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explanation. The antitoxic function, at least inthe form of Roger’s induced glycuronuria showed avariable behaviour of no clinical value or particularinterest for diagnosis.The conclusion which may be derived from these

interesting researches is that if it has hitherto beenadmitted that there is a parallelism of all the functionsof the liver and a complete association between them,this view will have to be modified. Even assuming,according to the general laws of physiology, theharmony of the various hepatic functions, we havenow evidence to show that this association is correctonly within physiological limits. Under the actionof different morbid conditions, the various functions,which perhaps have different anatomical sites in thecomplex and obscure architecture of the organ,do not all suffer simultaneously nor in an equal degree.So that we always find in functional exploration ofthe liver one or several functions more or lessprofoundly altered side by side with others which areabsolutely normal and intact. Prof. Sabatini pleadsfor further studies of the many hepatic functions inorder to arrive at an estimation of the functionalefficiency of the organ by the adoption of definite andidentical methods, so that results may be obtainedwhich leave no gaps and are intelligible and comparableand lead to the determination of constant relationshipbetween types of hepatic lesions and types of functionalefficiency. ____

FUNDAMENTALS OF THE CANCERPROBLEM.

AT this stage of the cancer problem a criticalselection from the enormous mass of material nowcollected, presented mainly in pictorial form, cannotfail to be of interest to students and practitioners. Itis therefore not surprising that the Governors’ Hall atSt. Thomas’s Hospital was filled with an audience ofnearly 400 people on the occasion of the first of the fourlectures on cancer being delivered under the auspicesof the University of London by Dr. J. A. Murray.This lecture was a survey of the main features commonto malignant growths, preliminary to the discussion ofexperimental and other research work in subsequentlectures. Dr. Murray’s main conception of cancer isthat of an aberration of the process of repair. Whethercancer arises in the covering epithelium of any portionof the body, whether it arises in the subcutaneoustissues, or from linings of the blood vessels, the sameprocess is at work, the differences in the histology of thegrowth being due to differences in the tissues of origin.Dr. Murray showed lantern slides of primary andsecondary growths in man and other mammals, andalso in amphibians and fish, and of histological prepara-tions demonstrating characteristic features of malignantgrowths. In a carcinoma which has developed from aglandular tissue the glandular structure is sometimesentirely lost, and a solid mass of cells results, but thisdifferentiation can be reversed under suitable experi-mental conditions. Such a growth can be made togrow in a solid mass or made to return to glandularstructure without having altered its characteristics asa growth. The superficial similarity between thehistology of a carcinoma of the skin and of the develop-ment of an embryo has given rise to many of thenow untenable hypotheses of the nature of carcinoma.In the early stages of malignant growths several fociof independent growth are to be found, and manygrowths have arisen by the coalescence of these foci ;but it is interesting to note that this coalescencedoes not take place by the transformation of the inter-vening portions into cancer. It is on the interpreta-tion of pictures as active processes-not as a

final stage-that the diagnosis and interpretation ofthe histology of malignant new growths must rest.If cancer remained localised tissue there wouldbe no necessity for the elaborate amount of investi-gation and study which we apply to it; verysimple remedies would be sufficient, such as itsremoval when it became troublesome-or dangerous.But it is the capacity for passing beyond the original

site in the body and disseminating to the distantparts which makes cancer so serious a disease.Dr. Murray proceeded to discuss the occurrence anddistribution of cancer. Here individual experience,he said, is of very little value. The experience ofcommunities is required. Of all the causes of death,cancer is responsible for one-tenth or one-twelfth ofthe general mortality. Recoveries from cancer arepractically negligible from the point of view of statisticsin this country. The age-incidence of cancer, both inman and animals, is suggestive, for as we go up inyears we find that the proportion of those dying fromcancer, to the total of people living, rises swiftly.Comparison of the incidence and mortality of cancerin different countries is not easy. The difficulty isthat we have no good grounds for believing that anumber of cases of cancer recorded in any countryrepresents truly the number of deaths in that countryfrom cancer. There may be more deaths or fewer.There is no means of knowing what other diseases weretermed cancer, or whether cancer was always diagnosed,and thus we have to read international statistics with

a certain reservation. The significance of the apparentincrease of cancer found in this and other countriesis very difficult to interpret. It is extraordinary thatthe increase is not in those regions of the body-for example, cancer of the uterus-where the diseaseis commonest. Again, while females of 75 and upwardsduring the period 1851-1909 show progressive andrapid increase in the proportion of deaths due to cancer,in women of 35-45 the increase has been much less.Dr. Murray considers that we are justified in takingcomfort from this observation by deducing that thefactors which can produce cancer are apparentlytaking longer to produce it now than in the past. Ifthe increase of cancer is significant at all, not merelydue to improvement in diagnosis or the like, then ittakes longer for the disease to develop than 40 years sago. That is one of the most hopeful features ofotherwise ominous figures.

