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in the duodenum. Gas under pressure, free fluid, and pus werepresent in the peritoneal cavity, and the presence of surgicalemphysema in the mediastinum was confirmed. A carefulsearch was made for the route of escape of the gas, but nocompletely conclusive evidence was discovered. There was a

tiny tear in the attachment of the right coronary ligament tothe diaphragm, though it was impossible to be quite surethat this was not a result of post-mortem manipulation. Theredid seem to be a concentration of gas-bubbles along theinferior vena cava. It must be presumed that the gas had insome way reached the retroperitoneal tissues through a smalltear, and then tracked up along the vena cava.The source of the intraperitoneal gas remains unknown.

It could have been swallowed-which seems unlikely inview of the considerable intraperitoneal tension. Itcould have arisen by bacterial action in the peritonealexudate-but no gas-forming organisms were cultured.Or it could have escaped from the bowel, the risingpressure in the lumen having possibly contributed to thebreakdown of the perforation.My thanks are due to Mr. H. A. Haxton for permission to

publish this account.

P. B. LACY.Crumpsall Hospital,Manchester.

INGUINAL HERNIORRHAPHY

F. S. A. DORAN.Tutnall, near Bromsgrove,Wores.

SIR,—May I examine Mr. Haxton’s exposure (Feb. 11)of the " fallacy " contained in my article ? He statesthat my argument is undone by a failure to note thatthe linea alba is elastic in its length.

Although I do not believe it, I propose to accept Mr. Haxton’ssuggestion for the sake of argument. The argument is thatif the linea alba is elastic the whole of the lower third of theabdominal wall can descend, thus collapsing the " arch " ofthe conjoined tendon on to the inguinal ligament. Elasticity,however, is a passive quality needing the action of a dynamicforce to demonstrate it. In this case the muscles provide thedynamic force. To achieve the desired effect a muscularmechanism for stretching the linea alba longitudinally in itslower half is needed ; but I cannot invent such a mechanism.The lower half of the rectus abdominis, the most hopefulmechanism, fails because although stretching from the pubisto the lowest intersection, at the umbilicus, its pull is balancedby the upper half of that muscle, which, as far as I know,is not relaxed synergistically. In the upright position, there-fore, the elasticity of the linea alba would be unused, as I amunaware of any evidence showing that the lower half of therectus abdominis can overpower the upper half.

Let us assume, however, that the lower half of the rectusabdominis can overpower the upper half and stretch the lineaalba downwards from the umbilicus, the active stretch

occurring between the umbilicus and the xiphoid. Thisaction is opposed by the contraction of those fibres of theinternal oblique arising from the anterior superior spine andrunning horizontally to be inserted into the linea alba--unlessit is suggested that they are synergistically inhibited. If these

internal-oblique fibres contract they will tend, as they becometaut, to fix the point on the linea alba into which they areinserted, in both the coronal and the sagittal planes.Whether they are powerful enough to balance the rectusabdominis I do not know, but they would embarrass its action.The only muscle that could act without this embarrassmentis the pyramidalis-a puny fellow. Therefore, even thoughthe linea alba could be stretched very easily, it would availthe " arch " of the conjoined tendon little or nothing. As faras I know the pull of the external oblique and the internaloblique, above the level of the anterior superior spines, balanceeach other, and, therefore, can be discounted.The last possibility of utilising the hypothetical elasticity

of the linea alba is to return to Keith’s original concept-thatas the muscle-fibres in the " arch " contract, it must approxi-mate in length and position to the inguinal ligament. Fromobservation I can state that the power of these " arch " fibresis so poor that they are unable to act in the way needed,even when stimulated alone, with the rest of the abdominalmuscles relaxed.Although the linea alba stretches with pregnancy it scarcely

"

twangs " back to " normal " with parturition, and I amsure that if Mr. Haxton repeats my simple experiments he willfind my observations substantially correct.

MEMORIAL TO SIR HUGH CAIRNS

GEOFFREY JEFFERSON President.

D. W. C. NORTHFIELDHon. secretary.

J. B. PENNYBACKERHon. treasurer.

SIR,—The Society of British Neurological Surgeonshas decided to commemorate the name and work of thelate Sir Hugh Cairns. The memorial will take the form,in part, of a lecture to be given in London or Oxfordfrom time to time by eminent men whatever their

country. For this it is necessary to provide an endow-ment fund to cover an honorarium and travellingexpenses.Our society, knowing the high esteem in which Sir Hugh

Cairns was held by people in many walks of life, believe thatthese might wish to show their respect and, where appropriate,their gratitude by subscribing to this object. The magnificentwork done by Sir Hugh in organising, with the warm coöpera-tion of the Army authorities, the special neurosurgical skillsto be applied immediately behind the battle marked a lastingadvance, we venture to believe, in military surgery.

Subscriptions should be sent to the hon. treasurer ofour society, Mr. J. B. Pennybacker, the RadcliffeInnrmarv, Oxford.

Parliament

QUESTION TIME

Unemployed Doctors

Replying to a question, Mr. JOHN BoYD-CARPENTER, theMinister of Pensions and National Insurance, said that onMarch 19 there were 35 doctors registered at appointments.offices in receipt of unemployment benefit.

Lung Cancer and SmokingMr. W. D. CHAPMAN asked the Minister of Health what

action he had now decided to take, following the reports ofhis advisory committees, to inform the public about thedangers of lung cancer from smoking.-Mr. R. H. TURTONreplied : I have this very important subject under urgentreview. Mr. CHAPMAN : Will the Minister try to tell us howquickly he can make up his mind on this very important issueand try to give us a date ? Will he also take note of the feelingwhich exists that there should be a national campaign andthat the matter should not be left to small bodies and localauthorities but should be officially sponsored by his Ministry ?Will he make a note of the fact’that he should try to emphasisein propaganda that one of the things which people can best doto help themselves is to give up smoking in the dangerousyears between 40 and 50 when they become more susceptibleto the disease ?-Mr. TuRTON : I am studying the verypoints which the hon. Member has mentioned.

Dr. BARNETT STROSS : Has the Minister yet consulted theMinister of Education to ensure that the facts are taughtthroughout all schools, and not only to boys but to girls aswell ? Will he bear in mind that this might well be the mostfruitful field if the facts as we have received them are correct ?Mr. TuRTON: The first step is to find out exactly what thefacts are at present as ’regards research.

Overtime for Nursing StaffsMr. ARTHUR BLENKINSOP asked the Minister what repre-

sentations had been received from regional hospital boardsregarding extra payments for overtime for staffs in mentaland mental-deficiency hospitals.-Mr. TURTON replied : Tworegional boards have expressed concern at the failure to reachagreement on overtime rates for nursing staff. Mr. BLENEIN-sor : Does the Minister not agree that in view of the expressedwillingness of the regional hospital boards to make some extrapayments for this purpose, it is vital that the procedure ofthe Vfhitley Council should be speeded up ?-Mr. TURTON:I understand that the claim for enhanced overtime rateshas been rejected by the management side of the WhitleyCouncil.