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or cropping out. Convalescence was exceptionallyrapid, the Widal reaction remaining negative fortyphoid, paratyphoid A and B. Practically all thecases occurred in adults.

I would ask : Were these cases of atypical entericfever or abortive enteric or were they cases ofinfluenzal pneumonia with enteric-like spots whichrapidly improved on removal from their homes to thepurer country air ? It is to be remembered that allwere obviously very ill on admission, and all quicklyimproved on admission, though most were admittedon the third day of illness, it was striking how farmore rapidly they improved than the cases of influenzalpneumonia in the same ward. On inquiry amongstpractitioners in the town I heard of three apparentlysimilar cases.-I am, Sir, yours faithfully,

EUSTACE THORP.Deputy Medical Officer of Health, Sunderland.

TREATMENT OF THE MALARIAS.

To the Editor of THE LANCET.

SiR,—I do not wish to take up your space byentering into a controversy upon the merits or

demerits of plasmochin. Dr. Manson-Bahr has, I amafraid, missed the point I tried to enforce. My simileof the goose would, I thought, have appealed even tonon-ornithological readers. In quoting me Dr. Manson-Bahr has not put in the full sentence I used. I didnot say " will act better than either given alone," but" it is quite possible, of course, that ... a combinationof these two drugs will act better than either givenalone, but, time only and careful observations willshow this." We may leave it at that. The subject istoo young yet to dogmatise upon.

I am, Sir, yours faithfully,G. CARMICHAEL LOW.

THE PRESENT POSITION OF THEVOLUNTARY HOSPITALS.

To the Editor of THE LANCET.

SiB,—I do not wish to trespass personally furtheron your space, for there are many, I am sure, muchmore fitted to discuss this question. I must just saythat Dr. Little attributes to me several statements I

Inever made. With some of them I agree, with others ’,not. The " 20 per cent.

" statement was not mine.In regard to my

" brick," as he genially calls it, Idisown it, but I stick to it, if you will pardon me.If Dr. Little really wants to know, let him write tothe medical superintendents of London poor-lawhospitals and ask them how many spare beds they have.It is quite easy. I can give him a good start myselfwith 120 or so extra beds filled over the proper comple-ment. My statement referred expressly to London.I said nothing about the rest of the country, not havingpersonal knowledge about that ; but I think it wouldbe worth while to inquire how many of the supposedsurplus beds are in country unions neither situatednor equipped to be useful to the chief centres ofpopulation. For the rest I leave it to your readersto judge how far Dr. Little has met the various pointsraised. I am, Sir, yours faithfully,

Whipps Cross Hospital, Feb. 10th, 1928.

RECURRENT COLDS.I

To the Editor of THE LANCET.SIR,—May I support -Dr. A. L. Grant’s letter in your

last issue. I also have found, both in my own caseand in the cases of others, that I can either prevent,abort, or cut short not only that dangerous condition,the common cold, but influenza also by means of Mr.J. E. R. McDonagh’s symmetrical ureas.

I am. Sir. vours faithfully.MACLEOD YEARSLEY.

Parliamentary Intelligence.NOTES ON CURRENT TOPICSRESUMED DEBATE ON THE ADDRESS.

IN the course of the resumed debate in the House ofCommons on Wednesday, Feb. 8th, on the motion that ahumble Address be presented to His Majesty in reply tothe gracious Speech from the Throne,

