TEl siBm 940 JUNE 2, I923] THE BRITISH MEDICAL ASSOCIATION. MIDICAL JODENAS 2-- I sufficient to defend the British Medical Association froin a similar charge. With the Annual Report of Council in his hands a representative would be better justified in reversing a farmiliar request and pleading 33rfettcbbournaI. for less matter and more art; but even so he would probably admit upon reflection that the art which can reduce the record of the year's activities to the volume SATURDAY, JUNE 2ND, 1923. even of the present report is by no means to be despised. For the Annual Report shows that while the Association continues to grow in membership, as THE BRITISH MEDICAL ASSOCIATION. indicated by an increase of over 700 in 1922, and in THIE British Medical Association, various and mutable, extent, with the formation of new Branches in St. takes for its province all that concerns the medical Lucia and in Tanganyika, its vitality, as tested by the profession-science, clinical medicine, public health, work actually performed and its ability to meet the and material interests. The vast majority of its changing needs of the profession, is amply sufficient members are, in the nature of things, general practi- to maintain that growth. Amongst the matters tioners, but from its earliest small beginnings in 1832 covered by the report a few may be distinguished as it has gone on the principle that, representing the of more than ordinarv interest. profession as a whole, it was under an obligation to We will place foremost among them the coming contribute to the advance of medicine. In the visit of the President of the Association to the first Memorandum of Association its objects are defined; session of the Australasian Medical Congress to be we read there that the Association was established to conducted under the control of the Federal Coin- promote the medical and allied sciences, to maintain mittee of the British Medical Association in Australia. the honour and interests of the medical profession, Sir William Macewen will, we know, receive a very to circulate such information as may be thought warm welcome, and the augury is a happy one for the desirable by means of a periodical journal, and to future relations of the central body of the Association grant sums of money for the promotion of the medical and its Branches in the Dominions. At home the and allied sciences. Another object is to hold Guildhall conference between representatives of various periodical meetings of the members of the Associa- bodies interested in National Health Insurance, and tion, and this has been fulfilled through the meetings the consequent appointment of a standing committee of Branches and Divisions, and through Annual to consider the various questions involved, maintains Meetings, which have been held without any intermis- the tradition of co-operation in public service, while sion save that caused by the great war. in another sphere the evidence given before the Lord The Annual Meeting this year is to be held in Chancellor's committee on the law affecting insanity Portsmouth, under the presidency of Mr. C. P. Childe, in connexion with criminal cases is of like significance. F.R.C.S., senior surgeon to the Royal Portsmouth The successful parliamentary campaign for the with- Hospital, who will deliver his address on the evening drawal of the Dangerous Drugs Regulation prohibiting of Tuesday, July 24th. The Sections, of which there prescription of the drugs bv a medical practitioner for are as many as sixteen this year, will meet on the his own consumption, and the excision from the three following days and will debate a large number Dangerous Drugs (Amendment) Bill of the distinction of subjects of current clinical or scientific interest. between a doctor " in actual practice " and other Thus in the Section of Medicine there are to be registered medical practitioners, shows the advantage debates on diabetes and on heart disease in early life. of a close central scrutiny of all legislative and In the Section of Surgery there will be, among other administrative proposals affecting the profession, and discussions, one on the treatment of acute primary the possibility of speedy and effective co-operation in infections of the hand. One of the discussions in the such matters between the Divisions, the central office, Section of Neurology and Psychological Medicine, that and the medical members of Parliament. on fthe sequelae of lethargic encephalitis, will be Amongst the matters for deliberation and decision followed by a demonstration. In the Section of two stand out as of primary importance: the hospital Diseases of Children there will be discussions on policy of the Association, and the proposed scheme for acidosis and alkalosis, and on summer diarrhoea. co-operation between the Association and the Society Modern methods of investigation of diseases of the of Medical Officers of Health. The hospital policy is, stomach, the value of serological tests in diagnosis, in its essentials, that which was before the Repre- and the part played by fungi in disease are the sentative Body last year at Glasgow. The work of *subjects selected for discussion in the Section of the year has Been mainly that of consolidation and Pathology. There will also be a Pathological Museum, definition, and while the need for decision as to the and it is hoped that many members will lend speci- vital question of the staff fund in relation to payments mnens, particularly if they have a bearing on the made by or on behalf of certain classes of patients subjects for discussion in the various Sections. A full remains as urgent as it was twelve months ago, and programme of the work of the Sections is printed in not less controversial, it will at least be debated with the SUPPLEMENT for this week. less chance of misapprehension as to the actual point The Annual Representative Meeting, which will at issue. begin on Friday, July 20th, has a full agenda paper. Three years have passed since the Representative In the current issue of the journal of a certain pro- Body at Cambridge declined to accept the scale of fessional organization a member complains that, whilst public health salaries submitted by the Society of the provisional programme of his association's annual Medical Officers of Health, and the policy now sub- meeting has been published practically in extenso, the mitted as agreed between the council of that Society delegates are still in the dark as to the work that lies and the Council of the Association is the fruit of before them. The fact that detailed reports on the three years' experience and deliberation. That ex- more vital issues of policy to be dealt with at Ports- perience covers both the short dav of reconstruction mouth have from time to time been circulated to the and inflation and the succeeding period of economic DiTvisions according to established custom is alone depression and retrenchment; the resulting proposals Tus 8 ZUNE 2, 19231 THE BRITISH MEDICAL ASSOCIATION. r MXDZCAL JOC"A& 941 should therefore stand the test of the searchina tunity of expressing its views on the reasons for the criticism to which they will rightly be subjected at shortage. It is understood that army pay generally Portsmouth. But, after all, the salary scale, though is about to come under review, and the Association an essential portion of the policy to be considered, is will take steps to ensure that the pay of medical not its only or indeed its chief feature. Neither the officers shall be dealt with satisfactorily. Association nor the Society is solely or even primarily The Association has been officially recognized as the interested in remuneration. The development of the mouthpiece of postal me'dical officers by the Post. powers and obligations of local authorities in regard master-General, and in November, 1921, set up a to public health, abnormally accelerated by war con- special subcommittee to deal with matters of concern ditions, no less than the continuous growth of preven- to them. Something has already been accomplished; tive medicine, calls for a more authoritative and com- it has, for instance, been decided that itinerant postal prehensive expression of professional opinion than servants shall as far as is feasible be placed on any yet promulgated. That an agreed statement of capitation lists. The fee for such itinerant servants policy with regard to the development of public health has been raised, and the rule fixing a maximum services is presented to the Representative Body number of visits to be charged for has been abolished. together with the new salary scale is in itself suffi- The fee for emergency cases has been increased, and cient earnest of the future. Finally, the recognition the half-yearly maximum of 13s. per case has been by the Society that all medico-political work should, replaced by a 12s. maximum per quarter. The form subject to certain safeguards, be left to the Associa- of report for candidates for the postal service has been tion, together with the provision for direct representa- simplified, and the fee for making it raised, as has also tion of the public health services on the governing the fee for special consultations. A strong effort has bodies of the Association, suggests a constitutional been made to obtain equal pay for whole-time post solution of a difficulty which at one time threatened office medical officers, whether male or female, but it a disastrous division. has not been possible to induce the authorities to The Association, through its Naval and Military depart from their established custom of paying a lower Committee, keeps in touch with members serving in rate for its women employees than for its men. the Navy, Army, Air Force, and I.M.S. During Of the work which has fallen to the British Medical the war and the years that immediately succeeded Association since the armistice none is more difficult, the armistice the work of the Committee was heavy, more complex, more subject to delay and disappoint- and many matters of importance to each service as ment than that on behalf of the members of the a whole were dealt with, as well as a very large profession scattered amongst the various colonies and number of cases affecting individuals. The value to dependencies of the Crown, most of them working as officers of all services of having a strong organization whole-time or part-time servants of the several to take up their grievances when it has been found Colonial Governments. True, there has been some impossible to obtain redress through the ordinary advance; but it has not been possible, notably in the channels is inestimable. The high-handed action of case of the West Indian colonies, to consolidate the the Admiralty in retiring compulsorily Senior Surgeon position which seemed to have been attained in -Commanders before the age of 55 was strenuously December, 1920, when, after the repeated protests of -opposed, but the means by which the rulers of the the Association and the exclusion from the JOURNAL Royal Navy can be resisted are restricted by law and of advertisements of vacancies in these services, the usage, even when their action amounts to a breach report of the Egerton Committee was published and of agreement, which in the case of a private firm satisfactory assumnces were received from the would be good warrant for legal proceedings. The Colonial Office that effect would be given to its more Admiralty was not willing to receive a deputation urgent recommendations. Substantial concessions from the Association, and memorandums stating the were then secured as regards pay and conditions of case for the officers met with a blunt refusal. As the service, particularly in the West and East African Admiralty remained obdurate it was informed that groups, but, even in these more favoured areas, the the Association must advise medical men that if they immediate outlook is dark. We have recently called entered the Royal Naval Medical Service they must attention to the reduction of personnel in the Kenya realize that so long as the present policy is main- Colony Medical Service and to its implications, more tained the Admiralty could not betrusted to keep any especially as regards security of tenure and the engagement it might make with its medical officers. licensing of partially qualified medical practice. Now An Army Order amending the Pay Warrant was we learn, from the reply of the Under Secretary of issued in 1920, and it was found that Majors were State for the Colonies to a question by Dr. Fremantle to lose rather than gain in the amount of their retired in the House of Commons, that ordinances have pay as a result of the revision; some of them, indeed, recently been allowed which reduce the standard stood to lose £44 a year. The matter was taken up required for medical registration in British Honduras, with the War Office, and the net result was a further the Turks Islands, and St. Vincent. revision of the retired pay, which amounted to a gain It is difficult to believe that the position now reached of £75 all round. By this the Major of twenty years' is exclusively determined by the financial difficulties service got back his lost £44 and received an addi- of the several colonies. Indeed, there is available tional £31 per annum. By the revision in 1920 of the direct evidence that this is of not the case. Other con- pay officers of the Indian Medical Service certain siderations are involved, and amongst these we would increases were received, and this improvement was give a prominent place to the defects in the central due to years of persistent work by the British Medical machinery for dealing with the affairs of the Colonial Association. Owing to political and economic con- Medical Services. Whilst agreeing with the Egerton ditions the future of this fine service is uncertain, and Committee that a unified Colonial Medical Service, the uncertainty, which is reflected in the recruited is in recruiting, by examination and administered by its own part due to the way in which the Government of Director-General, is an ultimate rather than an imme- India has played fast and loose. The difficulty all diate objective, we regret that more advance has not the medical services experience in obtaining recruits is been made along the lines recommended by the Com- well known, and the Association loses no oppor- mittee and urged by the Association; we are forced to -942 J UNE 2, 1923) PREVENTION OF tiBART DISEASE. JU T5f 2b 3) the conclusion that the existing expedient of a medical that have been adopted by the Society for the Preven- advisory committee is an insufficient safeguard for tion and Relief of Heart Disease of New York, to the interests of these services. A day will come when. which Dr. Moon refers when dealing with another the medical and sanitary services will be generally side of the same subject (p. 922). The magnitude recognized, in deed as well as in word, as productive and importance of the problem are very tividlv pre- services, and the successful development of agriculture sented in some of the figures which have been and industry amongst a population crippled by pre- collected by that society. Thus of 5,000,000 men ventable disease will be realized as dependent upon examined for military service in the United States, the adequate application of the principles of hygiene over 200,000 were rejected on account of heart defects; and sanitation. But the time is not yet, and until in one of the largest insurance companies 2.4 per cent. provision is made by the Colonial Office for the review were rejected for the same cause; of 250,000 children of all matters affecting its medical and sanitary in New York schools 1.6 per cent. were found to have services by a medical department with a responsible heart defects. In England and Wales, of 366,000 professional head, those services must continue to school children examined about 1 per cent. were found depend in the main upon the British Medical Associa- to have organic heart disease. Mortality tables tion as a means of bringing their needs and the needs present a similar picture, and place diseases of the of the communities which they serve before the distant circulation in an unenviable position at the head of authority which has the ultimate voice in determining the list of causes of death. In 1919 the total deaths theconditions of their development. in England and Wales from all causes were 504,203, and of this number 51,530 are registered as organic disease of the heart, while pericarditis, acute endo- PREVENTION OF HEART DISEASE. carditis, and angina pectoris account for other IN a summary of Sir George Newman's memorandum 3,112, and diseases of arteries, embolism, rheumatic on Recent Advances in Medical Education in England fever, and chorea add an additional 15,671 to the list. (BRITISH MEDICAL JOURNAL, May5th, p. 772) we quoted For comparison one may note the figures in the same the General Medical Council's recommendation " that year for tuberculosis (all forms), 46,312; bronchitis, throughout the whole period of study the attention of 45,543; cancer, 42,144; pneumonias, 38,949. Owing the student should be directed by his teachers to the to the incidence in different age periods the compara- imporstance of the preventive aspects of medicine." tive wastage from these diseases cannot be drawn The idea of prevention of disease is to be a pervading from these figures alone, but it is obvious that the influence guiding all clinical study and practice. In economic problem is one which demands serious con- other words, the " cure " of health, using the word sideration, particularly when one takes into account cure " in its now almost obsolete meaning of care, is to the years of invalidism that antedate the fatal issue be the ideal rather than the cure of disease. A feeling in most cases of heart disease. With a causal cou- has crept into the profession, perhaps unconsciously, dition that in the majority of eases is frankly infective that the control of certain specific- infections in greater something should be possible to mitigate the extent or less part by the public health authorities signified of these diseases, and in the rheumatic cases the that these diseases alone were considered to be pre- limitation of reinfection would of itself be of immense ventable, and perhaps less has been done in the way of value. Sufficient has already been done by the New prevention of other diseases than might have been the York society to warrant an extension of their experi- case. Janeway, in the Shattuck lecture in 1916, said: ments. Thus a limited number of so-called " potential ",By as much as the proverbial value of prevention cardiacs," children who had had rheumatic fever, exceeds that of cure does the importance of study of repeated tonsillitis, or chorea, but in whom there was the causes of disease surpass that of its manifestations, no evidence of heart infecti6n, were cared for and its results or its treatment." An attempt to discover watched for an average period of four and a half years. the causes of disease has not been wanting in this In the rheumatic or throat cases there was no instance country, but often any systematized attempt to make of heart involvement, while in the cases that had use of that knowledge has been absent. chorea, either alone or with rheumatic fever, 39 pei In the case of disease of the heart it is noteworthy cent. developed heart lesions, and this occurred in that the most that has been attained is not the cure each case in association with a further attack of of the disease but its care, and comparatively little is chorea. It would appear that the more general heard of its prevention. The natural history of rheumatic manifestations could be controlled, but diseases of the heart has been the subject of much when the nervous system was implicated there was study and already much Is understood; the less chance of stamping out the infection. This so mechanism of the heart has been investigated in a far supports the contention of Dr. Poynton that ,way that has rid the symptomatology and the semeio- " the subject of chorea is well worth most serious logy of many of their traditional inaccuracies; the investigation." The education authorities in different pharmacopoeia of. the cardiologist, after investigation parts of the country should be in a position to supply and experiment, has been very much depleted, and valuable statistical information on many of the points the few drugs that remain to him are useful in the with regard to the incidence of heart disease and some treatment of symptoms or of complications, but have of the etiological factors in its production in those little or no effect on the underlying disease. The of school age, and the incapacity as regards school futility of attempting cure is very generally accepted attendance that results from it. Much good could also for most cardiac diseases, and it would appear that the be done by arranging to give definite advice to parents ground has been sufficiently well explored to make of such children on leaving school as to employment practicable the adoption of preventive measures. suitable for their physical capacity. In one of his Dr. Poynton deals with a very important aspect of reports Sir George Newman writes: " Recent in- this subject (p. 919) in a lecture delivered at the quiries have furnished abundant evidence of the fact Hospital for Sick Children, where the rheumatic type that many children employed for the first time after of disease naturally attracts most attention. The leavino school break down physically from heart summary of his argument follows very closely the lines trouble. . . . "' In later years a similar condition TU BBMT 94. JUNE 2, T9231 THE SPHENOIDAL SINUS. I MEPCAL JOaDSA 943

