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- with a pressure effectually blocking the exit of urinefrom the cortical uriniferous tubules.

Clifford White has shown that in puerperal anuria(or oliguria) the renal tubules in the cortex are

dilated ; I have confirmed this in an experience of-my own (not yet published). Dr. Begg states thatin his cases of anuric diabetic coma the symptomswere those of obstructive suppression of urine. Inthese cases " certain changes " have been found" which suggest the kidney is an all-important factor."He promises us a further contribution on this partof the subject, which will be awaited with restlessinterest. Meanwhile, may I make two suggestions ?The one is that Dr. Begg, in his cases of diabeticcoma, should regard vomiting as an important patho-logical force, prone to determine renal aberrations.’The other is clinical: that patients with this diseaseand impending complication should be placed ontheir side ; that all means be adopted to limit or

prevent vomiting ; and that in the worst cases

decapsulation of the kidney should be done. If thepatient is to die, it makes no difference whether thisevent occurs in the theatre or ward ; in eclampsia,patients almost in extremis have been saved bydecapsulation ; in diabetic coma, if the blood-sugarhas been made to become normal by insulin, theobjection to operation surely subsides. Decapsula-tion acts by relieving the cortical pressure (in whichthe capsule of the organ plays an important part) ; itallows blood to flow again through the corticalvessels, which distension of the uriniferous tubulesprevented ; and since blood can now flow throughthe cortex, there is less to go through the medulla ;thus the block is removed, the vicious circle broken.

I am, Sir, yours faithfully,Rugby, July llth. R. H. PABAMORE, F.R.C.S. Eng.R. H. PARAMORE, F.R.C.S. Eng.

To the Editor of THE LANCET.

SIR,-Dr. A. Clarke Begg classifies diabetic comainto two groups : one the usual type with acidosisand normal blood-urea ; the other, the anuric typewith slight or no acidosis, very high blood-urea, veryhigh blood-sugar, and urine volume decreased even toanuria. This classification does not seem to meadequate. Last year Dr. E. F. Skinner and ’Ireported in your columns 1 a case of diabetic comawith anuria, under the care of Prof. A. J. Hall, whichcannot be placed in either of Dr. Begg’s groups.The blood analysis in this case on admission yieldedthe following results (per 100 c.cm.) : Blood-sugar,,0-957 g. ; blood non-protein nitrogen, 110 mg. ;plasma bicarbonate, 15-7 mg. ; ketone bodies,59.13 mg. ; blood chlorides, 0-465 g. The lowplasma bicarbonate and the degree of ketonæmiaindicated a severe grade of acidosis not found inDr. Begg’s cases. Otherwise the findings are similarto those he observed in the cases of coma associatedwith anuria. It seems, therefore, necessary to con-sider at least two types of " anuric diabetic coma"according to the degree of concomitant acidosis.

I am, Sir, yours faithfully,Sheffield, July 19th, 1925. C. GRAY IMRIE.C. GRAY IMRIE.

TUMORS AND CANCERS: A COMPLAINT.To the Editor of THE LANCET.

SiR,-In your issue of May 23rd is a review of awork by Mr. Hastings Gilford on " Tumors andCancers." This review struck me, as it has struckothers, as an unjust and misleading statement of thenature and scope of the book. It conveys the impres-sion that it is written by one who is himself a cancerresearcher, in the narrowest sense of the word, andhas taken advantage of the opportunity to make anonslaught on a book distinguished by its breadth andcatholicity of view and which therefore puts his ownparticular work into its proper perspective. Some ofhis-remarks were written obviously with the intention..of creating prejudice. Thus one of the undoubted,

1 THE LANCET, 1924, i., 14.

if unavoidable, faults of the book is its bulk, but thisbulk is largely due to the evident determination of thewriter to support every statement with an amplebacking of evidence. It is therefore an obvious andflagrant misstatement to say that the author’sconceptions " are so often supported by simpleassertions, by bad reasoning." Indeed a more logicalor rational exposition of a difficult subject it would behard to name. Such a statement could only have beenmade by one who had confined his reading to the" conclusions " and to mere glimpses at the mainstructure of the book. As for the other comments,some, such as that about alcohol, which is a truism,could have no other purpose than to bias the readeragainst the book. Then there is a grave and palpableomission. The reviewer is so occupied in his searchfor weak spots or for sentences which can by disloca-tion be made to appear gauche or ridiculous that hefails to do justice to the merits of the book. He dwellson those theoretical aspects and frills which he findsso disagreeable and says next to nothing of the realstructure. In short, he displays his own personalfeeling, but does not review the book.Now, Sir, I should not have drawn attention to

this subject now were it not for the circumstancesthat such a book as the book in question is so muchneeded at this juncture in order to form a backgroundfor recent achievements in laboratory research. It istherefore exceedingly unfortunate that an importantvolume containing such a recent and balanced outlookand review of cancer work in all its aspects shouldhave been treated so scurvily by your reviewer.

Finally I may add that in writing as I now do Iam expressing not only my own opinion but those ofothers who are equally impressed with the injusticethat has been done and with the desire that theinformation contained in " Tumors and Cancers "

should not be suppressed but should be broadcastedto all who wish to take a sane and just view of thepresent situation.-I am, Sir, yours faithfully,

Basingstoke, July 26th, 1925. NOLAN DALY.NOLAN DALY.

THE REMUNERATION OF R.A.M.C. OFFICERS.

To the Editor of THE LANCET.

SIR,—The action of the British Medical Associationwith regard to the Royal Army Medical Corps recallstheir similar action a few years ago with regard to theRoyal Naval Medical Service. It is further an

admitted fact that there is great difficulty in obtainingmedical men for all three combatant services. It is tobe hoped that the present dispute will lead to anexhaustive investigation of the lack of attraction tothese great services. In my opinion a supply of goodmen will be obtained only if the opportunities to dofirst-class medical and stirgical work and to keepthemselves abreast with advances in their professionalwork are afforded. Such opportunities under existingcircumstances are quite inadequate. Some time agoI submitted a comprehensive scheme to a committee,which included the Directors-Oeneral of the threemedical services. It was damned with faint praise;but I do not despair that some such scheme may yetreceive the official benediction.

I am, Sir, yours faithfully,J. HERBERT PARSONS.

Queen Anne-street, Cavendish-square, W.,July 23rd, 1925.

I am, Sir, yours faithfully,J. HERBERT PARSONS.

AN ACKNOWLEDGMENT.To the Editor of THE LANCET.

SIR,—In connexion with the second edition of the" Encyclopaedia, Medica," Vol. XIII., article Diabetes,we have to regret that on p. 641 an acknowledgmentwas not made of the nomogram there represented toDr. W. M. Feldman and Mr. A. J. V. Umanski, theauthors of the article in THE LANCET, Feb. llth,1922, p. 273, where the nomogram originally appeared.

We are, Sir, yours faithfully,Edinburgh, July 23rd. W. GREEN AND SON. LTD.W. GREEN AND SON. LTD.