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Vi.il- S 19a, fccjtions. lection &* ~ the BrlUtbT^JI <Unlv- If*0 ^ ^ r^AINTiFPS j EXHIBIT ( CSR-544 THE MEDICAL JOURNAL OF ausikalia Vou I---37tii Year. SYDNEY, SATURDAY, APRIL 15, 1950. ** No. 15. Table of Contents. {The Whole ef the Literary Natter la THE MEDICAL JOWIKAL OF AUSTRALIA la Copyright.] S&.'XTjyj 'inanee, Hou** ^ mamjsotfce, - Ownt4cpopmI*miownuJ>SQ .concern^ `dlcal '^Mnri.n^ *JtryU,`olSlto5dUtfcSo2mr*i. Friendly SodSS 5a vMJe*d}i*c*a,l aFnrdtwdfSiyI y; North &? Feple # PnjcieotS Mutual ProridMt dlcal Society HaB. Service# Limits?: atralian Prudential Federal Hemal U Provident Clak: or other tppabx* LH.A. House, US Isbane Assodstsi `uodaberg MMkal appointments and o any COUNTRY e are advlaed, to heir Agreement to tary. 1? Norik tmeata in Sostk 'tment* In Soutk etary, 205 Saint ltal; all Contract 11*. All goveia* of those of the s Journal canned lal articles for* offered to Tx# the contrary he the Editor, TO House, Seas* a: MW245I-2.) fy the Mas***' - Street. Glet* rularky in th* not accept say t of non-receip* ed within eM atlCiKAL ARTICLES-- Page. Beattie-Smlth Lectures--Whither Psychiatry?, * Lecture 1. by H. F.Maudsley........................................ 4*6 Management of Hwmatemesls and Melena, by John C Fitsherbert and R. G. Epps.................... .. 4*0 The Electrocardiogram in Old Age. by Pau) Hagen. M.B.. B.S., and Zelman Freeman, M.B., B.S., M.R.A.C.P. .......................................................................4*9 Anticoagulants in the Management of Cerebral Infarction: A Record of the Poor Result Obtained, by W. Mcl. Rose, M.D- M.R.C.F., XLRA.C.P.............................................................................. 60* pregnancy Tests, by H. F.Bettlnger................................604 STOUTS OF CASES-- Osteitis Deformans In a Brother and Sister, by Warren Murphy...............................................................60? rCTEtVS-- . . .. Essays by a Chinese Biologist .. .. .. 60? Human Personality................... ... .. . . .. 608 gOOKS RECEIVED.......................................................................608 LEADING ARTICLES-- Pelmatoscopy: A Method of Identifying the Newly Born ....................... ............................ .. .. .. 609 A Final Call to Brisbane .............................................. 609 CURRENT COMMENT-- Accident-Prone Motor Drivers ...................................... 610 Rigidity and Muscle-Spasm in Tetanus..................... 611 Medical Aspects of Submarine Warfare..................... 611 ABSTRACTS FROM MEDICAL LITERATURE-- Bacteriology and Immunology ...................................... 512 Hygiene ...............................................................................612 C6c 35eam'e=nut& JLetturcs.1 (The University or Melbourne.) WHITHER PSYCHIATRY? ` By H. F. Maudsley, Melbourne. Lecture I. Now see that noble and most sovereign reason, Like sweet bells jangled, out of tune and harsh. Sbakespeare'6 profound knowledge of human emotions ud human behaviour gave him a.keen psychiatric insight kto the discords that may be registered by the mind with consequent discordant human behaviour. "Sweet bells Jangled, out of tune and harsh" is no mere poetic fancy Ophelia's description of Hamlet's real or assumed mad- ess, but can be applied to all manner of psychiatric disabilities that we see today. ' There have been many dark chapters in the history of Psychiatry between Shakespeare's time and the present **otury, but I propose in these lectures to deal with some of the modern aspects and developments in psychological Medicine. ^e are said to live in an enlightened age; a fantastic o<e where scientific knowledge has run riot, might better describe it Medical science perhaps shines as a beacon o world full of doubts and fears. F. M. R. Walshe, in ois Harveian Oration of 194S, makes this statement: Yet the need of rebuilding the foundations of medicine was never greater than today, when we are being 'Delivered at Melbourne on August 16 and 22. 1949. SPECIAL ARTICLE^- ' Page. The Australian Rheumatism Council............................. 614 PUBLIC HEALTH-- Third International Conference of Expert# on Pneumonokonioais ...................................................... 614 CORRESPONDENCE-- Correct Footwear for Children...................................... 514 The Hairdresser's Backache................................... * 17 No More Babies...................................................................... 617 Final Results of Long-Term Therapy with Methyl Thiouracil in Thyreotoxlcosle ..............................617 OBITUARY-- Sydney James Woolnougb...............................................61* Robert Spencer Godsall...................................................... 