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case, and in 22 permission was granted and theexamination performed.Of the 21 cases that are still alive and on treatment:

in 3 the growth appears to be stationary; in 2there was a temporary, but definite, diminution inthe size of the growth, but this was not maintainedand the growths are now progressing; in 10 therewas a definite alleviation of pain and temporaryimprovement of the general condition with gain inweight; in the remaining 6 (Cases 64 to 69 inclusive)the period of observation was too short for anyappreciable result to be shown (see Table III.).

TABLE IIL-Patients Alive (29)

(a) Still on Treatment, August, 1935 (21)

The Medical Committee have pleasure in acknow-ledging Dr. Todd’s courtesy in demonstrating hismethod of treatment to Dr. Murray. They wishalso to record their appreciation of the care andzeal with which Dr. Murray has performed her duties,and the skill with which she has carried out a notalways easy technique.

PORTH HOSPITAL, GLAMORGAN.-On May 12th exten-sions to this hospital were opened which included an X raydepartment and 28 bedroms for the nursing staff. SirWilliam Thomas has given 1000 guineas to endow a bedin memory of men who fell in the war.

DR. BARNARDO’s EoMES.—At the annual generalbusiness meeting of Dr. Barnardo’s Homes, NationalIncorporated Association held on May 13th, the reportshowed that 118,113 destitute boys and girls had enteredthe homes to Dec. 31stlast. A total of 15,988 children andyoung people were dealt with during the year, and 1464boys and girls and babies were admitted-1332 permanentlyand 132 temporarily. The number in residence at the endof the year was 8182. These homes, it is claimed, have nored tape and no waiting-list; the need of the child is theonly consideration. The address of the association is 18,Stepney-causeway, London, E.l.

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(Continued from p. 1153)

AT the meeting of the section of kinesitherapy onMay 13th, held at the house of the Royal Society ofMedicine and presided over by Dr. JAMES B. MENNELL,a paper was read by Major C. R. DUDGEON on

Low Backache

He said that he proposed to make a general surveyand to select certain points for particular attention.In the past, cases of low backache had been treatedby applying hot irons, belladonna plasters, andliniments, and by all sorts of people ; by the time thecases came to the practitioner of physical medicinethe primary symptoms had become masked, and

secondary symptoms had become well established.It was thus often very difficult to find out the natureof the primary causal factor in a given case. Iflow backache had lasted a considerable time, onecondition which frequently became engrafted was thatof neurasthenia, due to the long-continued pain. Soobtrusive was the neurasthenia sometimes that theprimary backache was almost forgotten. Yet it wasthe latter on which attention should be concentrated,because no efforts directed to curing the neurastheniawere likely to succeed until the cause of the backachehad been discovered and treated. In an acute case itwas often very difficult to arrive at a diagnosis, becausethe patient’s only answer to the various manipula-tive efforts to localise the trouble was : " that hurts."When the patient presented himself to the physicianhe had probably been brought straight from bed tokeep the appointment, and on his journey had saton hard and uncomfortable seats in ’bus or train;and it was then good practice to put him on a bedfor a time and apply infra-red rays or hot wax, andsome massage for half an hour. The patient’s relief wasoften so great that subsequent examination wasmuch more revealing. Major Dudgeon attachedconsiderable importance to an accurate history,particularly as to habits or unusual occurrences;not the long story of how someone left orange peelon the pavement and the twist the patient got fromstepping on it, but rather an account of his generalmode of life, or any periodic strains he had under-gone. An instructive example was the following.A woman of middle age complained of backache

recurring on and off for several years. She said that heractivities consisted of ordinary household duties. Thediagnosis made was mild sacro-iliac strain, and the treat-ment was successful. But she returned with recurrencestime and again. Eventually, after close questioning,it was ascertained that occasionally she did some glove-making at home, and to work the machines she had toadopt a cramped attitude for considerable periods. Theattacks coincided with the bouts of glove-making, andwhen she followed the advice to stop this work the attacksof pain also ceased.Low backache could often be classed as an occupa-

tional disease. On a cold winter morning backachemight follow the laborious cranking of a motor-car.Some other causes were not so obvious. Motoringpapers had had much to say recently about the needof having " anatomically shaped seats " ; some

recommended special’rubber sponges which fittedinto the back, pneumatic cushions, and so on.

Generally speaking, the driver of a luxurious moderncar took up a lolling attitude, probably with hislumbar curve reversed. At a stop he might get out,

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stretch himself, and complain of backache ; andat the end of a long journey he might be so distressedthat his condition called for treatment. Passengerswere not so much affected as they could relax andchange their postures. The driver bestowed uponhimself a series of small traumata in a false position,a factor being frequent application of the brake pedal.The pain in all but one of the cases of this kindwhich Major Dudgeon had seen was on the right side.One case of severe pain in the region of the fifthlumbar nerve was due to the tilt of a driver’s seat,the springs having given way on one side. Previoustreatment had been ineffective, but when the seat wasput right his pain was cured. Mining was an occupa-tion in which these cases occurred frequently ; anotherwas in small printing establishments, in which a manmight perform a high treadle action to motivate afly-wheel. Nurses who lifted heavy patients alsotended to suffer from low backache. During thewar a number of cases of so-called lumbago weredue to the adoption of a stooping attitude by theoccupants of shallow trenches who were sometimesburdened with a heavy pack. In cases of recurrentbackache it was always wise to search for summationsof slight traumata extending over considerableperiods.Treatment of low backache could be grouped.

