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based on a study of pay beds as they now existedat a number of hospitals in London. The statisticalreport showed that in 1926 there were nearly 900 paybeds at 73 hospitals. Any suggestions the Pay BedsCommittee might make for the future would thus bebased on the experiments, if he might so call them,of the past and the present. The final list of grantsout of the legacies of the late Mr. and Mrs. JohnWells was the end of a most useful piece of workwhich began in 1924. The last instalment of the twolegacies had just been received, and the combinedtotal had come to z6255,000. His Royal Highnessconcluded by referring to the loss to the Fund bythe death of Lord Cave, Sir William Church, and SirJohn Craggs. In the place of Sir Francis Champneys,who had retired after 17 years’ good service, he(the Prince) had appointed Mr. Eardley Holland;Lord Iveagh he had appointed as a member of theCouncil.

The Finances of 1927.Lord Revelstoke (the hon. treasurer) then moved

the adoption of the accounts for 1927, which wasseconded by the Rt. Hon. M. C. Norman, and carriedunanimously. The Earl of Donoughmore (chairman ’’

of the Management Committee) proposed the adoption ’,,of the annual report, and this having been seconded iby Sir Berkeley Moynihan (President of the RoyalCollege of Surgeons), was also carried unanimously. I,The report stated that the total receipts of the King’s ’Fund for the year 1927 were .E352.340 18s. 9d. Of Ithis, z22,000 was from the estate of the late Mrs.John Wells. 21313 Os. 8d. from the estate of thelate Mrs. Florence Mary Hames, 21000 from theestate of the late Mr. Samuel Lewis, :B15,004 15s. 10d.from general legacies, 267,638 4s. 3d. from gifts tocapital (including z60,000 from the estate of the lateEarl of Iveagh), and z245,382 Os. 5d. from generalreceipts. These general receipts were made up asfollows : Annual subscriptions, 23,432 15s. 2d. ; ;donations, z20,789 16s. ; League of Mercy, 317,000 ;British Charities Association, j615,000 ; dividends andnterest from investments, 6168,959 9s. 3d. ; andtrustees of the Bawden Fund, 2200. The amount ofthe ordinary distribution was z247,000. an increase of2000 over 1926. The total sum distributed amongsthospitals, convalescent homes, and consumptionsanatoriums during the last ten years, including allspecial distributions, is z3,360,688. Since the founda-tion of the Fund in 1897 a total net amount of5,819,104 8s. 5d. has been distributed. ’

Grants under the Wells Legacies.Sir Cooper Perry (chairman of the Distribution

Committee) presented the final report on the Wellslegacies distribution which contained the followinglist of grants made from Jan. 1st to May 15th :-Acton Hospital : £ 1000 towards revised scheme of exten-

sion, increasing the number of beds from 50 to 60 ; jE500 ipayable when the work is begun, and 2500 to be the lastZ500 required to render the scheme free of debt.

British Hospital for Mothers and Babies : ,íJ500 towards

second stage of new hospital ; making, with J62000 grantedin 1927, a total of JE3500.

Central London Throat, Nose and Ear Hospital : JE750towards new out-patient department ; on condition that afurther B5000 is raised and the work begun by July 31st,1928.

Charing Cross Hospital: ,íJ2000 towards reconstructionand equipment of the building acquired from the RoyalWestminster Ophthalmic Hospital, increasing the beds byapproximately 50 : on the understanding that 6 additionalbeds, making 10 in all, will be reserved for accident cases.

Elizabeth Garrett Anderson Hospital: 9500 towardsextension ; making. with 22000 granted in 1926, a totalof B2500.

Forest Hospital: 2250 towards extension, increasing thenumber of beds from 28 to 37 ; payable when the workis begun.

General Lying-in Hospital: JE500 towards rebuilding ofadjoining house as nurses’ home and antenatal and postnataldepartments ; making, with JE1000 granted in 1927. a totalof 1500.

Guy’s Hospital : £ 1000 towards provision of site for out-patient department extension.Hampstead Hospital : 2600 towards new operating theatre

and casualty department and provision of 6 accident beds.

Hornsey Central Hospital: 2500 towards new nurses’home ; payable when the work is begun.

Hospital for Sick Children : 2500 towards provision ofisolation block for convalescent patients at the countrybranch at Tadworth, on the understanding that the blockwill ultimately be used as part of the provision for recoverypatients.King George Hospital: 210,000 towards the building fund

of King George Hospital, subject to conditions to be agreed.Mothers’ Hospital of the Salvation Army : £ 1000 to

extension, increasing the number of beds from 90 to 150,payable when the work is begun.

Prince of Wales Hospital : 93000 towards extension ofout-patient department ; 21500 payable when work isbegun, and B1500 to be the last 21500 required to open theextension free of debt.