518 MEDICAL SOCIETIES-- The Royal North Shore Hoapltal of Sydney Clinical y. * w Society. .. .. .................................................... 619 NAVAL, MILITARY AND AIR FORCE-- Appointments .......................................................................619 DISEASES NOTIFIED IN EACH STATE AND TERRITORY OP AUSTRALIA ...................................... 619 AUSTRALIAN MEDICAL BOARD PROCEEDINGS-- Queensland................................................... -- .. .. 620 MEDICAL APPOINTMENTS...................................................... 620 NOMINATIONS AND ELECTIONS ...................................... 620 DIARY FOR T1IB MONTH...................................................... 520 MEDICAL APPOINTMENTSt IMPORTANT NOTICE .. 620 EDITORIAL NOTICES .............................................................. 620 swept along a spate of new knowledge and new tech niques, and have so little time for their contemplation and investigation. Is psychiatry to further the scientific aims and healing functions of medicine, and to play its part in this integra tion? Or is it to remain in partial isolation, striving yet failing to attain its ultimate objective? More than a quarter of a century has passed since the foundation of these lectures. The late Dr. Beattie Smith under the provisions of bis will had the foresight and imagination to found lectures on the prevention of insanity. I am amongst the minority of you who have & vivid recollection of an alert man with a reddish pointed beard, kindly and lovable, with a shrewd and penetrating eye. A great part of his life was spent in tbe mental hospital service before he entered private practice as wbat was then known as an alienist Mental disorder was then largely associated with (be patient alienated from society because of more or less advanced behaviour problems which render segregation necessary. In his wisdom Dr. Beattie Smith visualized these patients as normal Individuals in whom something somewhere had gone astray through physical illness, through some distortion of temperament, or owing to some stress or strain of life, together with some probable hereditary factor. He realised that tbe preventive side of mental disorder was not only a medical problem, but one of dissemination of informed opinion amongst an almost hostile public, a hostility bound op in the fear that it might be known that some relative had suffered from a mental illness. It is for this reason that these lectures are partly technical and medical and partly for the education of the public. Since the foundation of these lectures there have been changes in the point of view regarding mental disorder. Tbe public is now conscious that mental disorder exists THE MEDICAL JOURNAL OF AUSTRALIA. 15. 1030. Special article. tub Australian rheumatism council Tub problem of the rheumatic diseases h:is lcn attracting world-wide attention. In Australia it has ln^n felt that the approach should follow broadly the lines adopted in the United Kingdom, where public interest is stimulated by the Empire Rheumatism Council, with membership embracing public-spirited citizens as well as members of the medical profession. The scientific aspects of the question are dealt with by the Scientific Advisory Committee. The recent formation in Australia of the Australian Rheumatism Council under the sponsorship of The Royal College of Physicians marks the first stage in a determined attack on the problem of the rheumatic diseases in this country. The objectives of the Council are: 1. Stimulation of public Interest in the provision of adequate facilities for the prevention and treatment of rheumatic diseases (rheumatic fever, arthritis et cetera). 2. Research into problems peculiar to Australia, covering the incidence, degree of economic loss, and other related aspects of rheumatic disease. 3. Training of the profession In the more exact methods of diagnosis and treatment. 4. Education of the general public In the public health aspects of the problem. 5. The provision of adequate methods of rehabilitation for sufferers handicapped by arthritic or cardiac sequeUe of rheumatic disease. . ' The Scientific Advisory Committee of the Australian Rheumatism Council Includes medical men from all States in Australia interested in this problem. . As a first step in attaining the objectives of the Council a classification of the rheumatie diseases has been adopted which it is hoped will be used throughout the Commonwealth. The adoption of a standard nomenclature and uniform diagnostic criteria will assist greatly in the collation of information and the improvement of the standard of treatment. - Classification. The classification is as follows: 1. Rheumatic fever, (o) Acute. (b) Subacute. 2. Non-articulnr rheumatism.- 3. Gout. 4. Rheumatoid arthritis. 