Mr. HARRIS said that he had great respect for the Ministerof Health, for whatever his faults might be they realisedthat he had knowledge and experience. They had hopedfor great reforms from him. Towards the end of 1925the right hon. gentleman produced a most interestingand almost an historic document in which proposals wereput forward for poor-law reform which were to form thebasis for consideration and discussion by local authorities.In 1926 he (Mr. HARRIS) asked the Government when theseproposals would take the form of an Act of Parliament,and he was informed that the Government wanted a yearfor consideration. They had had a year. They understoodthat the Poor-Law Bill would make its appearance during1927, but they were told by the Minister of Health thatalthough he was full of goodwill and good intentions theprogramme of the Government was so crowded with othermatters that there was no time to deal with this importantquestion. Nobody could say that the King’s Speech thisyear disclosed an overcrowded programme. There wouldhave been plenty of time to deal with the vital question ofpoor-law reform. It was not because the Governmentwere not prepared. The Ministry had been thinking overthe matter for two or three years, and there had beenconstant conferences with local authorities. He understoodthat there was something like general agreement. Whyhad the Government run away from this question ? Itwas now stated that poor-law guardians were to stay andthat there was to be no reform. Could not the Governmentwith their big majority force through Parliament the schemewhich they thought necessary ? Did the Governmentwant to leave the question to be dealt with by the LabourParty or the Liberal Party because they did not feel thatthey were competent to deal with it ? Having dropped theFactory Bill, was it not about time that the Governmentreally did some constructive work and put forward somescheme to deal with this thorny social problem ? They wouldnever get a solution of the problem of necessitous areaswithout taking in hand the reform of the poor-law. Thepresent poor-law system worked badly throughout thecountry. London had a right to demand that the systemof government should be changed. The present poor-lawsystem was gradually breaking up. Through the machineryof old age pensions the old people were gradually beingtaken out of the poor-law, and, thanks to the extension ofthe Education Acts, a large number of children were nowrelieved through the machinery of the education authorities.All who now remained were the sick and the able-bodied.The original scheme was that the hospitals throughout thecountry should be transferred to the county authorities.That would be a very simple proposal to carry through,and would not require any complicated legislation. Eventhe able-bodied who required assistance were very largely,at any rate for a period, taken away from the local reliefand were paid out of national funds through the machineryof the Insurance Act. Did it not seem the natural line ofadvance to remove from the local rates the able-bodied poor,or to use the phrase in a scheme put forward by the Ministryof Health, to correlate the system of relief with the machineryof unemployment insurance ? If they took the able-bodiedpoor out of the control of the poor-law guardians, andremoved the children from their care, and took away theold people, there was little work left for the guardians todo. The Government, he suggested, were under an obliga-tion to the nation to translate into a Bill the scheme outlinedby the Minister of Health in 1926.

Lieut.-Colonel ACLAND-TROYTE urged that one way inwhich the Government could help agriculture was byrefraining from throwing more burdens on agriculturistsby Orders like the Milk and Dairies Order, and for theProhibition of Preservatives in Cream. The Governmentwere quite ready to bring in Orders like these, but when theywere asked to introduce an Order to prohibit the importationof condensed skimmed milk they would not do it.

Mr. GROVES raised the question of slum clearances inWest Ham. Every month, he said, the medical officer ofhealth of that borough reported that 80 per cent. of thehouses inspected were not considered in all respects reason-ably fit for human habitation. The existence of this slumproperty in big boroughs were undermining the health ofour future citizens, and increasing the deaths among children.He believed that the Government were going to interestthemselves in a national campaign for the cure of rheumatism.

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Be wished them luck, but there were many other and betterways in which Parliament could approach this question.In West Ham they had people sleeping five, six, seven, and,even ten in one room. The less capable an area was ofmeeting its liabilities the more the National Exchequerimposed upon it in its schemes of social reform and publichealth. They were proud in West Ham of the way in which ’,- irrespective of party-they had tried to approach theproblem of restoring tuberculous people to some sort ofnormal health, but it cost them money. Their fever hospital ’,was one of the finest in the country, but that hospital was ’overcrowded. The local hospitals could not take in the IIpeople who were sick ; they had to be sent to poor-law Iinstitutions. Their sanatorium was also overcrowded, andthey had a large number of people on the waiting list. Theydid not object to bearing these responsibilities, but if theGovernment really intended to approach the problem ofrelieving local burdens here was the place to start. InWest Ham nearly 3000 scholars were fed daily by theeducation authorities. Otherwise they would go to schoolhungry. They would respond to any help that could berendered them, because they could not for many moreyears continue to carry their present burdens on the shouldersof the local ratepayers.

