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Notes, Comments, and Abstracts.HEALTH OF BECHUANALAND.

IN the annual report on the affairs of this Protectorate,signed by Mr. C. L. O’B. Dutton, Government Secretary,it is stated that health conditions during the year endedMarch 31st, 1928, have been, as regards widespread preval-ence of disease, the worst for the past ten years. Duringthe winter of 1927, which ushered in a series of severeoutbreaks of fever, following upon cold snaps, the incidenceof disease was little less favourable than what is usualat that date. But with the opening and advance of summerthere was a sudden rise in the prevalence of fever, whichcontinued to increase until during January, February, andMarch it had assumed epidemic form and prostratedthousands of the native population. The epidemic waschiefly confined to the southern portions of the Protectorate-especially the alluvial levels-the valleys and low-lyinggranitic areas, abutting on the main watersheds-Molepolole,Mochudi, Gaberones, Ramoutsa, and Gopane.

Associated with this extensive prevalence of malariawere the invariable complications of influenza and bronchialcatarrhs-bronchitis, acute pneumonia, rheumatic affections,enteritis, and the common sequelæ. The total returns ofdisease, which are the heaviest on record (close upon 20,000cases), have been swelled to these unusual proportions bythe record of many ailments, concurrent and otherwise,which the increased medical activities in connexion withthe epidemic brought under observation.

Free Government supplies of quinine were issued to theareas most severely affected. And this, together withmeasures of supervision of distribution and energetic medicalattention, helped to mitigate the effects of this disease.A fortunate and remarkable feature of the epidemic wasthe low rate of mortality. At Mochudi, where over a thousandcases of malaria were seen, there were only two deaths,and these of indirect or remote connexion. At Gaberones,Molepolole, Ramoutsa, and Gopane, where the numberswere still greater, the death-rate was equally low in propor-tion. The epidemic outbreaks were largely determinedby the conditions prevailing over the southern Protectoratethroughout the summer-that is, heavy rains at long intervals,over the impervious, low-lying, and easily water-loggedareas ; the constitutional lack of stamina of the peopleon the low-lying lands as against those on the higher levels-which is a long observed and constant factor-invariablyshows up under unusual meteorological conditions, suchas heavy rains or severe cold snaps.

Of other epidemic and infectious diseases the returnsfor the year show : anthrax 15 cases (1 death) ; dysentery,infantile or undefined diarrhoeas, 627 cases ; influenza, 257cases ; tuberculosis, 142 cases ; puerperal fever, 2 cases ;leprosy, 16 cases ; enteric fever, 8 cases (1 death) : tetanus,2 cases (1 death) ; cerebro-spinal meningitis. 5 cases ;scarlet fever, 1 case ; measles, 13 cases ; and a few casesof whooping-cough, mumps, and chicken-pox. The tuber-culous cases generally gave a history connecting the originof the disease with working on the Rand mines, whilstthe unusual outbreaks of enteric fever were clearly tracedto the Lichlenburg diamond diggings. There has been anincrease in the number of syphilitics treated. the returnsfor the various districts showing an aggregate of 4782attendances.During the month of November water was struck on the

site selected for the Serowe Hospital. Subsequent testshave proved the supply to be ample, and as the bedrockis pure sandstone, the supply is not likely to vary or beaffected by drought. The work of clearing the site andfixing the position of the hospital and accessory buildingshas since been put in hand, the hospital plans reviewed andadopted in final form, and it is intended that the newhospital shall be finished, equipped, and staffed duringthe next financial year.The position with regard to the extension of plague

and the proximity to the Protectorate borders of suspectedand proved infection gave cause for increased vigilance,and at the end of the financial year measures were underconsideration for taking practical steps, during the comingsummer, towards conducting a rodent-infected surveyof the Protectorate along the boundaries of possible approach.The territory of the Bechuanaland Protectorate is bounded

on the south and east by the Union of South Africa, on thenorth-east by Southern Rhodesia, on the north and onwest by the territory of South-west Africa. It has not Ibeen surveyed as a whole, but its area is estimatedat 275,000 square miles. Its mean altitude is about 3300 ft. II

A CASE OF ENURESIS. To the Editor of THE LANCET.

SÏR.—In reply to " Puzzled," when I meet such a caseas this I give a suitable gland compound : if the patient

is cured, I am right, if not, no harm is done. Generallysome good results. Using thyroid gland alone, I havehad at times to stop it, as unpleasant symptoms arose,but this has never occurred with a gland compound tablet,such as Dynotabs Thygon-Spermin. 106 (to be obtainedfrom Hormones and Chalones, 27, Cavendish-:-quare, W.1).I offer the suggestion that if the system needs a glandextractit absorbs it ; if it is not required it is simply passedout by some safety valve.