5. Osteoarthritis. (a) Generalized. (b) Localized. (i) Secondary to previous trauma. (U) Secondary to structural abnormality. (ill) Secondary to previous rheumatoid arthritis. (Iv) Unknown etiology. I. Arthritis associated with infection. 7. Ankylosing spondylitis. 8. Miscellaneous forms of joint disease, for example, neuro pathic. neoplastic, manifestations of systemic disease, and local joint disturbances. . Comments. Non-artlcular rheumatism includes non-suppuratlve pain ful conditions of muscles, tendons, burse, nerves, fibrous tissue and subcutaneous tissue, for example, fibrositis, myositis, neuritis, lumbago. - Rheumatoid arthritis includes classical and atypical forms, together with juvenile type (Still's disease). Felly's syn drome et cetera. Osteoarthritis includes osteoarthritis of the spine ("spondy litis") under the subheadings appropriate to the particular case. Arthritis associated with infection includes only those conditions specifically associated with a known infection such as goeorrhaa, brucellosis, dysentery. The following are excluded: (a) suppurative arthzitjsAOdtubeFculous arthritis; (b) arthritis which may, in the opinion of th&.physiclaa, be due to infection .of the teeth, tonsils, sinuses et cetera. Ankylosing spondylitis (synonym, spondylitis onfeylopoietica, Mnrie-StrtimpeH type of spondylitis) is the type of arthritis in which the brunt of the disease in the early stage falls on the saero-lllac joints and apophyseal joints of the vertebral column. There Is a tendency to centrifugal spread, with ankylosing changes later In the spine. Miscellaneous forms comprise a group in which are Included, under appropriate diagnoses, the various types of arthritic conditions sot otherwise included, for example, arthritis at n**uripsuhic origin, neoplasm* ot joints. ,,f scrum sickness, iiicmophilia, intermittent hy<lrarthr2* pulmonary osteoarthropathy, hysterical joints; disturtKtnt'cs .a..s...s..o..c..i..a..t..e...d. w'iih' osteochondritis dissecans), or secondary to contusion, fracture. local 7*^ Out or air embolism. ` *'*< / Conclusion. The Scientiliu Advisory Committee has before It a - *S rV gramme covering many aspects of diagnosis and Much preliminary work has already been done oait'Y'' subject of a nation-wide survey. At present there Is Uuu .&V ir any. accurate information available on the incident* '? ' economic consequences of the rheumatic group of dls^Z? v" Statistics from overseas are not applicable to local condltwT and much may be learned from a survey carried ut vast continent which possesses a relatively homog*2^ population living In tropical, subtropical and temperate seaZT From the educational viewpoint it to hoped that frw" ' graduate committees throughout Australia will Include^**'*' their programmes lectures and demonstrations on wV' various aspects of diagnosis and treatment of the rheimejfe't^ group of diseases. '^9'? - The cooperation of medical men throughout the ComawSr'-'' wealth is sought in furthering the objectives ot the AmV-s trallan Rheumatism Council. *3** w .. Sclwyn Nbusox, Medical Secretary. Scientific Advisory' Council. Australian Rheumatism Courw&f ET ProCeed'r "***t>y men11 tf wi^ ap: hQM. ot the c Dc J^ffionoS0; ferssLasbou-r ring deflnitc,srs3s ESSst rsssA lor the fut i<3 take the ;ef was expo trsed. Public health. THIRD INTERNATIONAL CONFERENCE OF EXPERT**/ ON PNEUMONOKONIOSIS. ,*; ` ` ` "i ' . 8ft' Thb third international conference of experts os pneuaoae-* konfoais, sponsored by the International Labour Organization,' ' was held at the invitation of the Government of the Common wealth of Australia ot the School of Public Health and Tropical Medicine. Sydney, from February 3$ to March lb, 1950. It was attended by experts from Australia, Denmark. France, Italy, the United Kingdom, New Zealand. Norw&y, Sweden, Switzerland, the United State* of America and the Union ot South Africa; the Australian delegates : were Professor E. Ford, Director of the School of Public Health and Tropical Medicine, University of Sydney, Dr. G. C. Smith. Senior Medical Officer of the Industrial Health Unit. School of Public Health and Tropical Medicine, University of Sydney, and Dr. K. G. Outhred, District Medical Officer of the Joint Coal Board of New South Wales. Tbsrs was a delegation of two members of the Governing Body. Mr. F. J. R. Gibson and Mr. A. Monk. In addition five experts attended the conference who had been appointed by the International Labour Office In accordance with the decision of the Governing Body designed to ensure that the agends would be adequately covered; these were Dr. W. E. George (Australia). Professor C. E. Gemez-Rieux (France), Dr. E. L. Middleton (United Kingdom). Dr. A. J. Orenatola (South Africa) and Dr. A. J. Vorwald (United States of America). . Opening Meeting. At the opening meeting the