as: (1) means to increase or to restore mobility ;(2) means to prevent undue mobility or malposturewhere this was diagnosed as the cause of the pain ;(3) means to stimulate local metabolism and decreasespasm.Means to increase or restore mobility.-Various

forms of manipulation and gymnastics were includedin this group. Manipulation could be divided into(a) forced manipulation, usually under anaesthesia,and (b) the more gradual forms, including the loosen-ing by shaking or otherwise of various parts. Itwas easy to abuse manipulation; in some condi-tions it was not only contra-indicated, but useless.A patient with fibrositis, for instance, should neverbe manipulated. Often manipulation was used asa shot-gun when a target rifle should have been

employed. "Shaking loose" and gymnastics playedbut a secondary role in the treatment of low back-ache conditions. After undergoing manipulation,especially extensive manipulating, the patient shouldbe given a respite from all weight-bearing functions ;his musculature could be maintained in a vigorouscondition by giving him functional exercises to carryout without weights. The muscles of the lowerback were so strong, and spasm in them was so

often present that, usually, it was unsatisfactory tomanipulate them except under anaesthesia so deepas to ensure really good muscular relaxation.Physical training and re-education were of the firstimportance in the treatment of the low backachein which wrong posture was a definite factor.The prevention of malposture should include all

kinds of causes. Mobility might be excessive, as

in constantly recurring sacro-iliac strain, or lessthan normal, as in patients with long transverse

processes of the fifth lumbar vertebra, one of whichimpinged on the ilium. The aim should be to limitthis movement by providing a support, or, as inlordosis, to properly distribute the strain. Webbing,with back plates, could be used, and excellent typesof surgical belts and corsets were now available,which might be modified to suit the particular case.These supports must be made of inextensible material;the modern elastic or suspender belts were useless.The belt should fit firmly over the pelvis and possessmsans of rapid adjustment, so that most of the

counter-pressure was taken from that part of thebelt or corset which was below the anterior superiorspine-the only firm origin of support. Modifica-tions could be carried out by means of front andback plates of celluloid, ebonite, or supports, suchas those made of red fibre, which could be made upon the spot and fitted with a strut. Women of

childbearing age who had suffered considerablyfrom low backache should be directed to reportpregnancy, for low backache was likely to recur

as lordosis increased. A belt fitted with a generousback plate and adjustable to conform to a pro-gressively altering contour, should be fitted and

every effort should be made to maintain the lumbarcurve during confinement and at the puerperium.For the stimulation of local metabolism and decrease

of muscular spasm Major Dudgeon favoured the useof pneumatic cupping which he had used with greatsuccess. The affected area of the back was thicklysmeared with vaseline, and the cup was applied andthen lifted, bringing the skin with it, when a slidingmovement of the cup was carried out. The processmight occupy ten minutes, at the end of which adefinite hyperxmia was present over the area ; thistreatment was useful for abolishing or reducingspasm and coccydynia. The wax pack, introducedfrom Sweden, was also valuable. A spongy cellulosesheet which had been impregnated with wax by themakers was put on the back of the patient and coveredwith an electric heater. It acted in the same wayas a wax bath, but without its inconvenience. Thewax was left on after removing the source of heat.Muscular spasm was thus reduced, and the skin wasleft in an ideal condition for subsequent treatment.If cases of low backache radiating from a singlesensitive spot did not yield to ordinary measures,ultra-violet rays up to the third degree of erythemamight be efficacious.Dealing with the question of cooperation by the

patient, Major Dudgeon said sometimes the lattercaused or aggravated the painful condition by attemptsto help himself, for example, by doing gymnastics.For correction of posture or maintenance of mobility,the patient’s help was essential. The type of bedused should be ascertained. A sudden change froma sagging feathered bed to a more rigid mattressmight cause pain. Sometimes a lumbar pillow,or one between the knees was helpful. Sufferersfrom low backache should be told never to sit in a

lounge chair, nor to loll in any chair, and not tochoose the corner seat in a train.

Mr. A. L. P. JEFFERY demonstrated, by means ofingenious models, the mechanics of a number ofthe deformities and malpositions of patients com-plaining of low backache. He spoke of the importancenot only of remedial postures and exercises, but ofcorrect deportment and of a recognition of the linesof stress and weight-bearing. He described anddemonstrated his methods of teaching students theessential points in the differential diagnosis of lowbackache.

On Wednesday, May 13th, with Dr. E. P. CUMBER-BATCH (London) in the chair, a meeting of the sectionof electrotherapy was devoted to a series of papers on

SHORT-WAVE DIATHERMY AND ARTIFICIALFEVER THERAPY

Dr. E. SCHLiEPHAKE (Giessen, Germany) gave anaccount of Ultra-short Waves in Internal Medicine.He said that ultra-short waves might be expectedon theoretical grounds to have special depth effectsand also specific effects. An increase of depth effect