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lethal cancers. This suggests that the content of non-progres-sive lesions, as stage-1 cancers, is the most potent factordistorting survival-rates and suggests also that the varyinginclusion of such lesions accounts for most of the differencebetween survival-rates of untreated and treated cases as wellas between the rates of treated cases.

These points are fully consistent with evidence pre-viously reviewed ; fully compatible, too, with the findingsofMurleyet a1. that all different treatments gave the samesurvival-rates,3 and also with the findings of Small andDutton that some patients with treated breast cancer dieat normal rates and others die at increased rates, that"mortality in cancers is a constant process, little affectedby treatment" and that " it is doubtful if many more

persons are cured by radical mastectomy than by otherforms of treatment." s The deductions or suggestionshere really go little beyond what is already well recognisedand is implicit in all the efforts that are being made tofind a sounder basis for prognosis than microscopyprovides.

N. E. MCKINNON.

Department of Epidemiologyand Biometrics,

School of Hygiene,University of Toronto.

5. J. Amer. med. Ass. 1955, 157, 216.

ObituaryHUGH ALLAN MACEWEN

O.B.E., M.B. Glasg., D.P.H., F.R.S.E.Dr. Hugh Macewen, a former senior medical officer

of the Ministry of Health, died at his home at Indian,Argyllshire, on April 1’7.He was a son of Sir William Macewen, professor of

surgery in Glasgow University. He entered the sameuniversity and graduated M.B. in 1905. lie early decided

to specialise in public health,taking the D.P.H. of Can1.-

bridge and of the Londonconjoint board in the follow-ing year. He gained experi-ence as assistant M.O.H. ofCumberland and M.o.H. ofFife and Kinross, and latervisited the United States,where he was lecturer on

hygiene at Cooper MedicalCollege, San Francisco. Tothis period belong his excellentmanual on Food Inspection,his account of The Pttbliclllilk Supply, and his investi-gations into conveyance ofwhooping-cough from man toanimals by direct exreriment.When Macewen was appoin-

ted a medical inspector ofthe Local Government Board, Sir Arthur Newsholme,then the medical officer of the board, lost no time inemploying him in important investigations. He workedat first in the foods branch, and then chiefly directedhis attention to epidemiology. His Report on the Pre-valence of Poliomyelitis in Certain Districts of Lancash’ireand lt’estniorland (1914) confirmed the views of Wickman,Reece, and others that the disease was spread by contactinfection.

During the first world war Macewen acted as one of theliaison officers between the War Oi’fice and the board inthe inspection of military camps and hospitals in Englandand Wales, and he was appointed O.B.E. for his services.He became a medical officer of the Ministry of Healthin 1919. From then onwards he was chiefly employedin medical administrative work at headquarters. Hisimmediate chief was Colonel R. J. Reece, the epidemio-logist, for whom he had a warm friendship. Macewen’sabilities soon marked him out for promotion, and a fewyears after the establishment of the Ministry he becamesenior medical oincer of the branch of sanitary administra-tion in relation to infectious disease. With the passingof the Local Government Act in 1929, the Ministrybecame concerned with the new municipal hospitals and

fEltiott &- Fry

their efficiency, and Macewen was appointed the seniormedical officer of the branch which dealt with public-health surveys, hospitals, and public-assistance medicalservices. This work he directed with his usual thorough-ness and success. He was in charge of the special investiga-tion into maternal mortality which was published asa white-paper by the Ministry of Health in 1937. Inthis inquiry his wife, Dr. Barbara Cunningham, o.B.E.,took an important share. In the early years of thesecond world war he was in charge of the regional medicalorganisation, and it was once said that even the evacua-tion scheme for expectant mothers could not removethe smile from his face.

In 1941 Macewen retired from the Ministry but notfrom medical practice. He became medical superin-tendent of Ballochmyle Hospital in Ayrshire and actedfor a time as M.o.H. of Ulverston rural and urban districtin North Lancashire.As a senior medical officer at the Ministry in the

’twenties and ’thirties he came into close contact withthe medical officers of the large local authorities, and asthe years went by he came to be more and more trustedby them. Many became his personal friends, and oneof them, W. M. F., writes : " Macewen showed hisdevotion to the cause of public health in everything heundertook. Despite the clinical atmosphere in which hewas brought up, as the son of Sir William Macewen,he was convinced of the supreme importance of preven-tive medicine. Before he began his long and successfulcareer at the Local Government Board and at theMinistry of Health, he was a medical officer of health and,after his retirement, he became-temporarily-a medicalofficer of health again. To him and his colleagues at theMinistry we owe the rapid development of the personalhealth and hospital services during the twenty-onevears between the first and second world wars. Hepossessed to an unusual degree the characteristic ofselflessness. Though he rose to a senior position at theMinistry, it was impossible to detect in him any signs ofoverweening ambition. Incapable of jealousy for himself,he was jealous of the reputation of the English public-health service."

