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would create almost exactly the same amount of povertyas would follow a rise of unemployment to the 1936level of 8-8% ; in other words, either of these mis-adventures would place double the number of familiesliving in poverty.The survey demonstrates clearly enough that welfare

legislation has produced no reckless changes in thedistribution of wealth but has merely lifted out of thedepth of poverty most of those families in York whoformerly spent their lives in it. The pendulum has byno means swung violently to an extreme, but is slowlyand cautiously approaching a meridian. Moreover theadvance is by no means certain : it is precarious andcould easily be reversed. Indeed, many a family swingsin and out of poverty once or twice in a lifetime. The

newly married couple with an income of E5 10s. a weekmay be reasonably well off, but with successive childrenthey drop below the poverty line ; when the children

grow up and start to earn the family returns to prosperity;but when the parents reach retiring age they enteranother period of decline and probably end their dayseither in poverty or on the borderline. To illustrate what.life below the minimum subsistence level can mean,Rowntree and Laver quote some examples, of which thefollowing are two :A man and wife, with seven children under the age of 11,

pay 19s. 7d. weekly for rent and rates. The average weeklyincome (including family allowances, free and cheap milk,and the value of home-grown vegetables) is E7 9s. 9d. Thedeficit below the minimum subsistence level is 2s. 11d. perhead weekly (26s. 3d. for the family as a whole).A spinster aged 87, paying 8s. weekly for rent and rates,

had nothing to live on but her retirement pension (at thattime n 6s.). The weekly deficit below the minimum sub-sistence level was 15s.

In Mrs. Gaskells day the cause of poverty wasoften and loudly declared to be the improvidence of thepoor ; no statistics were available to support this con-venient assertion. Rowntree and Laver show that inYork in 1950 the causes of poverty were honourable.In more than two-thirds of the cases, old age was thecause ; sickness accounted for more than a fifth ; andthe remaining causes were death of the chief wage-earner, and numerous children. Low wages caused

poverty in only 1-1% of cases.

CORTISONE IN SARCOIDOSIS

THE ability of cortisone and corticotropin to inhibitconnective-tissue formation and to promote involution oflymphoid tissue makes it natural to try the effect ofthese agents in conditions where granulomatosis is a

characteristic feature. One such disease is sarcoidosis,and several encouraging reports of the immediate resultsof cortisone therapy are now to hand. Siltzbach andothers 1 treated for 15 weeks a patient in whom severeuveal involvement had led to virtual blindness ; the

patient’s vision improved to 76% of’normal, and therewas simultaneous shrinkage of enlarged mediastinal

lymph-nodes. So far there has been no relapse. Lovelockand Stone 2 found in 2 cases that cortisone producedwell-marked regression of the pulmonary lesionsof the disease, but they emphasise that the durationof the improvement is still uncertain. Small 3 confirmsthat the lung involvement can be strikingly benefitedand refers to the similar improvement noted byKennedy 4 and Thorn 5 and their co-workers in cases ofberyllium granulomatosis of the lungs treated with

corticotropin.1. Siltzbach, L. E., Posner, A., Medine, M. E., J. Amer. med. Ass.

1951, 147, 927.2. Lovelock, F. J.. Stone, D. J. Ibid, p. 930.3. Small, M. J. Ibid, p. 932.4. Kennedy, B. J., Pare, J. A. P., Pump, K. K., Stanford, R. L.

Canad. med. Ass. J. 1950, 62, 426.5. Thorn, G., Forsham, P. H., Frawley, T. F., Hill, S. R., Roche, M.,

Staehelin, D., Wilson, D. L. New Engl. J. Med. 1950, 242,783, 824, 865.

It seems clear that in the early stage of granulomatouspulmonary disease, before irreversible fibrosis and

emphysema have developed, these agents may preventor even reverse the formation of granulomatous tissue.As experience has shown, where the underlying agentis a continuing infection-tuberculous, for example-the prevention of protective fibrosis may be disastrous.Where, however, the irritative factor does not seem tocause any local damage other than tissue reaction therewould seem to be a reasonable place for hormone therapy.

LYSOGENICITY IN BACTERIOPHAGE STRAINS

UNTIL last year there was no satisfactory theory toexplain the phenomenon of lysogenicity which is foundin certain bacterial strains. In these lysogenic strains allbacteria carry bacteriophage particles, but very few ofthem release active phage particles capable of infectingother bacteria. To explain lysogenicity Lwoff and Gut-mann 1 suggested that in these strains bacteriophageexisted in an incomplete form or

"

prophage," and thatsome stimulus was required to make this develop into theactive phage that we know in the laboratory.

