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the whiteness of the old Navy’s decks, were seatedmotionless a large squad of sturdy young seamen,who were. later to demonstrate the work of the schoolin which they are undergoing the six months’course for instructors. The Commander-in-Chiefhaving arrived, Sir PERCY BASsETT-SnTH voiced thepleasure and gratitude of the Association at beinginvited to the demonstration. Surgeon-Commander K.DIGBY BELL explained the purposes of (a) physicaltraining, to develop the recruit, teach him discipline,and make him anxious for more training; (b) physicalexercise, to make him thereafter ever more and morefit ; and (c) recreational training, to encourage theteam spirit and develop alertness and other desirablequalities. Then were shown, first free standingexercises to show the gradually increasing severity ofthe practices, and the systematic attention paid to theequal use of all the muscular systems ; these togetherteach a man to think and to strengthen his body, andare followed by activity exercises which make himsupple. This is a school for instructors, and theirteaching, and the teaching of judges and referees, wereexplained and then illustrated by a sabre v. sabrecombat, and an exhibition boxing match, in which thecombatants successively and by order did all thehorridest things, as kidney and rabbit punches, andgot freely knocked down, according to plan. Surgeon-Commander DIGBY BELL being here replaced as lecturerby a lieutenant-commander, clever and daring exhibi-tion work was shown on the horizontal and parallel bars,and on the horse, this last without any spring board.Two instructors showed how men were taught inself-defence training to fall safely, by falling protec-tively, not on their bones, but on the muscles betweenthe joints, and they illustrated how skilfully an oppo-nent, even when attacking with a knife, could becountered and overset by an expert. Then the recrea-tional games were shown, many of them. A ship issmall, and has many men ; they must take little room.They are extremely exciting, very popular, and no oneis a good instructor who cannot invent a new game ormake his squad interested in an old friend. Thus,two squads, " red " and " green," each of ten men,competed against one another ; while the " reds "tossed a ball from one to the other round an innercircle, " green " with eager feet were running a relayrace round them, and the instructor announced thatsimultaneously " red " had made 105 catches. Then" red " raced like mad round the catching " green "who, alas ! owing to a dropped catch, and time sowasted, only scored 88 catches in their period. Oneexpected that he who missed heard a good dealafterwards about his mistake, and would be veryeffectively stimulated to do better next time, and thatis the object of these games, to strengthen the teamspirit and secure accuracy of effort. After thegymnasium the swimming-bath, whose milky-bluewater evidenced its careful disinfection: hereswimming training and pretty diving off trapezesbrought the demonstration to a close. The thanks ofthe visitors to the Navy was expressed gracefully tothe Commander-in-Chief by Dr. LocKHART STEPHENS,the Vice-President of the Southern Division, and theofficers of the Naval Barracks (H.M.S. Victory) thenkindly entertained the party at tea after a mostinteresting two hours which showed what great usewas now being made by the Navy of its capablemedical officers in the training of the Service, educatingthe personnel to keep themselves always in the best ofphysical condition, and ready to deal whatever maybe before them of unforeseen, unimagined conflictsand emergencies. i

THE LANCET CENTENARY DINNER.THE dinner in celebration of the completion of the

hundredth year of THE LANCET will be held at theHotel Victoria, Northumberland-avenue, London,W.C., on Thursday, Nov. 29th, 1923, and not aspreviously announced on Nov. 28th. Mr. NevilleChamberlain, the Minister of Health, has signifiedhis intention to be present.

Annotations.

NATURAL AND ARTIFICIAL SUN CURE IN

TUBERCULOSIS OF THE LUNGS.

"Ne quid nimis."

THE brilliant results obtained by intensive sun

treatment in so-called surgical tuberculosis not onlyat high altitudes, but also in low-lying districts, havefor many years been recorded ; but the results ontuberculosis of the lungs have been, in many hands,disappointing, and have led to avoidance of thetreatment by many physicians, and even to itscondemnation by some as a dangerous and unjustifiableform of therapy. Dr. Johannes Schürer,l of Mulheim,combats this idea as a false one, maintaining thatthe action of the sun is not only on the diseased organor part, but mainly on the whole body. The oldtradition that direct sunlight is dangerous in cases ofphthisis still holds sway in the minds of themajority of the medical profession, in spite of thefact that Finsen reported good results 20 years ago,and that in 1903 Nizza used the sun cure methodically,and demonstrated that the sunlight stimulated thenervous system, producing dilatation of the blood-vessels, lowering the blood pressure, and favouringthe healing of the foci in the lungs. In the sanatoriumtreatment developed during the last 50 years, theaction of direct sunlight plays no part, and no provisionis made for it in the vast majority of sanatoriums.In 1921 Hoffner2 wrote : " .. it was attempted tomake the sun the cure for phthisis. The experienceof all observers was, however, that the effect washarmful.... Existing latent processes becameactive," and he expressed the opinion that in everycondition of tuberculosis of the lungs sunbaths wereto be avoided, Bacmeister 3 came to the same

conclusion, stating that " the most dangerous is thesimple lying in the sun in the first tempting days ofspring, or after a long period of dull weather. Eachyear a number of patients come to me who in this wayhave developed new foci, pleurisy, heamoptysis, andother complications." Koch4 reports similar cases ofsunbaths undertaken by the patient without medicalsupervision resulting in a rise of temperature, increasedcough, and haemoptysis.

Nevertheless it would be a great mistake toconfuse such unsupervised, unsystematic, and over-dosed sunbaths with a true sun treatment. Dr.Schiirer points out that spontaneous self-treatmentgives the effect rather of a

" sunburn," and that goodeffects can only be obtained by means of exact medicalobservation and supervision. His own experiencehas been mostly on phthisical patients with well-marked lesions, too severe to be sent to the outlyingcountry sanatoriums. The sunbaths were taken on theroof of the Evangelisches Krankenhaus in Mulheim,sheltered on two sides from wind currents. The roofof any town hospital might well be put to such use,and has the additional advantage of getting the sun atall times of the day, and of not being overlooked byother buildings, two objections to most verandas.The only cases which were not given heliotherapywere those with marked cachexia and high fever, thosewho were too weak to waeh themselves, and those withlarge cavernous or pneumonic processes. On theother hand, haemoptysis was not considered a contra-indication. In every case the patient was slowlyacclimatised to the sunshine, starting with five minutes,with the legs only exposed, and slowly increasingdaily with exposure of the arms and chest until in12 days a complete sunbath of an hour’s duration wasallowed. In 24 days two hours were reached, and insome cases three hours, the time of the day chosen,and the length of the treatment ultimately dependingon the weather and on the time of the year. It is

1 Deutsch, med. Wochens., June 1st, 1923.2 Strahler-Ther., 1921, xii., 819.

3 Zschr. f. ärztl. Fortbild., 1921, xviii., 284.4 Strahler-Ther., 1922, xiii., 134.