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Annotations.

THE TREATMENT OF THE WAR CRIPPLE :STATEMENT BY THE MINISTER

OF PENSIONS.

" Ne quid nimls,"

THE position of the war cripple has for long beena somewhat obscure one, and a flood of fresh lighthas been shed upon it by the important statementsmade last week by Mr. G. N. Barnes, M.P., Ministerof Pensions, in answer to questions put to him bymembers of a deputation from the British MedicalAssociation. The deputation included the Chair-men of Council and of the Insurance Acts andHospitals Committees, and the medical secretary ofthe Association. The Insurance Commissionerswere also represented. With regard to the statusof the discharged disabled soldier under treatment,Mr. Barnes said that the question of the retentionof the men in military hospitals and under militarycontrol might be regarded as settled. The WarOffice had agreed to keep the men in militaryhospitals as long as room could be found for themthere, to give them certain curative and manualtreatment, and on discharge to hand them overto the care of the local Pensions &c. Statu-tory Committees. These committees would alsobe responsible for the men when, on the con-clusion of the war, many military hospitalswere disbanded. For the treatment of thewar cripple after the war three alternativeswould be present: first, continuance of treatmentat the military hospital, where this continued toexist; secondly, at a civilian hospital, if one wasavailable; thirdly, failing both of these, treatmentby the ordinary practitioner or the specialistaccording to the requirement of the individualcase. Mr. Barnes added that he was committedto the provision of special treatment for the dis-abled man, whether within or without a hospital,and to the expense of such treatment, quite apartfrom any domiciliary treatment to which the manwas entitled as an insured person. The smallnumber of non-insured discharged men would, hesaid, be dealt with also by the Insurance Com-missioners, retaining the same choice of doctor asinsured persons possess. In regard to the addi-tional cost of such domiciliary treatment, Mr.Barnes said that it had been decided to watchevents and to compare the results with the

experience of pre-war years. Approved Societieshad assumed, he said, that there would beadditional sickness and consequent increasedfinancial risk. On the other side it had been

urged that the open-air life and physical train-ing of the Service would result in a diminishedsickness incidence. Mr. Barnes laid on the Houseof Commons the primary responsibility for the factthat the medical profession was so slightly repre-sented on the central and local Pensions Com-mittees, adding that he was taking steps to remedythe omission. A circular, he said, had been issued bythe central committee advising all the local bodiesto avail themselves of the services of the practi-tioners in their district, and in particular to appointmedical men on the disablement subcommittees.Every local committee, he said, should have itsmedical adviser. For the Central Advisory Com-mittee Mr. Barnes welcomed the nomination ofthree or four persons by the British Medical Asso-

ciation, with the addition of a consulting physicianand surgeon nominated by the English RoyalColleges. Mr. Barnes’s statement heralds, we hope,the beginning of an intelligent and comprehensivetreatment of a difficult problem.

TRENCH FEVER AND TRENCH SHIN.

WE publish in another column an interestingcontribution to the pathology of trench fever byDr. H. Moreland McCrea, which tends to con-

firmation of the view that this condition is causedby a spirocheete, since observations on the Wasser-mann reaction made by Dr. W. E. Carnegie Dicksongave a positive result in the vast majority of cases,and treatment by galyl and grey oil gave relief insome cases and rendered the Wassermann reactionnegative. In THE LANCET of March3rdwecommentedupon the observations of Professor Riemer, whoobtained spirochsetes from the blood in this diseaseand was able to cultivate them, though he hesitatedto assert that the spirochsete was the cause. Dr.McCrea and Dr. Carnegie Dickson’s observationstake the proof a stage further, and if the spiro-chaetes are constantly demonstrated, or if they canbe proved to be infective in similar fashion foranimals, the demonstration will be complete. Itseems to be clear that the more chronic forms oftrench fever are less typical than the acuteform, the description of the latter by differentobservers being singularly uniform. The paperwe published in last week’s issue of THE LANCETby Lieutenant-Colonel Graham Chambers on

Trench Shin raises an interesting question.The condition, as he admits, presents many pointsof resemblance to certain chronic cases of trenchfever and is by some observers considered to be ofthis nature. It would be of interest to find out ifthe spirochaete found in trench fever is also presentin trench shin or if the Wassermann reaction ispositive in cases of the latter condition. It ispossible that the symptom-complex seen in trenchfever may be produced by more than one specificorganism. Lieutenant-Colonel Chambers regardstrench shin as an infectious fibrositis, and hissuggestion seems probable. We shall await observa-tions upon the blood in these cases with interest,as they should throw light upon this question.

THE RE-EDUCATION OF THE BLIND,AT the Annual Congress of the Ophthalmological

Society the proceedings on one afternoon tookthe form of an inspection of St. Dunstan’s Hostel,Regent’s Park, the magnificent property placed atthe disposal of the Blinded Soldiers’ and Sailors’Care Committee by Mr. Otto Kahn. In the courseof this visit Sir Arthur Pearson, the chairman ofthe Committee and President of the NationalInstitute for the Blind, opened a discussion on theemployment of the blind, to which Mr. ArnoldLawson and Mr. H. B. Grimsdale, among others,made useful contributions, and the whole subjecthas now received wide illumination by theissue of the report of the work of St. Dunstan’sHostel during the year ended March 31st last.At this date the blind inmates of St. Dunstan’s,including the numerous annexes which havebeen added to the central mansion, numbered354, while new accommodation has been pro-vided for nearly as many more patients. TheWar Office has arranged now that all soldiers withbadly damaged eyes shall reach St. Dunstan’s