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the whole Army 56-4 (70-7) admissions to hospital forvenereal diseases, which was a considerable reduction.They were halved on the Rhine, 136-3 (234-2), and thisis ascribed somewhat pessimistically to the increasedvalue of the mark. The report well repays study forits observations on the prevention and treatment ofdisease.

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CANCER IN TAR-WORKERS.

COMMENTING recently on the death from cancer ofa man who had been employed for 24 years at amunicipal gas-works, we remarked that it should notbe impossible to bring to the knowledge of all workmenconcerned the protection which early treatmentprovides and the danger of delay. Sir Thomas Leggecalls our attention to a leaflet on the subject issuedby the Factory Department of the Home Officein June, 1924, entitled " Epitheliomatous (Skin)Ulceration as affecting Pitch and Tar Workers."" Some pitch and tar workers develop small warts or

ulcers on the skin of the face, arms, and very frequently inthe neighbourhood of the private parts of the body, especiallyon the scrotum, and it is these that may grow into the serious.condition.

" If a wart or ulcer appears on any part of the skin.medical attention should be sought at once, so that a doctorcan advise the proper treatment.

" All warts or ulcers do not necessarily grow into cancers,but those set up by pitch and tar and oil may do so, and.are therefore best removed. This can be done quite simply.There is little fear of cancer developing under 10 years of.employment and if the worker is under 35 years of age.

" The only treatment known to be successful at thepresent time is to remove the growth completely by operation,and therefore the smaller it is the more easily can this be.done, and the sooner it is treated the greater the chance fsuccess. Delay may make all the difference between 81J,ccnsand failure.

" Fortunately, the form of cancer which is the most curableby operation, so that it will not recur, is cancer of the skin.

" It is, therefore, very important to keep the skin healthyand the pores of the skin open. The only way of keepingthe skin healthy is by frequent washing with soap and water.The scrotum needs it as much as any other part. If thiswere done throughout life the trouble probably would notoccur."

We are informed that 12,500 copies of the leaflet havebeen issued to the staff for distribution in factoriesin which tar is used and that it has been reproducedsubstantially in a leaflet issued by the Amalgam-ated Association of Operative Cotton Spinners andTwiners which has been twice distril-uted to the.30,000 mule-spinners in Lancashire.

THE REWARDS OF MEDICAL DISCOVERY.

As our readers know, Sir Ronald Ross has long heldthat those who make important discoveries in medicineshould receive ample pecuniary recognition from theState, preferably in the form of life annuities. Hereturns to the matter in the January number ofScience Progress, and urges that part of the ratherconsiderable sums which are now spent on encouragingresearch should be devoted to rewarding discoverieswhich have been made. In theory the proposal isso sound that it is difficult to find anything to sayagainst it. If anyone would discover the cause of thecommon cold or of muscular rheumatism to be suchthat the knowledge gave us the means of preventingthese appalling diseases, it is not extravagant tothink and even to say that the State should give thediscoverer anything he wanted, at any rate up to thelevel of dukedoms, palaces, and princely fortunes.And the man who found out how to prevent a diseasesuch as pernicious ansemia, which by comparisonproduces a negligible amount of human suffering,might well have 21000 a year for life or somethingof that order.The principle is sound enough; the difficulties

arise only in its application. In the first place, who

1THE LANCET, Jan. 16th, p. 153.

is it that discovers anything ? Discovery is a process,not an event. The man who periodically steps outinto the limelight and tells people about it andpersuades them that there is something in it is onlyone of the links in a chain that had no beginning andwill have no end. It is true that some of these linksare very conspicuous and much more important tothe advancement of knowledge than the average.There is, too, a good deal in the proposal that thetruth and value of any theory is in proportion to thedegree to which it opens up fresh fields to the imagina-tion ; this it will not do unless it wins pretty generalassent, so that a higher place is rightly given toDarwin for making everybody think about naturalselection than to the gentleman who anticipated hisideas in an appendix to a book on ships’ timbers.But at the other end of the scale we have medicaldiscoveries of the greatest moment for which it wouldbe quite impossible to honour any individual by anymethod of selection more just than drawing namesout of a hat. If the children who live by the reductionof infantile mortality in the last 15 years wanted toput up a monument to their preserver, they couldnot get much nearer than an Epstein panel. And inthe second place, if it is possible in some instances todefine discoverers, who is going to have the courageto define them and value them against one another ?It might be done moderately well by a body as

