731

of disseminated sclerosis, he has several times observedthe occurrence of trigeminal tic and disseminatedsclerosis in members of the same family. In somefamilies there had been a familial tendency to

trigeminal tic ; in one no less than nine membersin three generations suffered from the disease.

PROLONGED ANALGESIA

THE relief of intractable pain is always a majormedical problem, and when the pain is chronic it isone that tests the resources of the practitioner to theutmost. Sometimes, of course, the pain depends ona local cause which is accessible to local remedies ;for instance, the pain following many rectal opera-tions is often of this description. Here much can bedone by strict cleanliness at the actual operation todiminish the suffering which used to be regarded asan inevitable sequel to any operation on the rectum.Nevertheless, operations in this region are more oftenthan not followed by pain, more or less severe, evento-day. Frequently opiates are employed to controlit, but since the symptom is of purely local origin itought if possible to be controlled by local measures.Some rectal operations are satisfactorily performedunder local anaesthetics, but the analgesic action ofthese is usually brief, and they cannot readily beapplied again to the wound. A local analgesic withprolonged action would therefore be a great gain,but it is no easy task to find one which is botheffective and innocuous. Quinine and urea chloride,for example, though excellent for its lasting effect,is liable to produce sloughing. N. J. Kilburne 1

describes the investigation, experimental as well asclinical, of a number of analgesics, with the objectof finding one which could be used locally and couldproduce long-lasting effects. This he claims to havefound in Eucupin, a modification of quinine hydro-chloride with urethane. This is also bactericidal,and is said both to relieve pain and keep downinfection. It is applied by soaking cotton in a 0.75per cent. solution and pressing it into the wound.Kilburne’s experiments with oily substances havenot led him to regard these with favour for prolongedaction, but we believe that trials now in progress ata London hospital are giving more encouraging results.

THE GOAL OF EUGENICS

AN attempt to portray in simple but accurate

language the main principles of eugenics and their ’

application to social problems has been made by Mr. Huntington in conjunction with the directors ofthe American Eugenics Society.2 It is an outgrowthof an original report of a committee of the AmericanEugenics Society, prepared under the direction ofProf. Irving Fisher, and it is intended for intelligent ;people who make no claim to scientific knowledgeconcerning eugenics. In a preface the author informsus that he has done his best to express the general Isentiment of the group of directors as a whole, butmodestly adds that he has doubtless given too muchweight to his own views. It is questionable whetherthe book will be found of much service to medicalreaders. It is prepared in the form of a catechismcontaining 371 questions and answers. Many ofthese are worded in such a way as to apply primarilyto American conditions. Much the most difficult i

task which to-day confronts writers on eugenics is to igive a satisfactory account of the aims and methodsof "positive" eugenics ; of how, in other words, i

1 Surg., Gyn., and Obst., March, 1936, p. 590.2 To-morrow’s Children : The Goal of Eugenics. By Ellsworth

Huntington. New York : John Wiley and Sons, Inc. ; London :Chapman and Hall Ltd. 1936. Pp. 139. 6s.

to encourage the fertility of persons regarded as

biologically well-endowed. The fact having beennoted that rural communities have a higher fertilitythan urban, American eugenists advocate a back-to-the-land movement which they hope may be

organised on a sufficient scale to affect the country’sbirth-rate. Such proposals are hardly applicable tothis country. Like most eugenists, Mr. Hunt-

ington is concerned lest schemes for promotingfertility should act dysgenically by encouraging thereproduction of biologically inferior strains at theexpense of biologically superior. In this connexionthe reader will frequently encounter throughout thebook phrases such as a

" well-matured plan of eugenicselection " or " an adequate basis of selection " whichwill enable us to distinguish eugenically superior frominferior stocks. A 372nd question which many medicalreaders would like to ask the author is whether

anyone has yet devised a workable and scientificallyvalid scheme of eugenic selection applicable to theaverage citizen; and if not, why the American

Eugenics Society does not try to do so. Most peopleadmit that a small proportion of grossly unfit personscan be distinguished, of whom it can be definitely saidthat they should not become parents. But in viewof the limitless variety of physical, moral, and mentalqualities which combine to constitute good and badcitizenship, it is far from obvious how we are to

recognise the person who embodies these various

qualities in such a way as to enable us to regard himas representing a eugenically average type. If an

average type cannot be recognised, how are we todevise well-matured plans, and establish adequatebases, of eugenic selection designed to encouragethe fertility of persons above that average and todiscourage that of persons below it ?

