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summer months the epidemic, as usual, declined.In the late summer and autumn, however, thedisease was still present in the Crimea; thus in theweek ending August 15th (28th), there were 10 freshcases in the Russian garrisons of the Crimea; andon August 25th (Sept. 7th) 53 cases remained inthe various hospitals; of these, 33 were in theTheodosia hospitals. Since the Crimea fell into thehands of the Bolsheviks, no information has beenreceived as to the presence of disease or as to theother conditions of life prevailing there. With theexodus of some 150,000 refugees from the Crimea toConstantinople, typhus and other diseases have, asalready stated, been imported to the Turkish capital.The special prevalence of relapsing fever amongst themhas been referred to above, and mention may here bemade (as a postscript to the earlier paper upon cholera)of an outbreak of cholera in a Russian refugee camp inthe neighbourhood of Constantinople. In this camp,situated at Chilinghirkeui, not far from the famous linesof Chataldja and some 20 miles from the capital, some10,000 refugees were interned. Cholera appearedamongst them in the night of Dec. 9th-10th. In allsome 88 cases and 47 deaths occurred. Energeticmeasures, however, were put in force at the earliestpossible moment, and the outbreak came to an end onDec. 19th, since when no cases have been reported.Four other cases were seen in a French hospital in thetown of Constantinople in the first few days of December.All four patients had been in hospital for some time forother diseases. Only one was a Russian, the othersbeing a Greek man, a Greek woman, and a Syrianwoman. Neither in these cases nor in those atChilinghirkeui could the source of infection be traced,and it is believed to have beensdue to some germ-carrieror carriers from the Crimea. It is, however, to benoted that, so far as our information goes, cholera hadceased to be present in the Crimea some time inOctober.Constantinople, Dec. 30th, 1920.

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Sanatorium Benefit in Scotland.THERE appears to be some misunderstanding of the

position of sanatorium benefit in Scotland. In Englandsanatorium benefit will not cease until May lst, to beincluded among the benefits conferred upon insuredpersons by Part I. of the National Insurance Act, 1911;but in Scotland this termination has actually takenplace, and as from the first of the present monththe local sanitary authorities have been requiredto make arrangements for the treatment of tuber-culosis in insured persons. Special arrangementshave been made to ensure that there shall beno break in the continuity of treatment resultingfrom this transfer, and a special scheme has beendevised for the treatment of ex-Service men sufferingfrom tuberculosis. The local authorities are to receivein respect of the treatment of insured persons sufferingfrom tuberculosis an Exchequer Grant, which may betaken broadly as representing the amount that has beenavailable to local Insurance Committees for institutionaltreatment. In respect of ex-Service men, they willobtain reimbursement of the entire cost and will alsoreceive payment for the services of their tuberculosisofficers.

Cameron Prize Lecture.

On Jan. 14th Sir Robert Jones, Inspector of MilitaryOrthopaedics, who last year was awarded the CameronPrize in Therapeutics, delivered a lecture at EdinburghUniversity on the Necessity of Orthopaedic Trainingand its Relation to the Prevention and Cure of Cripples.He emphasised the need for education of the student inorthopaedic principles. Deformities which occurred

early were mainly the result of tuberculosis, rickets,infantile paralysis, or were of congenital origin. Manyof them might be prevented, and practically all of themmight be corrected. They had to trust to the

practitioner for early diagnosis, and he should atleast know the possibilities of modern treatment.Nearly all crippling deformities of children and adults-were included in " orthopaedic " surgery, as well as alarge proportion of war injuries. It was in consequenceof the ever-increasing number of deformities that.orthopaedic centres were started during the war. Theycommenced with 250 beds in Liverpool, and eventuallythroughout the kingdom 20,000 beds were set apart.Specially qualified staffs were put in charge, and thepatients were allowed a longer period of hospital treat-ment than in the general military hospitals. Forpsychological and reconstructive purposes curativeworkshops were introduced. The advantages of thesemethods had been very marked. Training in the-treatment of fractures required to be more generalthan at present, and a thorough training in thesimplest types of appliances and the principlesgoverning their application would spare humanitynumberless deformities. Appliances should be ofthe simplest kind. In every hospital there shouldbe a fracture ward, and the chief should be bothinterested and competent. The treatment of frac-tures in this country was at present a sadlyneglected art, and it was only recently and as a.

result of the war that the need for orthopaedicinstruction had become recognised. A thoroughtraining in general surgery was an essential pre-liminary. In certain hospitals the orthopaedic depart-ment was too often a mere out-patient clinic. It was-better to have no orthopaedic department than to make-it a pretence. He welcomed the institution of ari

orthopaedic lectureship in Edinburgh, and would liketo see this new department add lustre 1 to the glorioustraditions of the University.

