blackpool, died suddenly on March 30th, in his sixty-ninth (year. He became a Member of the Royal College ofSurgeons of England in 1875, and had been in practice for i40 years in Blackpool. He was one of the founders of the Victoria Hospital and generously supported that institution, iof which he was honorary surgeon for 20 years.

Annotations."Ne quid nimis."

THE BUDGET AND THE MEDICAL PROFESSION.

THE Fourth War Budget is of the colossalmagnitude which was to be expected in view ofall the circumstances, and in its main features it isso clear that we may take it for granted that ourreaders are already acquainted with their mainpurport. It is doubtful if it was generally expectedthat the income-tax would be raised in quite themanner employed or to such high figures ; but theannouncement that there is to be no increase inthis respect on naval and military pay will be awelcome relief to the large numbers of our pro-fession who are doing their duty with the forces,The rest of us will bear the graduated increases,which range from 5d. in the JE on incomes above C500and under 081000 to lld. on incomes under £2000, withthat cheerfulness with which medical men usuallyshoulder their share of the responsibilities of citizen-ship. The increases on incomes between X2000 and082500, which are more onerous, do not affect a largeproportion of our unwealthy class. Those who areso fortunate as to possess unearned incomes willhave to pay an addition of 6d. in the JE on incomesbetween £500 and £1000, and of Is. in the 08 onincomes above this sum and below 082000. The new

proposals for taxation introduce some features ofparticular importance to the medical profession. Theraising of the licence duty on motor-cars will affectthe practitioner in proportion to the horse-power ofhis car. It will fall more heavily on the ownersof American cars, and especially on those who havethe " Ford " car, the duty on which is raised from086 6s. to £18 18s. This represents a serious differ-ence in annual outlay to a man whose practice isnot a large one, and indeed the doctor is being hardhit at the present time in connexion with hismotor-car, which he cannot put down as it hasbecome indispensable to him in the working not onlyof his own practice but quite possibly of the practiceof an absent colleague. The precarious supply of hispetrol is a source of perpetual worry, he has to payan exorbitant price for it when he does get it,and now he has to pay double or treble the licenceduty. We feel that before the Budget proposals passinto law an effort might fairly be made to give themedical man some relief.

THE SUPPLY OF PETROL TO MEDICAL MEN.

THE form issued to medical men at the end oflast week by the National Health Insurance Com-mission, asking them to supply details concerningtheir use of motor vehicles and their consumptionof petrol, is a welcome sign that our authorities arealive to the urgent necessity for securing to practi-tioners an adequate supply of motor spirit. If somesuch course is not taken it may become impossiblefor some medical men to carry out their pro-fessional duties with that expedition which theircalling and their attenuated numbers demand. Forit must be remembered that several thousands ofour colleagues are away from their practices andthat the shortage of medical men with the servicesis still unsatisfied. Complaints have reached usalready of the serious position in which some

medical men find themselves in consequenceof their inability to get petrol, especially in

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remote country places. That there would be a

sufficiency of spirit for the Government purposesand yet leave an ample supply to meet the realnecessities of the public appears to be generallyagreed if "pleasure" motoring is put down; theuse of petrol, for instance, in conveying the votariesof horse-racing to and from their places of meetingis simply a scandalous waste-that such a thingbe permitted reduces our allies to com-

plete bewilderment and seems to more thoughtful- citizens to render the Zeppelin raids, with theirattendant horrors, a tonic to be taken gratefully.Given an adequate supply of petrol, the great diffi-culties to be overcome are, of course, those of

proper transport and distribution. There is littledoubt that a restriction will soon be put upon thepresent indiscriminate use of the spirit, but themedical man, who is generally allowed to be amongthose who would have first claim upon the supply,will unfairly suffer under such a system. Aregularised supply will not avail the practi-tioner in the remote and smaller country villagesunless some means are evolved by which he canget without fail that amount of petrol whichwill enable him to carry on his work. Therewould appear to be only one way in which theregular supply of petrol to the medical professioncan be secured, and that is by the Governmenttaking over the whole of the petrol supply of thiscountry, and using the existing organisations of thetwo or three great supply companies for its distribu-tion. Otherwise it seems clear to us that manymedical practitioners in the country may haveinfinite anxiety and may be forced to curtail theirrange of work in a disastrous manner. The supplycompanies know the requirements of the districts,including every little village and hamlet; andthere would be no need for the wurk of the medicalman to be crippled if their services were properlyacquired. The question has become acute in someplaces, and no doubt much more acute than it needhave been at the present time owing to the actionof many car owners who, having bought largely inview of a threatened famine, hold up not merelythe spirit itself, but, what is of even more import-ance, the tins in which the spirit is stored. Anotherpoint to which the authorities should give theirattention is the exorbitant price which is nowbeing charged for the commodity. Is this governedby ordinary commercial considerations, or by thedemands of the oil trusts ? To the medical manthe successive increases in prices during the pastfew months are a very serious charge on hisincome.