a obtains. The' cardiac cripple, after a period of treat- bilities of disease which may result from septic ment in hospital which is frequently too short, goes invasion of this cavity are still perhaps not generally back to his former unsuitable -employment only to known, and the two articles by Sir StClair Thomson prepare for a subsequent and possibly last breakdown. in the current number may vell give food for thought. No one will deny that years might be added to many It was in this JOURRNAL that, in 1906, he published an lives by adapting work to incapacity, and while with article in which the cerebral and ophthalmic compli- the present amount of unemployment it would be cations of sphenoidal suppuration were illustrated by difficult if not impossible to find alternative -work for the records of no fewer than 42 post-mortem examina- the cardiac cripple, the problem is one which in' tions. One of his articles in our present issue is of more normal times ought to be faced. particular interest to the physician and general practi- In any scheme for the prevention of heart disease tioner. It shows how suppuration in the -accessory there will be room for the co-operation of many forces, sinuses of the nose, 'and particularly' in the sphenoidal and practitioners, school medical officers, hospital sinus, may be the sole cause of an acute illness of physicians, venereal disease specialists, throat and several weeks' duration. The other throws light on dental surgeons, and district nurses.would have to be' the association of retrobulbar neuritis with nasal enlisted. Additional auxiliary hospitals or convales- suppuration. It adds one more to the list of cases cent homes would be required, as residence- in ordinary proving that the cause of an optic atrophy may be hospital is necessarily too short and most convalescent found in a suppurating accessory nasal sinus, and be' homes object to the admission of cardiac cases; in any prevented by draining it. Such records have-appeared event there would need to be strict supervision of in this JOURNAL before." How frequent this associa- exercise and recreation. tion may be has still to be ascertained. It has been Dr'. Poynton o'utlines some avenues of attack while suggested that retrobulbar neuritis'may b~e chused by dealing more particularly' with heart disease in the simple want of ventilation of the ethmoidal 'and young. The attention of the student should be drawn sphenoidal cavities; that "the mere presence of pUs immediate and' remote effects as they affect the child in the sinuses is by no means the usual or only so that he may appreciate the difference in their cause "; and that these cavities should be opened and immediate and remote effect as they affect' the child- ventilated in certain cases, even in the absence of or the adult. The education of the public, and suppuration. Even should a retinitis' clear' up after specially school teachers, in the causes that operate the opening of a healthy sinus, this is no definite to' produce these effects would lead to the earlier pr9of that the condition of the sinus was the cause. enlistment of medical aid when prevention would be 'The doctrine is not free from danger, and Sir StClair most efficacious. In New York much good has Thomson, though he quotes, does not support 'it. resulted from the institution of cardiac clinics, where' He is concerned with cases of undoubted suppuration. patients and potential patients are looked after and Surgical treatment has been energetically criticized periodically examined, from the segregation of cardiac by Harvey Cushing, who states that "many unhappy cripples in special schools or departments, and from consequences of.indiscriminate and ill-advised opera- convalesc-ence hospitals, where those rec'overing from tions on the accessory sinuses" have come to his recent attacks have a prolonged period under daily attention, as he is often urged to see patients in observ'ation. extremis from meningitis the result of operation by The subject is to be brought before the Section of inexpert hands on the ethmo-sphenoidal cavities.- Medicine at the Annual Meeting of the Association, These tecnical disasters should not occur, and are,' and the arguments and information contained in the we believe,' unknown or rare in the hands of well papers by Dr. Poynton and Dr. Moon will serve a experienced rhinologists. But Cushing also doubts useful purpose by preparing the- way. Sporadic and the frequency of the association of sinus affection and isolated attempts 'at dealing with a subject of this visual disturbance, and protest's against the latter magnitude would probably prove very ineffectual, and being attributed to a cause in the nasal accessory some central controlling or advisory body would almost cavities simply because other possible causes can all be necessary for efficient organization. be excluded. As he observes, " when a retrobulbar neuritis is said to be accompanied by 2 or 3 diopters -of swelling we are certainly dealing with something THE SPHENOIDAL SINUS. which a hyperplasia of the mucous membrane lining As recently as the last decade'of last century there the accessory sinuses is not capable of producing."2 was to be found in a work on surgical anatomy-we Surely this matter is one which might be advanced, hav;e -unfortunately mislaid the reference-a state- if not settled, by ophthalmologists and rhinologists nrent " that the surgical relations of the sphenoidal discussing it conjointly. The former can tell of cases sinus might be dismissed in a few words, as it was where causes other than nasal were at work; of cases evident from its situation in the depths of the head- where no clear cause could be determined; and of cases, in the very base of the skull-that it was not and *which recovered spontaneously. The rhinologist can, never could be reached by surgical measures." This tell of cases in which he appeared to succeed, of others prophecy- was almost as unhappy as Erichsen's in which he failed, and of the local cond'itions he- met obiter dictum that surgery had reached its final and with in the suspected-accessory nasal sinus. ultimate limits, uttered in 1873, when Lister was Such an investigation might be expected to bear still in Edinburgh working at the development of the fruit in London now that we possess the finest collec- antiseptic system. tion in the world of specimens of nasal anatomy. Since the beginning of the present century the The Onodi collection, which was secured and presented S opening and draining of the sphenoidal sinushas come Bronner, Adolph: A Case of Thronibosis of the Cavernous Sinus ,due be recognized by expert rhinologists as a proper to Empyema of the Sphenoidal Sinus. BRITISH MEDICAL JOURNAL,-'1904 to Vol.ii,p. 1310. operation in suitable- cases. Moreover, growths have Fish, enry Manning: A Study of Optic Neuritis in Connexion with Nasal Accessory Sinus Disease. Ibid., 1907, vol. ii, p. 1218. been removed from the sinus, and it has been traversed Bradburne, A. Alison: Bilateral Optic Neuritis due to Sphenoidal, by the surgeon as a means of approach in attacking Sinusitis. Ibid., 1915, vol. i, p. 109. Accessory Sinus Disease and Choked Disk. Journ. Amer. Med. disease of the pituitary gland. But the wide possi-. Vol. 75, No. 4, p.276, July 24th, 1920. Assoc., r T DamiTE 944 JUNE 2, J9231 THE APPEAL FOR CANCER RESEARCH. M3XDICAL JOUuwIS I to the Royal College of Surgeons through the public tories of the appeal, many of them, are 'highly quali- spirit of British laryngologists, should go far in helping fied to allege the seriousness of the problem, but, to settle this question. One valuable clinical point has speaking quite frankly, we cannot think that they are already been learnt by all who have looked at these equally competent to direct the measures that can beautiful dissections-namely, in all cases of retro- best be taken for its solution. That perplexing task bulbar neuritis, even when unilateral, if a sphenoidal should be resigned to persons tried in the direction of focus is suspected, both cavities must be opened and research, well experienced in what has been pictur- drained, for anatomical abnormalities are so common esquely described as its " growing edge "-where, for that the sphenoidal sinus on one side may be in con- instance, to continue the metaphor, the individualism tact with the opposite optic nerve. This illustrates of the living cell, and its power of maintaining itself one of the many lessons ophthalmic and nasal surgeons and multiplying in an unwonted environment, is being may learn from this unique collection, which is full of watched and tested. There is no lack of such ex- interest when studied in connexion with the results perienced advisers, and there is also, as is enumerated of clinical observation. elsewhere (pp. 947-950), a respectable number of leaders experienced in this particular department of research. THE APPEAL FOR CANCER RESEARCH. The flrst duty of the promoters of this campaign is, WE publish elsewhere (p. 947) the text of an appeal no doubt, to obtain money by a fair statement of our to the public to subscribe to a fund established by a present disastrous position to the public. The second, body newly organized with the title " British Empire which should at once be undertaken, is to apply to Cancer Campaign." It is addressed to the people of the Imperial Cancer Research Fund, the Medical this country and of the Dominions. There is a pro- Research Council, and the Ministry of Health, asking verbial saying that he who sees the end sees the them to take steps for the appointment of an means, and we are prepared to believe that it advisory committee composed of men experienced in applies in this instance, but we confess to some general medical research, reinforced by others specially hesitation, due, in the main, to the terms of the skilled in this particular matter. Otherwise money, appeal itself. and what is vastly more important, time and energy, Cancer is an implacable disease, and the dread of it will be wasted. is present somewhere at the back of the mind of many men and more women who have reached middle age, especially if they be at all introspective. About THE HISTORY OF BART'S. its cause we as yet know little, bevond the facts that "THE history of St. Bartholomew's Hospital from its it sometimes follows long-lasting irritation, and that foundation in 1123 to the present day is a part of the some irritants seem more apt than others to produce history of England which has never before been written at it. But there are a multitude of cases to which this length." With these words Sir Norman Moore opened the explanation can be applied with diffiulty, if at all. pr eface to his monumental History of St. lBartholom ew's In fact, we do not know that all the cases to which the Hospital, which was published early in 1919 in two large term " cancer " is habitually applied are due to the volumes, of some 1,600 pages in all, with a wealth of same class of cause. This is one of the reasons which sumptuous illustrations. The writing of it occupied his render the problem difficult even of approach. We spare moments during more than thirty years of a life of cannot be sure that frontal attack is the right strategy. remarkable activity. His son, Sir Alan Moore, says in In the heart of man the time is ripe and over-ripe, a' interesting memoir in the April issue of the DuJblin but has scientific medicine reached the stage when the Re vewu: " The hospital records include many hundreds of attack can best be delivered in this way? Have we mediaeval charters, each about the size of a half-sheet of advanced far enough in biochemistry, in cytology and notepaper, containing usually ten or twelve lines of con- immunology, and, it may be added, in the study of tracted mediaeval Latin. All these he read, besides many the invisible viruses, to be sure that the line of progress others at St. Paul's, the British Museum, and elsewhere. is not along the roads they open? The conclusion of He printed in full, or gave extracts from, more than five some German investigators who entered on the quest hundred belonging to St. Bartholomew's alone. Cartularies, with much enthusiasm was that scientifically the journals, ledgers, and many other manuscripts had to be time was not ripe. perused and their contents weighed. . .. Moore read the It is for reasons of this order that we hesitate to old records till, for him, mediaeval London lived again. accept some passages of the appeal; they are no doubt He visited many places mentioned in the charters, talked guarded by other passages, but they may easily be with the inhabitants and discovered links witlh the past. read to promise too much and too quickly; before now His book is worthy of the great hospital and ancient city enthusiasts speaking in the name of medicine have of which it tells so much." Norman Moore died six promised more than could be fulfilled. This is not to months before the octocentenary celebrations of the great carp at the excellent aim of the promoters of the foundation whose histor y he wrote, and it has fallen to appeal, to which we do not doubt the public will make other hands to prepare for this occasion a shorter chro.nicle a generous response; there is no question that more and an anticipation of future progress bearing the title avenues of attack can with advantage be opened up A Short History of St. Bartholomew's Hospital, 1123-1923.' and larger forces employed in developing statistical The greater part of this handsome volume-well written, and epidemiological as well as laboratory methods; well printed on good paper, well illustrated, and well and if we are content with a cure, as to-day well we bound-is from the scholarly pen of Sir D'Arcy Power, may be, -the help of the new and vigorous science of whose intimate knowledge of the subject is known to all pharmacology, which already holds some hopes, must Bart's mern and to every student of the history of medicine. be enlisted. And there is radiology-radium and the There is no man better fitted for this labour of love, and intensive x rays. All this means money, it means bis outline of the past and present of the hospital gives men also, and wise direction. But from the money A Short History of St. Bartholomew's Hospital, 1125-1925. Past and aspect alone the public has a right to be assured that Present, by Sir D'A.rcy Power, K.B.E., F.R.C.S. The Fu,ture, by H. J. Waring, S.5., F.R.C.S. Londbit: Printed for the Hospital. 1923. (71x9j, the funds it supplies will be wisely expended. Here -pp.- xv + 201;- 52 illastratiorys.) Copies may be had for 11i. (includling p6ostage) from-Mr. Geoffrey Keynes, F.R.C.8, St. Bartholomew's Hiospital, again we cannot help a certain hesitation; the signa- E.C.1. aJu-N!f Z, THE UNITED AND TrHE OPIUM z BBE T93]L STATES CONVENTION. ID JOTNAL 945 17