Evidence supporting this theory has been describedby Lwoff et al.,2 who have induced mass lysis in a

lysogenic strain of Bacillus -rrzegathericrr by exposing itto a small dose of ultraviolet light. This lysis is accom-panied by the release of a large number of bacteriophageparticles. The activation of bacteriophage by ultra-violet light has been confirmed by Jacob 3 with a strainof Pseudomonas pyocyaizea, and by .American workerswith strains of Bact. coli. Bacteriophage is also activatedby other chemical and physical agents-notably reducingagents, such as ascorbic acid,2 and X rays, which haveproved 250 times more potent than ultraviolet light ininducing this effect.4 4 Lwoff and his colleagues 2 showedthat activation of the bacteriophage depended on themedia in which the bacteria were grown ; and to this stateof sensitivity they gave the name " aptitude." In a furtherpaper Lwoff

5 discusses the causes of this sensitivity andshows that numerous factors can prevent the irradiationfrom activating the " prophage." By ultraviolet irradia-tion Bertani s has obtained three serologically distincttypes of bacteriophage from one lysogenic strain ofBact. coli. He has shown that each cell contains the"

prophage" form of these three bacteriophages, butonly one type of active phage is released by eachbacterium. Thus the development of one "prophage"to active bacteriophage prevents the other " prophages

"

carried by the bacteria from undergoing a similar develop-ment. These experiments, and similar ones by Weigleand Delbruck,’ seem to support the " prophage " theoryof lysogenicity rather than Boyd’s idea that the phagecarried by lysogenic strains is a symbiotic variant of thelytic bacteriophage. Since " prophages

" are handed on

from cell to cell without a free existence and are presentin every cell of a lysogenic strain, there must be many"

prophages " within the cell so that their distributionis unaffected by cell division ; this implies a secondmethod of reproduction for such viruses. The alternativeis that the " prophage " is intimately attached to thegenetic mechanism of the bacterial cell, and divides with it.

There is an obvious similarity between the conditionsin lysogenic strains of bacteria and those in some animaldiseases. In experimental carcinogenesis, for example,the hereditary factor might be compared to the " pro-phage " and carcinogenic agents to ultraviolet irradiation.It would probably be unwise to draw too close an analogybetween bacterial and animal conditions, for one is

1. Lwoff, A., Gutmann, A. Ann. Inst. Pasteur, 1950, 78, 7112. Lwoff, A., Siminovitch, L., Kjeldgaard, N. Ibid, 79, 815.3. Jacob, F. C.R.Acad. Sci., Paris. 1950, 231, 1585.4. Latarjet, R. Ann. Inst. Pasteur, 1951, 81, 389.5. Lwoff, A. Ibid, p. 370.6. Bertani, G. J. Bact. 1951, 62, 293.7. Weigle, J. J., Delbruck, M. Ibid, p. 301.8. Boyd, J. S. K. J. Path. Bact. 1951, 63, 445.

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comparing not only bacterial and animal viruses but alsobacterial and animal cells ; and these cells differ evenmore fundamentally than the viruses. Since the dis-coveries about virus reproduction found with bacterio-phage appear to apply to animal viruses, one may hope"that stimuli such as those used by Lwoff will activatelatent animal viruses and so make it possible to locatethe carriers of virus diseases.

USING THE HANDICAPPED

IN the last thirty years we have made growing useof the powers of the disabled. And, as Dame GeorgianaBuller noted, in a lecture given this summer at theManpower Exhibition of the Ministry of Labour andNational Service, " what put the disabled on the map...was not primarily the desire to help them but the country’sneed of their help." Both world wars have changed thepublic attitude to the welfare of the disabled. After thefirst, she said, hardly a town or village was left withoutsome crippled ex-Servicemen ; while in the second the

country’s manpower needs led to the employment ofmany thousands of disabled in the munitions industries.This was a revealing experience for both the disabled andtheir employers. The able-bodied are apt to think onlyof what the disabled person lacks : " they do not realise,"she pointed out, " that a bountiful Nature provides usnormally with a number of spare parts." Many anoccupation thought of as needing two hands can be doneperfectly well with one. Again, a man may need twouseful hands if he is to sit at a bench and do a particularjob ; " but the fact that he has not got equally usefullegs is immaterial." Just as a blind man will offset his

disability by cultivating his hearing and training hispowers of interpreting sounds, or a deaf man will use hiseyes to detect events-such as the ticking of a watch-which other people identify by hearing, so a man confinedto a chair often develops exceptional manual dexterity.Dame Georgiana finds, moreover, that many of the

disabled have uncommon powers of concentration.The need to compensate for the disability, to competeon equal terms with those who are whole, is a sharpspur, and often leads to exceptional achievement. Shequoted the case of a builder’s labourer who, with noprevious qualification but a slight knowledge of arith-metic, qualified as a commercial book-keeper, passing theCity and Guilds examination at the end of a six-monthcourse, and a navvy who at the age of 53 learned watchand clock repairing in a year, and became in time branchmanager of the firm which employed him. It is more