Mr. SNELL said that they had hoped that the reform ofthe poor-law would be dealt with during the present session.Almost associated with that problem there was anotherabout which he felt the deepest and keenest interest. Ayear or two ago he served on the Royal Commission dealingwith Lunacy and Mental Disorders. They presented to theGovernment what they considered was a well-balanced,sober, and critical judgment upon a very difficult and avery moving problem, and they had hoped that the Govern-ment would have found time to deal with the unfortunatestate in which many of their afflicted fellow citizens foundthemselves under present conditions. There was also thequestion of housing. Whatever credit they might takefor the improvement in housing in recent years the problemcould not be regarded in any way as solved.

Mr. Chamberlain’s Reply.The debate on the Address was resumed on the 8th, whenMr. CHAMBERLAIN, Minister of Health, said that it was

not a fact that local government was breaking down. Itwas true that local government had been placed under asevere strain, but he thought it was going to come through.The effect of such conditions as those which existed in SouthWales had produced a vicious circle to which attention hadbeen called so often in that House. Unemployment meantincreased local charges, and those charges meant a furtherhandicap to the struggling industries of the district. Thatmatter had attracted the anxious attention of the Govern-ment. It was obvious, however, that any relief to localrates which involved the shifting of the burden from theshoulders of the ratepayers to those of the taxpayers couldnot be confined to one or two areas in the country, andanything of that kind must be part of a general and far-reaching scheme. The time had not yet arrived when theGovernment could make any proposition to the House.but to those who had so often taken part in debates onnecessitous areas it would at least come as a message ofpeace to know that the Government had not ruled out thepossibility of some relief of this kind coming within therealm of practical politics.

Ir. LANSBURY said that the Minister of Health had theimpudence to say that local government had not brokendown. In unions such as Poplar the board of guardiansdid not exist. They had no power to administer. Thenation would reap what it was sowing. Small-pox was avery deadly disease, and so were typhoid and other diseases.The reason why these diseases had not got a hold duringthe recent depression was because the physique of thepeople had been maintained. Food was one of the necessarythings for a healthy body. The best safeguard againstsmall-pox was

Dr. WATTS : Vaccination.Mr. LANSBURY said that vaccination without food would

not save anyone from small-pox, and everyone knew it. IHe would like to ask the hon. Member, who was a good ’,doctor, " Do you agree that muck and refuse should be leftabout the streets and be removed only once a week insteadof twice a week ?-Dr. WATTS : No.

Mr. LANSBURY said that in that case the hon. Memberwas on his side. He believed that collectively the nationcould do what it pleased in the matter of setting right socialproblems if it would give up the idea that mere wealth wasthe only thing that mattered.-The debate was adjourned.

PROTECTION OF DOGS BILL.On Monday, Feb. 13th, Sir ROBERT GowER presented

the Protection of Dogs Bill, a measure " to prohibit thevivisection of dogs." The Bill, which is supported by Lieut.-Colonel Moore, Mr. Bromley, Mr. Macquisten, Mr. Thurtle,Captain Arthur Evans, Mr. Sexton, and Mr. Radford, wasread a first time. ’

HOUSE OF COMMONS.

WEDNESDAY, FEB. 8TH.Cost of Social Services.

Mr. BECKETT asked the Minister of Health the amountper head of population distributed on the following servicesfor 1926-27 : poor-law relief ; old age pensions ; NationalHealth Insurance benefits ; domiciliary poor-law relief ;orphans’ pensions ; contributory widows’ pensions ; andcontributory old age pensions.-Mr. CHAMBERLAIN replied :Information showing the amount expended, per head, ofestimated population by poor-law authorities in Englandand Wales on poor-law relief in the year ended March 31st,1927, is not yet available, but the amount for the yearended March 31st, 1926, was 20s. 7d., including 8s. 1d. onoutdoor relief in money and kind. The amount expended.per head of estimated population, by those authorities onoutdoor relief in money and kind for the year endedMarch 31st, 1927, was 12s. 0d. As regards the remainderof the question the figures are :—

s. d.Old age pensions under the Old Age Pensions Act,

1908-1924 ............ 13 6-7National Health Insurance benefits .... 14 7Orphans’ pensions under Widows’, Orphans’ andOld Age Contributory Pensions Act, 1925 .. 0 1 z