a clear- and graphic Account of the of an institu- progress of the opium poppy and the coca leaf to quantities

tion which has remained for eight hundred years clusively required for strictly medicinal and scientific pur'

exact placed it the reign site where Ralhere in poses is one with which I am in entire accord." Presi-s

As our readers must be well aware, Rahere established dent is requested to report the results of such

Jlospital and his priory at the same time, and may take, on the lines suggested, by December next. Fro

the bouring church of St. Bartholomew Great-described a recent bulletin the League of Nations issued by woul " as most beautiful by Dean Inge still the appear that some forty States have now brought the in "-which held its own celebration London. March, national Opium Convention of 1912 into force; other! participating in next week's ceremonies. have signed but not ratified the convention (Argentine' between the kindred foundations is mentioned Colombia, Costa Rica, Esthonia, Latvia, Lithuania,<

present volume, but the progress of the hospital Paraguay, Persia, and Switzerland). Four Powers not, forms the leading topic. Sir D'Arcy Power's in March of in way to the this year, adhered any conven. past, based on original records, carries tion (Turkey, Afghanistan, Abyssinia, and Lichtenstein), pleasantly down the centuries, beginning On the other hand the United States, Germany, tho

days of the hospital and the objects of its Free City of Dantzig, though outside the League discusses in turn the various features, functions Nations, are nevertheless parties to the convention;

functionaries, and the customs and possessions, which it is to be that the Council and Assembly hoped thQ

helped to make St. Bartholomew's what it League may, before the close of this year, secure more

is. Next comes an account of the organization of general and effective enforcement of the Opium Conven-

hospital and its medical college at the present Mr. tion, now more than ten years old. Meanwhile, seizures H. J. Waring follows with a forecast of dangerous drugs in the course of illicit or fraudulent ments, which puts vividly before the reader transit are reported from various sources. The Canadian schemes of reconstruction; in this he has been Government seized 442 lb. of morphine cubes, of

a profusion of plans by by architectural of " heroin, and 65 lb. cocaine, falsely consigned cocoa " So far as can be j;udged in the twenty-four hours powder from Switzerland. Again; the smuggling the receipt of the book and the time of morphine into China through the French and this commemorative volume for next'week's Post Offices is and a Danish firm was reported, to a work which all Bart's men and many others to have been exporting morphine end opium Amoy the concerns will wish to possess. A hasty of which rate of 300 kilograms a year, some appears to pages gives us the idea that it is one those have been of British origin. It will be remembered the which are worthy, in the words of Bacon, chewed Home Secretary, in connexion with the recent conviction

be read wholly, and digested-that is, to and the licence of H. M. F. Humphrey, has cancelled Messrs.

and attention. The pictures are diligence exceptional Whiffen and' Sons of Battersea (also trading interest, and reproduced with great skill. name of J. A. Wink and Co.), and they will accordingly

not in future be allowed to buy, manufacture, sell, have

UNITED STATES AND THE OPIUM any in the preparations to which the 0THE CONVENTION. dealings Dangerous IN the issue of the JOURNAL for April Drugs Act (192)- applies. There is evident

dire2ted to the reawakened interest of United States keeping constant watch over the international

continues of America in the traffic in dangerous drugs. these drugs, so long as the production vastly the

League of Nations has been preoccupied with to exceed medicinal requirements and thus encourages

" trade is not sideration of what may be regarded as the illicit commerce. That the opium without its

use of opium and the other scheduled drugs, House financial aspects is disclosed by the recent announnement

Representatives has been inquiring and in the House of Commons that the Straits Settlements,

President in favour of very drastic international the Malay States, Brunei, and North Borneo respectively

cent. of their Last January Mr. Stephen G. Porter introduced derive 37, 16.7, 16, and 12.3 per revenues

to of Representatives deal to be tion the House from opium. There is a good yet before

Df the United States to seek "effective control we can claim imperially that our withers are unwrung.

drugs by limiting the production thereof to the As we learn that Mr. Stephen G. Porter is representing the required for strictly medicinal and the United States at the meeting of Opium Committee purposes,

thus eradicating the source or root of now in session, some interesting and, we trust, fruitful ditions, which are solely due to production times discussions are doubtless proceeding. greater than necessary for such purposes." the President was requested to urge upon LEAGUE OF NATIONS HEALTH COMMITTEE. ments of Great Britain, Persia, and Turkey THE sixth session of the League of Nations Health Com- necessity of limiting the growth of mittee began in Paris on May 26th, and the discussions production of opium and its derivatives exclusively which have taken place there show that co-operation in the amount actually required for strictly the Governments public health matters among various has scientific purpose, and also to urge since the greatly developed in the two years League ments of Peru, Bolivia, and the Netherlands Health Organization was founded. In the

restrict the production ,Tava) the like necessityt: epidemiological intelligence and public health statistics leaves in a similar fashion. In February considerable progress has been made in organizing on Foreign Affairs took evidence from medcial officers regular and rapid collection and distribution informa- health, prison governors, and social which tion, and it is hoped by the League Health Organization cated an amazing growth of the abuse of will become a central that in time it clearing for in the United States in recent years. There on the of all such matters. Reports progress three to be more than a mmilion addicts in States; committees of inquiry working under the auspices was said to be largely employed by the vicious criminal Health Organization were discussed. The first smalr underworld, and it was asserted tha't even yo'un'g persons committee of experts set up to investigate the prevalence were being introduced to indulgence in and abuse of these of isleeping sickness and tuberculosis in tropical Africa perilous of narcotics. The Secretary war. The second is the subcommittee since the joint the

