727

and purifying. It is also employed in the preparationof strychnine, quinine, brucine, and other alkaloids,and in connexion with very many different drugssuch as antipyrine and phenacetin.

THE SEX INCIDENCE OF CANCER.

WE have been told for so long and by so manyauthorities that cancer is much more frequent inwomen than in men that we are inclined to regardas unorthodox and heretical the view that the sexessuffer equally in this matter. The view that canceris more frequent in women is based on the obviouslytrue statement that cancer of the reproductiveorgans attacks women much oftener than men; thegreater longevity of women is also said to be a reasonwhy they are supposed to be more subject to cancerthan men. Some recent investigations suggest thatthe comparative immunity of males to cancer isfictitious, depending on the fact that the forms ofcancer which are most deep-seated, and therefore mosteasily overlooked, are more common in men than inwomen. A recent paper by Dr. A. Renaud 1 ofLausanne contains an informing statistical statementon the notifications of deaths from cancer throughoutSwitzerland in the period 1901-20. It is ihterestingto observe with regard to these notifications thatcarcinoma and sarcoma are kept apart, and thatwhen a patient suffering from cancer dies of broncho-pneumonia or myocarditis, for example, the causeof death is notified as cancer and not as a disease ofthe lungs or heart. The average annual mortalityin Switzerland during the 20 years under reviewwas 4717, males being represented by 2347 and femalesby 2370 deaths. Considering that women outnumbermen, it might even be argued that the risk of a mandying of cancer in Switzerland is even a little greaterthan the same risk for a woman. As Dr. Renaudcalculates, among persons over the age of 40 the annualcancer death-rate in the period under review was1 per 214 men and 1 per 243 women. He notes inthis connexion that experimental cancer in miceis equally common in the two sexes. Among hisSwiss cases, as great a proportion as 73 per cent. ofall the cancers in males affected the digestive tract,notably the oesophagus, stomach, and rectum, whereasthis localisation was comparatively rare in females.Indeed, in the case of cancer of the oesophagus, theratio of males to females was as 6 to 1. In anotherrecent publication Dr. F. G. Gade2 has pointed outthat in Norway women with 51.8 per cent. of allthe malignant tumours are at first sight a little worseoff than men with 48-2 per cent. But as 51.3 per cent.of the population in Norway in 1920 were females,it appears that in Norway as well as in Switzerlandmalignant disease is equally distributed between thetwo sexes. It would be interesting if the cancer

statistics of other countries, which have hithertobeen supposed to show a preponderance of malignantdisease in women, were to be revised in the light ofthe statistics from Switzerland and Norway.

THE LAST ILLNESS OF PRESIDENT EBERT.

THERE were special reasons why no mystery should Ibe allowed to attach itself to the circumstances ofthe death of the late German President Ebert, andhis medical advisers have, accordingly, published Ia full account of his last illness and the partial post- [mortem examination. The authors of the report, (," Bericht uber Krankheit, Operation und Tod desReichsprasidenten Ebert," which is published inDeutsche medizinische Wochenschrijt for March 13th,are Dr. A. Freudenthal, the President’s family doctor,Prof. A. Bier, who operated on him, and Prof. 0.Lubarsch, who examined the contents of the abdomenafter death. It appears from Dr. Freudenthal’saccount that Ebert, who was 54 years old at the time

1 Paris Médical, Feb. 21st, 1925.2 The World’s Health, October, 1924.

of his death, had suffered for a few years fromoccasional attacks of biliary colic which, on one

