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light coma, deep coma, and very deep coma. Theonset of " light coma is noted as soon as the patientis unable to respond to external stimuli, such as

calling his name or touching his body. He may be

quiet or restless. His reflexes are present. The onsetof " deep coma " is carefully noted and is characterisedby loss of the corneal reflex. A sign I have seen

frequently used is gentle blowing on the eyelids ;in " deep coma " there is no flinching. "Deep coma"is considered essential in treating excited and paranoidschizophrenics. It is never allowed to exceed one toone and a half hours. The patient is in a " verydeep coma " when the pupils do not react to light.As long as the pulse and respirations are satisfactorythis condition may be allowed to last for a shorttime, but the doctor keeps close to the patient andready to interrupt the hypoglycsemia.From personal experience in this hospital I find that

frequent examinations of the conjunctival reflexdelay the onset of deep coma and therefore I considerthe absence of response to gentle blowing on theeyelids as a useful guide. When deep coma has lastedfor several minutes a more thorough examinationcan be made with less likelihood of the patientreturning into light coma (release of adrenaline).

I am, Sir, vours faithfullv,L. A. FINIEFS.

A DISPUTED WILL

To the Editor of THE LANCET

SIR,—In THE LANCET of July 2nd, 1904, you werekind enough to publish an address I had recentlydelivered before the Hunterian Society on the subjectof perforating typhoid ulcer. In it I drew attentionto the fact that between the first symptoms of

perforation and those indicative of the consequentfatal peritonitis, a remission of symptoms may occurto such an extent that the diagnosis of perforationmay be abandoned, and I illustrated my remarkswith details of cases. One of these is very pertinentto the case referred to in your last issue, for the

patient, a man of 56, actually within a few hours ofhis death gave certain directions as to the dispositionof his property. He was quite compos mentis, andI should have been prepared to testify that he hadbeen so in any court of law had it been necessary, asI was present at the time.

I am. Sir. vours faithfullv.E. W. GOODALL.

SPAIN OR INDIA ?

To the Editor of THE LANCET

SIR,-A letter in your issue of March 13th, under theheading A Spanish Ambulance, reminds one againof that peculiar characteristic of the British peoplewhich impels them to lavish their time, energy, money,and even their life-blood for the relief of the foreignerin distress, whilst they will turn a completely blindeye on the needs of their fellow-countrymen. Let awar break out, or some major national disaster occurin Spain or Abyssinia, or indeed in any countryother than one belonging to the British Common-wealth, and at once appeals appear over distinguishednames calling for money, doctors, nurses, and allthe paraphernalia for equipping and dispatchingmedical units to the distressed area, and such appeals,apparently, meet a ready response.Does it ever occur, I wonder, to those who promote

and respond so generously to these appeals that thereis surely room for their philanthropic efforts in our vast

Empire, and indeed even in our own small island ?Do they realise, for example, that here, in India, thereare vast areas where sickness, disease, and starvationare rife and where perhaps the only person to whomthe people can look for the relief of their distress-if indeed there is anyone at all-is one underpaid andoverworked missionary doctor ’?

I am not a missionary doctor ; I hold no particularbrief for missions, nor is this letter an appeal in aidof the medical missions ; it is merely intended toindicate one channel into which I consider the charityof my fellow-countrymen might more profitably bedirected. However much one may feel for the unfor-tunate victims of the Spanish civil war, I think weshould remember where charity ought to begin, andI personally would not give one farthing to aid adistressed Spaniard or Abyssinian so long as one

fellow-member of our Empire is in need of assistanceand it is within my power to help him.

I am, Sir, yours faithfully,CIVANEC.

EXPLANATION AND APOLOGY

To the Editor of THE LANCET

SIR,-In the booklet recently issued by our,firmin connexion with a block of flats in Dolphin-squarethe name of Mr. Hope Carlton, F.R.C.S., was

mentioned as being a doctor in residence there andavailable in emergency. We regret to say thatMr. Hope Carlton’s name was inserted in this bookletwithout any authority from him, without his authoritybeing sought, and without his knowledge, and wedesire to express to him our sincere apology for theunauthorised use of his name and any inconveniencethat he may have been caused thereby. Mr. HopeCarlton is not practising at or from Dolphin-square,which is his private residence, but he is continuingto carry on his practice as a consulting surgeon asbefore. We are, Sir, yours faithfully,

RICHARD COSTAIN LTD.

THE FRUITS OF IDLENESS

To the Editor of THE LANCET

SIR,-Last week your Scottish correspondent againmentioned plans to shorten the students’ summervacation. Far be it from me to interfere with thetraditional sport of overburdening the curriculum;nevertheless I venture to hand on the opinion of agroup of young London consultants whom I latelyheard discussing medical education. The questionarose why the new Scottish graduate is a betterdoctor than his English contemporary. The answerwas that his long summer holiday, his life in lodgings,and his habit of frequenting places of public refresh-ment bring the Scottish student into closer touchwith real human beings and so promote an earlier

maturity of judgment. The holiday also preventsstaleness in teacher and taught.

Of course the argument breaks down at the sourceif the Scottish University authorities do not agreethat their graduates are superior.

I am, Sir, yours faithfully,Sussex, May 18th. VULPIS.

MEDICAL PRAYER UNION.—On May 26th, at 8 A.M.,in the refectory of University College, Gower-street,London, W.C., this society is holding its annual missionarybreakfast. The speaker will be Dr. Clement Chesterman.Those who wish to attend should notify Dr. Tom Jays,Livingstone College, Leyton, E.10.