Affairs, Mr. has written Charles E. Hughes, League of Nations and Health Committees Opium which " saying that the restriction- of the commercial deals with the present position of the' subect out CELEBRATIONS IN I~ - 946 JuNg 2; 3923] PASTEUR FRANCE. I~Mmrnoaz 3o,sm above. The third is a joint subcommittee of the Health associated with the platelets, and lice can be experi- ind Transit Committees, which is collecting information mentally infected by inoculation with platelets, success to serve as the technical basis for a conference between the beinig evidenced by the subsequent production of rickettsia Various European States which have navigable inland bodies. Dr. Woodcock's argument is supported by a waterways, for the purpose of co-ordinating and tightening number of excellent photomicrographs showing the types of up sanitary control and anti-epidemic measures without granules which result from''cell digestion or lysis, and which interfering with the normal working of these arteries of he considers have often, been mistaken for rickettsia bodies. trade. Further reports which were discussed concerned- the progress:of the applied research work, which aims at PASTEUR CELEBRATIONS IN FRANCE. international agreement as to the nmethods of establishing THE official French celebration of the centenary of Pasteur serological tests in order to facilitate international co- began in Paris on May 24th, when the many delegates from operation in improving -the whole technique of immuniza- universities and institutions throughout the world attended tion by serum injections. It is proposed by the Health a reception given by the President of the French Republic. Organization that a similar programme of research w ork, Oni the following morning the delegates were welcomed by conducted in many countries on a common plan, should be Dr. Roux at the Pasteur Institute; a bust of Pasteur inistituted in regard to certain biological products used erected in the gardens of the Institute was unveiled and as drugs, such as digitalis, pituitary extract, and insulin. wreaths -laid at its foot by foreign delegates, w'ho after- The question of further perfecting and developing the wards visited the museum and the crypt, where is the system of visits of international groups of public health tomb of Pasteur. Later in the day there was a great officers to study the sanitary systems 'of one or two meeting in the amphitheatre of the Sorbonne, presided countries was also considered. The first of these study over by the President of the Republic, who was accom- visits, so-called " interchanges," took place in Belgium' panied by the Ministers, by members of the diplomatic and Italy, the second in Great Britain and Austria; corps, by members of the five academies of the Institut de a third (for specialists in the campaign against malaria) F-rance and the Academie de Medecine, and by foreign is at present taking place in Italy, and another visit is delegates, to the number, it is said, of some seven hundred. being arranged to' the tUnited 'States. The proceedings began with the unveiling by M. Paul Appell, Rector of the UIniversity of Paris, of a marble THE NATURE OE RICKETTSIA BODIES. tablet placed by the university in the Salle des Autorites, BODIES which have been regarded either as definiite species bearing an inscription stating that it has been erected on of " Rickettsia " and named accordingly, or placed in this the spot where "le grand Frangais et le grand Anglais group as being of similar type, are now known to' be of Lister se sont embrasses" to commemorate "cette widespread occurrence among ectoparasitic arthropods, and etreinte fraternelle, symbole de l'amitie de deux peuples." 'fresh species are being discovered continually. Dr. H. M. Afterwards the Marquess of Crewe, British Ambassador in Woodcock holds a different view from that of many Paris, expressed the deep appreciation of this homage to autliorities as to the nature of rickettsias, and in a Lister paid in the heart of the intellect of France. The recent paper' he describes the' way in which structures popular celebration took place on Sunday, which was a morphologically indistinguishable from rickettsia bodies flag diiy in Paris and 'the chief towns of France, an'd appear as granular end-products of the digestion or lysis badges -were sold for the benefit of the laboratories of of cellular elements. Although the rickettsias are usually France. In the afternoon the delegates attended a recep- classed with the bacteria rather than the protozoa, they tion given by the City of Paris at the Hotel de Ville. differ from well known bacteria in two respects: they On Monday a visit was paid to Versailles, when a bust of stain best with Giemsa's stain, but appear bright red to Pasteur given by his daughter and son-in-law, Mie and M. lilac instead of intense purple, and they can be 'cultivated 'Vallery-Radot, was unveiled in the Galerie de Glaces. The only with the greatest difficulty, and usually in association President of the Republic at the end of last week'started withl other organisms, such as flagellates, from the dis- on a tour, during the course of which he is taking part in integration of which similar' granules are produced. On celebrations at Aibois and Strasbourg. morphological grounds it is impossible to distinguish the AMONG the names in the short list of honours bestowed granular end-products of the digestion of cells from the on the occasion of Mr. Bonar Law's retirement are those rickettsia granules, nor does cultivation enable us to dis- of Sir Thomas who receives a baronetcy, Dr. the true from the false. The rickettsia-like Horder, and. tinguish Chichester Gould May, who is created a knight. They granules all appear to be of the same fundamental have shared the anxiety which the state of Mr. Bonar character; the morph-ological variations which occur may has caused the last few months. possibly be explained by the action of slightly differing Law's health during enzymes in the case of different types of cell, or even in- WE regret to record the death on May 29th of Professor the same cell type on different occasions, and upon the John Chiene, C.B., Emeritus Professor of Surgery in the different kinds of organic matter on which these enzymes University of Edinburgh. Professor Chiene, who was in act, suich as haemoglobin, nuclear material, and parasites. his 81st year, resigned his chair in -1909. We hope to The epithelial cells of the louse take in and absorb haemo- publish an obituary notice in an early issue. globin, which they metabolize in such a manner that no pigment is produced; and the intracellular rickettsias, in SIR CLIFFORD ALLBUTT will attend the annual dinner of the Dr. Woodcock's opinion, should be regarded as having been West London Medico-Chirurgical Society at the Caf6 Monico produced as the result mainly of an altered abnormal form on June 19th to receive the triennial gold medal presented by the society to a distinguished member of the profession. of metabolization of the blood upon which the louse feeds. THERE is no better check on extravagant administration in Diseases such as typlhus, in which rickettsias have been public institutions than comparison with those of a similar demonstrated, are, he considers, due to pathogenic character. This is only possible, however, if there is a enzymes, and the granular elemenits are the inevitable standard system of accountancy so that the figures are really made comparable. With a view to securing such a standard witnesses of the digestion of the cells. For him the virus method of book-keeping in tuberculosis institutions the is the invisible pathogenic enzyme, attached or adsorbed to Ministry of Health has issued a skeleton form of accounts and carried by the protein particles or bodies of various 'Form T.90) the adoption of which will make it possible to kinds which are found in such ascertain the average weekly cost of a patient not only for constantly diseases. The the whole of the services rendered but also under various virius of typhus in the blood is, he holds, intimiiately subheads such as salaries, provisions, drugs, lighting and I ourn. R.A.M.C., February-April, 1923. fuel, laundry, etc. JUE. 2,.. 9231 CANCER RESEARCH. IDIOAL J@fUWAI /947 I against an enemy that is in their very midst? We plead with CANCER RESEARCH. all earnestness that we may be given the means wherewithal to carry through the task which we have set ourselves to WE have received for publication the following appeal, accomplish, and thus to bring relief and hope to those whose lives which has been issued to the press this week by the pro- are now darkened by suffering and despair. visional executive committee of a newly constituted body, The Fund will be administered under the direction of a the British Empire Cancer Campaign. The full list of the strong finance committee. committee, with particulars of the institutions already Cheques should be made payable to the British Red Cross " engaged in cancer research which are willing to be asso- Society, crossed British Empire Cancer Campaign," and sent to the Hon. Sir Arthur Stanley, G.B.E C. B., 19, ciated with the new organization, will, we understand, be Berkeley Street, London, W.1, or to Lloyd's tank, Ltd., at an early date. The appeal is made under published 71, Lombard Street, or to any of their branches or agencies at the auspices of the British Red Cross Society, which will home or abroad. receive subscriptions. We are. Sir. vours faithfullv. ATHLON{E. F. L. HOPWOOD. BRITISH EMPIRE CANCER CAMPAIGN. J. BLAI ND-SUTTON. THOMAS HORDER. NAPIER BURNETT. ROBERT KNOX. Sir, 30th May, 1923. N OF Cancer, DAWSOI PENN. G. LOCKER-LAMPSON. in spite of the advances which have been made, J. B. FTARMER. J. P. LOCKHART-MUMMERY, both in diagnosis and treatment, is still the most common F. E. IFREMANTLE. EDWARD MARSHALL-HALL. single cause of death in persons over 30 years of age, and is RICHAR] D GARTON. J. BEAUMONT PEASE. becoming so in an increasing degree. During 1920, in England CHAS. CxORDON-WATSON. BERNARD SPILSBURY. and Wales, nearly 43,000 persons over 30 and upwards died R. A. (IIBBONS. ARTHUR STANLEY. of cancer. In 1921, the last year for which the Registrar- ALF-RED GREENWOOD. WILLIAM WILLCOX. General's figures are avilable, the corresponding number was 45,328. During that year one in every seven deaths from the Communications should be addressed to the Honorary Secre- age of 30 onwards was caused by cancer. tary, Godfrey Locker-Lampson, Esq., M.P., at 19, Berkeley We are still ignorant both of the causation and cure of Street, W.1. cancer. Many other diseases have yielded their secrets to patient investigation, and there is no reason to suppose that The British Empire Cancer Campaign has been registered the problem of cancer will not eventually be solved. Yet as a company limited by guarantee. thotusands of suffering men and women, and those who suffer with them, are asking how long they must wait, and if there is CANCER RESEARCH NOW IN PROGRESS. nothing that can be done to hasten a discovery which will The appeal, it will be observed, promises to encourage, bringof relief to those whose outlook is to-day so hopeless. and(I The answer to this question is clear. The first step towards help financially where practicable, individuals and institu- finding the cure of cancer is to discover its cause. To find tions now working oii the cancer problem, and distinctly that cause no effort must be spared. Every possible line of repudiates any wish to interfere with work already being research mustbe diligently explored. More men must be set carried on. We have thought, therefore, that it would bo free to devote themselves wholly to research, and their work interesting to put together from information at present nmust not be or prevented by want of money. hampered available somiie particulars of the institutions engaged in sucl AMuch research work is being carried on and consid-erable advances have been made in the technique of operations work. designed to remove the disease in its early stages or retard its THE IMPERIAL CANCER RESEARCHFUND. pr-ogress in more advanced cases. All honour is due to those The Imperial Cancer Research Fund was founded in w.ho have done and are doing the work, but a vast amount still 1902 by the joint action of the Royal Colleges of Physicians remains to be done. Impressed by the need for immediate and Surgeons; representatives of the Royal Societies of action, we have joined together to found a movement which London and Edinburgh, the Royal Veterinary College, and will co-ordinate and support research on cancer throughout the other scientific bodies, and of several Government depart- British Empire. ments, were added to the Executive Committee, which This new concerted movement will be called the British is Em pire Cancer Campaign. It will be governed and directed the governing body. From the beginning the main efforts by an Executive Council, the members of which will act as of the Fund were directed to the development and exten- chairmen of small working committees, each dealing with a sion of the experimental method to the study of cancer. separate aspect of the cancer problem. Statistical investigations on the incidence of the disease Medicine, surgery, human pathology, chemistry, physics, in man at home and abroad were ulidertaken in conjunc- radiology, animal and plant pathology, hygiene and vital tion with the Registrar-General's Office and through the statistics, will all be represented by committees whose work Colonial and India Offices. An experimental study of the will be co-ordinated by the Executive Council acting, in fact, part played by heredity in modifying the incidence of as a central clearing house. The Council is anxious to make it cancer was undertaken and carried on for maniy years. clear from the outset that it has no wish to interfere with the work already being carried out. Individuals and institutions Coincidently with the starting of the Fund, the founda- now working on the cancer problem will be helped and en- tions of the experimental study of cancer in laboratory couraged, and, where practicable, financially assisted. animals were laid by Jensen and Borrel, and the work'3rs In this wayinvestigation can be carried out simultaneously of the Fund took *a large part in its development. The along many lines, and the results of these inquiries will be detailed analysis of the phenomena of transplantation and brought into the common stock of knowledge. A discovery in the production of resistance to inoculatio-n was carridoout. any one