471

injurious dust is so fine that it floats in the air and isdiffused far from its point of origin to become a sourceof danger to neighbouring workers. Evidence isadduced in favour of intermittent exposure, even

though the second process followed has its own differentdust risk. The efficiency of methods of dust preventionby the application of water at the grinding point, orof dust removal by localised exhaust draught, or of dustdilution by general ventilation, was estimated by dust-counts. The whole work provides a sound basisfor administrative action and has added to scientificknowledge.

____

BRITISH JOURNAL OF ANÆSTHESIA.

WE welcome the first appearance of the B1’itishJournal of Ancesthesia, a publication that it is proposedto produce quarterly,1 the contents of which are to beconcerned entirely with anaesthetics and the practiceof this special branch of medicine. The EditorialBoard, the names of which appear on the cover,comprises representative anaesthetists from the greattowns of England and Scotland. It is, however, theambition of the promoters of the journal to makeits scope Empire wide, and they hope to bring intoassociation with themselves representatives of theBritish Dominions beyond the seas. The first numberaugurs well for the future success of the journal.It starts appropriately with an historical articlefrom Sir D’Arcy Power, and this is followed by along account of some clinical experimental work onthe use of drugs in combination by E. P. Donovanand J. T. Gwathmey. W. J. McCardie writes on

broncho-pulmonary complications following anaes-

thesia, J. Blomfield gives a digest of his experienceof sacral analgesia, and there is an account of newanaesthetics by C. Langton Hewer and a comprehensiveabstract and bibliography of current anaestheticliterature. It will be realised that the magazine is amost useful one for any practitioner much concernedwith anaesthetics, and we have no doubt that if thejournal goes on as it has begun it will be a valuableaddition to periodic medica literature.

FREE INSULIN.

A MESSAGE from Toronto announces the freedistribution of insulin to diabetics in the province ofOntario who present a certificate from their medicalman that they are unable to meet the cost of thetreatment. As a matter of cold argument there isdoubtless much to be said on both sides of the questionwhether this is a sound social procedure. Doles ofAll kinds are objectionable. Those who have are

already taxed sufficiently for the benefit of those whohave not. Diabetes is not a catching disease, so thatthe reasons which have led to the free distribution ofdiphtheria antitoxin and salvarsan do not apply.Things which are to be had for nothing are generallyused wastefully. The cost will rise progressively bythe very success of the treatment in prolonging thelives of diabetics. Contrariwise, it is the business ofthe State to preserve its lives and to recognise thatit is a paying proposition so to do. The public is z,entitled to enjoy the benefit of discoveries whichhave been made wholly or in part with the aid ofpublic funds. Monopolies are held conditionally onno one being injured by their existence. Such and ’,such are the pros and cons which are bandied about ’,for dialectical exercise. The medical profession willrecognise that they are almost wholly beside the ’’,point. The entire hospital system is a plain monument !,to the ideal that the sick have a call on the service Iof the sound, that the needy are entitled to the help i,of those who have what they require, and that thosewho are sick as well as needy are a charge uponeveryone. So long as mankind clings to itsimmemorial axiom that life on any terms is betterthan no life at all, it will be unthinkable that a potent

1 Published by Messrs. Sherratt and Hughes. Manchester.Annual subscription, £2 post free; single copies, 10s. 6d.

and valuable remedy should, as a piece of actualpractice, be withheld from anyone merely becausehe has not got enough money to pay for it. Thepublic notoriety which has been achieved for insulinmakes it particularly impossible that it should beleft as a class remedy. There were inhumanity anddisappointment and pain enough through the periodwhen everyone with diabetic children and friendsknew all about it and very few could get it. Nowthat it is available in ample amounts, there ought tobe no more difficulties. Whether free insulin shouldbe supplied by some analogue of the Surgical AidSociety or by the public authorities is a minor questionof technique. There is not so much difference betweenthe two nowadays, and the State seems to be theobvious and simple medium. But the guidingprinciple is clear. It is the motto of Guy’s Hospital-dare quam accipere. ____

THE HISTOLOGICAL STUDY OF NEOPLASMS.