A. S. MacN. writes : " Hugh Macewen was a manwhose life and work were dominated by high ideals,and his sense of duty and devotion to the public wealnever wavered. He was serious in disposition, excepton social occasions when he would unbend and reveala sense of humour. He retained his Scottish accent,was outspoken in his beliefs, and, while just and con-siderate to his medical officers, demanded and obtainedthe best from them. Much of his valuable work for theLocal Government Board and the Ministry of Health isto be found in official files, reports, and blue-books, and inall he did he worthily maintained the high standards andtraditions of the central health department."A colleague at the Ministry of Health writes: " Around

1930, a number of medical officers entering the Ministrywere lucky in having Hugh Macewen for their chief andmentor. The formidable exterior soon revealed beneathit a real kindness, a devotion to duty, and a passionfor accuracy which would never tolerate slapdash work.’Verify your references ’-in the widest sense-mighthave been his watchword. The department lost some-thing of the old traditions and standards of the LocalGovernment Board when he left, though he was able todo excellent work in Scotland both during and afterthe war. He finished a fine life beside his beloved Clyde."

HORACE BRYDEN HILLM.B. Lond., M.R.C.P.

Dr. Horace Hill, medical superintendent of LaverstockHouse, Salisbury, who died on April 25 at the age of 76,was a man of considerable versatility.

After qualifying from St. Bartholomew’s Hospital in1904 he held house-appointments at Barts and atHuntingdon County Hospital. In 1907 he took theM.B. Lond., and about this time he joined the RoyalNavy and became a member of the staff of the RoyalNaval Hospital at Haslar. He had always been anall-round athlete : an international hockey-player, anda member of the United Services cricket xi, he alsotook a keen interest in boxing and played water-polo.This background led to his appointment to the staff ofthe Naval school for physical training at Portsmouth, and

1030

later he became instructor in physical training at theRoyal Naval College, Osborne. In 1911 he took theM.B.C.P.

During the 1914-18 war he served as a medical officerin H.M.S. Highflyer. He was made knight in the Orderof St. John of Jerusalem for his reorganisation of thetraining and service conditions of the Royal NavalAuxiliary Sick Berth Staff Reserve. He also collaboratedwith Naval officers in an investigation of the best methodof applying discipline in the Royal Navy. He was madea chevalier of the Order of the Crown of Italy for hiswork in the Messina earthquake.

After the war he left the Navy and settled in practicein Harley Street, joining the staff of the Royal ChestHospital, City Road. He was a vice-president of theMedical Defence Union. In 1930 he published a hand-book for students on Electrocardiography. In 1936 hebecame medical superintendent at Laverstock House.His later publications reflected his responsibilities andinterests in this new appointment. In his brochure in thePublic Attitude towards Mental Disease (1939) he pointedout how desirable it was that relatives should not delayin seeking early treatment for a patient. He also pub-lished a useful little book on safeguards in certifyingthose of unsound mind, and a more formal treatise onHistamine and Insulin Treatment of Schizophrenia (1940).He was no mean painter, and some of his paintings

hang in the Royal Fowey Yacht Club where he used tospend much of his leisure. His widow survives him.

DAVID WINN HOODLESS

O.B.E., B.Sc. Lond., L.M.S.S.A.WHEN Dr. Hoodless was appointed the first principal

of the Central Medical School in Fiji in 1929, he wasalready known, loved, and respected in the Pacific,for he had spent almost twenty years in the Colonyas a schoolmaster and later as its director of education.Though his father was an engineer Hoodless came

of farming stock. He was born in 1887 in a small villagein Nottinghamshire, and was educated at Sheffieldand at King’s College, London, where he gained a goldmedal for mathematics, graduating B.sc. with honoursin 1910. His first post as a teacher was in the trainingship H.M.S. Worcester, where he specialised in mathe-matics and navigation. Two years later he went to Fijias headmaster of a school for native boys, and laterof the Queen Victoria School at Suva. Through hiswork he came into close contact with the Fijian people,and his wish to serve them turned his thoughts to medi-cine. In 1919 he came to England for two years tostudy at Charing Cross Hospital. In 1921 he returned tothe Pacific as inspector of schools in Fiji, and the follow-ing year he was appointed director of education. Duringthe five years that he held this post he establishedfive new provincial schools to serve the Indian as wellas the Fijian communities and started a scheme forrecruiting teachers from New Zealand. Such was hisdetermination that he returned to England in 1928 tocontinue his medical studies, but illness prevented himfrom taking his finals in 1929. Despite his lack of formalmedical qualifications he was wisely appointed the firstprincipal of the Central Medical School. When hequalified in 1935 he also took the diploma of tropicalmedicine.