detached and remote as the Nobel Prize Committeebut hardly by anyone nearer home. Perhaps theLeague of Nations would undertake it.Such are a few of the more obvious practical

difficulties. It is possible that they might in somedegree be evaded and that some discoverers mightbe pleased, and more supposed discoverers more

pleased, without the rest being dissatisfied beyondtoleration. But we think Sir Ronald Ross is almostwholly wrong in thinking that such a system of rewardswould " encourage " medical discovery. The syn-thetic idea which is nearer the common notion oforiginal discovery than anything else generally comesby way of revelation, and like other revelations itcomes to people who are not particularly looking forit. One man may by nature be more receptive thananother and training may increase his sensitivityto some extent. But it seems scarcely reasonablefor anyone to embark on a search for a revelationbecause it may be worth 210,000 ; there is no evidencethat they are to be had that way.

CATALOGUE OF HUMAN PROTOZOA.

TWENTY-FOUR years ago there appeared the firstpart of one of the most useful and comprehensivebiological bibliographies which have ever been planned-namely, the " Index Catalogue of Medical andVeterinary Zoology," by Prof. C. Wardell Stiles andMr. Albert Hassall. Begun under the auspices of theBureau of Animal Industry, United States Depart-ment ’of Agriculture, the first section, comprising35 parts, was completed in 1911. Running to over2700 pages, it furnished a complete list of all publishedbooks, papers, articles, &c., dealing with medical andveterinary zoology, together with references to allreviews, critiques, and abstracts of these, arrangedunder the names of the various authors. The second,or Subjects, section of the Catalogue appeared from1908 to 1920 as a publication of the United StatesPublic Health Service and has, so far, dealt with thevarious species of parasitic worms hitherto found inman, in domestic stock, and in all other animals.In this section are to be found records of referencesto every known species of parasitic worm. The firstpart of the third section, or host catalogue, has recentlybeen published in the form of a small fascicle of93 pages, and deals with the species of protozoawhich have from time to time been recorded as

parasites of man. In its original design it purported1 Key Catalogue of the Protozoa Reported for Man. Hygienic

Laboratory Bulletin, No. 140, Treasury Department, UnitedStates Public Health Service, Washington, D.C. 1925.

245

to be a guide for use by the class of medical zoologyin the Hygienic Laboratory, but its scope is actuallymuch more extensive than that and, indeed, it willprove a much-prized addition to the library of thespecialist. Prof. Stiles needs no introduction to thecircle of English zoologists, for his name has longbeen well known for his persistent efforts to stabilisemodern zoological nomenclature. For the most partthe entries in the Catalogue do not diverge muchfrom the teachings of standard English text-books.The generic name of the parasitic amoebas is, however,written jEMoMK.as&et, not Eiitamceba as so frequentlyoccurs, and the valid species are given as coli, histolytica,gingivalis, and mur1S. The Flagellata and the Sporozoaare treated more or less according to rule, and we findthe Spirochaetacea, or spirochetes, included as a sub-division of the flagellates. The classification of thespirillar organisms has always provoked muchdebate, the trend of which is impartially indicated.The malaria parasites receive full consideration, andspecial attention is devoted to the somewhat difficultclassification of the Piroplasmidce. Not the leastinteresting section of the work is the last, entitled" Protozoa, Miscellaneous," amongst which we findsuch entries as Chlamydozoa (vera and strongylo-plasmata), Protobios, Rickettsia, Unicellula and otherswhich have in recent years become prominent inconnexion with the study of cancer and the filtrableviruses.

REPAIR OF THE URETER.

WHEN a segment of a ureter has been removed,either by accident or by operation, and the uretercan be neither implanted into the bladder nor unitedend-to-end, is there any method by which the urinecan be conducted into the bladder ? Dr. L. L.McArthur 1 reports a case in which he applied, withsuccess, to the ureter the method which he hasemployed for the common bile-duct. The left ureterhad been divided eight months previously by a