ARTHUR SHADWELL

THE death of Dr. Arthur Shadwell which occurredon Saturday last at a nursing-home at Richmondhas removed from among us a distinguished authorityon many social questions and an effective writer onsocial matters of the first importance. The son ofa Yorkshire clergyman, he was educated at Uppinghamwhere he acquired under Paul David a knowledge ofand taste for music which never left him. He wentto Oxford as an exhibitioner at Keble, was a studentat St. Bartholomew’s Hospital, and having graduatedin medicine practised for a time in Brighton, wherehe became assistant physician to the Sussex CountyHospital. He proceeded to the Oxford M.D. and waselected F.R.C.P., but he soon retired from the activepractice of his profession to use his academic andpractical training to fine advantage in dealing withsuch great subjects as the temperance question,epidemiology, urban water-supplies-especially theLondon water-supply-the arguments for and againstsocialism, and the application of economics to politicalactivities. As a special correspondent of the Timeshe made investigations into epidemics of cholera inGermany and Russia, and in 1909 he published underthe title of Industrial Efficiency a large volume inwhich he recorded the results of his personal study ofeconomic conditions in this country, on the Con-tinent, and in the United States, a work which gainedhim the degree of LL.D. Birmingham. Ten years agohe wrote an excellent handbook entitled the SocialistMovement, in which he was able to display his first-hand familiarity with much of what he discussed,his singularly fair attitude of mind, and his wideacquaintance with social history. The FitzPatricklectures delivered before the Royal College of

732

Physicians of London in 1925 and 1926 proved his tclassical learning. He was opposed to the State v

management of industry as advanced by the i’advocates of socialism, but he was able to give e

the authority for his arguments, either derived from Ihis own work or that of others, and his appeals for Ireforms gained added force from his reasonableness. t

Through his long and distinguished connexion with "’the Times and the historic and literary value of his ibooks, Shadwell became an authority in many <

provinces of political economy. If he wrote more sas a philosopher than a doctor his medical trainingwas always at the back of his arguments. 1

THE POSITION OF CHIROPODY

THE prosperity of the Incorporated Society ofChiropodists was emphasised at the recent annualdinner of the society noticed in another column; andfrom the mouths of the speakers it could be gatheredhow wise the attitude of the medical profession hadbeen in regarding the therapeutics of the foot as adefinite branch of ancillary medicine which oughtto be in the hands of an organised body of workers.When the movement for the recognition of chiropodyin this manner first took shape many members of themedical profession viewed it with but qualifiedapproval. But with the spread of scientific know-ledge a too exclusive attitude has long been foundillogical. As medicine in the development of its ownwork has had to call for aid from other sciences, thenecessity for proper cooperation in medical workwith workers outside the professional roll becameclear and the increasing importance attributed inthe medical curriculum to the preliminary subjectsmay be mentioned in obvious proof. But the

spirit thus shown in the scheme of general medicaleducation has not stopped there but has ex-

tended to various fields of practice, and the

Society of Chiropodists forms a good example ofthis. When the movement for professional collabora-tion with the society originated there were found inopposition those who held that the absence of fullmedical training made professional union a dangerouscourse, but those who desired to see professionalcooperation occur were able to counter by sayingthat as a matter of fact the fully qualified medicalman had not, save in the instance of a few specialists,cultivated that field of therapeutics. The treatmentof the foot, apart from definite surgical treatment,had been left to the charge of chiropodists and theadvocates of proper collaboration held that itwas a duty of the medical profession to assist the

chiropodists to become an organised and standardisedbody, with whom regular medical consultation couldtake place. The liberal view was taken with theapproval of the Royal Colleges and the British MedicalAssociation, and the effect has been successful. Thesociety, in association with its Foot Hospital, is doingvaluable work and extending its activities throughoutthe country.

