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130, and he had on the 28th become involved in a seriousmatrimonial difficulty which had upset him very greatly.Further, the majority of the patients remained in their bedsinstead of getting up and going into a subway which theyall know they may do, and a large number remained asleep,although the noise of the guns was very loud indeed.

We are, Sir, yours faithfully,R. WORTH,

(Temporary) Major, R.A.M.C.T. A. Ross,

(Temporary) Lieut., R.A.M.C.War Hospital, London, Feb. 4th, 1918.

To the Editor of THE LANCET.SIR,-The term psycho-neurosis, used more than 40 years

ago by Krafft-Ebing to signify some of the phases metwith in the clinical study of mental diseases, has received aconsiderable revival since the war and as subdivisions ofthis group of symptoms the terms neurasthenia and hysteriahave been in fairly common use.

Latterly, owing to some opprobrium attaching to thesecond of these and its admittedly inapplicable derivation,the new term "pithiatic" invented by Babinski is creepinginto general custom in English writings. I should like to

suggest before this word meets with general acceptance,that its modification into peithiatric (7relO"" to persuade orsuggest, and iaTpos, one who heals, or ta-rPLK6S, skilled in themedical art) be a more correct as well as a more fit word fromthe point of view of meaning and etymology.

I am, Sir, yours faithfully,Harley-street, W., Feb. 4th, 1918. ROBERT ARMSTRONG-JONES.

STOVAINE COMBINED WITH TWILIGHTSLEEP FOR GYNÆCOLOGICAL

OPERATIONS.T{) the Editor of THE LANCET.

SIR,—I have thought a few comments from me onMr. F. L. Provis’s article in THE LANCET of Jan. 26th maybe admissible, as I have had experience of about 60 suchcases. In regard to his general conclusions as to the

advantages of the method, I fully agree with him.The blindfolding of the patient and the placing of

cotton-wool in the ears is now usually done beforeshe is brought into the theatre, but for some reasons itmay be better to do it "after the stovaine injection."As pointed out by Dr. Giuseppi, if tabloids are used forthe hypodermic injections they should be dissolved indistilled water. To some nervous patients, and those whoseem excited by the hyoscine (this rarely happens), I haveoften given a little general anaesthetic for the spinal injec-tion ; otherwise they are apt to flinch and extend the lumbarspine, so that penetration is impossible.

It is better to enter the needle, not just below the upperspine, but above the lower, for there is sometimes a tubercleof bone growing from the under surface of the upper spine

- just inside its tip. Billon’s 10 per cent. solution is often

supposed to be a "light " solution—i.e., as light as, or evenlighter than, the cerebro-spinal fluid, but the makersinform me that its specific gravity at 370 C. is 1-0723.However, one can put a patient in the Trendelenburgposition after five minutes without fear of nerve-blockingmounting too high, so it seems probable that its effect ismore quickly expended in the immediate neighbourhood ofthe injection than is that of solutions made up with-glucose.

Mr. Provis considers that patients liable to headachesshould not be given stovaine. So far as my recollections ofgeneral practice serve me, gynaecological patients commonlycomplain of headaches due to various causes ; and until weknow more precisely than we do at present what causesheadache as an after-effect (Dana in a recent article admitsthe obscurity of its etiology), it seems hardly advisable todeprive such patients of the important advantages of themethod for an after-effect which is usually absent or, at anyrate, not severe.

It may be added that as spinal analgesia does not preventsensations of pressure and dragging in the same way as itdoes sensations of pain, the former should as far as possiblebe avoided for this reason beside others.

I am, Sir, yours faithfully,Fairhazel-gardens, K.W., Jan. 28th, 1918. J. D. MORTIMER.J. D. MORTIMER.

The War.THE CASUALTY LIST.

THE following names of medical officers appear amongthe casualties announced since our last issue :—

, Died.Lieut.-Col. J. McCrae, Canadian A.M.C., Consultant Phy-

sician to the British Armies in the Field, was educated atToronto University, and qualified there in 1898. He heldappointments at Toronto and at McGill Universities andat the Victoria and the Alexandra Hospitals, Montreal. Hecame overseas with the Canadian Forces in September,1914, and had served in the South African War as a com-batant officer. At the time of his death, which tookplace in France from pneumonia, he was second incommand of the McGill University unit.