severe blow which also fractured the left three lowerribs and the left transverse processes of the secondand third lumbar vertebrae. The result was a lumbarurinary fistula. At operation the ureter was founddivided 2 inches below its upper end. The ureteralends were 1 inch apart and could not be brought intoapposition. Dr. McArthur describes his technique asfollows : A longitudinal slit was made in the side ofthe proximal portion of the ureter, sufficiently longto admit two catheters. One of these, a rubberurethral catheter, was inserted upward to the renalpelvis ; the other, a ureteral catheter of good size,downward so as to pass out of the cut end of therenal portion and bridge the gap to the cut end ofthe vesical portion. The two cut ends of the ureterwere then approximated as closely as possible byabsorbable stitches. The catheters were then broughtto the surface and permanently secured to the skinby stitches or other device. The urine from thatkidney was thus diverted from the field of operationduring the time of epithelisation. The body tissueswere thus able to heal around the catheter bridgingthe gap between the renal end and the vesical end,the catheter simply remaining in situ until, in thejudgment of the operator, an epithelial lining hadhad time to grow between the ends. Dr. McArthurdoes not claim to have determined the length oftime required for epithelisation. In the case recorded,after the catheters had been placed in position, thegap between the ureteral ends was diminished bysutures two 4 inch. At the end of nine weeks bothcatheters were removed, when no further urineescaped from the wound, which healed immediately,the quantity of vesical urine being doubled at once.Nineteen months after operation the patient waswell in every respect. Dr. McArthur considersa fascia transplant to be unnecessary for epithelisa-tion of the gap, and believes that epithelium grows i

from each end of the divided ureter and lines the I1 Surgery, Gynæcology, and Obstetrics, December, 1925,

p. 719.

tissues surrounding the portion of catheter whichbridges the gap. No mention is made of the possi-bility of ultimate stricture at the site of the gap.

INSULIN DISAPPOINTMENTS AND HOPES.

TuosB who hoped that the administration of insulinto a diabetic might lead to the cure of the underlyingdisease are apparently to be disappointed. As aresult of observations lasting from 11 to 18 monthson five selected cases of diabetes mellitus, no evidencehas been obtained by Dr. G. A. Harrison of even apartial remission of the disease. The daily intake ofcarbohydrate, protein, fat, and calories remainedfixed throughout. The dose of insulin was adjustedto thefixed diet according to the results of estimationof the blood-sugar content. All five patients neededas much or slightly more insulin at the end of the .period of observation. Such fluctuations in dosageas occurred are considered to be due to the difficultiesin balancing the dose accurately against the diet,to increase in metabolically active tissue, and to varia-tions in the strength of different batches of insulin,Using the same batch of insulin, on a fixed diet, withthe patient’s daily routine kept as regular as possible,the blood-sugar curve remained remarkably steady.Every now and then, on changing over to a new batchof insulin, a patient suddenly appeared to relapse, or,on the other hand, suddenly developed hypoglycaemicsymptoms. Simultaneously, the blood-sugar curve

rose or fell. These differences between batches weremuch less noticeable in 1924 than in 1923, when themethods of standardisation were in their infancy.During the last six months of the investigation(September, 1924, to February, 1925) all these specialpatients were treated by the same batch of insulin,which arrangement Dr. Harrison describes as a greatboon to the patients and to himself. He recognisesthat every possible care and skill has been exercisedto standardise insulin, and notes that since the springof 1925 successive batches have appeared to be of moreuniform strength. This period probably correspondswith the use of the new comparative method ofassay devised by Mr. Marks, of the National Instituteof Medical Research. It is stated in the recentlypublished report of the Medical Research Council thatfurther experience with this method has confirmedits value. Quantitative clinical tests by Dr. Harrisonand Dr. R. D. Lawrence on volunteer patients, com-pared with the laboratory findings, are said to show acorrespondence so satisfactory as to warrant theconclusion that the rabbit test in the form devisedby Mr. Marks is, if carefully performed, capable ofdetecting any difference of activity which the mostelaborate clinical observation could discover, and thata supplementary clinical test ought not to be required.This is very reassuring, especially since the NationalInstitute of Medical Research has accepted, at therequest of an International Conference, the dutyof preparing and keeping the international standardof reference of insulin. A large supply of insulin,received from institutes and manufacturers indifferent countries, was purified and converted intothe form of a dry, stable hydrochloride. Simultaneousdeterminations were made in five laboratories in theUnited States of America, Canada, and this country,the results varying only from 8-4 to 8-8 units per milli-gramme of the dried preparation. As a result, theInternational Conference decided that this preparation,preserved at the National Institute, should be theinternational standard for insulin, and that one milli-gramme thereof should be taken to contain eight unitsof insulin. Samples of this standard have alreadybeen supplied from the Institute to the responsibleauthorities in 16 countries. It may be hoped that wehave now reached the stage when a diabetic, even ifcondemned to a constant dosage of insulin, may travelabroad without fear of being unable to obtain apreparation exactly corresponding to that which keepshim well at home.

1 Quarterly Journal of Medicine, January, 1926, p. 223.