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appointed to the medical charge of the Military Prison at ARMY EXAMINA’rIONS AND FOHS. Aldershot. H. J. at Woolwich for Captain M’Grigor joins This is the season for holding; competitive examinations duty. for army candidates and it is likewise the time for the ARMY MEDICAL RESERVE OF OFFICERS. occurrence of darkness and fogs. No one can tell when he Surgeon-Lieutenant A. Y. Greenwood, 3rd Lancashire goes to bed at night whether he will or will not wake in the Royal Garrison Artillery (Volunteers), to be Surgeon-Lieu- morning in a dense fog rendering vehicular traffic or even tenant (dated Nov. 26th, 1904). ordinary street locomotion a slow and difficult or possibly an IMPERIAL YEOMANRY. impracticable undertaking. We have often wondered whether Denbighshire (Hussars) : Richard Geoffrey Williams to be any provision has been made in such circumstances for the Surgeon-Lieutenant (dated Nov. 26th, 1904). non-attendance of candidates at such examinations or for their being unavoidably delayed beyond the hour fixed for VOLUNTEER CORPS. their being present. They cannot all locate themselves close : 4th Volunteer Battalion the Rifle : King’s (Liverpool to the place of examination. It occurs to us that something E. L. his Regiment): Surgeon-Lieutenant Hughes resigns should be done to meet bonâ-jide cases of this sort if only as a commission (dated Nov. 26th, 1904). matter of justice to the candidates and to their parents who THE REPORT OF THE BUREAU OF MEDICINE AND SURGERY have been put to much expense in their education. OF THE UNITED STATES NAVY. THE WAR IN THE FAR EAST. The of the chief of the Bureau of report Surgeon-General, There is but little news of a general kind from the seat of Medicine and of the United States for the Surgery Navy, war and none of any special medical interest to be year 1904 is a document which will repay careful perusal. chronicled this week. The armies on the Shaho have had From it we learn that the of difficulty securing qualified some desultory fighting and the fierce assaults on Port Arthur medical men for the is rendered the fact navy greater by are still going on. But there is one matter of present and that a lower rate of pay in some grades is given in the navy growing importance which calls for comment. It requires than in the In the case of assistant army. surgeons no great exercise of the imagination to form some idea, even on shore the is 15 cent. less employed duty pay per if it be a very inadequate one, of the situation and of what than the pay received by assistant surgeons in the sister must be the hardship and suffering of the belligerent armies service. The of rank is dealt with and it question now wintering in Manchuiia. Their sufferings and hardships is that shall be asked to suggested Congress change must be considerable, as all the available sources of water- the name of the different as follows :-In of grades place supply for men and animals are frozen, the ice has to be and in the other surgeon-general, surgeon-admiral; grades, thawed, and there is said to be but a scanty supply of fuel. medical director to become medical surgeon-captain ; If all we hear about the army commanded by General inspector, surgeon-commander; surgeon, surgeon-lieutenant- Kuropatkin be true-viz., that the troops at Mukden and commander ; passed assistant-surgeon, surgeon-lieutenant; elsewhere in Manchuria are badly hutted and that the stores and The assistant-surgeon, surgeon-lieutenant (junior grade). of warm clothing are inadequate to meet all their require- recommendation made in two preceding reports for the ments-they will need all their stolid fortitude to sustain enactment of legislation authorising the employment under them in such circumstances. It is officially stated, however, the control of the Bureau of Medicine and of skilled Surgery that the health of the Russian army is fairly satisfactory, dentists for service in the navy is renewed. With reference but it cannot remain so under such conditions as are to the model hospital ship for 300 patients, of which plans described and, in addition to frostbite, dysentery and have been laid it is out that such a vessel down, pointed outbreaks of other forms of camp disease may be expected will far more efficient than a diverted from a prove ship to occur, if, indeed, these are not already prevalent. commercial use and hastily converted into a hospital in time These remarks equally apply to the Japanese armies, but of war. in their case it is stated that they are well supplied The health of the and Marine for the calendar Navy Corps with ivarm clothing of good design and quality and as shown the statistical returns was year 1903, by good, the comparative nearness of these armies to their base the ratio of admissions to the sick list per 1000 of strength will greatly facilitate the work of furnishing the being less than the average for the eight years prior Mikado’s forces in Manchuria with all the needful The ratio is than that to 1902. slightly greater, however, requisites for a winter campaign. The conditions in the for the last The of the active list year. average strength case of General Kuropatkin’s army are very different and the was which is an increase of about during year 1903 37,248, make the problem one of very great and increasing difficulty. over the the for one-fifth previous year, average strength 1902 To feed and to clothe such an enormous force operating at such The total number of admissions to for being 31,240. hospital a distance from Russia and to provide it with all necessary all causes was the ratio of 28,569, per 1000 strength being war material and to transport all the sick and wounded who 782’ 24, as compared with a ratio of 767’ 63 for the previous have to be removed from the Manchurian hospitals to base and for the There were year, 797’ 10 eight preceding years. hospitals in Russia will be a