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invasion of a large part of the pharyngeal wall,though there have been a few successful cases ofremoval of the pharynx after preliminary gastros-tomy. However, the results of the operation aresteadily improving, and its position is now wellestablished. In reviewing statistics from abroad itmust be remembered that laryngectomy is often per-formed for cases which would be treated by laryngo-fissure in this country. Thus, Crile, in 1912, reported24 cases with 2 deaths from operation, but does notuse laryngo-fissure; Botez, of Barcelona, in 1914, col-lected about 200 cases and reported 17 per cent. ofdeaths, 52 per cent. of recurrences, and 20 per cent.of cures. Chevalier Jackson, who performs laryngo-fissure for intralaryngeal cancer, reported in 1906that, of 29 cases of extrinsic cancer, he did 8

laryngectomies with no deaths due to the opera-tion, 3 recurrences, and 3 cures at the end of12 months (1 case too recent to report and 1 lostto view); and in England F. G. Harvey reported6 cases in 1901, of which 3 were successes. It is

being increasingly recognised, as the result of

experience, that after this operation patients arenot reduced to a miserable existence, to whichdeath would be preferable. On the contrary, theycan swallow without discomfort or difficulty, andmost of them learn to utilise the air of the mouth andpharynx to produce a whisper easily understood,or can do so with the aid of a tube leading fromthe tracheal opening to the mouth. Sir ChartersSymonds, in a paper which we publish in thepresent issue of THE LANCET, gives a descriptionof four patients who have survived in comfort andhappiness and done useful work for 8, 12, 15, and22 years respectively; it is to be hoped that thisarticle will encourage doctors to submit suitablecases to operation before it is too late. Sir ChartersSymonds does not give any account of the remainderof his cases of laryngectomy, and the publicationof these would prove interesting, as also would adescription of the details of his operative method,for the technique of this operation has by no meansas yet been finally determined.

RECENT ADVANCES IN VETERINARY SCIENCE.

THE work of the Division of Veterinary Science,described in the annual report of the College ofAgriculture and the Agricultural ExperimentStation of the University of California, has beeninteresting and instructive. The diagnosis of tuber-culosis by the complement-fixation test, howeversuccessful in man, has proved unsatisfactory inanimals; 9’3 per cent. of positive results wereobtained in non-tuberculous cattle, and the testproved of no value in the diagnosis of tuber-culosis in 20 hogs. It is stated to have beenshown by experiments in the field that tuberclebacilli from diseased cattle became harmless in17 days in dry weather, whereas they retaintheir virulence for a long time (94 to 171

days) when exposed to rain and moisture. Inwater-holes tuberculous material was found toremain infectious still longer, in one case for687 days and in another for 548 days. Theseresults have an important bearing on the disinfec-tion of the surroundings of a tuberculous cow, forany medium which may contain infected materialshould obviously be freed from sensible moisture.Hypochlorite solution is largely used in disinfect-ing the stalls of tuberculous cattle, though whollyfavourable conditions for its effective actionseldom exist; nevertheless, the mechanical

removal of discharges and the use of disinfect-ants on general principles is a sane and safe pro-cedure. Other experimental results recorded inthe report include the beneficial effect of sour-

milk treatment in coccidiosis of chicks and entero-hepatitis of turkeys, the detection of aviantuberculosis by the intra-dermal test, and theexpulsion of intestinal round worms from fowlsby the use of 1 lb. of tobacco-dust to50 lb. of dry mash, or a dose of llb. oftobacco-dust per 100 birds. Investigation of

preparturient paralysis of ewes, a troublesomedisease from which many losses occur, did notreveal its cause ; but as a preventive measure it isadvised that the amount of dry food given to ewesduring the last months of pregnancy be limited,and that they be made to rustle for their food inorder to gain plenty of exercise. An interestingaffection of rams denoted by enlargement of one orboth testicles, and known locally as

"

big ball," wasfound post mortem to involve the whole of thegenito-urinary tract and to be due to the .6<MtHMSpyogenes, which produced pus and necrosis ofsoft tissues. A contingent of these rams, not

visibly affected, or apparently recovered, onlygot 33 per cent. of the ewes in lamb. Infec-tion appeared to occur through the urethra. Afarm is kept where students may see demonstra-tions of the methods of clean milk production. It,is here that science ought to be able to produceexcellent results without greatly upsetting or dis-organising present operations. Cleanliness of cow-houses, cows, milkers, properly constructed milk-cans, and care in the distribution and storage ofmilk are matters of intelligence and industry, andcow-keepers, farmers, and dairymen can secure

much more favourable conditions by the exerciseof watchfulness and zeal.