Lieut. P.A. Wedgwood, R.A.M.C., attached Yeomanry, waseducated at Edinburgh University, and qualified in 1898.He was at one time medical officer of the Great OuseburnUnion, York, where he was in practice at Green Hammer-ton, and later he practised at Kirby Underdale. He joinedthe R.A.M.C. in April last year.

Wounded.

Capt. H. A. Cochrane, Canadian A.M.C.

Previously reported Missing, now reported Prisoner inGerman Hands.

Capt. H. J. Davidson, M.C., R.A.M.C., attd. Royal Fusiliers

Missing, believed .Drowned. °

Lieut. H. K. Bhat, I.M.S. -

CASUALTIES AMONG THE SONS OF MEDICAL MEN.The following additional casualty among the sons of

medical men is reported :-Lieut.-Commander A. L. Fenner, R.N., only surviving son of

Dr. H. Fenner, of London.

THE HONOURS LIST.The following awards to medical officers are announced.

The acts of gallantry for which the awards were made arenot yet published. All are members of the R.A.M.C. unlessotherwise stated. The dates in parentheses, in those caseswhere bars have been awarded, refer to the number ofTHE LANCET in which a record of the original decorationwill be found:-

Bar to the Distinguished Service Order.Maj. (temp. Lt.-Col.) A. C. Osburn, D S.O. (June 10th, 1916, p. 1195).

Disting1tished Service Order.Temp. Capt. F. F. Carr-Harris ; Maj. (temp. Lt.-Col.) C. A. A. Stidson.

Bar to the Military Gross.Capt. C. D. S. Agassiz. M.C. (Oct. 6th, 1917, p. 549); Temp. Capt.

A. J. Blake, M.C. (Sept. 30th, 1916, p. 620); Capt. E. A. C. Fazan, M.C.(Jan. 22nd, 1916, p. 215) ; Temp. Capt. J W. Macfarlane, M.C.(August 4th, 1917, p. 176); Capt. S. McCausland, M.C. (August 4th,1917, p. 176); Capt. J. S. Wallace, M.C. (August 4th, 1917, p. 176).

The Military Cross.Capt. R. V. C. Ash; Capt. A. J. Beveridge, Spec. Res.; Capt. J. H.

Blackburn ; Temp. Capt. J. V. Cope ; Temp. Capt. D. MoM. Dickson ;Capt. (temp. Maj.) J. D. Fiddes; Capt. J. H. P. Fraser; Capt. P. JGaffakin, Spec. Res. ; Temp. Capt. H. B. German; Temp. Capt. F. A.Grange; Temp. Capt. E. A. T. Green; Temp. Lt. A. C. Hallowes ;Temp. Capt. J. P. Jones ; Temp. Capt. F. B Julian : Temp. Capt. A. G.Maitland-Jones ; Lt. (temp. Capt.) W. W. MoNaught; Temp. Capt.J. Manuel; Lt. J. Marshall, Spec. Res. ; Temp. Capt. D. J.McAfee ; Temp. Capt. F. B. McCarter: Temp. Capt. J. A. Montgomery;Capt. G. Morris, Spec. Res. ; Temp. Lt. D. A. H. Moses; Temp.Lt. E. E. Owens; Capt. H. D. Pickles; Capt. J. A. Pritham,Spec. Res.; Capt. W. Robertson ; Temp. Capt. L. M. Rowlette, D.S.O.;Temp. Capt. C Russell; Temp. Capt. R. Rutherford; Temp. Capt.B.H.Swift; Capt. A. P. Thomson; Temp. Capt. G. D. K. Waldron;Capt. D. L. Wall ; Capt. J. A. Young; Capt. J. C. Young, Spec. Res.Canadian Army .1Medical Corps.-Capt. E. Douglas; Capt. A. D.

Irvine; Capt. G. L. Jepson; Capt. J. G. MacNeill ; Capt. W. H.Secord; Capt. W. E. Sinclair.New Zealand Medical Corps.-Capt. R. C. Brewster.

i I.M.S.-Lt. S. Dutt. -

WOUNDED AT WINCHESTER.-It has beendecided to extend the accommodation for wounded soldiersat the Royal Hants County Hospital, Winchester, by erectingon the grounds additional huts to provide 70 beds. Therewill be no financial liability on the hospital funds for theextension, as the cost, estimated at £2500, has been met.Miss Burrell, of Botley (who during the last 18 months hasgiven £2000 worth of war stock to the hospital), has offered£1600, and Lady Portal has guaranteed £1000.