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carefully considers the alternative ways in whichthe necessary funds might be made forthcoming.Closer cooperation between hospitals, so desirable intheory, has proved unattainable in practice, andfounders on one of our invincible national traits.Exemption from local rate charges, also unlikely ofattainment, can hardly be cogently urged whenhospitals, like other ratepayers, benefit so greatlyfrom certain municipal services. On the other hand,exemption from legacy duty would benefit thehospitals to the extent of 6150,000 per annum, andmake such a difference in the hospital budget that nofurther suggestion of " going on " the rates or theExchequer, as Sir Arthur Stanley puts it, would needto be entertained. Dr. Menzies, however, believeshimself that the Treasury, given the choice, wouldprefer a lump sum contribution to such a permanentloss of revenue. The final alternative suggested in thereport, which does not exclude any other method ofimproving finance, would be the establishment of aCentral Fund on somewhat similar lines to those ofKing Edward’s Fund for London. The proposal,rejected at Sheffield two years ago, has yet much tocommend it, although it may be years before such afund could grow to any considerable dimensions, andtime is of the essence of the problem. In one way oranother the need for additional hospital accommoda-tion, which in certain areas is very acute, must be met,and careful study of Dr. Menzies’s report will be ofmaterial help to those who are concerned to raise themoney. The report this year also contains a series ofvaluable essays on various aspects of hospital adminis-tration, one of which we print on another page. Inthis essay Mr. N. Bishop Harman sets out the claimfor the general hospital as the ideal unit of organisa-tion. There is, he argues, no justification for separatehospitals for disease of the nose, throat, skin, heart,rectum, urinary organs, for cancer cases, or for radio-logical treatment. Special hospitals run the risk ofone-sided growth through loss of contact with generalmedicine and surgery or from failure to know whatother branches of medicine are doing. The issue is onewhich needs to be clearly thought out in contemplatingthe addition of hospital beds in the near future.

CHIROPRACTIC.THE first essential in the practice of medicine is

the honest attempt to make an accurate diagnosis.Licensing bodies throughout the world prescribe aprolonged course of study, after a stiff entranceexamination, with a view to producing a certainstandard of diagnostic ability amongst those who areto have the care of the sick. In his presidentialaddress last Monday to the Medical Society of London(summarised on page 807), Sir Holburt Waringruthlessly laid bare the exiguous curriculum of manyof the osteopathic and chiropractic schools in America.It would appear that many of these schools make nocondition of entrance save the ability to read andwrite ; they prescribe a mere 18 months of studyprior to granting a doctorate of osteopathy or ofchiropractic. The type of manipulator thus pro-duced preaches the utterly unscientific doctrine ofdisplacement of vertebrae with direct pressure onnerves and vessels as a result. There is a moreenlightened school which describes the osteopathiclesion as an immobilisation of the joint outaidc itsposition of normal movement, and which attributesthe resulting ills to irritation of the sympathetic.The growth of these two schools, whilst undeniable,need give rise to no serious anxiety unless there isfailure on the part of the medical curriculum itself torecognise the value of manipulation in the treatmentof pain, local or referred. We know of only onegeneral hospital at which a class of students istaught the technique of joint manipulation, andattendance at this class is not compulsory. In casesin which manipulation offers a chance of relief thiscan now be obtained only at the hands of a smallgroup of qualified practitioners, and relief, therefore,tends to be sought in unqualified channels.

Annotations.

RESEARCH IN THE MEDICAL SERVICES.

"Ne quid nimis."

OuR issue this week opens with an address, entitledas above, and delivered before the appropriate Sectionof the Royal Society of Medicine by Sir WilliamLeishman on Monday last. The Director-General,A.M.S., points with confidence to the opportunitiesenjoyed by the officers in his and in the sisterServices, for contributing to the medical wisdom ofthe world both by cooperation and by individuallabour. His words in the latter respect, with regardto the planning of work, are wholly admirable;especially does he inculcate that self-criticism whichwill go far to prevent premature enunciation oftheories, a proceeding which is unfortunately followedby personal disappointment or resentment for thewould-be discoverer, while it is woefully embarrassingfor all workers along the same lines. Sir WilliamLeishman’s counsel is designed to create a fineindividual worker who shall contribute to collectiveresearch. Alterations in the conditions of servicein the R.A.M.C., which took effect under Sir JohnGoodwin some five or six years ago, with the activecooperation of Sir William Horrocks and the presentDirector-General, have made it possible for soundscientific workers to attain to positions in the Serviceof proper trust and emolument, so that the greatscope for original labour in tropical and preventivemedicine offered by the sphere of duty can beproperly taken advantage of. The reform is bearingfruit now, while the urge of scientific enterprise hasmanifested itself also in the Navy and the Air Force.In all the Services there must arise difficulties dueto isolation, to change of station, and to the dailypressure of routine, but in all of them there is aspirit abroad surmounting the obstacles, and thatit is the spirit rather than the provision of materialappurtenances which counts is sufficiently shown bypast records. The zoological-pathological work ofManson and Ross was accomplished largely whilecarrying on their arduous duties, and with a similardisability Sir Leonard Rogers found time to reversethe figures of cholera mortality. Sir David Bruce,with many patients but no laboratory save whathe could construct for himself, found the germ ofMalta fever and initiated a campaign which addeda battalion to the effective strength of the Army ;after which he, with the devoted assistance of hiswife, went on to discover the relations of the tsetse-nyto sleeping sickness. Sir William Leishman himself,while engaged in the duties of his office, discoveredthe cause of kala-azar, and Sir Percy Bassett-Smith,as a naval officer, showed the Navy how to escapethe menace of scurvy. Last week we publisheda paper read to the International Congress of AerialNavigation at Brussels by Group Captain MartinFlack, in which the relation of stable nervous controlto flying efficiency was fully discussed, and theelaborate work there indicated, which has to beundertaken for the assessment of a candidate for

flying duties, demonstrates the high range of scientificaccomplishment to which officers in the Air ForceMedical Service must to-day attain if they are todischarge their duties. Medicine may look confidentlyto the Services for competent and zealous recruits tomedical research. ____

THE TEACHING OF HEALTH.THE Royal Sanitary Institute was recently respon-

sible for a National Health Week, when nearly 400 citiesand towns of the United Kingdom joined in the cam-paign for rousing a sense of personal responsibilityfor health. Such a health week has usually as one ofits attractions popular lectures on health matters,and there seems to be an increasing demand for publichealth propaganda by the spoken word. In view of