EPIDEMIC DROPSY IN CALCUTTA.

RECENTLY Calcutta has experienced an outbreakof epidemic dropsy, which has been the substanceof an inquiry by the workers at the Calcutta School ofTropical Medicine, under Lieut.-Colonel J. W. Megawand the staff of the Health Office, Calcutta. As aresult of careful investigations, the ingestion of injuredrice has been suspected as an astiological factor inthe outbreak. The disease first appeared among thewomen students of a medical school, who made theirown messing arrangements. It was found that theirrice supply came from a small dealer in a differentlocality. An interesting fact was discovered-namely,that the family of the dealer was suffering fromgeneralised oedema, and that a number of people inthe neighbourhood who obtained their rice from thesame source were also affected. About 75 cases inall were detected. Colonel Megaw reports that allthe effects which were observed went to show thatthe disease originated from the consumption of rice,and it was quite possible that one consignmentof rice might have been responsible for all the cases.There have been many different views as to the natureand cause of epidemic dropsy. ’. In 1914, Lieut.-Colonel E. D. W. Greig, I.M.S., classified epidemicdropsy as one of the deficiency diseases, similar toberi-beri. It has also been regarded as an infectiousmalady, and in support of this view Dr. BepinBrahmachari, I.M.S., has published a paper in a

recent issue of the Calcutta Medical Journal. 2 Again,it has been widely held in Calcutta that a poisoncontained in an adulterated mustard oil is responsiblefor the condition, but no evidence of the presence of anypoison has been obtained on scientific investigation.The opinion which now holds the field on the aetiologyof epidemic dropsy is that rice which has been damagedby improper storage develops a mould which, when

1 THE LANCET, 1920, ii., 1234.2 Calcutta Medical Journal, December, 1923, p, 519.

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taken, acts as an intestinal irritant, and so affects Ithe sympathetic nervous system. This view has been,in essentials, held by Colonel Megaw ever sincethe Calcutta outbreak of 1909, but conclusive proofhas not yet been established. There are apparentlygreat practical difficulties in the way of subjectingsamples of suspected rice to exact experiment. Incombating the present outbreak the Director of theSchool of Tropical Medicine recommends that riceshould be cut out of the diet the moment symptomsof dropsy appear. In this way, it is believed, the courseof the disease will always be arrested.

INSPECTORSHIPS UNDER THE BOARD OFCONTROL.

WE have before now commented upon the range-broad yet delicate-of duties carried out by theinspectors under the Board of Control (Lunacy andMental Deficiency), and welcome the advertisementof the Board inviting applications for two moreinspectors; but the terms of the advertisement, whichwill be found in our columns last week, have led to arepresentation being made to us upon two points.The words of the advertisement are :-The salary will be-

(a) 500, rising by annual increments of k20 to 800 formen-and for women possessing a Medicalqualification ;

(b) .6400, rising by annual increments of k20 to 9650 forwomen.

Bonus, which varies with the cost of living, is also allowed.Present bonus on salaries of 9500 and P400 is .8184 and..8158 Is.respectively.The duties will include the Visitation and Inspection of

Institutions, and candidates should possess a competent know-ledge of the methods of Teaching, Training, and ManagingMental Defectives. A Medical qualification though not essentialwould be of value.

It has been pointed out to us that a differentiation insalary has been made between the sexes, and we agreethat such differentiation in respect of public appoint-ments in the medical world has now been generallycondemned ; but the second point, to which moreattention was drawn, is that it would appear that,for the male candidate for the post, a medical quali-fication, though regarded as an asset, is not to be anessential. The layman who, whatever his experience,will not have undergone a standardised course

terminating in testimonials to the attainment of thestandard, will be on the same footing as a candidatewho has completed five or six years of intensive study.It will be agreed that many of the duties falling undervisitation and inspection of institutions can be dis-charged by laymen, but it will not be obvious how acandidate is to prove experience in the managementof mental defectives if he has had no special trainingin the phenomena of mental disease. The posts donot appear to us to carry a salary that will be attrac-tive to medical men with special claims over andabove a general medical training, which would seemto us to furnish a further reason for not minimisingthe scientific status to which they rightly attachimportance. _____

A RE-DISCOVERED BLOOD CORPUSCLE.

