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capitation fee offered per insured person on a doctor’s list,7s., was below the 8s. 6d. demanded by the Association.Yet when on Jan. 15, 1913, medical benefit came intooperation, 17,796 practitioners had accepted serviceunder the insurance system. ’ -

Looking back, there can be no doubt that Lloyd Georgemeant to deal fairly and even generously with themedical profession. He knew that their cooperation andgoodwill were essential to the successful working of thegigantic system of health services he had created.There is nothing in his long career to suggest that whengreat national questions were at issue he was moved tothe exercise of unduly stringent economies : indeed, asthe M anchcstcr Guardian points out, when he becameChancellor of the Exchequer he rejected the traditionalview of that office, preaching and practising the economyof wise expenditure. In handling the provision of medi-cal services he was on unfamiliar ground, and mademistakes that could have been avoided by the preliminaryreconnaissances which nowadays precede legislation.On the other hand he had that capacity to come, see,and conquer by which a few men work great changeswhile the large majority, for all their good intentions,consider it their main duty to describe the obstacles toaction. By his vigour he gave this country the first in-stalment of social insurance, and thereby strengthenedit against the strains of war and economic depression.If he had done nothing else-and he did much-hewould deserve the thanks of all his fellow countrymen,including his opponents of 1911. ,

THE HYPERABDUCTED ARM

NEUROVASCULAR disturbances in the upper limbs havebeen attributed to a variety of anatomical abnormalitiesin the neck. Thus Elliott and Kremer 1 lately demon-strated that some cases are due to herniation of the 6thcervical intervertebral disc. Obliteration of the sub-clavian artery, and abnormal stretching of the brachialplexus or its branches, which also lead to these disturbances,may however be produced in some normal people if theyadopt the appropriate posture. Thus Falconer andWeddel12 investigated 50 normal men and 50 normalwomen, aged 19-47 years, and found that- in 25 of themen and 29 of the women the radial pulse was affectedby backward and downward bracing of the shoulders,the pulse being obliterated in 18 cases of each group.An even more striking illustration of such obliterationis reported from America, where Wright has investi-gated the effect of hyperabduction of the arms on theradial pulse in 150 normal young. adults. Hyper-abduction he defines as " that phase of circumductionwhich brings the arms together above the head (withthe elbows flexed or with their long axes correspondingin plane to that of the body)." He found that the rightarm pulse could be interrupted by this procedure in125 cases (83%), and the left arm pulse in 124 cases. In

only 11 cases could no obliteration be produced in eitherarm. The facility with which the pulse could be stoppedvaried considerably, but it was easily done in 94 caseson the right and in 95 cases on the left. The twolikeliest sites for this stretching or torsion of theblood-vessels are where the subclavian vessels and thetrunks of the brachial plexus pass behind the pectorali§minor muscle and beneath the coracoid process, andwhere they run between the clavicle and the first rib.

The clinical significance of these observations deservesinvestigation. Some people sleep with their arms

hyperabducted, and Wright records 4 cases in whichthe adoption of this attitude in bed seems to have led toneurological and vascular changes in the upper limbs.Some of his normal subjects said they often fell asleepin this position but were usually awakened by discomfort

1. Elliott, F. A., Kremer, M. Lancet, Jan. 6, 1945, p. 4.2. Falconer, M. A., Weddell, G. Ibid, 1943, ii, 539.3. Wright, I. S. Amer. Heart J. 1945, 29, 1.

or pins and needles in the arms and had to move them.It is also a position adopted in certain occupations, suchas painting ceilings, and, as Wright points out, the armmay be deliberately hyperabducted on the operating-table or in splints or casts. Before fixing an arm in this .

position it would be wise to make sure that the circula-tion is not interfered with.

A METHOD OF TREATMENT PATENTED

- IT is unusual for medical men to take out a patent for amethod of treatment or prophylaxis. This course hasbeen adopted by the originators 1 of the method of treatingand preventing silicosis by inhalations of aluminiumpowder. The reasons for patenting the method aregiven by, Dr. Robson in a paper read to the CanadianInstitute of Mining and Metallurgy.2 He says that theuse of aluminium in silicosis therapy has been patentedin most of the principal countries of the world, because :(1) We were concerned in the earlier stages, lest some outside

party, learning of our work, might apply and obtain apatent, then attempt to fit the process into a commercialventure.

(2) We realised also that, whatever might be the advantagesobtained from the use of aluminium powder, it could notbe used as a substitute for dust control. Moreover,even with good housekeeping, it was necessary that thealuminium powder should be administered under

competent supervision and control.(3) First impressions are lasting, and, if haphazard methods

of application had been permitted, many things couldhave happened that would cast unfounded suspicionupon the process and thus delay its wider applicationand the benefit it is expected to bring to those sufferingfrom silicosis or exposed to the hazard of siliceous dust.

(4) The discoverers were determined that all benefits to bederived from the use of the process should be madeavailable to those suffering from or threatened by silicosis,so far as is practicable, without let or hindrance (ouritalics).

Denny and Robson transferred the patents to McIntyreResearch Ltd., a company formed by them together withthe McIntyre Porcupine Mines Ltd. Jacob 3 states thatthe commercial manufacture of aluminium powder forprophylaxis has been undertaken at the McIntyre Minessince October, 1943. Robson goes on to say that Mc-Intyre Research Ltd. offered the use of the process to theworld without compensation or hope of reward, stipulat-ing only that a licence fee should be charged sufficientto cover the cost of administration and to provide in duecourse enough revenue for the support of further researchon silicosis and similar diseases.The practical effect of the patent is that any investi-

gator or body in England, wanting to test the action ofaluminium in the prevention or treatment of silicosis,will have to apply for permission from McIntyre ResearchLtd. in Canada. A licence fee (amount not stipulated)will have to be paid, and the aluminium powder used willhave to be approved by the research company. Pre-sumably if anyone is rash enough to give silicoticpatients inhalations of aluminium powder not approvedin Canada, he will render himself liable to a court actionfor infringement of patent rights. May not the effect ofthe patent be opposite to what the discoverers of themethod wish-namely, that it should be " made availableto those suffering from or threatened by silicosis ...without let or hindrance " 1 It seems possible too thatthe method will be discredited more by the act of takingout a patent than by allowing investigators in otherindustries and in other parts of the world to experimentin their own way and not only with aluminium powdersapproved by McIntyre Research Ltd. The publishedresults of treatment and prevention of silicosis by the1. Denny, J. J., Robson, W. D., Irwin, D. A. Canad. med. Ass.

J. 1937, 37, 1 ; 1939, 40, 213.2. Robson, W. D. Trans. Canad. Min. Inst. (Inst. Min. Metall.)

1944, 47, 172.3. Jacob, A. W. Ibid, p. 185.