RECENT developments in the experimental studyof the origin of tumour growth have in great partdiverted attention from the results of the traditionallines of investigation rendered illustrious by the workof Waldeyer, Virchow, Cohnheim, and Ribbert. Dr.G. W. Nicholson’s studies in tumour formation, ofwhich No. VIL1 has just appeared, come as a usefulreminder of the prime necessity of accurate histologicalwork as the basis of knowledge in all cellularproblems. Dr. Nicholson has come to the conclusionthat tumours arise in displaced or dislocated cells orcell-groups of the tissue of origin, and in Study VII.extends this conception to the heterotopic new growthsin which the histological differentiation departs fromthat of the surrounding organ. With an extensive andexact knowledge of the literature and a skilful choiceof well-executed figures the author marshals theevidence to the conclusion that the heterotopictumours arise from normally differentiated cells by anintrinsic transformation of which there are manyexamples apart from tumour growth. Withoutabating one jot of our admiration for the author’spainstaking devotion to a laborious specialty, it is

permissible to venture the suggestion that the ultimatesolution of the problems of neoplasia will come from acombination of the methods of descriptive and experi-mental pathology, rather than from their pursuit asseparate disciplines. ____

CARDIO-VASCULAR COMPLICATIONS OF

KYPHOSCOLIOSIS.

j Dr. Ernest P. Boas, 2 medical director of theMontefiore Hospital for Chronic Diseases, New York,who reports an illustrative case with a review of theliterature, remarks that the functional disturbancesof the respiration and circulation connected withkyphoscoliosis have not received the attention towhich they are entitled. Although the frequency ofdyspnoea in such patients was known to Hippocrates,Bouvier in 1874 was the first to show that dilatationof the right chambers of the heart was a very frequentfinding in scoliosis. The most complete investigationis to be found in a monograph published in 1899 byBachman, based on 197 personal cases of scoliosis orkyphoscoliosis which came to autopsy, as well as

79 cases recorded in the literature. Of the total276 cases 247, or 89-5 per cent., presented an organiclesion of the heart or pericardium, but only 13 hadorganic valvular defects. Among 154 cases in whichthe heart was examined more carefully to determinethe nature of the hypertrophy or dilatation 87, or56-4 per cent., had hypertrophy and dilatation ofthe right ventricle, 27, or 17-5 per cent., of the leftventricle, and 40, or 25-9 per cent., of both ventricles.Bachman also noted that displacement of the heartupward and in an opposite direction to the scoliosiswas very frequent, giving rise to a tortuous and angular

1 Guy’s Hospital Reports, vol. iii., fourth series, No. 3, 1923,p. 298.

2 American Journal of Medical Science, July, 1923.

472

deviation of the aorta, the large vessels, and inferiorvenacava. Of 195 deaths studied by Bachman, 116,or 59-4 per cent., were due to cardiac failure and 24to tuberculosis. The usual symptoms are dyspnoea,due at first to pulmonary atelectasis and emphy-sema, and later to myocardial insufficiency, cyanosis,and oedema of the legs. Attacks of palpitation andpain may occur in crises. The pulse is not infrequentlyrapid and may be irregular. As the myocardialinsufficiency progresses, dyspnoea, cyanosis, andoedema become more marked, the liver becomes

enlarged, the excretion of urine is greatly diminished,and anasarca and ascites may ensue. The prognosisin patients with kyphoscoliosis depends mainly uponthe reserve power of the heart. It is unfavourablewhen once the signs of myocardial insufficiency areestablished, and the end is frequently precipitated byintercurrent pulmonary affections. Dr. Boas’s patientwas a woman, aged 29, in whom scoliosis was firstnoted at the age of 9, and had slowly and progressivelybecome worse. For 10 years she had suffered fromattacks of giddiness appearing every month, and forabout five years from dyspnoea on exertion. Examina-tion showed the case to be one of paroxysmal auricularfibrillation with symptoms of myocardial insufficiency.The issue of the case is not recorded.

LIFE ASSURANCE AND SYPHILIS.

