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nerve, but over the course of the superior gluteal nerve.Neuralgic sciatica is felt specially in the upper part ofthe thigh and rarely extends below the knee, though inthe,paroxysms the pain may radiate to the foot. Inthis sciatic stage the articular pain has diminished ordisappeared. There are physical signs in the form ofdorso-lumbar scoliosis with the concavity towards theaffected side, lowering of the shoulder, and diminutionof the costo-iliac space. Owing to hypotonia of themuscles the gluteo-femoral fold is lowered and thefurrow between the buttocks is deviated below towardsthe affected side. In ordinary sciatica the patientsuffers more in the calf and foot, and pressure on thecourse of the nerve produces acute pain ; and it is inthe leg and foot that atrophy is earliest. In sacro-iliacsciatica atrophy is earliest in the buttock. Accordingto Professor Barre and Major Duprey, sciatica with apainful sacro-iliac point is due to sacro-iliac disease.The treatment consists in using the ordinary anodynesfor the pain (aspirin, aconite, gelsemium), hot air,liniments, and massage. In the rheumatic form salicylateis given. The joint is immobilised by applying a binderof inelastic material extending from the iliac crests tothe trochanters.

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LIMBLESS MONSTERS.

THE case reported last week by Dr. Cawas Homi isan example of a well-known, though uncommon, typeof deformity which has always excited interest amongmedical men and in the laity. As is the case with somany monstrosities, the condition is usually referredby the mother to some strong pre-natal impression.The impossibility of explaining the modus operandi ofa maternal impression, or of imagining it in action, isnot of much logical weight in considering the matter,but it has so happened that the deformity in most casesmust have been produced at a stage in normal develop-ment antedating by a greater or less time the occur-rence of the impression. This, in conjunction withmodern views as to the percentage of all conceptionswhich become monstrous to some degree, is enough toafford an explanation apart from the impression; butwe still lack reliable data concerning the percentage ofpregnant women who suffer from ante-natal impres-sions. The frequent occurrence of other commonmalformations with the ectromelic state does not agreewith the influence of maternal impression. Dr. Homi’scase is not open to the objection that the suggestedmaternal impression came too late in the gestation-period to have its influence, but is an ectromelic casediffering in no other way from the rest; it is to be regrettedthat no expert dissection of the limbs was possible.

IMPROVEMENTS IN THE INDIAN MEDICAL SERVICE.

IN our last week’s report of proceedings in Parlia- I,ment 1 we gave in detail the new rates of pay and other

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improvements in the conditions of the Indian MedicalService, as stated by Mr. Montagu in the House ofCommons on July 12th. They may be summarised, asregards the chief points, as follows: Formerly, a

medical officer on joining, with the rank of lieutenant,drew Rs.550 per mensem until promoted to :captain,when he received Rs.700. According to the new scalehe commences with Rs.650, and after three years’service becomes captain with Rs.800. Formerly, whilein the rank of captain, he obtained successive incre-ments of pay up to Rs.750, Rs.800, and Rs.900 after 5, 7,and 10 years respectively ; now he draws Rs. 800 duringhis first three years as captain, Rs.950 in his nextthree, and Rs. 1050 in his tenth, eleventh, and twelfthyears, reaching Rs.1200 on promotion to major after12 years, instead of Rs.1000 as formerly. After15 years he draws Rs.1350, and after 18 years Rs.1500,as compared with Rs.1150 formerly from the completionof his fifteenth to completion of twentieth year, or pro-motion to lieutenant-colonel. After 20 years’ servicehe now draws Rs.1750 (compared with Rs.1550 pre-viously), after 23 years Rs.1850, and after 25 yearsRs.1950, and if on the selected list Rs.2100. Charge

1 THE LANCET, July 17th, p. 161.

allowance, varying from Rs.120 to Rs.240, is also issuedto officers in command of all except the smallest hos-pitals, and in the larger hospitals of the first andsecond class the second in command also draws anallowance of Rs.120 and Rs.90 respectively. Con-cessions are to be granted with regard to pensions,passages, and leave; and as regards the status of theDirector-General and Surgeons-General, these officersare to have the right of direct access to the Viceroy orGovernor, as the case may be, and of access to docu-ments the same as possessed by the Secretary to theGovernment. The improvements indicated, both

pecuniary and in regard to official status, appear tohave a substantial value and to evince a genuine desireon the part of the Indian Government to meet thelegitimate claims of the officers in the- Medical Service.

THE VALE OF SIDDEM.

WITH perfect good faith, doubtless, some of ourAmerican friends have commented on the evidences ofdegradation and immorality which they have foundwhen visiting the cities of Europe, and have congratu-lated themselves on the superiority in these respects of"God’s own country." This complacency will receivea shock if they will devote themselves to the perusal ofa book which has just reached us from the UnitedStates.1 Its title seems to foreshadow something of

poetry, and its format lends support to the anticipation,for the work is one of those neat and modest littlevolumes with which diffident minor poets are wont todeprecate their indulgence of the cacoethes scribendi.There is, indeed, " poetry" in it, for it starts off withthe following rhyme :-

" All the wicked peopleIn the Vale of SiddemThought of things they shouldn’t do,And then they went and did ’em."

Thus are we prepared to face a grim and depressingstory. In a valley through which flows one of thetributaries of the Mississippi river, in the State ofMinnesota, there dwells a community known locally as" timber rats " and " bark eaters." Its members are thefruit of regular and irregular unions between severalfamilies all hopelessly antisocial. Thus we have the Yaks,from one daughter of whose house there were derived79 persons, of whom 10 were insane, 15 feeble-minded,and 8 epileptic ; the first generation including 14

children, of whom 9 were insane and 1 was feeble-minded. Another Yak married into the Bart family.His wife, herself insane, was one of five brothers andsisters, three of whom were insane. These five hadamong them 14 descendants, 7 of them being eitherfeeble-minded or insane. Delilah of the Cam familywas one of 9 children, of whom 7 were feeble-minded.She married into the Glade family, whose record ismuch the same, and had 11 children, of whom 2 diedyoung, while of the remainder 1 only was of normalmentality. " Muskrat Charlie " married a feeble-minded woman and had 11 children, of whom 3 diedshortly after birth and the rest were feeble-minded.So the story goes on. Summed up, of 1619 dwellersin the Vale of Siddem 892 furnished no sufficientinformation for any report, 114 died in infancy or

early life, and of the rest there were only 156who could be regarded as normal; 199 were feeble-minded, 34 insane, 125 sexually immoral, and 134alcoholic-i.e., individuals who drank " habituallyand to excess." Of the feeble-minded only about5 per cent. have been reached by the available agenciesfor care and control. The outlook could hardly beless satisfactory. As the authors themselves put it:" From the standpoint of eugenic consideration theexistence of such communities as the Vale ofSiddem makes our present attempts to care forthe feeble-minded quite idle. The sources of theapparently inexhaustible supply of mental defectivesremain unaffected. It is like trying to stamp outmalaria or yellow fever in the neighbourhood of amosquito-breeding swamp."

1 Dwellers in the Vale of Siddem. By A. C. Rogers and Maud AMerrill. Boston : Richard G. Badger, The Gorham Press.