important to ensure that the capacities of the disabledare fully used than to find them unskilled work forwhich they may be quite unsuited. Thus a well-intentioned employer gave a man with an artificial legthe post of messenger-which he was quite unable tomanage because he had to move over oily slipperyfloors ; but when he was transferred to instrument fittingthe man forgot all about his disability and became ahighly efficient precision worker. Again, a young manwith a disorder of muscular and nervous control had aclerical qualification ; his employer, doubting his abilityfrom his looks, put him on the telephone switchboard,but it was quite beyond his physical capacity to respondquickly to sudden demands. When he was at last allowedto do clerk’s work he was perfectly efficient, though thejob-by the standards of the able-bodied-was muchmore exacting. Many more opportunities could, shebelieves, be found for the disabled, and she mentionedsuch things as wig-making, mechanised invisible mending,and picture-frame making.Like Sir Robert Jones, she holds that curative work-

shops are an important element in the treatment of theinjured : " the hospital is no watertight compartment,but an anteroom to life." The trend is nowadays tokeep this in mind. The Ministry of Labour’s records showthat between August, 1946, and February, 1951, nearly

900,000 disabled people entered employment, while ofthe registered disabled only 5.8% were unemployed.There must perhaps always be some unemployabledisabled : age, advanced disease, complications, and lowmentality can all prevent handicapped people from

earning a living ; and since they are as human as therest of us there will always be some who are work-shy.But a physical disability is not the only thing that canhinder a man from doing his share of the world’s work.Most of us can remember a brilliant schoolfellow of whom

great things were prophesied, but who never fulfilled hispromise because his inner conflicts, not the world,defeated him. As Dame Georgiana sums it up, a badtemper or an inferiority complex can be a greater obstacleto a successful career than the loss of a limb. The able-bodied should not decide too hastily what constitutes adisability.

AN AMERICAN CANCER REMEDY

THE Chicago Medical Society have temporarily sus-

pended Prof. A. C. Ivy, vice-president of the Universityof Illinois college of medicine, for the " methods heemployed in promoting a substance known as Krebiozen’in the treatment of cancer... whose physical andchemical properties were kept a secret." Dr. Ivy, whosework on the physiology of the gastro-intestinal tracthas been familiar in this country for many years, wasuntil lately a director of the American Cancer Society.The decision of the Chicago Medical Society, made onNov. 13, closely followed a report on krebiozen by acommittee of the American Medical Association.! Thisreferred to a brochure by Dr. Ivy and others (An ,4Htfor the Treatment of ]}[alignant Tumours) published inChicago this year, which described the drug in vaguegeneral terms as a regulator of proliferative activitywhich controlled the permeability of the body cell or

its enzyme systems." In krebiozen-deficiency, thebrochure explained,

" an increase in anaerobic oxidation

and acidity within the cells produces uncontrolled

growth and cancer ; and when krebiozen is supplied, areturn to normal growth occurs." Dr. Stevan Durovic,a Yugoslav living in Chicago who invented the drug, isquoted as follows : " Dr. Durovic stimulated the reticulo-endothelial system of the horse and separated from theserum by a chemical process the krebiozen in a pure oralmost pure state." The substance is a white powder,soluble in water, mineral oil, and most organic solvents,supplied in 1 ml. ampoules containing 0-01 mg. ofkrebiozen in mineral oil. The committee’s report goes on :

"After determining the product’s lack of toxicity as

evidenced by animal studies, it was standardized ’ in humansby testing its ability to reduce tumor induration and size ina single case of untreated adenocarcinoma of the breast.

Following this standardization ’ the material was used inthe treatment of 22 patients with cancer. The conclusionsdrawn can best be summarised by a direct quotation: ’Onthe basis of objective anatomical and clinical evidence, 20of the 22 cancer patients have shown an improvement intheir general condition and a cessation of the growth, and aregression of the cancer which has been consistent and hasconformed to a general pattern.’ Subjective results were

reported apparent in 1 to 10 days and objective evidence oftumor regression in 2 to 12 weeks. The presentation wasmade before a specially invited group of the press, publicrelations counsel, the laity, and cancer specialists, and excitedworld-wide comment and interest."

The A.M.A. committee has tested krebiozen on 100cancer patients from seven independent sources, andthe findings are as follows :In 98 patients there has been no objective evidence of

improvement, though several showed a "

temporary or

subjective response."2 patients showed some evidence of temporary improve-

ment coincident with krebiozen therapy. In 1 of themthis was apparently fortuitous ; in the other, the majorlesions showed continued rapid progression.

44 patients have died. ____

1. J. Amer. med. Ass. 1951, 147, 864.