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male, in feathering female. It was clear that theaddition of thyroid to the diet of unaltered males wassomehow responsible for this condition. As to thecastrated birds that had been subjected to thyroidfeeding, it would seem that the gonad is a necessaryfactor in the result, for not a single castrated bird ofeither sex showed the least evidence of thyroid feedingin any of the characters previously enumerated.The thyroid-fed castrated females, like their castratedcontrols, approximated males in feathering. Thethyroid-fed castrated males exhibited the ultra-maleplumage characteristic of capons. The authorsdiscuss the organic mechanism through which thyroidfeeding achieved its effect, having special referenceto the " lutear cells " present in the ovary of the hen, Iand in the testis of hen-feathered Sebright birds. Ifthe appearance of hen-feathering in normal males as aconsequence of thyroid feeding is dependent on thepresence of lutear cells, the question still remains asto the nature of the relation between thyroid andlutear tissue.

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TRAINING OF HEALTH VISITORS.

THE shortest course of training for health visitorsprovided for in the regulations of the Board ofEducation lasts for a year and this is intended forwomen who already possess substantial knowledge orexperience. As a rule, no student may be admittedto this course unless she is a hospital nurse with threeyears’ training or has acted as a health visitor forthree years, or alternatively has obtained a Universitydegree or its equivalent. As a matter of fact, sincethe regulations were published in 1919, few trainednurs,es have entered for this shortened course, and itnow appears that nurses who have already devoted threeyears or more to professional training are often unableon financial or other grounds to devote a further yearto training as health visitors. Moreover, in a numberof hospitals the training for nurses now includesinstruction in certain subjects of the course prescribedfor health visitors, and it is hardly necessary torequire nurses so trained to spend a whole year infull-time preparation for the further certificate. Inthese circumstances the Board of Education hasannounced its willingness to approve whole or part-time courses of less than one year’s duration at recog-nised institutions for trained nurses who have had athree years’ course of general hospital training or afull course of training at a children’s hospital, andthese shortened courses will also be open to womenwho have acted for three years as health visitors inthe service of local authorities and who are willing totake a short refresher course. Institutions which havenot hitherto made arrangements for the training ofhealth visitors, but which now desire to establish one ofthe shortened courses, are invited to forward schemesfor consideration by the Board of Education. Nogrant will be payable in respect of students who takea course shorter than one year.

SUBMUCOUS LIPOMA OF THE STOMACH.

THE extreme rarity of lipomata developing in thissituation is commented upon in a recent paper byH. Verger and C. Massias in the Journal de 1Jj édecinede Bordeaux. The authors here briefly review theseven cases recorded in the literature, adding detailsof a case of their own. The patient, an alcoholicwoman of 58, gave a history of slight jaundice withtransient right hemiplegia two months previously,and of nausea and diarrhoea with progressive lossof weight for one month. Abdominal palpationdisclosed no signs of tumour ; the liver was notenlarged ; there was no free hydrochloric acid inthe gastric juice either after fasting or after a test-meal ; nor were there any signs of hypersecretion,stasis, or haemorrhage. Radioscopy showed nothingabnormal save some irregularity in the outlines ofthe upper portion of the stomach, and pyloricinsufficiency. The Wassermann reaction was nega-

tive. The diarrhoea, proved intractable; the patientbecame increasingly cachectic, and finally died, thepost-mortem showing adipo-cirrhotic changes in theliver, with some sclerosis of the kidneys. Upon thegreater curvature of the stomach, 5 cm. from thepylorus, there was a tumour the size of a hazel-nut,smooth, sessile, non-ulcerated, and moderately firmin consistency. This proved histologically to be apure lipoma situated in the submucous tissue betweenthe muscularis mucosae and the muscular coats,neither these nor the mucous coat showing anyhistological changes.

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PROF. HARVEY CUSHING’S VISIT.

Prof. Harvey W. Cushing, who delivered theCavendish lecture on Meningiomas last Tuesdavevening before the West London Medico-ChirurgicalSociety, returned to America the next day, afteracting for a fortnight as Director of the SurgicalUnit at St. Bartholomew’s Hospital. Some yearsago, when the Peter Bent Brigham Hospital at Boston,Mass., was founded in association with HarvardUniversity, arrangements were made for exchange ofvisits by distinguished foreign surgeons, the visitingsurgeon to be temporary surgeon-in-chief in place ofProf. Cushing for some period in each year. Prof.G. E. Gask deputised at Harvard in the spring of1921, and Sir Cuthbert Wallace has just returnedfrom filling a similar office. Although recognised asthe leading neurological surgeon in the world, Prof.Cushing did not operate while he was in this country,but spent his time in observing methods of instruction,talking to students, and teaching in the out-patientand casualty departments of the hospital. Hisassociation with British surgeons during the war andthe knowledge then acquired of the ways and mannersof British sick and wounded made it possible for himto enter at once fully into the life of an Englishhospital. Our own surgeons envied Harvard itsabundance of surgical assistants and its organisationof typewriting clerks and dictaphones to mitigate thelabours of record keeping. It would be interestingto know what impression the great American surgeonformed from his intimate visit here. At all events,he has left a pleasant impression behind him.

WORMS AS AN INDEX OF CIVILISATION.

IT is not often that the presence of intestinalworms is an indication of efficiency and progress.But such may be the case, as Dr. W. G. Smillie pointsout from his studies in South America. He finds thatin the older, more backward areas of Brazil almost theonly hookworm found to-day is Necator a7nericanus,while in the districts which are active and progressiveand have good colonists the proportion of Ankylostomaduodenale is much greater. Ankylostoma is, indeed, anindex of progress. The explanation of this bizarresituation is found in the history of South Americanlabour. The original home of Necator appears to havebeen Central Africa, from which it has been carried toCeylon, India, and the East Indies, and, with theslave trade, to North and South America. Theearly development of agriculture in Brazil was

effected by negro slave labour. With the end ofslavery in 1887 new conditions arose, and with theextension of the coffee industry colonisation on a largescale began from Southern Europe ; in more recenttimes there has also been an influx from Japan. Thenatural haunts of Ankylostoma extend from SouthernSpain, through Italy, Egypt, Persia to China andJapan, and the more advanced travellers havebrought with them their own worms as well as

their superior capacity for progress. Labourers andworms alike are aliens ; an energetic campaign of theInternational Health Board should go far to breakup their old association.

1 Monographs of the Rockefeller Institute for MedicalResearch, No. 17, 1922.