conference was addressed by Mr. R. Rao, Secretary-General of the Conference, the Honourable H. E. Holt, Federal Minister for Labour sad National Service, the Right Honourable Sir Earle Pag*. Federal Minister for Health, and the Honourable C. A. Kelly, Minister for Health In the State of New South Wales. . Agenda. The following items made up the agenda of the conference as determined by the Governing Body of the International Labour Office: (1) the present state of knowledge of the pathogenesis, clinical aspects and diagnosis of pneumonokonlosis; (ii) the present stage of preventive measure* (medical and social measures, mechanical and technical measures); (iil) an exchange of views on the possibility 01 defining minimum international standards of compensation for disability caused by pneumonokoniosls. Election of Office-Bearers.' The conference unanimously elected as chairman Dr. W. Bj George. Chief Medical Officer of the Joint Coal Board New South Wales, as vice-chairmen Dr. L. Greenburg (United States of America) and Dr. A. J. Orenstein (South pneumc Jfbe conference 'denes ' Btries. and : ft ot vie' Recent Ad | g discussion tc knowledge o' aumonokonios< ilosis in coni eac of the curr the lungs H yu fully accept cr was still t eeference the; advances alread wstinued and acquisition of {grtherance of pest. The infi production of p ly. Is gener g fibrous dusts . fthe larger sizes many mine Bore injurious. {ttod not yet bee Aluminium c It was agreec kiore the confe lay form prove fThere was no ev powder was ot tfJeosls or that \ There was some j Inhalation of a! harmful, and tu >' la animals the ' pulmonary tube: Pnev The conferent tubercle bacilli peeumonokontos Importance of e: ecupations, and It was ge toriou* phy# o phyaiolog] Jtosent stag, Initial and Worker*, it frfocedurea a Vi'JtiL 15, 1950. Apkil 15, 1950. THE MEDICAL JOURNAL OF AUSTRALIA. ' 515 of joints, arthritis ttent hydrarthrosis joints; local Joint ondrltis (juveniu racture. dislocation * before It a pro. osis and treatment, been done on the ent there U little. i the incidence and - group of * to local condition*, -y carried out in a itively homogenous nd temperate soots. < hoped that post. Jia will include la nstrations on the ?t of the rheumatic rbout the Common* ctlves of the Aos~ OAOH, ientlflc Advisory umatism Council ^ica). and as reporters Dr. C. It. Davison (Canada) and jr. R. Even (France). Proceedings and Conclusions of Conference. fbe 'conference took the form of a general discussion -aMgst al) delegates, during which a series of original ^aers by members and other authorities was introduced, gather with appropriate reports prepared by the conference following is a summary of the proceedings and con* geions of the conference. Definition of Pneumonokoniosis. Whilst recognizing that in a wide sense the term peumonokoniosis" connoted any condition of the lungs g)ting from the inhalation of dust that might or might not g *f clinical significance, for the purpose of the Inter nal) Labour Organization the conference accepted the glowing definition: Pneumonokoniosis Is a diagnosable disease of the tongs produced by the inhalation of dust, the term "dust" being understood to refer to particulate matter In the solid phase, but excluding Uving organisms. Moreover, the conference deprecated further extension of ssu beyond those already in common use, and suggested mi for the future the terminology of pneumonokoniosis *>eld take the form of naming the dust to which the taker was exposed, or alternatively the industry or process seemed. ...... Pneumonokoniosis in Various Countries CE OP EXPERTS IS. The conference Considered reports received concerning the I tetenoe and varieties of pneumonokoniosis in various ___ . and a number of members took part in the A | adsage of views which followed. Recent Advances is Pathogenesis end Pathology. >ert* on pneumo&oabour Organization, ;nt of the Common* Public Health and y 28 to March II, Australia, Canada -] dom. Hew ZesJsnd. States of America ustralian delegates ^ School of PuhUlc y of Sydney, Or. Industrial Health! rropical Medicinal *S. District Medial] uth Wales. There] oveminr Body. Mr.' Idition five experts, Appointed by tbs] with the decisis*j e that the agenda] Dr. W. E. GeorgsJ ux (France), Or . A. J. OreastsMl (United Stats* ^ ii was addressed: Conference, for I*boar_ Sir Earle jrable C. A. KsWig outh Wales. A discussion took place on the subject of recent advasoes S knowledge of the pathogenesis and pathology of (o) Mamonokonioscs in general, (b) silicosis, (c) pneumono* taiosis in coal workers, and <d) other pneumonokonloses. lot of the current concepts of the way in which dust acts tbe lungs in producing the disease pneumonokoniosis w* fully acceptable to the conference, and it was felt that toe was still much need for research in that