A HOSPITAL FOR THE METROPOLITANPOLICE FORCE.

IN a report recently made to the Home Secretaryby Sir C. F. Nevil Macready, Commissioner of theMetropolitan Police, it is stated that a committee,under the chairmanship of Sir Hamar Greenwood,has recently had under consideration the wholequestion of the medical treatment and hospitalaccommodation for the Force, which seemedcapable of some improvement. It is hoped that inthe near future the Force may be in possession of ahospital to meet the needs of all ranks, which willgo far to put an end to the present system, underwhich officers and men requiring treatment areoften kept for long periods before being able toobtain admission to one or other of the greathospitals of the metropolis.

THE BACTERIOLOGY OF TUBERCULOSIS OFTHE SKIN.

IN the last number (Vol. XXIII., No. 2) of the Journalof Pathology and Bacteriology Dr. A. Stanley Griffithdescribes the results he has obtained in the examina-tion of 52 strains of tubercle isolated from cases ofsubcutaneous tuberculous abscess (scrofulodermia)occurring in Middlesbrough. In 32 instances theorganism was of the human type, in 20 of thebovine type, and in testing the virulence of thesecultures he made the interesting discovery that13 per cent. of the former and 20 per cent. of thelatter were of definitely low virulence. Hithertothese " attenuated " strains of tubercle bacilli have

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hardly ever been found in man except in lupus,and it is worthy of note that seven of the eight casesof scrofulodermia from which they were obtainedwere suffering or subsequently suffered from someform of lupus. In the magnificent series of 1068fully tested cultures of tubercle bacilli from humandisease which Dr. Griffith and his collaboratorshave examined during the last ten years, these" attenuated " strains have occurred 46 times-in36 out of 45 cases of lupus, in 8 of 52 cases ofscrofulodermia, once in a cervical gland, and oncein an intermuscular abscess; 24 have provedhuman and 22 bovine in type. We could wish thatall bacteriological facts rested on such ampleand strictly comparable data.

THE STORY OF SALVARSAN.

IT is possible to take the story of the waremergency in organic arsenical compounds one

stage further back than was done in our leadingarticle last week. In September, 1914, Dr. W. H.Willcox was consulted by the Board of Trade inregard to the serious situation which had arisen,no salvarsan being then available in England.Dr. Willcox, in collaboration with Professor SirHerbert JacksoiLi, F.R.S., and Professor A. W.

Crossley, F.R.S., carried out a laborious investiga-tion on samples of kharsivan submitted by Messrs.Burroughs, Wellcome and Co., as a result of whichit was established that this product, toxicologicallyand clinically, was practically equal to salvarsan.Their report was issued on Oct. 24th, 1914, andfollowing upon it kharsivan was placed on themarket. Afterwards the routine testing was handedover to the Medical Research Committee.

THE Minister of Health has added to the Com-mittee on Medical Records Mr. G. S. W. Epps,F.I.A., to represent the department of the Govern-ment Actuary.

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THE house and library of the Royal Society ofMedicine will be closed from Thursday, April lst,to Tuesday, April 6th, both days inclusive.

COMPLIMENTARY DINNER TO DISTINGUISHEDCHESTERFIELD MEDICAL MEN.