branch will be made known to all, and may lead to In particular, the significant limitation of the resistant discoveries in other branches. It is in this co-ordination of to of successful grafting, and the effort that our most confident hopes are placed. conidition prevention No one can say with certainty that we shall succeed in our failure of these reactions in animals spontaneously affected quest to find the cause of cancer, but a movement so *broad by the disease, were worked out and their importacec must inevitably advance the knowledge which we have of insisted on. During the war, by rigid economy of effort, this disease, and every step forward brings us nearer to our the Director, Dr. J. A. Murray, found it possible to main- goal. tain the essentials of the working organization. In conse- The British Red Cross Society has placed its organization quence the other institutes at home and abroad which 'had and machinery at the disposal of the Council of the Campig suspended were able to call on the Fund for And a genierous donor has already given a sumsufficient to operations cover the preliminary expenses of this appeal. All future con- material enabling them to begin work again without delay. tributions will therefore be expended in encouraging, assisting, Since the war, the experimental production of cancer by organizing and administering systematic research and treatment the application of tar has been energetically studied. The on a scale that has hitherto been impossible. essential characters of cancer cells anid the subtle distinc- To do this a large sum of money will be needed, and we tions between them and normal cells have been investigated appeal with confidence to the British public in the United by the method of tissue culture and by a study of the Kingdom and in the Dominions and Colonies overseas. During tissues, In the war we had ample evidence of the capacity of this Empire processes of respiration of surviving additioni forunited and relation of the intensive effort, and in no fieldwas it more aai elaborate investigation of the growth of effectively shown than in the reief -of suffering and the preven- canlcer to diet has been carried through, defining theeffe!ts tion of disease. Is it too much to hop-e that the same spirit of vitamin and other specific deficiencies both in nor-mal will animate our people whe'n they are called upon to wage war animals and in those carrying inoculated tumours. 94J 2, 1923] JUNF, CANCER RESEARCR. I MaZOICALTrUBaRmT = JOUsig*I I A summary of the published work in each year is given Middlesex Hospital possesses are 92 beds in the charity in the annual report, along with an account of the dedicated to cancer patients and the resour-ces of the Medical administration and finanicial position of the Fund by the School completely eqiuipped in all -branches. Executive Comnmittee and treasurer respectively. Full During the twenty-three years the laboratories hliave been accounts of the investigationis are published from time to- in existence tlle advantage of their close association with time in the scientific reports, of which seveni have already the hospital wards has been shown- by the verv practical appeared (Taylor and Francis, Red Lion Court, Fleet Street, character of the researclles carried out and by the names of E.C.4). those wlho have held assistantships or scholarships. Among those who have held appointme'nts mrray be mentioned Mr. CANCER HOSPITAL RESEARCH INSTITUTE, LONDON. Sampson Handley, Mr. Gordon-Taylor, Mr. Victor Bonnev, The Cancer Hospital, founded in 1857, possesses a well Mr. Somerville Hastings, Dr. Henry MacCormac, all of designed and well equipped Research Institute, built a few wholml are niow members of the honorary staff of the hospital; years before the war. For the last two years it has been Mr. Cecil Rowntree, surgeon to the Cancer Hospital, Fulhaim under the directorship of Dr. Archibald Leitch, with whomn Road; Dr. Archibald Leitch, director of the Cancer are associated Dr. E. L. Kennaway as chemical pathologist Research Laboratory at the C(ancer Hospital; and Dr. J. C. and Dr. H. J. B. Fry as clinical pathologist. Working in Mottram, director of the Pathological Department of the close connexion with the surgical and radiological depart- Radium Institute. Tlle practical character of the researches ments of the hospital they have unrivalled opportunities of is indicated by the fact that all the records of the hospital being familiar with all sides of the cancer problem. The have been worked up statistically and a number of mono- chemical and biochemical investigation of tumours and of graplhs on cancer at the principal primary sites have been serum from cancerous patients, histological examinations of published; investigations have been conducted into the tumours of all kinds, the study of cell and tissue' changes increase of calcer, and attempts made towards earlier anid under treatment by x rays and radium, and the detailed better diagnosis. Much work has been done in reference to investigation of operative and post-mortem material from the radium and x rays and'as to the production of cancer in lower point of view Qf practical surgical pathology, represent aniimals by these agents. Research in the therapeutic value some of the numerous lines of research provided by the of radium or x rays has been instituted, and since 1914-- association of clinical anid pathological departmenits. though much interrupted by the war-investigations have From the purely exper-imental side work has been pro- been conduAted, and are still in progress, with the hope ceeding on an intensive scale, mainly on inquiries into of causing experimental animals to develop an immunity the causation of cancer. We published in the JOU,RNAL towards cancer. Sufficient success has been obtained in the last December three important papers from the Cancer case of transplanted tumours in rats to apply the principle, Hospital Research Institute on the experimerntal :pro- with caution, to man, and during the past two years it lhas duction of cancer, and we hope soon to publish two more. bee'n utilized in the treatmeit -of selected patients in the The research staff have been endeavouring to add to the wards. It is too early to speak of the results, but at least number of substances which are capable of producing it may be said that they are hopeful. At the present timo tumours, anid though they have already contributed three experimental endeavours are being made to facilitate the or four such substances, we understand that scores of techllique and heighten the degree of induced immunity. III suspected agents have been tested. Studies of the early these animal experimiients, as always, the underlying thoughlt changes preceding and accompanying tumour formation, in the mind of the investigator is that they must be chemother apeutic essays in experime'ntal cancers, and the applicable to the human sufferer. The Medical Research investigation of the conditioiis under which occupational Council, in addition to the important allocation of radiumw cancers arise, constitute at present the main objectives. The menitioned below, has supplied the services of Dr. Helen striking feature about the Cancer Hospital is the par- Chambers for work in Dr. Lazarus-Barlow's department ticularly friendly co-operation betveen the suIgeons, radio- and of a whole-time assistant. In laboratories attached and so logists, laboratory staff, tlhat each individual member to a general hospital and medical school the practical as is conversant with the observations and problems of the contrasted with the atademic side of resear-ch comes to the others. The governing board appears to be verv progressive. fore, and this is the guiding principle of the work at the caincer laboratories of the Middlesex Hospital. THE MIDDLESEX HOSPITAL. The Middlesex Hospital Cancer Charity was founded in MANCHESTER. 17T1 witlh the object of alleviating suffering and investigating Research work on the various aspects of cancer is being the disease. Until 1900 its activities in the latter direction1 carried out in several departments at Manchester. At the consisted chiefly in the compilation of records and publica- Royal Infirmary, the new x-ray department is one of the tion of papers on cancer from time to time by members of most completely equipped of its kind in the country. Witlh the hospital staff. In 1900, largely owing to the initiative the advent of the intensive x-ray therapy a research com- of Sir Alfred Pearce Gould, laboratories were opened for mittee was instituted, consisting of physicians, surgeon-s, investigation of maligniant disease by modern methods, anid radiologist, pathologist, and physicist, to investigate the Mr. A. G. R. Foulerton was appointed director. On his effects of this form of treatment in cancer. For this pur- resignation in 1903, Dr. WV. S. Lazarus-Barlow was elected pose a research scholarship in radiotherapy for the inten- to the office, and held it until in 1920 it was merged in a sive treatment of cancer has been instituted, and the first Professorship of Experimental Pathology in the UTniversity scholar spent six months on the Continent studying the of Londlon, to which he was appointed. The avowed object latest technique in x-ray therapy. The new apparatus is of the change was to widen the range of activities available all at the Royal Infirmary, where the investigations are in for cancer research and enable it to be taken up in anv their initial stages, and two separate outfits for the inten- department of the Medical School that seemed advisable. It sive x-ray treatment of cancer are in use. Although it is coincided with the establishment in the schlool of Universisy too early to speak with any confidence, as the work has only Professorships in Physics, Chemistry, Anatomy, Physiolog, been in progress for about twelve months, yet the initial and Pathology. Recently a University Reader in Biology lhas response in carcinoma is considered to have been satisfac- been appointed. From its first inception the charity has tory. The late results cannot, of course, yet be stated. In grown conitinuously, but beniefactions have been mainly on sarcomatheoutlookappears more hopeful, and in some cases the clinical side. Specificallyfor research the cancer labora the primary growth has apparently completely disappeared. tories (which were built and equipped the trustees of the Six beds are in by set apart at the Radium Institute and the Barnato bequest 1910) have to rely upon the income of a Chr istie Hospital for patients undergoing intensive x-ray sum of £20,000 and £1,000 per annum for ten years recently treatment for the relief of inoperable carcinoma. So far giveni by Sir W. Veno, and for the remainder of the expendi- about 100 cases have been treated. At the Radium ture on annual Institute volunitarvcontributions. The amounttthus tlhirteen beds are set apart solely for the treatment and obtained is inadequate to the complexity and difficultvof the subject, and extension in manydirections is possible and investigation of cases of cancer; 668 cases of cancer wer e treated last year, and the whole work of the Institute is desirable. assets The for cancer research which the really an investigation into the cause of cancer. A new JUNE 2, CANCER RESEARCH. THR BRITISH 19t231 IMEDICAL JOURWAL 949 research laboratory is slhortly to be equipped; all the cases ABERDEEN. at the Institute are subject to pathological investigation, In 1907 Sir Alexander McRobert, Cawnpore, India, estab- and careful records are kept which are available for statis- lished the Georgina MeRobert Fellowship at Aberdeen' tical study. Results at the Institute shiow that 71 per cent. University, for the investigation of the cause, preventionl, of all cancer cases (miany inoperable) under treatment are and treatment of cancer. In 1916 this fellowship, as a resu4lt- alive and well after periods of. -two to -seven years. A. of a further gift f'rom Sir Alexander McRobert, was mergod special research into the physical chemistry of serum in in a larger fouiidation, the McRobert Lectureship in health and disease has recently been undertaken with the Pathology, with special reference to malignant diseases. help of the Institute's radium; it has been foundthatalpha, The first appointment to the lectureship was made in beta, and gamma rays have a very marked effect on serum. 1920. Accommodation, for a laboratorv and funds for A technique has also been devised for following changes in its equipmetit were provided by the University of Aber- the colloidal condition of whole blood, whereby only a very deen, and work has been in progress since 1921. The staff small quantity of blood is required for each determination. consists of Dr. John Cruickshanik, the lecturer, and one A natur al extension of this work will be to follow the assistant, Miss J. L. Lockhart. The alnnual income from colloidal changes in blood due to the absorption of the the trust is not large enough to allow work on a large scala products of the destruction of a tumour in a patient who to be undertaken. During the last two years the productiou is being treated with radium. In this way help may be of cancer in animals by the application of tar and-other sub- obtained in prognosis and in judging the dose a patient stances has been investigated. The results of this work havo will tolerate. The Committee of the Christie Hospital has in part been communicated to various societies, and will recently received a gift of £1,000 to be devoted to research shortly be published in full. A study of some of the bio- work, and it is hoped shortly to start a cancer research chemical activities of cancer cells as contrasted with normal fund in Manchester. Investigations are being carried out cells has also been attempted. In this work Dr. Cruickshank at the Cancer Research Laboratory at the University on has been in close association with the Imperial Cancelr the metabolic functions of patients suffering from cancer Research Fund. The scope of the laboratory work has bee.i and also into the chemistry of tumours. Considerable extended by the loan of radium from the Medical Research interest has been aroused in the question of the incidence of Council to Aberdeen Royal Infirmary, and to facilitate scrotal cancer among cotton-spinners in Lancashire. A clinical research work Dr. Cruickslhank has been appointed paper on this subject by Mr. A. H. Southam and Mr. S. R. to the honorary staff of Aberdeen Royal Infirmary as Director Wilson was published in our columns last November (page of Radium