575

does not distinguish between fibrous tissue which isthe result of disease, and adhesions which have beendeliberately provoked by the surgeon. In a case

published some years ago an intensive dose ofX rays was given to a patient in whom a ventro-fixation of the uterus had been successfully performed12 months previously. Within a few weeks of theirradiation the adhesions to the abdominal wall gaveway, and the original prolapse recurred. This casewas quoted by a surgeon to illustrate the dangersof X ray therapy ; in reality it was an excellent proofof the power of X rays to dissolve fibrous tissue.That this particular result was not the one aimed atdoes not in any way invalidate the demonstration.I am frequently called on by my surgical colleagues toattempt to render an inoperable case operable, andin many instances I am able to cause a fixed growthto become movable. This is a statement which it isquite obvious that no responsible medical man wouldmake unless he were prepared, if necessary, to produceindependent surgical testimony as to its truth.To quote Mr. Bonney further (p. 499):-" His experience of this treatment (deep X rays) both for

primary and secondary growths was most disappointing ...No one was more anxious than himself to find a bettermethod of treating carcinoma of the cervix than operation,but there was no sense in the advocates of radiation carping,at the results of surgery until they had produced a series offigures comparable with those he had just put beforethem.... What was needed was the publication of a Britishseries of not less than 100 cases treated by radiation, in allof which at least five years had elapsed between the date ofcessation of all treatment and the date of publication."The idea of the British radiologist carping at the

results of surgery makes one smile. If he has erredin the past it is by excessive deference to surgicalviews. Dwnnat (fuod non iHtelliuit is not a faultwhich can be laid at his door. But Mr. Bonney issuesa direct challenge. It is, however, one that he mustknow he is quite safe in making. To carry out sucha test it would be necessary to secure 100 cases of

pelvic cancer not of the moribund type, which theBritish radiologist usually sees, but similar to anaverage 100 of the cases which are now operated on.At present the sequence of events is this : The prac-titioner sends the patient to a gynecological surgeon,who invariably recommends operation when this istechnically possible. The radiologist sees only (1) theinoperable cases, (2) recurrences, and (3) a fewpatients who refuse operation. It is only from theselatter that statistics such as Mr. Bonney asks forcould be compiled, and I doubt if there are manyradiologists who see 20 such cases in a life-time ofpractice. Is Mr. Bonney-is any gynaecologicalsurgeon-prepared in his hospital practice to setaside 50 per cent. of all operable cases for five years ormore in order to put the matter to proof ? I think not.But unless those who control the cases are preparedto follow some such plan it is idle to taunt the Britishradiologist with the failure to produce statistics.

I express no opinion as to what the probable resultof such a test would be. Personally, I have alwavsadvocated combination in treatment. My object hasbeen to show that Mr. Bonney has issued a challengewhich, through no fault of the radiologist, cannot beaccepted.-I am, Sir, yours faithfully,

Harley-street, W., Sept. 5th. F. HERNAMAN-JOHNSON.F. HERNAMAN-JOHNSON.

LONDON MEDICAL GRADUATES ANDCONVOCATION.

To the Editor of THE LANCET.SIR,-May I point out to all M.B.’s of London

the significance of the amendment of Statute 41,Clause (ii), which was ratified by the King in Councilin May last, and is now in force, which entitles everyM.B. to be registered as a member of Convocation(and, subject to the Representation of the PeoplesAct, 1918, places him on the Parliamentary roll forthe University vote) immediately he or she graduates,provided the age of 21 years has been attained.Hitherto every graduate was compelled to wait

three years from graduation, which produced thestriking anomaly that, whereas graduates in otherfaculties (divinity, arts, law, music, science, in whichgraduation can be attained after a three years’course) might enter Convocation six years frommatriculation, graduates in the medical faculty werecompelled to wait eight and a half to nine years.

, I pointed this out in the Times of Oct. 23rd last,and at the same time memorialised the facultyrepresentatives and the present Member of Parlia-ment for the University. They agreed that theexisting anomaly called for removal, and accordinglya motion was framed, and put by Mr. Eason at themeeting of the Faculty of Medicine on Oct. 29thlast, which called the attention of Convocation tothis anomaly, and recommended the amendment ofStatute 41, para. (ii) by the abolition of the pro-bationary period of three years. This was carriedunanimously, and was sent on to Convocation.Independently of this action Dr. James Mould, atthe request of the Twentieth Century Society ofLondon Graduates, placed a notice of motion onthe agenda paper of the meeting of Convocationheld on Jan. 16th, 1925. Convocation resolved inaccordance with the terms of Dr. Mould’s motionwhich was then forwarded to the Senate, and, as

stated above, was finally approved by His Majestyin Council in May.The link between the University and her graduates

needs strengthening by every possible means, andnow that our Alma Mater stretches out her hands inwelcome, it behoves every M.B. to become a memberof Convocation as soon as possible, and thus to takean active interest in the government of the University.

I am, Sir, yours faithfully, - - - -

CHARLES A. H. FRANKLIN, M.D. Laus.,M.B., B.S. Lond.

Bickley, Kent, Sept. 7th, 1925.

SILICATE IN A HARROGATE WATER.To the Editor of THE LANCET.

SIR,-Valuable therapeutic uses are attributed tosilicate by Prof. F. Luithlen in the article annotatedin your issue of August 22nd (p. 392). Luithlen therepoints out the importance of a proper balance betweencalcium and silicon in healthy tissue. A deficiency ofsilicate is said to result in decreased elasticity andcertain senile conditions. Any natural medicinalsource, therefore, containing silicate presents pointsof interest hitherto rather neglected, although Weberand Weber (" Climatotherapy and Balneotherapy,"p. 341) refer to the therapeutic influences of thiscompound.In the Harrogate John’s Well we have a water

which appears particularly suitable for the adminis-tration of silicate. Only in very rare cases does thesilicate content of a natural water approach thecalcium in amount, and a brief search discloses noinstance in which the ratio Si/Ca is so high as in theJohn’s Well. Results of analysis of John’s water,expressed in terms of parts weight of ions per 100,000 :

The water is palatable and assimilable. It is hypo-tonic, having an osmotic pressure of about 130 mm.of mercury. Usually it is prescribed for its iron content,which is small, but as Bain and Edgecombe say of thisspring (" Harrogate Waters, Baths, and Climate,"p. 66) : " There are certain patients so peculiarlysusceptible to the influence of iron that, unless weaksolutions easily assimilated are prescribed, the remedyhas to be abandoned." The ration of silicate tocalcium is 1-93.

I am, Sir, yours faithfully,A. WOODMANSEY, M.SC.,

7 Sept. 4th, 1925. Analyst, Royal Baths, Harrogate.A. WOODMANSEY, M.Sc.,

Analyst, Royal Baths, Harrogate.