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less extent of the globus pallidus. with loss of cellsand fibres, was found ; there was a general rarefactionand absorption of tissue in the vicinity of the blood-vessels in these basal nuclei-a kind of etat criblé.Thus, though there may be as yet no precision orexactitude in regard either to the site or the natureof the pathological alterations, no doubt can beentertained of the general localisation of the morbidchanges. Further research ought to be devoted asmuch to the physiological mechanisms involved asto the morphology of the lesions. There is room formore intimate study of the problem both of muscularhypertonus and of involuntary movement, and thesyndrome of paralysis agitans is not to be divorcedfrom others which are e equally characterised byrigidity and one or other type of hyperkinesis.Lesions of the cerebellum, for example, and mesen-cephalic lesions, may reveal themselves by disordersof tonus and by involuntary movement, and thesame is true of the optic thalamus. Only by takinga large view of the question can we arrive at informa-tive results. The widespread interest aroused inneurological circles at home and abroad apropos ofthe corpus striatum and its syndromes is calculatedto prove less useful than will otherwise be the caseif due attention is not paid to the occurrence ofcombinations of dystonia and involuntary movementthat are shown to be independent of structural lesionsof that part of the brain. ___ .

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THE GOLD MEDAL OF THE ROYAL SOCIETYOF MEDICINE.

As we have already announced, the first award ofits Gold Medal will be made by the Royal Society ofMedicine to Sir Almroth Wright. The gift of themedal has been instituted as a method of recognisingoriginal discovery in medicine or other allied sciences.It will be awarded triennially, and the prize can begiven for the practical application of the results ofprevious investigations of other scientists as well asfor new and personal work. This is a thoroughlysensible admission that the finest contributions tothe art and science of medicine must be founded onthe work of predecessors. All such progressive workis original in the best scientific sense, and the RoyalSociety of Medicine has been wisely inspired in itsdeclaration of the fact. Sir Almroth Wright willdeliver a lecture before the Society on Wednesday,July 6th next, when the annual general meeting ofthe Society will take place and the medal will beawarded. The design for the medal is the work ofMr. E. Carter Preston. It bears on the obverse thefigure of Hygieia bestowing a wreath upon Research.typified as a figure carrying a lamp. At the bottomof the obverse side of the medal is the legend " Nonest vivere sed valere vita." On the reverse we haveEsculapius supported by Chiron, the wise centaur,his master. Below the centaur we see the serpent ofEsculapius and the bow of his father Apollo. Onthe field are the words " Finis coronat opus."

ROEHAMPTON AUXILIARY HOSPITAL.

LAST weeK we puDlisnecL an account by JLT. L.

Jennings Marshall of the admirable work of thearm-training centre at Roehampton, in which hedwelt on the demoralisation and resentment of a manwho suspects that he has been fitted with a badly-fitting artificial limb and the psychological effect ofthe provision of a comfortable and useful one.

Queen Mary’s Convalescent Auxiliary Hospitals atRoehampton, for sailors and soldiers who have losttheir limbs in the war, are this week celebrating thesixth anniversary of their opening. Over 41,000officers and men have suffered amputations of theleg or arm owing to the war and, though other centresfor the supply, renewal, and repair of artificial limbshave been organised by the Ministry of Pensions,Roehampton has dealt with a very large proportionof these service men. 1324 officers and 21,339N.C.O.’s and men have passed through the hospital,as new patients, since June 28th, 1915 ; readmissions

of all ranks for second limbs and repairs amount to55,707, and this figure does not include the 16,518cases dealt with by post. 8453 men have receivedtraining in instructional workshops opened in 1916.Of these the employment bureau has found work for4987, and has made arrangements for further trainingfor 4166.

In 1918 arm instruction classes were instituted,and many who had found artificial arms an encum-brance were taught how to get the utmost work,and indeed enjoyment, out of their use. Dr. Marshall,in his article, emphasised the keen interest taken bythe men in their own manipulative progress-notconfined to progress in work, but also in sport. Thesight of those who in a few weeks are able to playcricket and golf must indeed be stimulating to theneurasthenic who enters the hospital despondent asto his chances of getting any fun out of life, evenshould he ultimately be able to work. The in-patientaccommodation at Roehampton has now beenreduced to 200 beds, for which it is hoped to getpermanent endowment, but since between 50 and60 men attend every day for major and minor repairsthe out-patient department is still busy, and likelyto remain so. An account of these hospitals willmake one of the most inspiring chapters of the medicalhistory of the war. ____

THE METROPOLITAN HOSPITAL SUNDAY FUND

.L’.L’ 1& L’00 uariy LU JU.U.0 U11C 1-CJI-ttta d L11U tijJpt’&M!?-on behalf of the metropolitan hospitals which weremade from pulpits in London and elsewhere byministers of all denomination last Sunday; but neverwas the need of our hospitals greater than it is at thepresent, and it is earnestly to be hoped that, whenthe totals are announced, we shall learn that anaggregate sum has been collected surpassing that ofany previous year in the history of the Fund. Inthe past the appeal has been made on the groundsof a common humanity, but the events of recent yearshave added new impulses to the conscience of thepeople, and we may fairly look for their expression.The part which our houses of healing played in winningthe war, and in ministering to the needs of its victims,will surely have its influence over the purses of many.But what is necessary is permanent effort as well asa quick and special response. Sir James Paget,wisest and best of men, nearly 70 years ago said :

" Ifin all our improvements of our means of life, onlyhalf the trouble had been taken to prevent or remedythe future evil, that was taken to attain the presentgood.... our state might have been far different."The report of Lord Cave’s Committee shows that thevoluntary system of hospital support must be main-tained and indicates the way in which the money canbe provided. The Government has respondedpromptly-though to only half the amount mentionedas an early requirement-by voting 2500,000 in aidof deficiencies in the funds of the voluntary hospitalsduring the year, and the Minister of Health hasexpressed the opinion that the balance should befound by voluntary effort. This should be forth-coming from a national and coordinated effort, andit would be a splendid incentive to such effort if theMetropolitan Hospital Sunday Fund collection thisyear proves to be an outstanding one in the annalsof hospital charity. -

THE honour of knighthood has been conferredupon Dr. John Walton Browne, surgeon to theBelfast Ophthalmic Hospital.

Mr. A. W. Sheen, C.B.E. (Military), M.S., F.R.C.S.,has been appointed Professor of Surgery, WelshNational School of Medicine from Oct. 1st, 1921.

INDEX TO "THE LANCET," VOL. I., 1921.

THE Index and Title-page to Vol. 1., 1921, whichwas completed with the issue of June 25th, willshortly be nublished in THE LANCET.