field. The Bferesce therefore, whilst recognizing the valuable (fances already made, urged that intensive studies be **tlnued and extended. It was considered that the Wsition of such knowledge was essential for the iterance of effective methods for prevention and treat- Tbe influence of the size of dust particles in the Ruction of pneumonokoniosis was undergoing constant 7g- In general terms it could be stated that in the case mrous dusts such as asbestos and certain vegetable dusts J.wrger sizes appeared to be the more harmful, whereas many mineral dusts the smaller sizes seemed to be the 2* injurious. The lower size limits of injurious particles *ot yet been determined. os e Prophylactic or Therapeutic Agent. agreed that there was no conclusive evidence the conference that the inhalation of aluminium in rorm Prevented the development of silicosis in man. JJ7 *** ho evidence before the conference that aluminium *** of value as a therapeutic agent in human vlII1*1* or that it was harmful when used for that purpose. *** zotne evidence that under certain conditions the of aluminium in industrial processes might be fhd further, there was experimental evidence that the inhalation of aluminium dust aggravated T?84*? tuberculosis of the confer the Inter knowledge of sis of pneur ventive rn< al and test the possibility of compe" ^nevmonokoniori* and Tuberculosis. ^tl*eWk!lrence recognized that infection, especially by aggravated and was aggravated by ^Jr"*onlosls, ***d accordingly drew attention to the f excluding subjects of tuberculosis from dusty --- *a and to the value of good hygiene and nutrition. Tests Used during Examinations. generally felt, after a discussion during which 5**WoUw0,0glca3 tests were described, that there was jgWzt -J^pcal or laboratory test (or tests) which in the .Jjhj of development could be adopted for routine Tjkn , Periodical examination of large numbers of * agreed that the essential criteria for such ' would be as follows: they must measure dis ability; the error of estimate must not exceed acceptable limits; they must be objective, and the results obtained with normal subjects at ail ages must be well established as control standards; they must not require an undue amount of time. Before even those minimal criteria could be met, special research was necessarily directed to the problem both in the laboratory and in the field. Diagnosis of Pneumonokoniosis. After hearing various contributions on the early diagnosis of pneumonokoniosis and the differential diagnosis, the conference reached the following conclusions. In the diag nosis of pneumonokoniosis- - ths- history and conditions of exposure to harmful dust, the clinical examination and the radiographic findings are all of Importance. The diagnosis of pneumonokoniosis must not rest solely on the radiograph. In the radiological Investigation of pneumonokoniosis as an initial step, the claasiftcation of radiographs should be in the manner set out in a report compiled by a special committee and approved by the conference, provided, however, that It is clearly understood that that classification deals with radiographic appearances only and cannot be used for any other purposes such as the assessment of clinical conditions or disability; it is not sufficiently exhaustive to be applicable to all forms of pneumonokoniosis. The conference noted that pneumonokoniosis might be simple in 1U nature, or might be complicated by infection, and that If it was complicated, particularly by tuberculosis,- it became a .much more serious condition. Related Pulmonary Conditions and Concomitant Diseases. An exchange of views and experiences took place on pulmonary conditions related to pneumonokoniosis and on concomitant diseases, but it was fell that the existing data. did not lend themselves to the reaching of definite con clusions. The conference recognized, however, that not all pulmonary abnormalities occurring in workers In dusty occupations were necessarily attributable to the dust. The Radiograph and Assessment of Severity. The conference stressed the fact that appearances on a radiograph in the case of pneumonokoniosis were not neces sarily related to the severity of tbe disease. Pulmonary Concer in Relation to Silica and Coal Dust. The conference reached the conclusion that there was no evidence that pulmonary cancer was more common among persons exposed to silica dust and coal dust than among the general population. The Significance of Dust Found <n the Lungs Post Mortem. The conference recorded its opinion that the quantity and kind of dust found in tbe lungs post mortem could not be accepted as & criterion in estimating the presence or degree of pneumonokoniosis. Diagnosis of Tuberculosis. The conference expressed the view that the absence of acid-fast organisms from the sputum could