A complimentary dinner was held under the chairman-ship of Dr. R. A. M. L. McCrea on March llth by themedical profession of Chesterfield and district in honourof Sir Josiah Court, recently knighted, and Surgeon-MajorA. W. Shea, D.S.O. Sir Josiah Court, in reply to the toastof his health, told a story typioal of student wit. At Guy’sin his student days Partridge, the famous surgeon, had ahorse with a very long neck; so the students christened it"Longus oolli" ! Later he got another horse, and this onehappened to have a very broad back. It was promptly dubbed"Latissimus dorsi"! In course of time this horse alsodisappeared, and he got another which was thoroughlywell built and presented nothing upon which to "hang alabel." However, the student ingenuity was not to bebeaten, and one day a super-wit conceived the delightfulname of "Os innominatum," by whioh title the horse wasever after known. In responding to the toast of "TheVisitors," Professor Arthur Hall congratulated Surgeon-Major Shea on his recent honour, and pointed out that he wasthe senior past student of the Sheffield School of Medicine togain a distinction on active service. A review of the distinc-tions gained during the war by members of the schoolshowed a very fine record : one V.C., one C.M.G., twoD.S.O.’s, one M.C. with bar, five M.C.’s, seven mentionedin despatches. The foreign decorations included the Croixde Guerre (won by a woman) and the Order of St. Savaof Serbia. The actual percentage of honours amongst the254 old students who joined the school between 1888 and 1913,and are still living and in practice, came out, said ProfessorHall, to little short of 8 per cent.

THE EGYPTIAN LUNACY DIVISIONREPORT.1

THE review of the Report of the Lunacy Divisionfrom Egypt is very full and informing, agreeing inthese respects with the last report.2 There is greatovercrowding in the institution, and, as a consequence,the premature discharge of patients results in relapseor recurrence of mental disorder, and, what is worse,we have criminal attacks of partially recovered patients,who have no longer to be treated as ordinary lunaticsbut as criminal lunatics. These are the salient featuresof the document.

The 1’eed for -Jloi,e Awyl1t’inS.Dr. J. Warnock, the head of the lunacy work, sketches

out some big plans as to other asylums which shouldbe started as soon as possible. The idea that thelunatics in Egypt were very imperfectly provided forwas perceived by Lord Cromer, who also recognisedthat there was not only a want of provision forpatients, but (which, he said, was a much more importantthing) a want of financial means to carry out any largemeasure of reform. Dr. Warnock considers that, besidesanother large asylum somewhere in the neighbourhoodof Alexandria, there should at least be an asylum formale criminal lunatics; also an asylum for chronic,evidently incurable, but quiet lunatics, and that properseparate provision for European lunatics is needed. Healso thinks that reception wards should be provided,probably in association with general hospitals, in variousprovincial towns. The central reception-houses shouldcertainly be in Cairo and Alexandria, but provincialasylums also are necessary. When it is reckoned thatnot one-fourth of the insane in Egypt can possibly becared for in the present asylums, it will be seen thatDr. Warnock’s suggestions are quite reasonable. But,as in Lord Cromer’s time, the financial difficulties willprobably hinder the development of this scheme.A short special note is made of the military asylum

which was established to meet insanity occurring in thetroops, as well as of the asylum at Abbasiya, whichreceives patients of both sexes, chiefly from Cairo andthe neighbourhood, including criminal lunatics. AtKhanka a certain number of the more quiet patients-all males, by the way-are sent from Cairo. At this

asylum the majority of the non-city dwellers arereceived, the result being that a different class of

patient and a different class of disease is met with inthe two asylums.There was during the last year a great increase in the

number of female patients. Provision of accommoda-tion for several classes of paying patients has steadilyprogressed. As has been noted before in thesecolumns, the lunacy reports, both by Dr. Warnockand Dr. H. W. Dudgeon, are models of clearness andaccuracy. All details as to expenditure are given, and thescientific work is not overlooked, though during recentyears it has been greatly hindered by war conditions.The death-rate is-high ; as Dr. Warnock points out, therate is 21 per cent. in Egyptian asylums.Chief Ca1tSeS of Insanity in Egypt: the Prevalence of

Pellagra.Pellagra again is represented as the chief cause of the

insanity met with in Egypt, and in respect of the highmortality a special study has been made as to the

relationship of pellagra to diet. This is referred to later.As to the overcrowding, in April, 1919, there were 2075lunatics resident, whereas there was only accommoda-

tion for 1581. This leads to a high mortality-rate, a highdisease-rate, a high accident-rate, and a low recovery-rate. The British staff, both medical and lay, is small,and was reduced by men being called up for war

service.In the special hospital for soldiers, during the year

125 men were admitted. Of these only five died. In

1 Report of the Ministry of the Interior, Egypt, Lunacy Division,1918, at Abbasiya and Government Hospital for the Insane atKhanka.

2 See THE LANCET, 1919, i., 117.