A Glasgow Society for Psychical Research.A society has been formed in Glasgow for scientific

research work into psychic phenomena. Its membersare committed to no definite opinions on the subject ofpsychic phenomena, and their work is to be purely thatof investigation. The medical office-bearers of thesociety, of which Mr. A. J. Balfour is president, includeDr. A. K. Chalmers and Dr. L. R. Oswald, vice-presidents. The honorary secretary is Miss Margaret.H. Irwin, 58, Renfield-street, Glasgow.

The John Farquhar Thomson Lectureship.The first of this year’s series of lectures on the

Structure and Functions of the Human Body was givenin the Anatomy Theatre of Marischal College, Aberdeen,on Jan. 15th, by Dr. R. W. Reid, professor of anatomyat the University. The lectureship was founded by thelate Mr. John Thomson, of the University Press, inmemory of his son, formerly a distinguished student ofthe University. The lectures are open to the public, andare intended chiefly for young persons, to instruct them-in the care of the body, its healthy development, andthe prevention of its abuse by intemperance. Thecourse consists of six lectures, which are to be deliveredeach winter, when a different lecturer will be chosen.

Infant Mortality in Inverness-shire.The report of the medical officer of health for

Inverness-shire for the year 1919 gives infantilemortality statistics for the last six years for eachdistrict ;-

The rate is thus lowest in North Uist with 37, followedby Lochaber. The infantile mortality rate for thecounty is 60.

The late Dr. J. W. Simpson.On Jan. llth the death took place at Edinburgh from

pneumonia of Dr. J. W. Simpson. Dr. Simpson wasbest known professionally for his work on children’sdiseases, on which subject he had made numerous con-tributions to medical literature. His work as physician

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to the Royal Hospital for Sick Children and his abilityas a teacher were recognised by students and graduatesalike as being of an exceptional high standard. From1893 to 1899 Dr. Simpson was well known as one ofScotland’s most prominent Rugby internationalists,playing altogether in 13 internationals. He graduatedM.B., C.M. at Edinburgh in 1896 and M.D. in 1906. Hewas a Fellow of the Royal College of Physicians ofEdinburgh. For his sterling qualities Dr. Simpson wasgreatly esteemed and beloved by all who knew him,and his early death has caused widespread sorrow.Jan. 17th.

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PARIS.

(FROM OUR OWN CORRESPONDENT.)

Health Insurance and the Medical Profession.THE possibility of à forthcoming Health Insurance

Bill before the French Parliament was recorded in theminutes of the last general meeting of the " Union desSyndicats Médicaux," which was held on the 4th and5th of last month. The committee of the " Syndicatdes Medecins de la Seine " has pointed out that such amedical act would completely transform the practice ofmedicine in France and has urged all practitioners totake an active interest in the question before theBill is actually discussed in Parliament. The above-mentioned committee has appointed a subcommitteewhose members are: MM. Ferry, Gascuel, Hartmann,Lafontaine, Le Fur, Rinuy, and Rouyer. Mons. Rinuyhas been appointed secretary. This body will dealwith all matters concerning health insurance, and theresults of its investigations will be regularly publishedin the Bitlletin.

Rates and Payment of Pensions in Alsace.

According to Article 62 of the Versailles PeaceTreaty, Germany is to pay in marks the pensionsallotted to Alsatians who fought in her army duringthe war. Alsatians who fought in the ranks of theFrench army benefit from the French Pension Act,March 31st, 1919. Mons. Daussat, medecin-chef of themedical board for Strasbourg, has given recently adetailed account of the German Pension Act of May 14th,1920, and has pointed out that on many points it is inaccordance with the spirit of the French law. Hementions that owing to the disadvantageous rate of

exchange of the mark the French Government havedecided to make up the difference and to secure to thedisabled Alsatians who served in the Germany armypensions approximately the same as those paid topensioned ex-Service men in France.

P1’ophylaaeis of Malaria.Mons. Marcel Leger, Director of the Medical Service

in French Guiana, has published a report on variousmatters concerning malaria in this French colony:" L’Endemie Palustre a la Guyane Franchise" (Annales.de Medecine et de Pharmacie Coloniale, numére excep-tionel, 1920). Mons. Leger concludes by referring tothe results attributable to prophylactic measures;.according to statistics taken in prisons a markeddecrease in the occurrence of malaria amongst convictshas been recorded since 1900. Moreover, since 1909the number of patients suffering from malaria whohave been admitted to hospitals has been graduallydiminishing, leaving out of consideration an epidemicin the course of the years 1917 and 1918.