not alone be regarded as conclusive evidence of the absence of pulmonary tuberculosis in the worker suffering from pneumonokoniosis. In some cases tubercle bacilli had not been found in the sputum even after the use of culture and inoculation methods. Zn such cases, however, the existence of the bacilli might be demonstrated by more intensive investiga tions involving, for example, bronchial or gastric lavage. Dust Investigation. After hearing several contributions on the subject of Industrial dust in relation to dust investigation, the con ference agreed that an analysis of material from which dust was derived did not of necessity represent the com position of the dust inhaled in an industrial process, and further, that it was important In dust studies to determine the distribution of dust particles by composition and by size. It was agreed that, whilst generally speaking mineral dusts (with the exception of asbestos) exceeding -in particle size were of minor importance, the lower limit of the size of particles causing pneumonokoniosis had not yet been determined. Dust Suppression and Control. In regard to dust suppression and control, it was agreed that the protection of the worker against harmful dust exposure might include one or more of the following: (i) abolition of the process creating harmful dust: (ii) sub stitution of harmless material in certain processes where '.'16 'HIE MEDICAL JOURNAL OP AUSTRALIA. Ami, 15, 195^ t^t-ngcrous matori;i) is beinc used; (iii) suppression of dust > at the source; <iv> removal of dust as near as possible to the point of origin; (v) reduction of the concentration of the dust by ventilation; fvi) removal of dust from the air by wetting; (vii) electrostatic precipitation; (vlii) personal respiratory protection of the worker. The conference reaffirmed the opinion expressed at previous conferences that the main efforts in prevention should be directed towards dust suppression and control, and that personal respiratory protective devices should be used only where the former could not be satisfactorily applied, or as ancillary to dust suppression measures. It was agreed that sandblasting with siliceous abrasives was highly dangerous. Some experts considered that the use of siliceous- abrasives In sandblasting was so dangerous that it should be prohibited and non-siliceous abrasives substituted. Others, however, were of the opinion that azperience had proved that siliceous material could be used with safety If effective protection was provided. Finally, the opinion was expressed that there were known methods of dust suppression and control which. It fully applied and maintained, would protect the worker against hazardous exposure. The conference therefore recommended that every effort should be made to apply those methods. Grain DuMt from Cereal Cargoes. The conference recommended that the Interaationi Labour Organization should take steps to inquire into the possibility of controlling the grain dust associated with the handling of cereal cargoes. . ' BUicosis end Civil Engineering Undertaking!. The conference agreed that the attention of governments, public utility corporations, local authorities and contractors should be called to the occurrence of silicosis following relatively short exposure to dust in civil engineering under* takings such as tunnelling and excavations. Preemployment and Periodical Medical Examinations. Experience gained In various countries in relation to premployment and periodical medical examinations was described. Attention was drawn to the requirements of the examination and to the need for technical competence of the examiners. It was emphasized that such examinations were necessary In order to prevent physically unsuitable workers from entering an industry with a dust hazard, and to assess the pathogenic effect of dust exposures in relation to the period of exposure and the concentration and the composition of the dust, and that such details should be available to the examiner. The desirability was stressed that such examinations should include radiography of the lungs of technically satisfactory standard. Cooperation against Tuberculosis. A proposal was made to the effect that, in communities where there were pneumonokoniosis-producing industries, there should be cooperation between those industries and the health authorities In the general corepaign against tuberculosis. . -Disability and Compensation. The conference agreed that in the assessment of disability the three same factors should be taken into account as in the diagnosis of pneumonokoniosis--namely, the history of exposure to harmful dust, the clinical examination and the radiographic findings. The assessment of the degree of disability must be left In each case to the best judgement of the examiner. The conference agreed that