C. G. S. BARONSFEATHER, M.D.Bournemouth, June 15th, 1929.

CARE AND TREATMENT OF THE PATIENT.Dr. Emerson has brought together here nine essaysl by

well-known American authorities, the origin of the workbeing the establishment of a set of lectures in the HarvardMedical School dealing with the personal care of the patientby the physician. The following well-known teachers havecontributed to the volume : Dr. David L. Edsall, Dr. C. F.Martin, Dr. W. S. Thayer, Dr. Austen Fox Riggs, Dr.Franklin G. Balch, Dr. Lawrence K. Lunt, and Dr. AlfredWorcester. One of the most useful essays is entitled " TheMedical Education of Jones by Smith," and purports to beintroduced by Dr. Thayer. The characters may be imaginarybut the precepts have the ring of being founded upon reality.Whether " Smith " is " Jones," whether either is Prof.Thayer, and who was " Fowler " are questions the answers towhich could probably be provided at Harvard, but thepersonalities have no significance, which is exactly what theteaching possesses. It is interesting to read Dr. AlfredWorcester’s chapter on the care of the aged alongside thesection in Dr. David Tindal’s book on the treatment of theaged (see below) for the obviously learned American and thedelightfully simple Englishman provide sensible teachingbetween them, each supplying notes that are lacking in thepages of the other.Dr Tindal2 has set down in his " Gleanings from General

Practice " the results of long experience as an urbanpractitioner, in the hope that they may prove of service to-young members of the profession. We may say at once thathis gleanings are useful while his advice is sound. Wiseremarks on professional conduct, some of which are so obviousthat they are perhaps needless, lead to chapters on treatmentgenerally, treatment of children and of the aged, and where.as not infrequently happens,part of the treatment is connectedwith diet, reference is given to a useful section of the bookcontaining notes on cookery and the serving of meals in thesick-room. The last 50 pages of the book are taken upwith formulae, the prescriptions being directed generally orspecially towards the relief of common conditions. Certainpreliminary reflections of the author, which point to theabsence of instruction given to-day to students in regard tothe conduct of practice, justify the issue of this unpretentiouswork.

PHARMACEUTICAL LATIN.A COMPACT little book,3 measuring only 6t by 4 inches.

provides the pharmaceutical and medical student witha concise Latin grammar and a list of phrases and abbrevia-tions used in prescriptions, a few exercises and examplesof prescriptions, and a Latin-English vocabulary. Afterabsorbing its contents the student should be well primed.He will note that O.o.o. stands for the best olive oil (oleumolivse optimum) and that S.o.S. to a pharmacist is a callfor help only if there is need (si opus sit). M.d. means asdirected (more dicto) and M.p. is a pill mass. The reactionof a grocer to the precious student who asks for pastilleas "coni odorati " or for a packet of isinglass as " collapiscium " might be alarming. Incidentally, for isinglassmost dictionaries prefer the Greek " ichthyocolla." " Cascarasagrada," which is included in the Latin-English vocabularyand explained as cascara, bark, sagrada, adj. sacred, isreally pure Spanish, except that the first a has an accentin that language. The word cortex, bark, is included in itsproper place. Vehiculum is described as vehicle. Theexplanation might have been extended by adding " excip-ient or medium." Ne tr. s. num, (ne tradas sine nummo)seems to be the druggist’s way of saying what other trades-men more simply call " C.o.d.", but then the druggistkeeps a " taberna " and not a shop. The book will be usefulespecially to students near qualification whose powers ofwriting prescriptions are too often limited to a quotationof the name of the mixture in the Hospital Pharma-copœia deemed most nearly appropriate to the patient’scondition.

1 Physician and Patient: Personal Care. Edited by L. EugeneEmerson. Harvard University Press. London: HumphreyMilford, Oxford University Press. 1929. Pp. 244. 11s. 6d.

2 Gleanings from General Practice. By David Tindal, M.D.,F.R.F.P.S. Glasg. London: Baillière, Tindall and Cox. 1929.Pp. 209. 6s.

3 Aids to Pharmaceutical Latin. By G. E. Trease, Ph.C.Lecturer in Pharmacognosy, University College, Nottingham.London: Baillière, Tindall and Cox. 1929. Pp. 168. 3s. 6d.