A PANORAMA OF CURRENT THERAPEUTICS

THIS week the first 35 articles of the series ontreatment in general practice now running in theBritish Medical Journal have been issued togetherin the form of an attractive book.l The contributionsinclude those on diseases of the respiratory tract (14),acute specific fevers (6), and cardiovascular diseases(15) ; the other group of articles published in 1935-referring to the nervous system-and those on the

1 Treatment in General Practice. Articles from the BritishMedical Journal. London : H. K. Lewis and Co., Ltd. 1936.Pp. 250. 8s. 6d.

treatment of digestive disorders appearing this yearweek by week, with their successors, will be collectedin subsequent volumes. The whole will form, as theeditor of the British Medical Journal says in his

preface, a panorama of current therapeutics, a com-posite picture of the art and science of medicine

to-day none the less valuable because parts of itwill need touching up and perhaps even repaintingto-morrow. All the contributors are teachers ofclinical medicine in various schools, and the practicalsimplicity of the methods of treatment outlinedrefutes once again the calumny that the outlook ofthe modern specialist is too academic or his arma-mentarium too dependent on diagnostic aids to makehis advice of much use outside the great cities. Atthe same time some of the credit for the practical,even occasionally dogmatic, nature of the teachingis due to editorial vigilance. The volume is slender

enough to be pleasant to handle and the type iseasy to read.

WE regret to learn the sudden death at Farncombeon Sunday last of Sir James Smith Whitaker, latesenior medical officer to the Ministry of Health.

Dr. A. Rupert Hallam, lecturer on dermatology inthe University of Sheffield, has been appointed bythe National Radium Trust to be a member of theRadium Commission, in succession to Sir ArthurHall.

THE Lister memorial lecture will be delivered bySir Robert Muir, F.R.S., at the Royal College of

Surgeons of England on Tuesday, April 7th, at5 o’clock. He will speak on malignancy withillustrations from the pathology of the mammal.

THE SERVICES

ROYAL NAVAL MEDICAL SERVICE

Surg. Capt. E. MacEwan to Barham (on transfer of flag).Surg. Lt.-Comdr. J. H. Nicolson to Woolwich.Surg. Lt.-Comdr. (D.) L. R. Armstrong to Pembroke

for R.N.B.Surg. Lts. J. G. Slimon to Challenger A. H. O’Malley

to Victory for R.N.B. ; and C. J. Mullen to Pembroke forR.N.B.

Surg. Lt. (D.) R. S. Jenkins to Woolwich.The following have received appointments as Surg. Lts.

for short service : B. M. Goldsworthy, St. Thomas’sHospital; T. J. Harkin, Royal College of Surgeons inIreland; M. G. H. Heugh, London Hospital; L. Merrill,Guy’s Hospital; E. H. Murchison, Glasgow University ;and G. A. Maxwell Smith, Edinburgh University.

ROYAL NAVAL VOLUNTEER RESERVE

Surg. Lt. S. C. Suggitt to Pembroke for R.N.B.ROYAL ARMY MEDICAL CORPS

Lt.-Cols. E. G. R. Lithgow and P. C. Field retire onret. pay.Majs. L. M. Routh and F. D. Annesley, M.C.,

to be Lt.-Cols.TERRITORIAL ARMY

Supernumerary for service with O.T.C.-Lt. N. J. Logie(empld. Aberdeen Univ. Contgt. (Med. Unit), Sen. Div.,O.T.C.) to be Capt.

ROYAL AIR FORCE

Group Capt. F. N. B. Smartt to Headquarters, R.A.F.,Iraq, Hinaidi.

Flying Offrs. A. S. Amsden to No. 3 Armament TrainingCamp, Sutton Bridge, and H. E. Bellringer to No. 1 Arma-ment Training Camp, Catfoss.

Dental Branch.-Flight Lt. W. D. Guyler to R.A.F.Record Office, Ruislip. Flying Offrs. 1. St. C. Alderdice,0. F. Brown, J. H. G. Fensom, S. Hill, R. A. Pepper,and W. A. H. Smith to Medical Training Dep&ocirc;t, Halton,on appointment to non-permanent commissions.