Dr. Robin Fahraeus, whose work on the rate ofsedimentation of the erythrocytes has given us amost valuable test of disordered metabolism, publishesin Acta 141edica Scandinadca (1924, 1., 12) an accountof a blood corpuscle which modern works on theblood appear to ignore. This corpuscle seems to bea red corpuscle which has undergone haemolysis, and,curiously enough, it is to be seen in every freshpreparation of blood, or, to be more accurate, itsposition is to be seen, for the corpuscle itself, havingthe same refractive index as the plasma, is invisiblein this medium. In a strongly aggregating specimenof blood an isolated rouleau may be seen with agap of quite the same appearance as the surroundingplasma. Yet the rouleau behaves mechanically as acoherent string, swaying to and fro with the currentsin the preparation. The two corpuscles boundingthis gap are curved inwards, although the last cor-

puscles at the two ends of the rouleau are convexoutwards, owing to the surface-tension. The twoconcavities bordering the interval outline a spherewith a radius of about 3,a. These colourless corpusclesare more easily found in strongly aggregating bloodthan in blood of normal rouleau formation, and theobvious fact that they aggregate with the red cor-puscles makes it probable that they are spherical" red " corpuscles without haemoglobin. Similarbodies may be created by the artificial haemolysisof the red corpuscles, a fresh preparation ofblood being subjected to the heat of a strong sourceof light such as an electric arc lamp. Underthese conditions a red corpuscle begins to changeits appearance in the middle of a rouleau, swellingand becoming transformed from a disc into a

sphere, turning more and more pale. This process isindicated in the accompany-ing diagram. When the ———————————-———

corpuscle has become spheri- jHSttBMBtcal there is only a trace of I faint yellow left, and this

’

fades away soon. In the case of the colourless corpuscle jjMtMSM*seen in an ordinary blood !l.preparation it is not clear

whether it represents an intra-vital process or not. Dr. ’

Fahraeus favours the former 3. ’

view for various reasons, and *

he believes that this corpusclerepresents the final stage in 4 the life-history of the erythro- _cyte, of which we have hitherto been in ignorance. Though this corpuscle doesnot figure in modern works on the blood cells. it waslong ago described by Dr. Richard Norris, professor ofphysiology at Birmingham, and the father of micro-photography in haematology—a process he introducedin 1877. From a study of his photographs of freshblood preparations he discovered a formed, colourlesselement of the same size as that of a red corpuscle.Almost at the same time Bizzozero published hisclassical discovery of the blood-platelets, and Norris atfirst thought that the two structures were identical.In his principal work, published in 1882, Norrisdescribed his corpuscles as the nuclei of the lymphcells which had lost their protoplasm and representedearly stages of the red corpuscles into which thecolourless discs were transformed by the absorptionof red pigment. It will thus be seen that, thoughDr. Fahraeus makes no priority claim to the discoveryof this corpuscle, his opinion of its past, present, andfuture characteristics is very different from that ofits original discoverer.

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DIATHERMY IN ANTERIOR POLIOMYELITIS.

OF late years much stress has been laid on theimportance of the relaxation and the prevention ofstretching of paralysed muscles in cases of anteriorpoliomyelitis. And no doubt, rightly laid, althoughattention has thereby been diverted from the use ofphysical agents, other than massage, in the aftertreatment of this malady. The older forms of elec-trical treatment-viz., by the faradic and galvaniccurrents-are still sometimes applied, but they areprescribed solely for the purpose of causing theparalysed muscles to contract and undergo artificialexercise. Recently, Prof. H. Bordier, of Lyons, hasremarked on the value of diathermy in infantileparalysis. It is well known that recovery fromparalysis is greatly retarded by cold ; the heatgenerated by the diathermy current in its passagethrough the tissues is retained longer than the heatconducted to or radiated to the tissues from externalsources. Heat from external sources does not cause arise of temperature beneath the skin, whereas thatproduced by diathermy is actually generated withinthe tissues traversed by the current, both superficialand deep. Bordier states that the cold paralysed