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trained to conduct normal labour, and if the medicalman is insufficiently educated he will be unable todeal with emergencies, and when confronted withthem will fall back on radical surgical proceduresinstead of the milder obstetrical methods whichwould serve better. If the medical practitioner’seducation is insufficient, it is probably better that heshould not attend confinements at all. The Plunket

Society for infant welfare, which cares for the motherin pregnancy and the infant during its first year oflife, has made admirable progress tssisted by thesupport of the Government and the general public.The obstetrical department of the medical school,however, the work of which is equally important, isleft in the same financial position as it occupiedmany years ago. It has no professor at its head,no suitable hospital in which to educate its students,and insufficient funds to pay its teachers. The publicare probably unaware of the close connexion betweenthe poverty of this department and the high maternalmortality-rate. Provision of the needed funds ispresumably a matter for the Government, and onewhich in the present financial position of the Dominionthey may find very difficult. There must, however{says Dr. Jellett), be many wealthy individuals or- corporations who would be willing and able to helpif the need were brought home to them, but this has,so far, not been done. The faculties of medicineand surgery have each £1600 a year, mostly fromprivate benefactions, with which to pay their staffs ; ;the faculty of obstetrics has a bare £530, and eventhis is to be reduced at the end of this year by .675.Dr. Jellett suggests that the Department of Healthmake a public demonstration of the needs of theobstetrical department of the medical school a partof its propaganda for the reduction of maternalmortality.The second great need, that of asepsis, is treated-

very fully by Dr. T. L. Paget, inspector of hospitals.He has succeeded after great exertion in makingcheap and efficient sterilising equipment availablein hospitals, and in minimising the spread of puerperalsepsis in maternity institutions, holding that ifthe same standard of asepsis were maintained inprivate practice as under the regulations in hospitals,puerperal sepsis rates for the Dominion would greatlydiminish. This depends not only on the educationof the medical man, but on the coöperation with himof the patient and nurse. The training of nurses andmidwives in asepsis is slowly improving, but muchremains to be done, especially in private practice. Toquote Dr. Paget: the adoption of asepsis in surgerytook 15 years, and the training of the nurses who hadnot learned it originally was done by surgeons inactual practice. The training of maternity nursesin asepsis can, he says, only be done in a reasonabletime, when every medical practitioner feels it hisduty to see that it is completely carried out. Thepatient must be made to recognise its importance,and be advised to choose a nurse who understands it,and to provide a sterilised maternity outfit. Theantenatal clinics supply these outfits, yet only 515of a possible 1900 patients confined in private tookthe opportunity of obtaining them. Dr. Paget isurging their provision in all centres of maternalwelfare ; they cost about £1 5s. each if made oftowelling (convertible after use into babies’ napkins),and 10s. if made from old sheets. He sees the keyto the problem of maternal welfare in cooperationbetween the expectant mother and her husband,a well-trained antenatal clinic nurse, an alert andefficiently trained medical attendant, and a well-trained maternity nurse or midwife on the one hand,and the services of the hospital board, which canprovide hospital accommodation for patients whoneed it, and services for sterilising outfits for allpatients on the other. If the Dominion Govern-ment and people attack the problem on theselines under the energetic leadership of obstetricianslike Drs. Jellett and Paget, there is no doubt of theirsuccess, but a great awakening of public interest isobviously necessary. The recent inauguration by

Mr. Victor Bonney of the New Zealand ObstetricalSociety marked a definite step forward by the

profession ; the entire frankness of the Director-General’s report indicates that the Dominion Govern-ment is willing to play its part. The education of thegeneral public lies with the Minister of Health andthe lay press.

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Annotations.11 Ne quid nimis."

INTERNATIONAL VISIT TO BRITISH SPAS.

MEDICAL hydrology has had its meetings at conti-nental health resorts whether in France, Italy, or

Czecho-Slovakia, but until now no internationalmedical party has visited British spas. This is tobe put right when the International Society ofMedical Hydrology holds its annual meeting fromthe 9th-17th of next month. The rendezvous willbe London, where a reception will take place at thehouse of the Royal Society of Medicine on Tuesdaynight, Oct. 9th, and conferences have been arrangedfor the two following days, under the presidency ofLord Dawson. The first of these discussions, to beintroduced by Dr. C. W. Buckley (Buxton), will dealwith the organisation of the spas in various countries,especially for the treatment of insured persons,and the second with the humoral factor in disease,with particular reference to the action of waters.After this the party, numbering over 100 indi-viduals of 17 nationalities, will make a tour of thespas, where they will see at first-hand the wholedevelopment of the native waters of Britain. AtHarrogate opportunity will be given for consideringspecially the treatment of children by waters andbaths, and at Buxton there will be a conference onrheumatism as a national problem. Visits will alsobe paid to Droitwich and Bath. Places are stillavailable for a limited number of members of themedical profession who would like to make thetour of spas under such stimulating conditions andto take part in the discussions. A programme ofarrangements in three languages is available, andparticulars may be obtained from the Hon. Sees. ofthe Society, 139, Marylebone-road, London, N.W. 1.

LOCAL ANESTHESIA IN THE REDUCTIONOF FRACTURES.

LOCAL ancestiiesia is making rapid advances ancl isbeing used more and more for surgical conditionswhich formerly could be treated only under generalanaesthesia. English surgeons are perhaps more

conservative in their attitude towards local anaesthesia.than their American and Continental contemporaries,and, while this is a tribute to the excellence of ouranaesthetists, the use of local anaesthesia might withadvantage be extended. A useful application hasrecently been described in two American medicalpapers-namely, the reduction of fractures of theforearm after infiltration anaesthesia with novocaineor procaine. The shorter article of the two describestwo cases of fracture of the forearm which werereduced at the Boston Dispensary after infiltrationwith 1 per cent. novocaine solution.1 In the otherarticle 2 Dr. Carl 0. Rice, of the Minneapolis GeneralHospital, gives a more detailed description of thismethod of reduction, a method he has used withsuccess in a series of more than 50 cases treated duringeight months in the receiving ward of his hospital.In no case did the manipulations cause pain, and thegreatest discomfort that was ever noticed was afeeling of pressure or a painless grating duringreduction. The reduction itself was always easy, andit was never necessary to use much force owing to the

1 New Engl. Jour. of Med., 1928, cxcix., 66.2 Jour. A.M.A., 1928, xc., 1768.