THE bearing of syphilis upon life assurance isdiscussed by Dr. W. P. S. Branson in the currentnumber of St. Bartholomew’s Hospital Reports (vol. lvi.,part 2.). Dr. Branson begins by inquiring into theincidence of syphilis among the insuring population,and comes to the conclusion that the best estimateis a figure of about 10 per cent. He then discussesthe effects of syphilis as a lethal disease, and pointsout that it may kill as the result of (1) general paralysisof the insane, (2) aortic aneurysm, (3) gummatousdisease of the cerebral vessels, (4) tabes dorsalis,(5) epithelioma of the tongue, implanted on syphiliticleucoplakia, (6) suicide. Dr. Branson admits thatthere are other causes-one of the most common iscardiac failure from syphilitic disease of the coronaryarteries, and this probably increases the mortalityamongst syphilitics to a large extent. The authornext takes up the period at which syphilis producesfatal results and points out that general paralysisand aortic aneurysm cause death between 30 and 50,while tabes, when it kills, as a rule kills late in life.He is not impressed with cerebral syphilis as a causeof death, but the statistics of the American Life Officesshowed that the mortality among syphilitics wasvery high the first six years after infection, and deathwas almost always due to cerebral syphilis. Dr.Branson next discusses the question as to whethertreatment can cure syphilis. It is well known thatsyphilis has been cured by mercurial treatment asrecommended by Jonathan Hutchinson, who noted theoccurrence of a second primary chancre after suchtreatment, and cases have been described of secondinfections after treatment with arsenic ; but it is prob-able that in the great majority of cases once syphilishas been contracted, whatever the treatment, it isalways liable to recur. This is especially true when anysecondary manifestations of disease have developed.Dr. Branson does not place extravagant confidencein a negative Wassermann result. The blood testmay be negative whilst the cerebro-spinal fluid ispositive, and it is no uncommon event for the bloodto be negative to-day and positive in six months’time. He says, however, that he considers a positiveW.R. as a bar to life insurance. While agreeing withDr. Branson that a negative W.R. is of no value asevidence of a permanent cure of syphilis, we are notso sure that a positive W.R. should be a total bar tolife assurance. In a recent case a proposer, who hadbeen perfectly well for seven years after contractingsyphilis, was found to have a positive W.R., and inhis anxiety to turn it into a negative one he had noless than 20 injections of neo-salvarsan in 12 months, I

the W.R. continuing positive, though he himself wasin good health. Dr. Branson draws up rules as to theeligibility for insurance of lives who have had syphilis,and comes to the conclusion that those who haveexhibited tertiary lesions, who have Argyll Robertsonpupils, or leucoplakia of the tongue are ineligible,while increased rates must be charged for those whohave had secondary manifestations and have beenthoroughly treated for three years or more. Heconsiders those who have been thoroughly treated inthe primary stage and can produce evidence ofnegative W.R. three years or more after contractingthe disease may be taken at ordinary rates. Someexperienced observers would not entirely excludecases of tertiary skin lesions, as many of these casesoften live to a very considerable age. But all cases,even those giving a history of a primary sore only,should, we are convinced, be rated up.

EDIBLE FUNGI.

THE latest publication of the Natural HistoryDepartment of the British Museum is a Handbook ofthe Larger British Fungi, by Mr. John Ramsbottom,M.A., F.L.S., assistant in the Department of Botany.Types have been selected for description on theground of their economic and biological interest. Indealing with the fleshy agarics the basis of selectionhas been the edible or poisonous qualities of thespecies, the term " edible " being used simply toimply that the fungus has been eaten without illeffects. In this country only the field-mushroom(Psalliota campestris) and the horse-mushroom(P. arvensis) are commonly eaten, and for mostpeople the cultivated variety of the field-mushroomis the only edible fungus. Mr. Ramsbottom expressesregret that this is so, for many of our common toad-stools are far more delicate in flavour than either ofthese. This conservatism of taste is a modern failing.Classical literature contains frequent reference tovarious edible and poisonous fungi, and the only wayin which to know whether a fungus is edible orpoisonous is by being able to distinguish it in the sameway as one does other edible plants and to ascertain itsrecord. There is, says Mr. Ramsbottom, no other way;and his handbook will serve its purpose if it popularisesthe safe use of a number of cheap and appetising foodproducts. The edible fungus contains roughly2 to 5 per cent. of protein nitrogen (of which probablynot more than one-third is digestible), 5 per cent. ofsugars, 1 per cent. of fat, and to 1 per cent. ofmineral matter. With this composition, fungi are acomplete food. a fact established by the Fuegians, wholive on Cyttaria during a large part of the year. InCentral Europe, where the use of fungi as food is muchmore widespread, coloured wall charts are posted inthe elementary schools, so that children learn from anearly age the distinguishing marks of the poisonousand non-poisonous varieties.

VALUE IN DISINFECTION.

THE Brazilian National Department of Health hasreprinted an article from the Boletim Sanitario,No. 2, of 1923, with the view of impressing uponmedical practitioners the futility of terminal disinfec-tion in the prophylaxis of infectious disease. Thegist of this article is that chemical disinfection ofpremises in which infectious cases have occurred canbe of little value, seeing that the micro-organismswhose destruction is desired by that procedure arein number and virulence far less dangerous thanthose scattered through direct human agency or bymeans of recently infected articles. Moreover, manyof these micro-organisms escape destruction by anymeans of terminal disinfection, whether by forma-linspray or by disinfectant solution. Finally, the pointis made that the employment of terminal disinfection

Printed by order of the Trustees and sold at the BritishMuseum (Natural History), Cromwell-road, London, S.W.7.Pp. 222. 7s. 6d.