Therapy and Research. Dr. D. W. Berry, a 971). Their attention was called to the matter by cases part-time worker under the Medical Research Council, is observed at the Manchester Royal lnfiimary. They made associated with Dr. Cruickshank in the investigation of the some inquiries at a Manchester cotton mill; further investi- clinical effects of radium treatment, and assists in tlhe on gations are in progress, and experimental work is under laboratory work malignant diseases. consideration with a view to getting this condition scheduled under the Workmen's Compensation Acts, if it GLASGOW ROYAL CANCER HOSPITAL. should be proved to be due to the occupation. Statistics The Research Department of the Glasgow Royal Cancer Hospital is directed a Research Committee of con- show that the death rate from cancer is steadily on the by five, increase in Manchester, the annual increase being sisting of three medical men and two laymen. The medical nearly men are Robert 4 per cent. In a period of thirty years the death rate Sir George Beatson, Dr. Muir, professor of from pathology, and Dr. Noel Paton, professor of physiology in this cause has doubled, and deaths are occurring at an earlier age. It is held that the hope of the future lies the University of Glasgow; the lay members are the Chair- in men of Directors of the Hospital and of its House Committee. research. Men and the brains can, we are assured, be The Research Department was broken up the war, found at Manchester to proceed with this work if more by anid, to want of has money is forthcoming. owing money, only been re-established duri:sg the last two years. As soon as funds were available the,c chemical branch of the work was sot in order under Mr. LIVERPOOL. Currie, a biochemist. At present efforts are being concen- There has been in existence in Liverpool for some time trated on the biochemical features of cancer; last year Mr. a committee for cancer research consisting of business men Currie published a paper in the Journal of Pathology and anid scientists working in close association with the Univer- Bacteriology on the condition of the fat in cancer patients, sity. It has secured the services of the best men in all especially in the vicinity of the growth, and Sir George departments-chemical, biochemical, pathological, medical Beatson published in the Lancet a paper on the possibility and surgical-either as whole-time or part-time workers, of a pigmentary origin of cancer. Mr. Currie is also workitig and has the necessary laboratories with accommodation for at tar cancer in mice and studying the respective frequeney animals and other equipment, and also the command of of its occurrence underthe different pigments of coal tar clinical beds necessary to enable it to conduct its inquiries. and the susceptibility of different coloured mice to develop This small but well equipped and self-contained body is pie- the disease. Dr. Primrose is also working in the depart- pared to carry on the piece of work it has undertaken. It ment, investigating in particular the internal secretionsiln is entirely duie to the initiative of Professor Blair Bell, who relation to carcinoma and the growth of cancer tissue in -recently published a preliminary statement, giving his vitro. A proposal has been made to the Committee of the reasons for believing that lead salts possess an inhibitory GlasgowHospital to co-operate with the appeal, but it will action on the growth of malignant cells. He pointed out the *not come to a decision until after it has considered the views practical difficulties and dangers which necessarily accom- of its Research Committee. pany the use of these toxic substances in treatment. Lead salts have, however, already been used on many occasions THE MEDICAL RESEARCH COUNCIL. during the present inquiry, and those who have been closely A great deal of valuable research into the nature and treat- associated with the treatment throughout are impressed ment of cancer is being carried on in various centres with witlh the belief that lead undoubtedly has a destructive action the assistance of the Medical Research Council. Grants are upon cancer cells. A preparation has not yet been found made towards the cost of inquiries now in progress at the which can be pressed sufficiently to make the treatment Middlesex Hospital, London, by Dr. James Young at the specific. Some cases have yielded striking results, though Royal Infirmary, Edinburgh, at St. Mark's Hospital, and the investigators as yet hesitate to speak of them as cured- at the Glasgow Royal Cancer Hospital, as mentioned above. extent maniy others have responded, but not to the of cure, The Government has entrusted to the Council for medical and in some the toxicity of the remedy has been a difficulty. research purposes nearly 5 grams of-radium bromide The Liverpool Cancer Committee has scope in Liverpool for recovered from military uses; the whole amount was lent in a definite and, it is believed, important research, and it has the first instanice to workers at the Middlesex Hospital to a very enthusiastic body of men prepared to do their utmost carry out a series of initial experiments andtherapeutic to carry it to a successful conclusion, if that be possible. trials, and the results were published in, oiie of the Council's A good income is giiaranteed for the next two years. Special Reports. Later on the whole supply was diviil CANCER r T-TTai- 950 Xu,I 2',T9231 RESEARCH. I fDICAL JOUmnEd I and fractions allotted to a number of hospitals in England, work has attracted favourable attention. The Association Wales, and Scotland. Research committees have been estab- fran9aise pour -l'd6tue,du Cancer,- fou-nded- in 1906, is a lished at the different centres, anid the Council has appointed voluntary organization of pathologists and clinicians a cenitral radiological committee, of which Sir Cuthbert interested in cancer; it makes a gallant attempt to stimulato Wallace is chairman, anid Professor Sidney Russ, D.Sc., of public interest and has a very distinguiislhed list of members, the Middlesex Hospital, secretarv. An important fractioni both -French and foreign. Its proceedings are recorded of the radium is in use at the Middlesex Hospital, where it monithly in a I3ulletin which contains the papers read at its is being used both clinically and for pathological and physical meetings and short abstracts of foreign literature. Under investigations. At Uniiversity College Hospital, London, the the guidance of its secretaire-general, Professor Roussy, it radiuim has been employed chiefly in the treatment of malig- has become a most important journal and is probably now nanit disease of the uterus and of menorrhagia. The quotumn to be considered the premier organ of cancer research. It supplied to St. Bartholomew's Hospital has been employed is publishing an atlas of beautifully drawn histological in the treatment of carcinomata of the uterine cervix, anid preparation of all kinds of tumours, which may possibly be the treatment of malignant growths of the nasopharynx, the standard work of reference on the subject. The French larylnx, and oesophagus. At King's College Hospital the Association has arranged to hold a congress in Strasbourg on radium has been used for the treatment of cancer of the July 23rd and 24th in connexion with the Pasteur celebra- uterus and breast, rodent ulcers and naevi, and it has also tions there. The first subject for discussion-the experi- been made available for experimental work on the effects of mental production of cancer-will be introduced by Professar radiation on the body tissues, for which purpose the Council Borrel of Strasbourg University, and continued by Professor makes a grant for a part-time assistant. The fraction in use Fibiger of Copenhagen, Professor Ichikawa of Japan, Dr. at the London Hospital is beinig applied to the treatment of J. A. Murray, Director of the Imperial Cancer Research diseases of the skin and of malignant diseases of the uterus. Fund, London, Dr. Archibald Leitch, Director of the Cancer Other fractions have been allotted to the King Edward VIi Research Institute, London, and Dr. Pentimalli of Naples. Hospital, Cardiff, and to the General Hospital, Birmingham, The other subjects to be debated are the local and clinical where observations are now being made. In all instances the reactions to cancer, and treatment by radium and x rays of observatiolns on the effect and treatment are carefully con- epithelioma of the skin and mouth. trolled, and recorded with scientific precision. Reference In Germany ambitious plans were made previous to the is made above to the radium lent to the Aberdeen Royal war, anid a special institute of experimental research in Infiriimary. One of the earliest allocations was to the Irish cancer was established at Heidelberg under the direction of Public Health Council, under whose supervision radiumi! Professor Czerny; it is an association witlh a home whicll emanation, prepared from a central laboratory in Dublin receives patients suffering from or suspected to be suffering under the direction of Professor J. Joly, F.R.S., is issued froin cancer, or from tumours of other kinds. It was to certaini hospitals and private practitioners, and records reported that some well known pathologists originally are kept of the results obtained. A fraction has also been associated with the project withdrew, believing it probable allotted for experimental purposes to the Radium Institute, that fruitful results were little likely to be reached until London, where Dr. J. C. Mottrarn is studying the effects of more was known of the structure and physiology of the radiation upon the testes, the pituitary gland, the thyroid healthy cell. Since the war the institute has been placed glands, and the blood platelets, and upon fat absorption in under the directorship of Professor Sachs, a former assistant the intestine. Dr. William Cramer and Dr. A. H. Drew cf of Professor Ehrlich, though Dr. Teutschlander seems to the Imperial Cancer Research Fund have been associated have carried out most of the experimental work on the with Dr. Mottram in part of this work, and the Council has genesis of cancer. Dr. R. Bierich presides over a small made a grant to Dr. A. N. Kingsbury of the Middlesex cancer researeh institute at Hamburg. Owing to tlle Hospital for co-operation in some bacteriological problems economic conditions prevailing in Germany, research work has that have incidentally arisen. Finally, a fraction has been suffered, and in no department more than cancer investiga- allotted to Professor Sir Ernest Rutherford, F.R.S., for tions. The Germans publish regularly the Zeitschrift lihr experimental work at the Cavendish Laboratory of the Krebs/orschung, a well known though somewhat heavy -University of Cambridge. journal of international repute. An inquiry is being made by the Statistical Department of In Holland a young -and promising laboratory has been in the Council into the incidence of cancer in different trades. existence for two or three years, conducted under the The Registrar-General has for this purpose made available auspices of the Netherlands Cancer Investigation Society by data referring to 46,235 deaths from cancer among males, Dr. H. T. Deelman. It was here that last October a small both occupied and retired, occurring in over-900 trades and band of enthusiasts met round a laboratory table and sub- professions in England and Wales during a given period. mitted to each other their recent experimental investigations Particulars are thus being obtained for each trade as to the in malignanlt disease. They agreed to form a friendly ty.pe of cancer, the site of the growth, and the age dis- society which, at the suggestion of Dr. Archibald Leitch, tribution among occupied and retired males. The analysis was, out of compliment to the Dutch hosts, named fhie is being made bv Dr. John Brownlee, director of the depart- "Leeuwenhoek Vereeniging." We understand that the menit, in collaboration with Professor E. L. Collis. members are in constant communicationi and indicate to ea-ch other the particular lines of investigation they are pursuing. FOREIGN COUNTRIES. The Society consists of Drs. Fibiger, Bang, Murray, Leitchi, The desire to attack the problems of cancer by intensive Rotgans, Deelman, Roussy, Peyre, Bierich, Teutschlander, research has not been confined to this country. In the Lipschutz, and Bloch. United States the most imiiportant or1ganiization is tho Crocker Institute of Cancer Research at New York, which is now a department of Columbia University and produces very THE fifth French Congress of Orthopaedics will be held in valuable work. It was in this Institute, for example, that Paris on October 12th, when the following subjects will be introduced M. of the experimental production of sarcoma of the liver was discussed: (1) Pes cavus, by Laroyenne Lyons; (2) bone cysts (exclusion of hydatid cysts), introduced accomplished in rats by the transmission of Taenia crassi- by M. Roederer of Paris; (3) congenital elevation of the collis. The laboratories are under tile direction of Dr. J. C. shoulder, introduced by M. Delchef of Brussels. Under their auspices is Woood and Dr.' William Woglom. A PunLIC appeal is being made for funds to extend the published the Journal of Cancer Research, the only special National Library for the Blind in Westminster. The library :journal on the subject in the English language. We ought 'began on a small scale in 1882, and has grown (including the also to-mention the Research Institute at Chicago, where the Northern Branch at Manchester) to a collection' of some 92,000 iml)ortant of Miss Maud and Dr. Gideon .volumes in Braille and Moon The bulk of the volumes experiments Slyc types. in Wells on the lieredity of mouse cancer have been conducted. -in. high, 11 in. broad, 2 in. thick, and 5 lb. in weight), (14 blind from France is badly off for speciahlist institutions dealing with addition to their cbst, precludes the reader possess- an and the -National Library cancer research; are a few scattered places, but ing adequate private library, thlere over a ton of to readers at home most dispatches daily literature nothing adequate. The efficient, perhaps, is the- Hospice *and abroa&t. Donations should- be addresed- to Captain Paul Brousse-, of which the director is Professor G. Roussv, Lachlan Maclean, National Library for the Blind, Tufton. an able and energetic pathologist, whose receiit experimental Street, Westminster, S.W.1. JUNE 2, NEW BACTERIOLOGICAL DEPARTMENT AT NEWCASTLE. Ti Ba C 1923] I MI JOC 9 I