Widows’ pensions under Widows’, Orphans’, andOld Age Contributory Pensions Act, 1925 .. 3 0

Old age pensions under the latter Act were not payabletill Jan. 2nd, 1928.

Cost of Poor-law Maintenance.Mr. BECKETT asked the Minister of Health the average

daily number of persons maintained in workhouses ; theaverage weekly cost per person ; The total amount expendedin connexion with the institutions ; the number of adultsmaintained ; the number of children under 16 ; and thetotal number of officers and staff employed in 1926-27.-Mr. CHAMBERLAIN replied : The latest information availableas regards the maintenance of persons in general poor-lawinstitutions in England and Wales (that is, institutionsother than those wholly appropriated to the sick andmentally infirm, and establishments for children in caseswhere separate accounts are kept) relates to the year endedMarch 31st, 1926, and such of the particulars asked for ascan be given, are, in respect of that year, as follows :-

Average daily number of inmates.... 134,418" weekly cost per inmate.... 24s. 2d.

Total expenditure in connexion with thoseinstitutions ..... £8,469,749

The average daily number of adults and children in theseinstitutions has not been ascertained, but the numbers onJan. lst, 1926, were 123,373 adults and 11,075 childrenunder 16 years of age. I regret that I am unable to givethe numbers of the staff employed.

Voluntary Health Insurance Contributors.Mr. RHYS DAVIES asked the Minister of Health the

number of persons who had become voluntary contributorsunder the Health Insurance scheme consequent upon thepassing of the Widows’, Orphans’, and Old Age ContributoryPensions Act ; and, if so, how did the number comparewith the actuary’s calculations when the Act was passed ?-Mr. CHAMBERLAIN replied : The number of persons whobecame up to the end of 1926 voluntary contributors,consequent on the passing of the Widows’, Orphans’ and OldAge Contributory Pensions Act, is estimated at 150,000, orabout 10 per cent. more than the number assumed in theGovernment actuary’s calculations for the purpose of theBill.

THURSDAY, FEB. 9TH.National Health Insurance Funds.

Mr. FENBY asked the Minister of Health what was thetotal amount of funds invested, directly or indirectly, onbehalf of approved societies under the National HealthInsurance Act on Dec. 31st in each of the years 1923, 1924,1925, 1926, and 1927 ; and, if the information was notavailable for Dec. 31st, 1927, what was the amount of thefunds so invested on the last available date.—Mr. CHAMBER -LAIN replied : The approximate amount of funds invested,including the temporary investment of current balances.on Dec. 31st in each of the years specified was as follows :-

I 1923

.... £87 million

1924 .... 101 "

1925 .... 114 ..

1926.... £ 113 million1927.... 111 "

Slum Clearance Schemes.Mr. WELLOCK asked the Minister of Health the number of

slum clearance schemes sanctioned by his department forthe various local authorities in Worcestershire, and the totalamount of money granted by his department in each case.-

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Mr. CHAMBERLAIN replied : Three slum clearance schemeshave been confirmed in Worcestershire, two at Oldbury,and one in the city of Worcester. The annual Exchequercontributions in aid of the schemes have not yet been fixed,but on provisional figures they are estimated at £500 inrespect of the three schemes, representing 50 per cent. ofthe estimated annual loss.