Princess Louise Kensington Hospital for Children : ;8500towards second stage of new hospital ; making, with 2500granted towards first stage in 1925, and 21000 towardssecond stage in 1927, a total of .82000.Queen Charlotte’s Maternity Hospital: 23000 towards

first stage of extension scheme. increasing the number ofbeds ; payable when a further .815,000 has been raised andthe work begun.

Queen’s Hospital for Children : 21000 towards extension,increasing the number of beds from 134 to 155, and providingadditional nurses’ accommodation ; to be the last 21000required to enable all three parts of the scheme to be openedfree of debt.Royal London Ophthalmic Hospital: 2500 towards

additional nurses’ accommodation ; making, with 2500granted in 1926, a total of 1000.Royal National Orthopeedic Hospital : .81500, of which

2500 towards acquisition of adjoining site at country branchat Stanmore ; and £ 1000 towards building of additionalward block at Stanmore, increasing the number of bedsto 273 ; payable when the work is begun.Royal Waterloo Hospital for Children and Women : X250

towards final stage of extension scheme ; making, with23000 granted in 1925, a total of .83250.

St. Mary’s Hospital : 21000 towards extension ; to be thelast 1000 required to render the extension free of debt ;making, with 24000 granted in 1926, a total of 25000.South London Hospital for Women : oE500 towards the

provision of block containing new out-patient departmentand nurses’ quarters ; making, with oE2000 granted in 1926,a total of 22500.Westminster Hospital: £100 towards provision of accident

ward, increasing the number of beds in the hospital from234 to 242, of which 10 will be reserved for accident cases.Woodford Jubilee Hospital : 2300 towards extension,

increasing the number of beds from 23 to 31 ; payable whenthe work is begun.

Reports were also presented on the work of thePropaganda Subcommittee by Lord Burnham ; on

the new edition of the Statistical Report by Mr. L. L.Cohen ; and on the position of the inquiry by thePay Beds Committee (to which reference was madein the Prince’s opening speech) by the Earlof Donoughmore. During the absence of LordHambleden through illness, Sir John Rose Bradfordis acting as vice-chairman of this committee.A vote of thanks to his Royal Highness terminated

the proceedings.

MEDICINE AND THE LAW.

Death Certification by Unregistered Doctor.Charles Forbes, aged 77, pleaded guilty at the Old

Bailey on May 18th to a charge of forging and utteringa death certificate. The certificate, as was stated amonth earlier at Clerkenwell Police-court, related toone Mary Wagner and purported to be signed byCharles Forbes, M.B., Ch.B., a registered medicalpractitioner. A second charge in the police-courtproceedings alleged that he had knowingly andunlawfully caused to be inserted in the register ofdeaths kept for the subdistrict of South St. Pancrasa false entry relating to Mary Wagner’s death. Therewas evidence that Forbes had been living for aboutseven years at a private hotel and, posing as aregistered medical practitioner (though he had notput up a brass plate), had treated many poor peoplein the West Central district of London. For thedefence it was stated that Forbes had duly qualifiedas a doctor at Glasgow after being a student at the

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Middlesex Hospital, and that he had been struck off the Register about 30 years ago after a conviction forfraud. The Recorder remarked that he was ofopinion that Forbes had never been a doctor at all ;he was a danger to society. Sir Ernest Wild thenpassed sentence of nine months imprisonment withouthard labour. It seems that the accused, in treatingMary Wagner, who was dying, had been obliged topose to her nephew as a registered medical practitionerwho could sign a death certificate. The unregisteredpractitioner must sooner or later be exposed to therisk of thus being led into a definitely illegal act,though the general public naturally takes little interestin the certification of qualifications or the fact ofregistration. As Forbes was not in fact registered, hisprevious career was not directly in issue ; otherwiseit would have been interesting to know whether he hadin fact ever obtained any qualification.

Escape from Asylum.For the offence of wilfully permitting, assisting, or

conniving at the escape or attempted escape of apatient from an institution for lunatics, Section 323of the Lunacy Act lays down a rather strangely limitedpunishment. The offender is to be " liable to a penaltynot exceeding £20 nor less than ;132." A man who wasformerly a mental attendant at a St. Leonards homepleaded guilty at Hastings on May 18th to the chargeof having aided and abetted the escape of PrinceAhmed Seif Ed Din, a certified lunatic, from Hastingsin August, 1926. He brought his £20 to court and thefull penalty was imposed, the chairman of the benchstating that it was a serious offence. The chiefconstable had observed that the maximum penaltywas totally inadequate in a case of such a nature.When, if ever, our lunacy law receives its long-delayedamendment, perhaps Parliament will take note of thisofficial opinion.

THE GERMAN SURGICAL CONGRESS.

(FROM OUR OWN CORRESPONDENT.)