nature was established. During the nineteenth century the IJNIVERSITY OF DURHAM COLLEGE OF MEDICINE, foundations of bacteriology were laid. Two great discoverie,s

.EWCASTLE-ON-TYNE. opened men's eyes to the fact that these specks of living vegetable matter were after all of serious -impor-

DEPARTMENT. they OPENING OF. NEW BACTERIQLOGICAL tance to man. It was found that causes of

THE new building recently erected by various fermentations; and-that they- _the' Coll-ege of causes Medicine for'the Department of Bacteriology of infectious' disease. It was not until the chemistry

could by Sir Frederick Andrewes, M.D., F.R.S., on the afternoon that the nature of fermentation understood, and

of May 25th. The ceremony was attended then the microscope revealed that tlhe mysterious substance

number of people, inciuding many members fermentable material, which, when added to the initiated

of the power- to and dental professions, the members the chemical changes, owed -its presence of

Ar mstrong College 'and the College of even more important micro-organisms. An was

Principal and heads of departments of Armstrong given by the discovery of the relation of micro-oitganisms and the President, staff, and undergraduates to infective disease. As early as 1825 a silkworm disease " of Medicine, as well- as by many men prominent Bassi known as "muscardine was found by be' to

publie'affairs of the'district. The guests were a decade the parasites fungus, and in the following favus

D.C.L., LL.D., Sir David 'Drummond, M.D., and ringworm were discovered. The first bacterial disease' the College of Medicine, in the Kiig's Hall'of to be identified was anthrax: the infecting seen

College,' and, after being entertained at tea, by in the blood of infected animals' Pollendei and

to the Physics.Theatre, where an address was in all the great names which by Davaine 1850. Of out Sir Fre'derick Andrewes. in the nineteenth century that of Pasteur musttake the first'

offered a hearty welcome 'Sir DAVID DRUM0MOND Sir place in connexidn'with bicteriology. For chief claim' to was Frederick Andrewes and the visitors' had agssembled immnlortality notthat 'he was a great chemist as he to take part in the function.' He explained a' new was-but 'that' heifounded'a new science. Pasteur trans- building was found to be necessary, and why formed bacteriology into an ex'perimental science. He was. to erected upon a site in connexion with Armstrong the first cultivate bacteria artificially and to bring them upon the 'site at present occupied ather than into the domain of the laboratory. The second name College of Medicine. The accommodation in in bacteriological science was that of Robert Koch. The

requirements, especially in fallen short 'of the principles of most of our modern methods more technical and practical sections of curriculum the technical genius of Koeh, who devised the means of cul- were concerned, and the pressure had ture on solid media and enabled the bacteriologist to make acutely in the department of bacteriology. Council certain of the purity of his growths. No difficulties seemed- of the College in 1918' appointed a committee consider too great for this man to the best method of meeting the requirements, discovery of the cause of tubercle.: proposals were made, amongst them to uponl tk'e It was on the medical side that bacteriology first developed. but present College of Medicine sit'e, this was found to be As the new methods of study began to be applied, the actual impracticable on account of want of space. Council' Jauisal organisms of the various infectious diseases which sister Armstrong' College, then' made' of their college, scourged mankind had been one after the other unveiled., magnanimous offer of a site adjacent to the agricultural- The- earliest discovered causes* of infectious disease were department, and further offered to advance capital fungi of a higher group than, the bacteria, and for the causes, necessary for the of the building, _stipulating erection only: of many diseases which in the most modern times received- that they-Armstrong College-should as' 'consulted their explanation it had beeln needful to go still further, tJi.rdesign and structure of the building, so'that afield.-- The first new lighteame fromi workers on tropical to needs when the College- readily be converted -their diseases. Asearly-as 1880 Laveran had found-the malarial- themselves able to erect the new Medicine found parasite, which- was shown to be a member of the animal- upon the site recently acquired by the kingdom, while beforethis a trypanosome had been found Queen Victoria Road, next to Armstrong in rat's blood. Obermeier, too, had found in relapsing fever the Royal Infirmary; opposite Victoria the spiral organism now bearing his name, though the exact Medicine to rent the building and so inte'rest- jiature and similar microbes was still a matter uipon the capital. This most generous offer wassaecepttdd dispute. It soon becamee lear that some important toieical by the Council of the College of Medicine'with and he, thankful- diseases were due to animal micro-parasites a'nd others ness, as President, took the present oppor- organisms which could with certainty be referred either to tunity to announce publicly the great debt the animal or to the vegetable kingdom, and which were owed the and their tlhey Council colleagues sisteer by-Haeckel under a new kingdom-" Protista." College, by whose liberality- and generous outlook they- Nor did matters stop there, for in recent years evidence had. the College of been relieved Medicine-had the been brought forward to show that many specific fevers were. inconvenience from which they were over- suffering scdue- to virusesinvisibleor- almost invisible under the -micro- Durham and crowding. The University of city of of passing cope,and andcable through the pores of a filter so Newcastle-upon-Tyn e had thus acquired important- fine as to keep back ordinary bacteria. Bacteriology Lad educational development in the shape of what, veitureed to change itself into microbiology. The younger sciences of to hope, Sir Frederick Andrewes to one of beo protozoology and protistologywhere e now beginning to claini the best departments in bacteriological their own separate places in the field. Presently came a- time when workers turned to the effects of pathogenic SIR K ANDREWES FREDERicI s ADDRESS. bacteria on the human and animal body. In particular they Sir ANDREWES, in outlining FREDERicK some animals susceptible

the arts and sciences of the bacteriology in 'day, a given' infection and others immune. Pasteur himself had bacteriology said tat to make the positio clear, opened up this field of inquiry in relation to anthrax and- was needful first to consider a little of it rabies.'But.theo mechanism by Which immunity was pro- development' of that science. Probably the first duced Was still bbscure. Fortunately, the subject lent itself. distinctly saw the- organisms now known which to the experimental method. First in the field was was 'that -of --the gat Dutchmnan Leeuwenhoek, often Metcchikoff, whose brilliant researches on the comparative-. spoken of as the father of microsoys"y This was nearly pathology of inflammation led him to lay great stress -oni L years a his- 250 ago,, ttand Leeeuo wnhoek, ad indeed suc-^ the destruction of invading bacteria by certain cells the-of cessors for more 'tha1n 'yyears,150 the'y were 'merelyobjects body, notably the leucocytes of the blood. It was now'iknown- were regarded of interest and wonder.! They animals, and th-at Metchnikoff was largely, but not- wholly, right- thiSsin