occasion, was associated with jaundice. He had beenailing since Christmas, when he contracted whatappeared to be an attack of influenza, and inFebruary of this year he was complaining of lassitude,loss of appetite, and a cough. On the morning ofFeb. 23rd he complained of pain in the liver region,and tenderness was observed over the gall-bladder.Elsewhere the abdomen was flaccid and not tender.A violent attack of abdominal pain began in thelate afternoon of the same day, and on this occasionthere was marked tenderness over the appendixwith slight muscular rigidity. The rest of the abdomenwas flaccid. At 8.45 P.M. of the same day thetemperature in the axilla was 37° C., the pulse was 72,and there was an increase of the tenderness andrigidity over the appendix. An injection of morphinewas given, and Prof. Bier was summoned. It wasagreed that an operation should be performed atonce, and Ebert was taken to a hospital where hewas operated on at midnight. Much cloudy, odourlessfluid was found in the peritoneal cavity, and theintestines were seen to be much distended andinjected. The appendix, which was very difficult tofind, was gangrenous and perforated. For severalhours preceding death, which occurred on Feb. 28th,the clinical picture was characterised by intractableintestinal paralysis. At the necropsy the gall-bladderwas found to contain calcali, and there were ulcersof the stomach, one of them extending down to itsmuscular layer. The lining of the small intestinewas necrotic in places, and it was probable thatthe changes in its walls were not altogether recent.Indeed, it seemed that the intestinal paralysis, whichcontributed so much to the fatal issue, dependednot only on the inflammation of the peritoneum, butalso on the diseased condition of the mucous liningof the stomach and intestine. The interval betweenthe onset of vague abdominal symptoms and theoperation was one of 20 hours, and seven hours betweenthe detection of signs of appendicitis and the operation.One of the many features of this case which is ofinterest to the surgeon is the liability of a historyof recurrent attacks of biliary colic to delay thediagnosis of an acute attack of appendicitis. Passingfrom this isolated case to generalities it is interestingto note that, as a rule, much greater publicity isgiven to the causes of death of distinguished personsabroad than in this country. Reticence in suchmatters is, of course, natural, but there is much tobe said in favour of the course taken by the medicaladvisers of Germany’s first President.

CARBOHYDRATE METABOLISM DURING

PREGNANCY.

SINCE the introduction of insulin, all alterations incarbohydrate metabolism have received additionalattention. Ehrenfest,l in a recent article, considersthe matter very fully. So long ago as 1895 it wasshown by V. Jaksch that 100 g. of glucose taken bymouth would cause a glycosuria in the majority ofpregnant women; this amount has no effect on

non-pregnant ones, and certain tests for pregnancyare based on this fact. The routine testing of theurine of pregnant women has shown that glycosuriaas estimated clinically is not uncommon in thesesubjects, and the improvement of technique in theestimation of blood-sugar reveals the explanation ofthis phenomenon, which lies apparently in the loweringof the " renal threshold " for sugar. There are, however,other factors at work. During pregnancy the wholeof the endocrine system is in a condition of hyper-activity. The increased activity of the thyroid whichhas been proved to exist results, according to Olmsteadand Gay, in an increased metabolism, a delay inglycogenesis, or augmented glycogenolysis. It is well

1 Ehrenfest : American Journal of Obstetrics and Gynæco-logy, December, 1924, vol. viii., No. 6, p. 685.

728 INDUSTRIAL ACCIDENTS AND DISEASES.

known, too, that increased activity of the adrenal Itissues results in glycogenolysis with a resultinghyperglycaemia and glycosuria. That pregnant womenare abnormally sensitive to injections of adrenalin is i

known, and all evidence suggests that in them theadrenals are in a state of hyperactivity. The difficultyin assessing the action of the ovarian secretions isvery great on account of their multiplicity. Someinteresting experiments by Kuestner show, however,that a secretion from the ovary of pregnant animalsis responsible for a lowering of the sugar tolerance.The increased activity of the pituitary during preg-nancy is familiar, and this factor considered aloneresults again in the lowering of the sugar tolerance.In spite of an alteration in all these factors havinga bearing on sugar metabolism, authorities agreethat the blood-sugar concentration in healthy pregnantwomen varies within the normal limits. We mustconclude, therefore, that although metabolism takesplace on a higher rate, it remains normal. Thelowering of the renal threshold for sugar maybe a protective mechanism against the effects ofhypcrglycsemia on the foetus. ,,

INDUSTRIAL ACCIDENTS AND DISEASES.

A MEDICAL congress, the Fourth InternationalMedical Congress for the Study of Industrial Diseasesand Accidents, will be held in Amsterdam in

September, commencing on Monday, the 7th, andconcluding on the following Saturday. This is thefirst representative meeting of medical authoritiesto be held since the war, and so much work has beendone in this country along the whole line that wemay expect our delegates to play a prominent partin the conference. The President of the Congress isDr. P. H. van Eden, of Amsterdam, and the BritishExecutive Committee consists of Mr. R. de Mareesvan Swinderen, the Minister of the Netherlands(Hon. President), Sir Thomas Oliver and Prof.E. L. Collis, as President and Vice-President, respec-tively, and the following members of Committee:Dr. D. A. Coles, Sir William Collins, Prof. J. Glaister,Sir K. W. Goadby, Sir William Hale-White, SirRobert Jones, Dr. J. R. Kerr, Dr. A. Mercer, Dr.Howard Mummery, Dr. A. Scott, Dr. TheodoreThompson, Dr. A. Trimble, Dr. H. M. Vernon, Dr.Thomas Watts, M.P., and Dr. R. Prosser White.Dr. C. S. Thomson is Hon. Treasurer, and Dr. H. 1Menko, 2, Grosvenor-gardens, London, N.W.2, isHon. Secretary, from whom full particulars may beobtained. It will be seen that the constitution ofthe Committee warrants the expectation that theywill make practical contributions to internationalwisdom on a difficult subject.