Stimulation of Milk Consumption.Mr. BUxTON asked the Minister of Agriculture what

steps he proposed to take to stimulate the consumption ofmilk in accordance with his recent statement to the Councilof Agriculture.—Mr. GUINNESS replied: The EmpireMarketing Board, after consultation with the Ministry ofAgriculture, propose to undertake next April a publicitycampaign in favour of the consumption of fresh milk. Thecampaign will extend over six months in the first instance,but it may be continued for a further considerable period,if the preliminary results are satisfactory and if producers’and distributors’ organisations then show themselves prepared to devote to publicity for the same purpose a sum equal to that contributed by the Board. I need hardlyadd that I propose to do all I can to promote this schemeand ensure its success.

Mr. BUXTON : Will the right hon. gentleman endeavourto guard against a price-raising campaign because a rise ofprice occurred in the case of the fruit campaign ?

Mr. GUINNESS : I do not think there ought to be any risein price. As the right hon. gentleman is aware, there is aconsiderable excess of milk which cannot find a fresh marketat the present time, and that could quite well be absorbed,I should imagine, without any serious effect in a rise inprice.Mr. MONTAGUE: Will the right hon. gentleman make

representations to other Ministers as to the discouragementof the consumption of milk likely to be due to the announcedreduction in miners’ wages ?

Colonel HOWARD-BURY: While encouraging the consump-tion of fresh milk will the right hon. gentleman discouragethe importation of foreign condensed milk ?

Lieut.-Commander KENWORTHY: Will the right hon.gentleman also discourage the consumption of alcohol ?

Dr. DRUMMOND SHIELS : Will the right hon. gentlemansee that in this advocacy of fresh milk some measures aretaken to discriminate between tuberculosis-free milk andother milk which may be dangerous ?

Mr. GUINNESS: There has been a most remarkable improvement in the condition of the milk supplies. The proportionof tuberculous milk is very much lower than it was a fewyears ago, and I do not think any more can be done than isbeing done at the present time in the way of improving oursupply of milk and avoiding this danger.

Lieut.-Colonel FREMANTLE: Does the Minister proposein this pub icity campaign to work with the Ministry ofHealth, who are naturally able to get at the medical channelsof recommending milk and who have already a publicitycampaign on hand ?

Mr. GUINNESS: We will certainly work in conjunctionwith the Ministry of Health.

MONDAY, FEB. 13TH.Beet-sugar Effluent and Public Health.

Major GEORGE DAVIES asked the Minister of Agriculturewhat progress, if any, had been made towards solving theproblem of the disposal of the effluent from beet-sugar factoriesin such a way as to avoid any menace to the health, sportingfacilities, and general amenities of the surrounding popula-tion.-Lord EUSTACE PERCY (President of the Board oiEducation), who replied on behalf of the Department oiScientific and Industrial Research, said: Satisfactoryprogress is being made with the experiments which arebeing conducted by the department in the biological treat.ment of the waste waters of beet-sugar factories. The dataaccumulated in the course of a semi-commercial scale tria:at one of the factories during the manufacturing campaigrjust closed are now under consideration. While promisingresults are undoubtedly being obtained, it is as yet too earl)to say whether the experiments will lead to an economi<solution of the problem. It is further understood that a1most of the factories additional plant has been instancefor the improvement of the effluent.

Miners’ Nystagmus.Mr. THOMAS WILLIAMS asked the Minister of Laboui

how many ex-miners who had suffered from nystagmusand who were unable to obtain work, were receiving unemployment pay on the last date for which figures were available.-Mr. BETTERTON, Parliamentary Secretary to the Ministry oLabour, rep ied : I regret that no figures of the kind asketfor are available.

hafeetiora from Domestic Refuse.Sir ROBERT THOMAS asked the Minister of Health whethe:

any action had recently been taken, or was about to be takenby his department to urge local authorities to use covere<

sanitary dustcarts, in order to minimise the risk of infectionfrom refuse blown about the streets.-Sir KINGSLEY WooDreplied : Local authorities are increasingly making use ofdustcarts with covers and are encouraged by my departmentto do so.

TUESDAY, FEB. 14TH.