Jan. 15th.

ROYAL SOCIETY.-At the next meeting, onJan. 27th, at 4.30 P.M., the following papers will be read:-31r. K. Sassa and Professor C. S. Sherrington, P.R.S., on theMyogram of the Flexor-reflex Evolved by a Single Break-shock. Sir Almroth Wright, F.R.S., on "Interaction "

Between Albuminous Substances and Saline Solutions.Professor S. Russ, Dr. Helen Chambers, and Miss GladwysM. Scott, on the Local and Generalised Action of Radiumand X Rays upon Tumour Growth, communicated by SirWalter Fletcher, F.R.S.

THE HYGIENE OF INDUSTRY.

Fatigue and Efficiency in the Iron and Steel Ind1tstry.AN interesting study has been issued by the

Industrial Fatigue Research Board relating to the ironand steel industry. 1 The inquiry upon which it isbased was set on foot to establish a comparison betweenthe 12-hour shift system of working and the 8-hourshift system, which commenced in February, 1919.The comparison was difficult to make, for Dr. H. M.Vernon, the investigator to the Board, who writes thereport, found himself face to face with an intricate

problem in attempting to estimate accurately the effectof work upon those employed. He describes clearlythe processes of producing pig-iron, of converting itinto steel by different methods, and of rolling steel.Readers unfamiliar with the industry will be struck bythe complexity of the processes, by the variety ofmethods in vogue in different parts of the country, andby the difficulties to be surmounted in separating thehuman from the trade technical factors.

Unnecessary Labour is the Rzcle.Dr. Vernon is not a technical metallurgist, but never-

theless his survey of the industry enables him to pointto curious anomalies in working methods; indeed, wefind ourselves wondering at the extent to which thiskey industry seems in this country to be behindhandrather than marvelling at splendours of metal smelting.Much of the work, on account of the physical labourinvolved, together with exposure to great heat andvarying weather conditions, belongs to the heaviestwhich men have to undertake ; but the picture drawnfor us is that of human intelligence busied with theextraction of metal, absorbed in wrestling with metal-lurgical problems, with no time devoted to the workingof the human beings who guide the operations-those beings who after all are part of the com-

munity needing the metal. Often, as in the case

of blast furnaces, unnecessary labour seems to bethe rule rather than the exception; here "theefficiency of mechanical charging is four to eighttimes greater than that of hand charging," yetin Scotland no furnaces were found mechanicallycharged, in Yorkshire only 21 per cent., in South Wales26 per cent., and in Lincolnshire 32 per cent.; in all,only 18 per cent. out of 146 furnaces inspected. Themen lose an undue proportion of time for sickness, andDr. Vernon concludes that " a reduction of the 12-hourshifts to 8-hour shifts will lead to an improvement oftime-keeping and thereby increase the efficiency withwhich the blast furnaces are run." Equally importantwould appear to be the introduction of labour-savingdevices. The same story is told regarding open-hearthsteel furnaces; here a steel melter transferred froma 30-ton hand-charged furnace to a 70-ton machine-

charged furnace declared the latter by comparison tobe almost child’s play. In terms of man-power, machine-charged furnaces were about five times more effectivethan hand-charged ones. " There can be little doubt,therefore, that all hand-charged furnaces ought to bescrapped with the utmost expedition and replaced bymachine-charged furnaces."

Efficiency and the Health of Worke1’8.Other factors adversely influencing production are

also pointed out, such as the use for conversion intosteel of metal still hot from blast furnaces instead offirst allowing it to cool and then reheating it; and alsoimperfect balance in the plant leading to later pro-cesses being frequently delayed for lack of material-" the consistency of the delays," writes Dr. Vernon, " isvery striking." He finally concludes that probably-" if all the iron and steel works in the country adopted themost efficient methods they could, on an average, improvetheir output by something between 50 and 100 per cent. Inother words, they could enable their employees to earn morein 8-hour shifts than they had previously done in 12-hour

1 Fatigue and Efficiency in the Iron and Steel Industry. H. M.Vernon. Industrial Fatigue Research Board. Report No. 5.Pp. 99. H.M. Stationery Office. 1920. 3s.