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THE DISINFECTION OF SEPTIC JOINTS.

Dr. F. J. Cotton has contributed to the BostonMedical and Snrgical Jou1’Jtal an important paperon a subject of considerable interest at the presenttime-the disinfection of septic joints. He stronglycondemns the drainage of joints as responsible forthe disastrous results obtained in the past in casesof suppuration. Either the attempt to save thejoint should be regarded as hopeless, in which casethe joint should be laid wide open (not drained), orall efforts should be made to preserve the functionof the joint. About 10 years ago, when engaged inwashing out gonococcic joints, Dr. Cotton found,both in the small minority which gave a cultureand the majority which did not, that the resultswere better if the joint was sewed up tightly thanif it were left to drain through loose suturing,while wick or tube drainage proved, as has since

been recognised, disastrous to function. He thentreated septic joints (principally staphylococcicwith a few streptococcic) by sewing up the capsuletight after irrigation for 15 minutes with a fullstream of 1 in 15,000 corrosive sublimate and

flushing out the excess with saline solution. Heeffected water-tight closure of the capsule bymattress and single sutures in such a way as toleave the synovial membrane cut-edge to cut-edge asaccurately as possible. Usually the membrane isso swollen as to make this possible. The externalwound is left wide open or nearly so, for completedisinfection of the external soft tissues is not prac.ticable. After operation effusion into the joint mayor may not occur. If it does, it disappears in oneto three days and is not accompanied by pyrexia ormuch discomfort. With few exceptions, Dr. Cottonhas not found traction for the separation of jointsurfaces necessary. There was neither pain norspasm sufficient to indicate it. In about twodozen cases treated by this method there were

only two failures. In a case of streptococcicinfection of the knee in a man, due to a

punctured wound, recurrence took place. Thejoint was then laid wide open. Later, aftervaccine treatment, the granulations were cleanedout from nearly intact cartilage and the dividedligaments were sutured. In the end the patientregained a good leg with 45 to 50 degrees of motion.In the other case a boy had an epiphyseal staphylo.coccic infection of the knee. The joint was cleanedout and sutured. Later the joint broke down andankylosis resulted. The following shows the usualresult. A sturdy girl aged 10 years was seen in con-sultation. About two weeks previously she hurt herknee in jumping down a cellar. The knee was

greatly distended, tender and hot, but not red. The

temperature was 102’5°F. A juxta-epiphyseal in.fection of the knee was diagnosed. The joint wasopened on the inner side and found full of thickcreamy pus. The irrigation described above wasperformed and the joint closed. Through an

incision on the outer side a large popliteal abscesswas opened and drained. After eight days there wasno fluid in the joint, the tenderness was less, andthe wound had nearly healed. Though a seques-trum formed in connexion with the epiphyseal lineof the femur and a sinus at this spot persisted fora year, the knee-joint so completely recovered thatit could be distinguished from the other only by thescars.

AMBARD’S COEFFICIENT.

THE index of urea excretion known as Ambard’scoefficient or constant and enunciated by him in 1911is perhaps less appreciated in this country thanon the continent and in America. The formula de.

Ur r visedbyAmbardmaybe expressed as-. ’ " == E, where Ur represents grammes of ureaD v C per litre of blood, D the grammes ofv- urea excreted in 24 hours, W the

weight of the patient in kilogrammes, C the grammesof urea per litre of urine, and K the coefficient orindex of urea excretion. Dr. V. Grossi has lately madesome observations on the clinical application of thiscoefficient which are published in Il Policla7aico(Surgical Section, Feb. 15th, 1916), the cases con.sisting of 13 renal tubercle, 9 haematogenous infec-tions, 8 calculous pyelitis, 3 renal growths, and 8surgical affections of the lower urinary tracts. Theconclusions arrived at by Dr. Grossi are thatAmbard’s coefficient is a valuable method for ascer-taining the efficiency of the renal function, and is