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infant mortality. Dr. Moore is a firm believer in theprinciple of keeping infants and their mothers togetherin the home and bringing help to them there. Sincethis method has been in operation in Huddersfield theinfant mortality-rate has been reduced by about 30 percent., a reduction which Dr. Moore points out comparesfavourably with that of neighbouring boroughs in whichother-and more costly means have been adopted. He

proposes that one visit per week per child should bepaid during the first month of life, two visits permonth during the next two months, and one visit permonth thereafter, these visits being aided and supple-mented by the work of the local Public Health Union.Dr. Moore calculates that this will require three womendoctors at a salary of :B500 per annum and six nursesat .S180 per annum (total about JE2700, including uniform),and that nursing material and other forms of help mightrequire another 1000 or so. Dr. Moore is insistent thatnone but duly qualified and legally registered medicalwomen should be employed on this important task,which consists in large part of overcoming ignoranceand prejudice. It is idle, he thinks, to try to eliminateold-fashioned and ingrained mistakes if the would-beeliminator is on an intellectual and social level withthe person to whom the prejudice is a religion. Weshare Dr. Moore’s high opinion of the function ofmedical women in public health matters, but mustconfess to a little astonishment that he can see no

training, other than the full medical course, likely toresult in producing efficient health visiting. The schemehas been approved in principle by the HuddersfieldSanitary Authority, and Dr. Moore has been directed toapply it to one-third of the area of the borough. If thisis disappointing for the other two-thirds, at all eventsthey will serve as a control to gauge the success of themethods employed. -

BENZYL BENZOATE IN ASTHMA.

WE have called attention recently to the value inhiccough and in whooping-cough of a new remedy,benzyl benzoate, discovered by Dr. David I. Macht atthe Pharmacological Laboratory of the Johns HopkinsUniversity, which has a remarkable sedative effect onthe spasm of smooth muscle and yet is not narcotic.

Among the affections in which it has proved useful isasthma. Dr. B. Woloshin 3 has now called attention tothe value of hypodermic when oral administration hasfailed.He reports the case of a woman, aged 54 years, who came

under observation a year ago. She had suffered frombronchial asthma for 14 years, during which time she wasunder fairly constant medical treatment. Her attacks,which varied in severity and frequence, were as a

rule promptly relieved by injections of morphine andatropine or adrenalin. About eight months previouslythe attacks increased in frequency and severity. Adrenalinno longer gave relief, while the dose of morphine hadto be increased. Benzyl benzoate was given in 20-dropdoses every four hours by the mouth. She was com-pletely relieved in several days and remained so for twomonths. Without apparent cause she then suddenly beganto suffer severely, being in an almost constant state ofdyspnoea. Neither adrenalin by injection nor benzyl benzoateby the mouth gave the slightest relief. For temporaryalleviation the hypodermic administration of one-third toone-half a grain of morphine every four to six hours wasnecessary. This condition continued for about two weeks.She became obstinately constipated, took little nourishment.Her skin was dry, tongue parched, heart action poor, andpulse rapid and weak. Benzyl benzoate was given in 20-dropdoses every three hours by hypodermic injection and digalen,10 drops every four hours, by the same method. At the sametime salines and enemata were administered. In three days Ishe was completely relieved, after a week she got up, andever since she has been free from attacks. ,

Dr. Woloshin emphasises the value of digitalis inasthma, particularly in long-standing cases, where the

1

resulting dilated right heart, with consequent impaired 1

pulmonary circulation, adds to the sufferer’s trouble. 4

Dr. F. R. Mason 4 also publishes a paper on Bronchial 1Asthma in Childhood. He refers to benzyl benzoate as Ia harmless antispasmodic which in many cases gives

1 THE LANCET, Sept. 4th, 1920, p. 512.2 THE LANCET, Sept. 18th, 1920, p. 615.

3 New York Medical Journal, Sept. 18th. 4 Ibid.

satisfactory results. But it does not relieve all cases,and has the disadvantage of having an unpleasant andlasting taste. In children who are old enough he givesthe drug in capsules containing 2 minims four times aday. In the 10 per cent. solution the dose is half a

teaspoonful four times a day for a child of 6. Benzylbenzoate is best given continuously to patients havingfrequent attacks, but this is not necessary in those’having only occasional attacks.

ACTIVITY AND REPOSE.

ALL living organisms have alternating periods of

activity and repose. In man the cycle normally is

complete in 24 hours ; do all members of the animalkingdom manifest a similar 24-hour cycle? J. S.

Symanski has made some experiments, recorded in arecent issue of the Rivista di l3ioLogicc, to determine thequestion. The animals were placed under conditionsas natural as possible in an apparatus which he calls anactograph, arranged to record graphically their move-ments. As regards periodic activity it appears thatthere are two main types. In the first or monophasictype, which includes man, bird, goldfish, and fiy, a

simple 24-hour record was obtained with’ only one

well-marked period of activity and one of rest.These animals are awake during the day and sleepat night. The second type showed in 24 hours morethan one active and one reposeful period; thistype includes mouse, dog, rabbit, snail, earth-

worm, and human infant. On the activities of thesepolyphasic creatures day and night have no markedinfluence. They orient themselves chiefly by smell andtaste in contradistinction to the monophasic " optical "-animals, in which the sense of sight is highly developed.The transition from polyphasic suckling, with its

prevailing guidance by touch and taste, to the mono-phasic optical child is an occurrence of great interest.It appears that the more frequent the periodic change,the lighter is the intensity of sleep. Animals of bothtypes exhibit in the 24-hour period one or two periodsof activity which seem to be independent of hunger andother stimuli, whether geo-, photo-, or thermo-static;applied during the maximum period of activity theseare without effect. The cause of the periodicity musttherefore be sought in some deeper internal and as yetundiscovered change in the organism itself, possibly arhythmical alteration of metabolism.

CLAIMS OF THE VOLUNTARY HOSPITAL.

I A RECENT number of the official New Zealand Journa I

of Health and Hospitals indicated that to the people ofthat well-ordered island, accustomed to adequate andwell-equipped hospitals established wherever necessaryand maintained out of public moneys, the idea ofBritish hospitals having to close their wards on accountof lack of funds was simply amazing. We, too, should beamazed at the present financial position of the voluntaryhospitals in this country were we not hardened byfamiliarity. Sir Napier Burnett is meanwhile doing hisbest to point out to each section of the community whyits support of hospitals is a business proposition, as thephrase goes. In an address which he recently gave to thenewly-formed regional divisions of the British HospitalsAssociation at Birmingham and Manchester he put itto the individual citizen that the hospital has a valueto his wife and family and that therefore he shouldcontribute towards its maintenance, whether by a.

periodical levy or by paying beds. He put it to’theemployer of labour that the hospital is doing work forthe employer of labour which reduces his businessexpenses from sickness and disablement among hisstaff. He put it to the insurance companies that thelow tariff rates now quoted for life policies are theresult of actuarial calculations based in large measureon the voluntary work done by hospitals. He put it tothe municipality that the accidents occurring within itsarea are fed, doctored, and housed in hospital, and thatwhile in compensation cases the lawyer, the doctorgiving evidence, and the patient concerned all get paid,the hospital itself goes empty. He put it to theState that such expenses as the provision of new