the relative Importance of each factor varied from case to case, and that It was at present quite impossible to lay down generally acceptable standards for assessment of disability in pneu- snonokoaioais. - The meaning of the term "pneumonokoniosis** having been dehned. it was .decided that no further elaboration was necessary; each country iTTdul*'define `the xonditions for compensation, which should be such as to-ensure that any worker suffering from pneumonokoniosis should receive compensation regardless of the time that had'elapsed since be was exposed to dust. The term "diagnosable'* incorporated in the definition Indicated the presence of signs or symptoms, but not always loss of function. The conference agreed that where pneumonokoniosis Increased disability due to other diseases or to age. the compensation accorded should take account of that fact. Rehabilitation of Workers. The conference considered the experience in several countries with the rehabilitation of workers suffering from pneumonukomoMis. It was agreed that, when a ^ suffering from pneumonokoniosis had to leave hiaaccuu2S employment, every endeavour should be made to pUe??? immediately in. or train him for. suitable alternative .m.r? ment. which should not reduce his standard of llvin* * provision of such alternative employment shobw 2 prejudice the amount of his compensation. *** Further Conference on Prevention. i * The conference unanimously adopted a proposal by naM_j Kingdom members for the holding of a subsequent coafS! at an early date to consider the prevention of pneumelz koniosls from the point of view of the engineer, the i>hv?r and the chemist. Directory of Workers in Pneumonokoniosis. ' A United States member proposed--and the conferee adopted the proposal without opposition--that th* should prepare a directory of workers in the field of ntt monokoniosls for the use of Interested persons. Publication of Material Presented at Conference, The conference emphasized the importance of the reports submitted to it and the discussions which took N--t concerning them. These dealt with the incidence, patholon signs and symptoms and methods of diagnosis of pneuaoBe* konlosis. They also dealt with the various means adopted t protect workers exposed to the hazard of pneumonokonlo+ as well as with curative and rehabilitation measures. FUaa lantern slides and other relevant material were demov strated during the conference. The conference agreed tHt it was impossible to summarize the material brought befoce the conference, most of which ,w<ts cl immediate value t$ those concerned with the study of pneumonokoniosis also to those charged with the framing of legislation and the administration of relevant laws, and regulations, and there fore recommended that the papers presented to the e* ference and the stenographic record of the proceedings is published and widely circulated as early as possible. Correspondence* CORRECT FOOTWEAR FOR CHILDREN. Sir: The importance of correct footwear, particularly is relation to infants and children, is a matter of constant concern to orthopedic surgeons. This concern has bee* reflected in the appointment by resolution at an annual general meeting of the Australian Orthopedic Association, of a subcommittee to discuss and draw up specifications of an adequately designed shoe for children. The recoo* mendations of the subcommittee, having been adopted, wet* brought to the notice of certain shoe manufacturers in ** endeavour to secure their cooperation in the manufacturing shoes in accordance with the specifications, Ylf^near to ese negotiations were fruitless, and it did not 6y e Council that any good purpose would M Mowing this approach any further. The Council. w of the opinion that some very useful purpose w ^ hieved if parents seeking advice on the **'Joints tided by their private medical attendants on cessary In the selection of satisfactory shoes for ew I have been Instructed, therefore, to lay before 7"^ commendations of the Australian Orthopedic A*a<***" % respect of what are considered essential features *** rrectly designed shoe, and to ask your cooperation eking these findings available to practitioners through" e Commonwealth, through the columns of the journsJ- AFRiL l5. A correctly control So# acrossJ tbe metators. th toe endof uu>ad*voc^atedhoe loathe that portion total length c Sateiy A**" xtremlty of he med whll An old aayii the great to win look al sufficiently r The gene: inswung, fo border. Th< (J) or (b) 1 be shod. Such alte: tarsal pads incorporated should be a tiUoner. Sh It Is COO be used on] these specif A sketch the shoe m 116 Macq Sydney. Hare: 8m; A fe an interestitioner. 1 and I urg( journal. I at a comp; as. But h of my recc For Huom dresse an oic servlc b&cka< dress! Hospi mostl: masse variet Prlc He cc single "Why you c