The Heart in Gall-Bladder Disease.

(Journal, April 23, p. 884), particularly from the statistical point of view. There are certain debatable points. The number of cases-namely, sixty-four-examined by Dr. Laird appears to be much too limited. If one realizes that it is obviously necessary to consider different age groups separately, this number becomes even smaller (five, eleven, seventeen, and four in Dr. Laird's paper). In view of the fact that the incidence of heart lesions is comparatively high after middle age it seems reasonable to investigate at first only younger patients, say, between 30 and 35 or 30 and 40 years of age. If such investigations should prove definitely either positive association or no association at all between heart and gall-bladder disease for the age group considered, one could after-wards investigate other age groups if necessary. This criticism would equally apply to the controls of Schwartz and Herman from the point of view of the small number of cases. The choice of controls, in which they exclude cardiac cases per se, is also, in my opinion, a debatable point. Would it not be wiser to apply the method very often used in statistics to this particular investigation-that is, not to choose a certain number of gall-bladder cases and an equal number of non-gall-bladder cases, but to examine all cases in a certain age group admitted to hospital within a certain time and to divide them into gall-bladder and non-gall-bladder cases, subdivide them again into cardiac and non-cardiac cases, then further into obese and non-obese cases, and then to investigate the " association " between gall-bladder and heart disease in each group and sub-group? If this method is used the cases with normal gall-bladders would probably be much more numerotus than those with disease of the gall-bladder, and the difficult question as to which cases should be excluded from the control series would not arise.-I SIR,-In the annotation in your issue of April 30 (p. 955) you quote the recommendation of the Departmental Committee on Maternal Mortality and Morbidity that " new maternity accommodation should, when practicable, be associated with general hospitals," but you add " it is now, however, generally accepted that this recomme.nda-tion is not in accordance with the-lessons of experience. .. .. The experience of the members of the NorthWestern Branch of the Medical Superintendents' Society has not led them to this conclusion, and their experience of large maternity departments is not negligible …