Infective Origin of Malignant Tumours.AT the recent Surgical Congress the first subject of

discussion was the problem of malignant growths.Prof. Heidenhain (Worms) put forward the view thatcarcinoma, cancer, and sarcoma have the same

origin and are conveyed from one person to anotherby an agent still unknown. The transference of humancarcinoma to mice is, he said, impossible, as thehuman cells are destroyed in the foreign organismby autolysis. He has therefore endeavoured topreserve the virus without the cells and has producedautolysates by keeping cells of human cancer in athermostat for 20 to 30 days. The products of thisautolysis were inoculated into mice by subcutaneous,intracutaneous, intramuscular, or intraperitonealinjections or into the liver ; sometimes also freshtumour pulp was used for injection. The result wasthat a growth developed after several months.Inoculation of carcinoma often evoked sarcoma, andvice versa, whilst in other cases neoplasms of bothcategories were produced. The clinical features ofthe growth in the mice were similar to those of humancancer, and the primary tumour often appeared at apoint distant from the place of injection. Metastasesalso occurred and autolysate made from a metastasisgave the same results on injection as autolysates fromthe primary growth. More than 2500 mice wereinoculated and malignant disease developed in6 per cent. of them. The success of the inoculationwas seldom obvious before six months had elapsed,more often after 6-12 months, and generally afterabout a year. Primary growths developed in nearlyevery organ, but never in the skin and only once eachin the stomach, the gall-bladder, and the colon. Prof.Heidenhain believes that his experiments have provedthat carcinoma and sarcoma are caused by an agentoutside the body ; it has not yet been possible toascertain its nature. I

Treatment of Traumatic Meningitis.Prof. Nicolai Guleke (Jena) said that 80 per cent.

of cases of fracture of the base of skull prove fatal’from meningitis. Nevertheless he recommended’that operation should not be attempted unlesssymptoms of meningitis develop.. Lumbar or sub-occipital puncture is indicated when the point ofentry of the infection has not been ascertained. Theimprovement following puncture is due not toremoval of the germs, but to reduction of the cerebral’pressure. Puncture is not without danger, as it maycause a local meningitis to become general. Ifpuncture proves insufficient, open drainage of thebrain, combined with laminectomy of the second orthird lumbar vertebra is indicated. The mortality in,325 cases in which operation was performed was only19 per cent.

’

Operation for Pulmonary Embolism.Prof. Gustaf Nyström (TTpsala) reported three cases

of pulmonary embolism treated by the Trendelenburgoperation. One patient lived 30 hours, one five hours,and the third recovered. Prof. Nystrom said that asit is sometimes difficult to remove the embolus, hehad used an aspiration pump. Dr. A. W. Meyer a’(Berlin) recommended digital compression instead of’the compression tube.- Good results were reportedby Dr. Fernstrom (Stockholm), who had had two,cures in four operations, and by Dr. Stegemann-(Dortmund), who said that a patient operated on fouryears ago is still in good health.

Avertin.Dr. Bernhard Martin (Berlin) described his method,

using avertin as an anaesthetic. He advises that an.enema should be given on the preceding day and aninjection of scopolamine and of narcophine one and-a half hours before operation. A lukewarm solutionof avertin is then administered per rectum half an.hour before operation, the dose being 0-125 to 0-5 g.per kg. of body-weight. The method was used for-259 patients, whose ages ranged from 1 to 59 years;: ;:the cases included 104 laparotomies and renal opera-tions. The method proved unsuccessful in 4 per cent-of the cases, in which a small quantity of ether had tobe given as an adjuvant to secure complete anaesthesia..Prof. Seefisch (Berlin) reported 8 per cent. of failuresin 104 cases. He had observed circulatory troubles,_the blood pressure sometimes falling 20 mm., butdeath had never occurred as a result of the anaesthetic.Dr. Keysser (Lichterfelde) drew attention to theexcretion of avertin by the kidneys, which makes- itdesirable in his opinion to administer diuretin.

X Rays in Prostatic Enlargement.Dr. Bolt (Konigsberg) reported 58 cases of prostatic:

enlargement treated by X rays ; 12 of them were in-the first, 13 in the second, and 33 in-the third stage ofthe disease. In nearly half of the cases normal functionof the bladder was obtained without residuary urine.Twenty-four patients were re-examined after two anda half years, and all of them could- pass urine spon-taneously. The method, Dr. Bolt says, should alwaysbe used in the first stage of the disease, and in thesecond and third stages the results are no worse than.those of operation.

1 Two cases reported by Dr. Meyer were mentioned by ourBerlin correspondent last summer (THE LANCET, 1927, ii., 350).—ED. L.

MILD7-qAY MISSION HOSPITAL.—The new wing ofthis hospital in Bethnal Green was opened on Saturday lastby Lady Cooper. The extension includes a new operatingtheatre, X ray, massage, and electrical departments. Thenumber of in-patients has doubled in the last five years andthe accommodation has become quite inadequate. Seventy-five doctors and 120 nurses have gone from the hospitalto undertake missionary work, and 350 women have beengiven a measure of practical training to fit them for tending-the sick both at home and abroad. The chairman of thecouncil paid a warm tribute to the work of Dr. Henry-White, the medical superintendent, and of Miss Woodhouse,the matron..