very great, difficult, and costly 24,545 admissions for disease and 4024 for injury, giving undertaking. ratios of 671’ 82 and 110 14 The respectively. correspond- Miss McCaul’s entitled Under the Care of the ratios for 1902 were 640 - 07 and 125 - 56. There were work, ing War is to be Messrs. Cassell 224 deaths during the year, giving a ratio of 6’ 01 per 1000, Japanese Office," published by which is less than that of the during the present week. It should, we think, prove both considerably previous year and instructive. or the of the interesting (6’75), average eight preceding years (6’ 78). The Medical has drawn the attention of 164 deaths occurred from disease, with a ratio of 4 ’ 40, and 60 Army Department the officers at home stations to the for from with a ratio of 1’60. There responsible necessity injury (including poison) the caused the of was a increase in admissions for diseases of the reducing expenditure by employment general civilian digestive apparatus. With the exception of the class of practitioners. "general infectious diseases" venereal diseases gave a greater number of sick days than any other class. The total of 114,571 sick days due to venereal disease is equal to the entire loss to the service of 314 men for the year. The total admissions for venereal disease during the year are Correspondence. 1207 in excess of 1902 and the total sick days are 22,572 in "Audi alteram partem." excess. This cannot be accounted for by the increase in strength. In comparing the above figures with those of the CANCER OF THE CERVIX COMPLICATING previous year it is noteworthy that wliile the ratio of admis- sions to the sick list per 1000 of strength is greater than in LABOUR. 1902, the mortality is not only less than that of 1902 but ’1’0 the Editors of THE LANCET. lower than the average for the past eight years. SIRS,—In THE LANCET of Nov. 19th, p. 1449, Dr. Herbert REGIMENTAL HOMES AT DEVIZES. Spencer advocated the old Porro-Cassarean operation with the At Devizes, on Nov. 24th, the Countess of Pembroke serre-nceud instead of conservative Cassarean section for two homes for disabled soldiers cases of cancer of the cervix uteri formally opened regimental inoperable complicatingt, which have been erected as a memorial to Prince Christian labour but he does not bring forward any case of his own in Victor and officers and men of the Wiltshire Regiment who support of his view. During the discussion which followed were killed during the South African war. - the reading of his valuable paper at the Obstetrical Society 1613

.of London on Nov. 2nd, Dr. Spencer asked for the experience kind of delinquency is far too much in evidence. As the of others and Dr. G. E. Herman, Dr. Cuthbert Lockyer, and writer of a modern history of medicine, referring to this myself each gave an instance of a successful conservative very subject, says : " There is a half-confessed leeling that Csesarean section under the circumstances named. No we are the men ; and that knowledge was born with us." I instances of Porro’s operation were cited. Thus the expressed beg leave to enter an emphatic protest against such selfish, practical experience of those present was in favour of the con- ridiculous, and unscientific conceit. servative operation. Dr. Herbert Spencer now quotes foreign It is a flaw in the character of the great Herbert Spencer statistics in favour of his view and he gives a 60 per cent. that he never would recognise the still greater Auguste mortality (Sarwey) for the conservative operation and 35 per Comte as his intellectual father, and yet nothing is more cent. for the Porro operation (Porro Report, 1901). It is certain than that all his "idées rnères" had been previously unfortunate that these statistics are not compiled from the enunciated by Comte. Every impartially minded person who same sources and that they are not taken from concurrent has studied the subject must admit that Dr. Beard’s doctrine series of cases. is related to Weismannism in a precisely similar way, and The "Porro Report" statistics appear to relate to 38 to complete the parallel he now repudiates the relation- Porro operations with 14 deaths (36’8 percent.) in inoperable ship. Similarly, for certain important parts of his doctrine cases, the results of which are compared in the tables with he has Haeckel for hi s predecessor and for certain other those of other methods of hysterectomy for operable cases, parts I stand in a similar relation. Indeed, my doctrine but no comparison is drawn between them and conservative of tumour formation includes and embraces every essential Cae,arean section operations during the same or any periods of his tumour theory and much besides, just as the of time. Sarwey, however, does actually compare the two part is embraced by, and included in, the whole. There is operations in question and his figures do not support Dr. only one important exception and that is with regard to the Spencer’s views as to the great relative value of Porro’s opera- modern doctrine of. "germ cells," the essential facts of tion in these cases, for though 20 deaths (60 per cent.) which had not been discovered when my work was written ; occurred in 33 cases of conservative Csesarean section 13 but of this more anon. deaths (54 per cent.) occurred in 24 cases of Porro’s opera- Biology is greater than embryology, even in its com- tion. This is not a large enough difference upon which to parative form, and if there is one branch of it more than found an argument. Theoretically, it is easy to agree with another in which the origin of tumours specially centres that Dr. Spencer as regards the risk of septic infection of the branch is teratology-the Cinderella of the biological placental site in the conservative operation. Taking, how- sciences-as I have specially pointed out in my work. ever, my own case as a practical test it will be seen that the Moreover, in my treatises on uterine, mammary, and