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drawing into the protective shell of reticence at theslightest hint of surprise or embarrassment on thepart of the physician, just as we can imagine--orperhaps reca,ll-physicians whose manner invitesthat open confession which is good for the soul.One temperamental type of medical man finds him-self making observations and gathering facts aboutneurotic illnesses which for another type remain asin a closed book. The fundamentals of psycho-pathology are now sufficiently established for suchinequalities to be lessened by giving instruction inthe subject to the medical men and women of thefu,ture. Whatever kind of case may be allotted tothe psycho-therapist, the middle way in treatmentmust be the way of the general practitioner.

PROF. IVAN PAVLOV IN LONDON.

AT the conclusion of a two-months tour in Franceand the United States, Prof. Ivan Pavlov of Petrogradattended the International Congress of Physiology atEdinburgh, after which he spent a week in Londonbefore returning to Russia. We have received froma correspondent an account of a visit which he paidto the Middlesex Hospital on August 6th, when hewas received by a number of members of the medicalstaff of the hospital and its medical school, andexpressed appreciation of all that he saw, beingparticularly interested in the cases of diabetes undertreatment with insulin, and in the new laboratorieswhich are shortly to be opened. The eminent physiologist, who is now in his seventy-fourth year,is a striking example of the boundless activity andimaginative force which is the gift of the greatestscientists. Amidst the tragic chaos of the revolutionin Russia he has been able to continue his work, andit comes as a surprise to many in this country to learnthat at the present moment he has some 30 fully-qualified assistants working under him at his labora-tories at Petrograd. Prof. Pavlov, during his visitto the Middlesex Hospital, made especial commenton two things. The first was that the hospital, theresearch departments, and the medical school formeda complete unit, allowing the fullest coordinationbetween teaching, research, and modern treatment,a condition of affairs seldom successfully realisedelsewhere. But side by side with this lie was disap-pointed to find here, as in other institutions in England,that research is seriously hampered by the severityof the restrictions on vivisection. The wide reputeof Pavlov’s book on the " Work of the DigestiveGlands " may have obscured the realisation in theminds of the medical profession of the fact that hiswork has chiefly been concerned ’with the physiologyof the central nervous system. For many years pasthis experiments have been directed to elucidate theproblems of sleep, inhibition, and conditional reflexes.We are happy to learn that this work is now faradvanced, and that Prof. Pavlov hopes in the autumnto bring out a book which will be to the neurologistas profoundly interesting and important as was his I’work on digestion to the general physician andphysiologist.

KING’S COLLEGE HOSPITAL.-An extraordinarymeeting of the Committee of Management of King’s CollegeHospital was held on August 9th to authorise the establish-ment of a dental school under the direction of Dr. AlexanderLivingston of Liverpool University. At the same meetingwas received the resignation of Mr. F. F. Burghard, seniorsurgeon, to whose work in connexion with the hospital andmedical school a tribute was paid by the chairman, ViscountHambleden. He is succeeded on the committee as seniorsurgeon by Sir G. Lenthal Cheatle. To the committeewas also added Mr. P. A. Willson. The other businessincluded the appointment of Mr. H. J. R. Surrage as anadditional honorary anaesthetist. The committee passed aresolution of thanks to the Winter Distress League for

Iundertaking a considerable amount of cleaning in different !Itparts of the hospital which could not otherwise have beendone owing to lack of funds, and also gratefully accepted Ithe offer of the Talfourd College for Girls to maintain a cot Iin the children’s ward.

Modern Technique in Treatment.A Series of Special Articles, contributed by

invitation, on the Treatment of Medicaland Surgical Conditions.

XXXIII.

TREATMENT OF SYPHILIS IN THE WOMANOF CHILD-BEARING AGE.

SOME competent observers have stated that syphilis.in women is in the main a much less serious infectionthan it is in the male. This may be so for the indivi-dual, though I am not prepared wholly to admit it ;but for the ultimate welfare of the race no case ofsyphilis in a woman can possibly be dismissed as alight case, or as necessitating a lower standard oftreatment than one showing more serious manifesta-tions. The treatment of syphilis in women presentstwo different aspects : the first is that of acquiredsyphilis with signs and symptoms as in the male ;the second is conceptional syphilis in which frequentlyduring the child-bearing period no signs appear, thewoman complains of no disability, but gives birthto premature, stillborn, or weakly and diseasedchildren.

Acquired Syphilis in Primary or Secondary Stage.Here the treatment is straightforward, its duration

depending on the stage at which the case is seen ; -,the patient requires a minimum of two years’ steadytreatment if seen in the primary stage-considerablymore if not seen till secondary lesions are present.

If properly prepared--i.e., with bowel empty andno meal having recently been taken-women almostalways take intravenous injections of 914 preparationswell. At the menstrual period a smaller dose maywell be given, but otherwise doses ranging from 0-3to 06 g. are injected once a week, either of novarseno-billon, sulfarsenol, or stabilarsan, till 4 g. in allhave been given. At the same time pil. Hutchinsonshould be taken thrice daily and a gargle of pot. chlor.is used as routine after each meal. In my experiencewomen much prefer taking pil. Hutch. orally ratherthan have the routine injection of Lambkin’s creamin addition to the 914 injection. After a course of914, pills are stopped for two weeks, and then a Wasser-mann test is done. If the W.R. is negative and thecase was first seen in the primary stage, the patientis allowed to carry on with pills alone for two months,when the W.R. is again tested ; but if the case was firstseen only when well-established secondary lesionshad developed, the patient is given pills to last a monthand told that a further set of injections will be givenat the end of that time. The patient either takesa little sulphur at night during this month-manypatients like confection of sulphur or trochisci sulphurisas aperients--or else the second course of injectionsis ushered in by an injection of intramine, sulphurbeing used as an antidote to, or as a preventive of,metallic poisoning by arsenic or mercury. Thesecond course of injections may be of a slightlydifferent type from the first-i.e., if N.A.B. was givenin the first instance, sulfarsenol (0’36 to 0-6 g. dose)may be given, or silver salvarsan (0’1 to 0’3 g. dose)till 1-5 g. of the latter or 4 g. of the former have beengiven. The W.R. is then repeated, and if it is negativeand if no signs or symptoms are present the patientis treated by pills only. The urine is tested foralbumin as routine before each injection and inquiryis made as to any unpleasant symptom following thelast injection-any complaint of headache, sickness,or urticaria requiring careful investigation. Bowelsshould be carefully regulated with salines and allcarious teeth must be removed.During the remainder of the treatment Wassermann

tests are taken about every three months and a furthercourse of injections is given if required. If all thetests are negative and the patient’s condition issatisfactory pills only are given during the remainderof the time.