PROF. GUIDO BANTI.

Guido Banti died early in the year, aged 72, atMontebicchiere in Florence, the place where he wasborn and from which he rarely moved. For 35 yearshe was director of the Institute of PathologicalAnatomy in Florence and also physician to theHospital of Santa Maria Nuova, where he had 150 beds.A retiring man of the true scientific type, he waspersonally hardly known outside his own country,but Banti’s disease has made his name familiar to thewhole world of medicine. Two notices of him byformer pupils (La Riforma Medica, Jan. 28th, andRivista Sudamericana di Immunologia, Feb. 15th)depict a man who was deeply beloved and admired byhis students, one who had a great reputation both asa clinician and pathologist, though his outspokenfrankness and tendency to regard the patient ratheras a scientific problem prevented his being successfulas a physician with the public. He was not avoluminous writer, but his published works covereda considerable range of subjects. Almost his firstwork was on aplasia, in which he tried to enlarge thesomewhat narrow teaching of the French school.

In 1881-82 there followed contributions on theprogressive aneemias and on splenic anaemia; in1886 one on the bacteriology of cerebral meningitis.His theses on splenic anaemia,l in Italian, attractedlittle attention, but in 1894 he published papers bothin French and German journals on splenomegaly withcirrhosis of the liver, which won him recognition asa great clinical observer and has caused his name tobe indissolubly associated with that type of thedisease. In 1895 he published a short work onendocarditis and nephritis, and in 1902 one on thepathology of the lung. In 1905 there appeared thefirst numbers of a great work on pathological anatomy,but this, unfortunately, was never completed, partlyowing to his having suffered for years from writer’scramp. From 1908-17 he was editor of the RivistaPatologica Quindicinale, published at Genoa, and hemade no further individual contributions to medicine.It will be seen that Banti’s work covered a consider-able field. He had a keen, independent, and progressivemind and an immense store of clinical and pathologicalexperience and he was an indefatigable worker. Hispapers are excellent examples of close reasoning, basedon keen observation and great knowledge ; they areneither dogmatic nor obsequious to received opinion.There is little doubt that had he written in a languagemore generally accessible to physicians, he wouldhave attained a much wider reputation, one that wouldhave justified all that his countrymen thought of him.

THE NEW FACTORIES BILL.

IT is an open secret that the prospects of this Billhave been much improved by the stream of steadyexplanations which has been forthcoming fromexperts on the subject. Many Members of the Houseof Commons have taken advantages of opportunitiesfor real comprehension of the views of those who seein the Bill an overdue measure for righting certainmanifestly wrong positions, and in this way appre-hensions of unduly burdening the factory ownersare, we think, being dissipated. At the Universityof Birmingham this week Miss L. Carbutt, who hasacted as a temporary Inspector of Factories, gave alecture under the auspices of the Y.W.C.A. IndustrialLaw Bureau, in which she drove home those generalpoints that have been emphasised in the press, whileshe added an argument of considerable force forreform when she stated that in a large Birminghamfactory during the past winter the women had workedthroughout every Saturday afternoon, bringing theirtotal work for the week up to 60 hours. The Govern-ment can see, therefore, that the legislation which isdefinitely included in their programme is necessary as

well as widely desired.

I As already announced in THE LANCET, an Inter-national Congress on Thalasso-Therapeutics will beheld at Arcachon from April 22nd to 25th.

THE House and Library of the Royal Society ofMedicine, 1, Wimpole-street, London, W., will beclosed from Thursday, April 9th, to Tuesday,April 14th, both days inclusive.

AN extraordinary general meeting of the membersof the National Council for Combating VenerealDiseases will be held at the Board Room of the Girls’Friendly Society, 39, Victoria-street, London, on

Monday next, April 6th, at 4 P.M., to consider and,if thought fit, to pass the following extraordinaryresolution : " That the name of the company bechanged to the British Social Hygiene Council."Should the resolution be passed by the requisitemajority, it will be submitted for confirmation as aspecial resolution to a second extraordinary generalmeeting which will be subsequently convened.

1 Osler and Macrae, first edition, vol. iv., p. 759.