argument does not always apply. vaginal tumours I have, in the same spirit, specially .. , A woman, a 9-para, aged 35 years, was eight months indicated the not infrequent association of malignant and pregnant. The cervix, vaginal vault, and the whole non-malignant tumours of these parts, with local develop- of the pelvic connective tissue were occupied by a hard, mental irregularities. fixed mass of cancerous growth. The patient was in labour Two items in Dr. Beard’s letter strike me. In the first when admitted to Charing Cross Hospital, so I delivered the he belittles my publication without, as he says, having child by Caesarean section. The uterine incision was directly read it; in the second, he accuses me of having criti- over the placental site. It was then found that the growth cised his doctrine without having read his essays. Both in the uterus reached as high as the superior attachment of of these are purely gratuitous assumptions for which, as a the bladder. Owing to the fixation of the lower uterine matter of fact, there is absolutely no basis whatever. With segment it would have been impossible to draw the uterus regard to my work on "The Principles of Cancer and sufficiently out of the wound so as to avoid amputation Tumour Formation," he reproaches me because it is not in through the placental site and at the same time not to go the Edinburgh University library, as if the fault were mine. perilously near to the malignant growth. It is evident that If it were not treason to hint at such a thing, is it not just to apply a serre-noeud round the uterus close to a carcino- possible that the management of this institution may fall matous growth would court disaster ; and it is equally a little short of the best possible ? And is it altogether in- evident that if any portion of the placental site, or, indeed, conceivable that even Edinburgh scientific life may occasion- any large portion of the uterine body were left below the ally need just a little quickening in respect to matters of this serre-nceud the risk of sepsis would be very little less than kind ? I have long been aware of the fact that the scientific in a conservative operation. output of Edinburgh is by no means commensurate with the Dr. Spencer will agree with me as regards my case that richness of its endowments. It is passing strange that as the uterine incision and the ligatures involved the Dr. Beard should have to resort to the University library to placental site the risk of sepsis was much increased. Yet read my book, for on July 7th, 1902, I sent him a copy of it the patient recovered well from the operation. When it is with my own hand. Although Dr. Beard cannot recognise also considered that a Porro’s operation with separation of a family likeness between his hypothesis and my tumour the strangulated mass by sloughing involves about five doctrine he appears to be much impressed by the " close weeks’ tedious convalescence in a woman already exhausted correspondence " between his ideas and those expressed by by a vital disease, and who has, at the best, only a few Dr. A. S. Vallack in a contribution to a recent number of the months to live (my own case lived only three months), it Aecstrccliccn 1’lledieccl Gazette. Well, I have read this paper will be agreed that even the theoretical advantage of a and I have not the least hesitation in asserting that the Porro’s operation is doubtful. Personally I prefer a con- ideas there enunciated are merely echoes of my own publica- servative Cassarean section in these inoperable caes, though tion from across the water and they are by no means the in a not very advanced case, where the patient is fairly first ones that have reached me. When Dr. Beard has read robust, where the uterus is still slightly mobile, and the my book he will be able to appreciate this. placental site well above the serre-noeud, a "Porro" " would I have now to deal with Dr. Beard’s second assump- be an alternative which should be carefully considered by tion as to my presumed ignorance of his general bio- the operator. I am, Sirs, yours faithfully, logical doctrines, as set forth in his numerous memoirs, AMAND ROUTH, M.D. Lond. and I flatter myself that in this respect I shall be able Manchester-square, W., Nov. 28th, 1904. to give him complete satisfaction. To be quite frank, I regard the great body of scientific truth relating to growth, reproduction, variation, heredity, and allied biological CANCER GENESIS. problems as being more fully enshrined in the works of and his lieutenants, Darwin and Haeckel, than 10 the Editors THE LANCET. Spencer great of in any other publications ; and it is mainly on this basis that SIRS,-In replying to Dr. J. Beard’s letter in THE LANCET I have built up my doctrine of tumour formation. I have of Nov. 19th, p.14447, I wish at the outset to make it perfectly convinced myself that Weismannism is a degeneration of clear that this is no idle dispute as to priority of publication. Spencerism, and that Beardism is a degeneration of Weis- No one can be more deeply conscious than I am as to the mannism. I am satisfied that both alike as to their main futility of such disputes. I have long recognised that contentions must be regarded as being quite outside the those who promulgate new doctrines are merely the organs pale of scientific truth, owing to the essential faultiness of antecedent, predetermined, intellectual movements: as of their initial conceptions. In my former letter I Leibnitz has so well said, "The present is pregnant with the stated my conviction that the reproductive properties future." This being so, the ever-increasing tendency of of somatic and germ cells are the same in kind modern scientific authors to ignore their intellectual pre- and that they differ only in degree. this is decessors cannot be too Although strongly reprobated. Nowadays this the rock on which Weismannism is splitting and on which