the icroscope foundith phagocytosis seemed to be the with improvementS in that they o idea; main defencethh varied in size and'shape, so tha't iEhr-enberg in 1888 was ableo bdy agai-nst certain bacteria, but his doctrines soon suffered. to four types. distinguish different it after eclipse,owingg to the discovery of the power of the fluid the middle of the nineteenth centuryththteir vegetable elements in the blood of an immune -animal. It' was even 2 TUNR 21, NEW BACTERIOLOGICAL DEPARTMENT AT Tax BRm 95 19231 NEWCASTLE. M.umDCAz. JOURNAL. -1 0- I found that ths body fluids might become " antitoxic." fortune if the establishment of the central teaching of Yet another science was thus founded-the science of bacteriology in that institution led to any divorce from immunology. It could. now be affirmed that the body had medicine, and he trusted it might have the contrary effect. many different means of defence. The medical aspecto of bacteriolog could only be studied tQ What practical results had emerged? So far as medicine advantage in close relatiohi with medicine itself. was concerned, any doctor.would give an answer. Bacterio- On the conclusion of the address Sir DAvID DRUXMOND had become an of all that of logy, integral part section moved a vote of thanks, which was very heartily.received, a half-which dealt with pathology-7fully infective. pro- and presented to Sir Frederick Andrewes a key with cesses. The would that without the which physician say knowledge he asked open new building. pf disease which had accrued from bacteriology, he would him to the be still working by rule of thumb in a large part of his .TEE NEW BDING. practice. What physician would fail to seek the help of the The building recently erectea by the College of Medicine bacteriologist in a doubtful case of diphtheria, or neglect for the department of tacteriology Is situated on the north- the use of antitoxin in the treatment of that disease? Ask, east side of Armstrong College and next to the building again, any surgeon what value he set upon aseptic methods housing the departmen1G of agriculture, which was erected in his art and what judgement he had formed of Lister's largely through the generosity of the late Dr. Clement wotk in this respect. The name of Lister was honoured Stephenson, F.R.C.V.S., in 1912. The building .of these throughout the whole world. And what was true of surgery laboratories is, as a matter of fact, the first item in a much was true of obstetrics. It was all the outcome of larger programme which comprehends nothing less than the ,acteriology. While a multitude of diseases were not removal of the College of Medicine from its present situation bacterial, it would scarcely be disputed that, directly or in Northumberland Road to. a site which has been acquired indirectly, bacteriology had saved more lives than all the in conjunction with Armstrong College at the junction of other sciences combined. 'In the prevention of disease Queen Victoria Road and St. Thomas's Street. When this bacteriology performed two different services: it was able scheme for an entirely 'new College of Medicine is com- to trace the ways in which infectious diseases spread and pleted, the University Colleges of the City and the General to introduce measures by which human beings could be Hospital will all adjoin each other, with very considerable immunized. Once the infecting agent in any disease hadl mutual advantages to everyone concerned. been ascertained its distribution in nature could be searched The building, which has been very skilfully and artisticallv out and the channels found by which it reach-ed -man. Coil- designed by Messrs. Knowles, Oliver, and Leeson of Newv- sider the change in outlook when it was shown that malaria castle, is of fireproof construction and was built by Messrs. was exclusively transmitted by the mosquito, typhus -by the Pringle of Gateshead. It is built'of red brick and stone in louse, and plague habitually,-though not invariably, by -the thle style of the late Renaissance, and harmonizes with, rat flea. Certain diseases were known to be sometimes water though it does not repeat, the design of the buildings about borne, some were spread by milk, others by shellfish and other it. The main laboratories are situated on the ground anid foodstuffs; in all such cases the services of the bacteriologist first floors. Below there is a basement and in the roof were invaluable. But the greatest service the bacteriologist accommodation is provided for experimental animals. There had iendered was the attention he focused on the human is a large and lofty entrance hall into which open a large carrier of infection. It was now known that many human la`b6rSto'ry to accommodate fifty students or more, a chemical beings might become so far immune that were laboratory, thlree small laboratories for special work, a of they capable dark har-bouring ancd, what was worse, of disseminating the roomi, and a room fitted as a writing room and office; Access infecting agents of certain diseases in a fully virulent coni- is given by a staircase behind the- door to thelras6ment below. dition: the bacteriologist alone eould detect these dangerous The" tiain staircase, which is very well lighted by a large peoj)le. lead-glazed window occupying the whole Width of thie stair- SiI Frederick Andrewes then spoke of the service which case, leads to the first floor, upon which are situated a large immunology furnished to preventive medicine in devising laboratory partly lighted from the roof and fitted for pur- meanis for rendering a population immune to certain diseases poses of-sterilization and the preparation of culture media, -at least for a time.- The experience of the war was con- and four other spacious laboratories intended chiefly -to clusive as to the vast reduction in the incidence and mor- accommodate'the staff of the department. A small staircase tality of tyThoid as the result of preventive vaccines and as leads from the landing to the animal houses above. to the marvellous diminution of tetanius which followed the In going thro'ugh the building the visitor is greatly struck serum treatment of the wounded. Yet, notwithstanding the by the amount of light in all the various rooms; yet this has attention which their importance had attracted, probably been provided without in any way sacrificing the archi- not one in a hundred of the existing species of bacteria bore tectural amenities of the building. Moreover, the labora- anv ielation to disease. Take the process Ioosely described tories give a sense of loftiness and space. So far as the as fermentation; sometimes it was of importance to prevent structure itself is concerned, it appears to be extraordinarily suclh chemical changes, as in the preservation of food; in well adapted for the purpose for which it has been built. other industries it had proved possible to utilize the chemical Considerable attention,' too, has been devoted to the finishinig powers of bacteria. Nature worked more economically than of the building. The concrete floors are overlaid with wood art, and the chemistry of these minute organisms was more blocks; the corners both of walls and floors are rounded, anid subtle than that which the laboratory could accomplish. But the walls of the laboratories are tiled with white glazed tiles it was in agriculture and allied industries that some of the below and enamelled white above this latter, of course, most important applications of bacter iology were to be contributing materially to the lighting, which is so con- found. In the front rank stood the discoveries of the spicuous a feature tllroughout. The benches are, as in tlic nitrogen-fixing powers of certain bacteria, especially *well present laboratories, made of pitch pine covered with Eino. seen in the root nodules of leguminous the stand on r plants, whereby leum; incubators, water-baths, etc., tables covered importance of these in the otation of crops rieceived a with asbestos sheets. The cupboards and bookcases are rational explanation. Again, milk was a particularly similarly constructed of pitch pine, stained and varnished, favourable medium for the growth of bacteria, so that the and have sliding doors. The animal cages on the top fltox whole dairy industry was deeply concerned in questions of are raised some two feet above the floor and consist ol bacteriology. Thus bacteriology was a subject of high indus- reinforced concrete with stout galvanized iron wire tops trial importance, fully worthy of careful studly even if it had and fronts. This method of construction was introduced into no application to medicine. It must be taught in two stages. the College of Medicine some few years ago, and has been First muist come the academic study of its general principles. found eminently satisfactory in practice, for it allows of For this purpose the situation of the laboratories seemed opened thorough cleaning and limewashing. In the basement are to-day admirably adapted, and the Universitymigiht cloak rooms, store rooms, boiler house, etc., and a room for congratulate itself on such provision for the teachingof t}le heavy centrifuges. The building is heated by steam on the subject. The second stage of teaching could becarried atmospheric system and artificial ventilation is effected out in only by eff'ectively relation to-the special arts and sc'iences to means of an electrically driven fan placed on the roof, the which bacteriology might be applied. It.would be a mis- air inlets being behind the radiators. The fan is capable of JtNE 2, 1923] SCOTLAND. 953 M ICJU extracting 5,500--cubi-c feet of air a minute, which is worker was ill reference should be made to a medical man equivalenlt to changing the air of the laboratories four times to know whether it was safe or otherwise for the affected all hour. worker to proceed with the, work of milking. The The standard set in these laboratories is high, and if it be defendant in the present case should have got from iis maintained in the future the Newcastle Medical School will employee, when she sought to resume work after an possess buildings second to none in the kingdom. illness, a certificate from her medical attendant that she did not suffer from an infectious disease and was otheriwise fit to undertake milking. As the defendant was appar- ently the first person to be prosecuted in Scotland for this [L}ROX OUR PARLIAMENTARY CORRESPONDENT.] offence, tlhe sheriff imposed a modified penalty of £1, witlh The New Government. the option of seven days in gaol. MR. BALDWIN'S MKinistry was announced as complete, suibject to one office, £fn May 28th. For a time Mr. Baldwin retains, HOME NURSING W5ORK IN FIFESHIRE. along with the Premiership, the Chancellorship of t,he Viscountess Novar, presiding at the half-yearly meetin)g Exchequer, but his hope is that Mr. Reginald McKenna, Mwho of the Fife County Nursing Association at Dunfermline last is convalescent frorn a serious illne'ss', will be 'able to take week, stated that, as a whole, the progress of the Association this position (which has been offered to him) in the autu-mn. had been most satisfactory; fifteen new nurses had begun One addition has been made to the Government. Lord and four associations had been resusci- Robert Cecil has become, Lord- Privy Seal, an office which of work in-the county late was linked with another, but which, having compara- tated. At the present time the Association had sixty nurses tively few. duties, will enable- Lord Robert to undertake at work in the county, but it was hoped to increase the service for the Government in connexion with the League of nuniber to eighty, as there was still a great deal of scope for Nations, and also assist in debate in the House of Commons. organizing this service, particularly in the mining districts. Sir William Joynson-Hicks, who was Postmaster-General in One aim of the Association was to secure co-ordination Mr. Law's administration, has been made Financial Secre- between private nurses, voluntary nurses, and public health tary to the Treasury and is thus available to aid Mr. Baldwin to waste of effort and expenditure. The in the passage of the Finance Bill through its stages. Sir work, so as preveint L. Worthington-Evans, who went out of office when the meeting was also addressed by the Countess of Elgin, who Coalition ended, succeeds at St. Martin's-le-Grand. One made an appeal for financial assistance. other change is of special interest to our readers. Lord Eustace Percy, who was Parliamentary Secretary to the EDINBURGH SICK CHILDREN'S HOSPITAL. Board of Education, has been appointed Parliamentary The sixty-fourth 'annual meeting of contributors to the Secretary to the Ministry of Health, so that Mr. Neville Royal Edinburgh Hospital for Sick Children was held on Chamberlain may have assistanco in the Commons in his May 17th, Sir John R. Findlay, chairman of the direc6ors, arduous work. The Earl of Onslow, who was Secretary to presiding. During the year 1922 there were treated in 'the the Ministry of Health and answered for it in the Lords, is now Secretary to the Board of Education. wards 2,427 cases, as compared with 2,634 in the p-revious year; the average daily number in hospital was 108 and the Coroners' Law and Dea:h Certification (Amendment) Bill.-This average duration of residence 18 days. Of the total numnber bill,which is designed " to amend the law relating to coroners' law of patients admitted 1,281 were medical and 1,037 surgical. and the certification and registration of deaths and burials," In the out-patient department 2,811 medical cases and has now been printed. It was presen.ted by Dr. Molloy, and is backed by Dr. Fremantle and Dr. Watts. Broadly it embodlies 3,121 surgical cases were treated, and 1,853 minor surgical a scheme of death certification based on the policy,adopted by the operations performed. -Th-e number of further operations Annual Representative Meeting of the British Medical Association on in-patients was 879. The seaside convalescent home had in 1905; with proposals in the Draft Coroners' Bill approved by the year by 165 children, of the sa`h meeting, and the recommendations on burial regulationis been fully occupied during adoptedAbythe Association in 1905. It is understood that in the whom 126 were medical and 39 surgical; In the medical present state of business the bill leas no prospect of passage this repoirt the staff expressed the opinion that the effects of session; but the publication of the text will tend to elucidate had been matters. unemployment and its attendant poverty Vaccination at St. Lucia.-In reply to Mr. Rhys Davies, on strikingly manifest, both in the class-of case and the condi- May 28tb, Mr. Ormsby--Goke said that- the St. Lucia ordinanuces tioni of-the patients admitted to the medical wards during relating to public vaccination,-whioh were passed many years ago, the second half of 1922. Just as towards the close of the didnot provide forexemption on grounds of conscien-tious objection.- of cases of He had no information as to any legislation or administrative war there appeared an unusually large number action taken or contempfateod by the local Governament, but tuberculosis, so, after tPwenty-four months of bad trade, iinquiry would be made of- thie Governor. the hospital was now, experiencing an increased demand for the admission of patients on account of malnutrition and its results.' The chairman stated that'expenses continued -to decrease- and were now £2,000 less than they had been two years ago. There was cause for congratulation on the FARMER' RESPONSIBILITY FOR HEALTIH OF WORKERS. very handsome contribution made to the hospital funds by AT the beginning of this year a rather serious outbreak employees in offices and public'Works. Such subscriptions of Atphoid 'fever occurred at' Camp-beltown, in A gyllshire; ought to be the mainstay of the finances, whereas legacies some two hundred persons were affected, and three died. hlad to be drawn on' to' a very much larger extent than was .The Cainpbeltown Courier of May 12th gives a full report desirable. This year the hospital had an unprecedented of an action raised in the sheriff's co'urt against a local revenue fromii this source (£18,000). farmer, under the Dairies, Cowsheds and Milkshops Order, for allowing a female worker (who was apparently the CARE OF INCURABLES IN THEIR HoMES. cause of the epidemic) to milk cows while suffering from -The annual meeting of the,Royal Society for Home Relief all infectious disease. In the course of the epidemic Dr. to Incurables was held'in- the Council Chambers, Edinburgh, Harvey Thomson, medical officer of health for Campbel- oln May 18th. In mo,ving adoption of the report for 1922, town, was able to trace the source of infection to a certain wllich was approved, Lord'Provost Hutchison, who was-in farm, and found on investigation that a woman employed the chair, said that the society had had a long, honourable, there (whose husband was a scavenger) was suffering from and most useful career. Its work was not confined' to typhoid fever. It was not alleged that the farmer knew Edinburgh, for its beneficiaries were' 'situated in nearly that the woman was suffering from an infectious disease. every county in Scotland, and possibly its operations in ouit- Slheriff Macmaster Campbell, in delivering judgemnent, lying countiry districts were even of greater value than in said that the facts and conditions were of such a de-scrip- a town, where people suffering from incurable disease could tion as to exclude the defence of excusable ignorance. A be received and treated in institutions. The society's work niilk producer dealt with a commodity which was peculiarly originally had been upon a small' scale, but every year had and highly susceptible to contamination by the communica- seen an increase in its usefulness, till now there were nearly tion of infection. The obvious disability of an employer 500 annuitants on the roll. The yearly grant of £10 to of milkers to detect the presence of infectious disease in eachl beneficiary was of assistance iIi securing better attend, stiy of his workers should induce care to ensure that .his ance ~and gr,eater ,comfort. , Th,e amount of subscriptions '.orkers were in a sound condition of health, and where a received during the year wvas £2,176 12s.