Health of Railway Dining-car Attendants.Sir ROBERT THOMAS asked the Minister of Transport

whether he was aware that railway dining-car. attendantswere habitually required to be on the trains for periodsup to 48 and 53 hours, with insufficient sleep and greatirregularity of meals, in consequence of which there was agreat deal of ill-health among these men, particularly tuber-culosis and gastric disorders ; and whether he would makeinquiry of both the railway companies and the employees’representatives regarding the conditions of work on dining-cars.-Mr. BETTERTON (Parliamentary Secretary to theMinistry of Labour) replied : I am informed by the GreatWestern, London, Midland and Scottish, and London andNorth Eastern companies that there is no foundation forthe statement that the railway dining-car attendants arehabitually required to be on the trains for periods up to48 and 53 hours. The conditions of service of the staff onthese lines are the subject of agreements with the NationalUnion of Railwaymen, except on a section of the London,Midland and Scottish. With regard to the SouthernRailway, who do not directly employ dining-car staff, I ammaking further inquiries, and I will communicate with thehon. Member on the subiect as soon as I have furtherinformation.

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Medical News.UNIVERSITY OF LONDON.&mdash;Dr. Donald Hunter has

been recognised as a teacher of medicine at the LondonHospital Medical College.A Chair of Biochemistry, tenable at the London School of

Hygiene and Tropical Medicine, is to be instituted, andapplications are invited for this as well as for the Chair ofPublic Health at the same school, and the Chair of Pathologytenable at the London (Royal Free Hospital) School of Medi-cine for Women.The University medal at the M.S. examination in December

was conferred on Mr. R. M. Walker, of University CollegeHospital, and the medal at the M.B., B.S. examination inNovember on Mr. R. S. Pilcher of the same hospital.A Carpenter medal, together with a money prize, of the

value of jB20 in all, will be awarded in 1928 by the Senate: for a thesis of exceptional distinction in psychology sub-! mitted for the degree of Ph.D. between 1925 and 1928.; ) Applications for grants from the Dixon Fund must bereceived between April lst and May 15th.

Applications for grants from the Thomas Smythe HughesMedical Research Fund must be received between May lstand June 15th.The Laura, de Saliceto Studentship for the advancement

of cancer research, a part time appointment of the value of2150 a year, will be awarded shortly. Applications must be

received before July 2nd.The fifteenth election of Beit Fellows will take place on

or about July 16th. Applications should be sent in beforeApril 20th.

U niversitu College.-The special short course in’anatomyf and physiology, designed to meet the requirements of thef Primary Fellowship Examination of the Royal College of

Surgeons, will begin on Monday, March 5th, in preparatione

for the June examination. Particulars may be obtained-

from the secretary of the College.ROYAL COLLEGE OF SURGEONS OF ENGLAND.&mdash;At.

an ordinary meeting of the Council held on Feb. 9th, SirBerkeley Moynihan, President, in the chair, the proposalto send examiners to Canada to hold a primary examination

Y’ in anatomy and physiology for the Fellowship at Torontoc in 1929 was further considered, and a revised scheme wast approved. Instructions were given to the secretary to

forward a copy of the revised scheme to the CanadianMedical Association for consideration.&mdash;Mr. C. H. Faggewas appointed Bradshaw Lecturer for the ensuing year.-

r Sir Berkeley Moynihan was appointed delegate to take part

. in the centenary celebration of the Faculty of Medicine,’’ Cairo, and the International Congress of Tropical Medicineand Hygiene to be held at Cairo from Dec. 15th to 22nd.--

It was reported that an election would take place on Thurs-d day, July 5th, to fill the four vacancies on the Council

occasioned by the retirement in rotation of Sir AnthonyBowlby, Sir D’Arcy Power, and Mr. F. J. Steward, andby the death of Mr. Thelwall Thomas ; that notice of the

r election would be given to the Fellows by advertisement andi, by circular on March 9th ; that March 19th would be thed last day for the nomination of candidates ; and that a