Hoodless did his task in Fiji so well that he was sentto inspect medical schools in Africa, but when the warbroke out in 1939 he was recalled as he was indispensableto the Fijian government. On his retirement in 1947 hewas appointed o.B.E. He was an associate of King’sCollege. In 1953 he became correspondent to The Timesin Fiji.

P. M-B. writes : " The name of Hoodless was one toconjure with in the Pacific. He probably did more formedicine and education in Fiji than almost any otherman. He was the moving force behind the CentralMedical School for Polynesians in Suva, and it musthave been a great satisfaction to him when two yearsago the Queen opened the fine hostel for Polynesiansand the ancillary teaching blocks at the school. Aneven greater satisfaction to him was the renown whichthe graduates of his school won from so many quartersduring the late war. Many of the Allies, mostly theAmericans, were amazed at the knowledge and efficiency

shown on many a lonely Pacific atoll by the Polynesiandoctors who had been educated in Suva. It was thegreatest compliment to him that the American govern-ment for the island of Guam and the New Guineagovernment sent their quota of medical students to Suva.Throughout the myriad islands of the Pacific he will bemourned as the guide, philosopher, and friend of thePolynesians, for he not only taught but guided andadvised them as the ideal leader of their youth."

Dr. Hoodless married in 1923 Miss Hilda Adlington, andthere is a daughter of the marriage. He was on holidayin this country with his wife when he was taken ill inCambridge. He died on April 15.

Dr. EGBERT MORLAND

. S. T. writes : a Egbert Morland was a connoisseur of" obits." Not for him the list of dates and appointmentsculled from the reference books. Every obit. must standon its own merits. To write dully about the dull was asin against the craft of journalism. The ethic of happycuriosity, which he professed, made him certain that nolife could be so barren as to yield nothing of interest;and it was the thing of interest alone which was worthrecording. But a good obit. must not only interest; itmust entertain, amuse, or edify. It must tell the truthwithout unduly offending the relatives. It must pleasefriends and pacify enemies. It must follow no logicalpattern, but must blend fact and interpretation into awhole, having an artistic integrity of its own. And if,on reading it, our eyes are filled with that divine mixtureof laughter and tears, then it may be said to havesucceeded.

Egbert’s attitude to obits followed from his rationalChristian view of death. Dying might be very unpleasant.but death was a brief moment of transition only and thegateway to another " awfully big adventure." He saw noreason to doubt the spiritual validity of Christ’s promise ofimmortality. So when those we know or love come todie, selfish sorrow at our loss should deliberately bereplaced by joy at their good fortune. For Egbert, theconventional condolences and the trappings-of mortalitywere a source of endless delight and amusement.

I think Egbert was a Benthamite, a pragmatic utili-tarian, to whom happiness was very important indeed.He wanted everybody to be happy, and saw no reasonwhy he should not begin with himself.

Despite an occasional witticism at the expense ofreformers, he was a reformer himself. He was seekingever to make the world happier, wiser, and more amusing.He was not always sure of the precise course to follow,but he turned this multivalence to positive advantage.He would back people rather than plans. Having pickedhis men or women, he would test them and try themwith every devious tortuosity he could devise. If theystill came up smiling, or at least came up, he wouldgive them their head. At times, indeed, his trust wasalmost alarming. So we of his staff were able to becomeonce again " those sharp Lancet fellows " who had foughtthe good fight a hundred years before.

Arrogance as a cloak for ignorance he would nottolerate. Indeed the puncture of pomposity was a

favourite occupation. There was no subject on which hewas ashamed to confess that he did not know, and heexpected a like humility in others. He had no patiencewith the establishment of a committee as an excuse forinaction, and his gentle ruthlessness was often an

unpleasant surprise to the " No " men of his day.It would be incorrect to say that the truth was not

in him. But sometimes it took a lot of finding. " Alwaysremember," he told me, " that in journalism interest ismore important than accuracy." He held the view thatthe only purpose of writing was to be read. If this failed,then the whole thing became a sterile intellectual exercise.For the same reason, he loved the stimulating or provo-cative headline, the carminative which tempted the lazyappetite into operation. The right place for the purelydescriptive heading was the abstracting journal.

Egbert’s insight into his tortuosity was complete." Whether I have continued to edit The Lancet or becomean inmate of Brixton has rested upon a knife-edge.A single tiny genetic alteration and the coin might havecome down the other way.... I hope I am enough ofa knave not to be a fool."

1031

As the years rolled by, his obliquities became moreoblique and the knight’s moves of his mind took on anever more fanciful pattern. " I cannot solve your

problems, my dear fellow ; at best, and even this isimprobable, I may perhaps enable you to solve themfor yourself." We were talking under a mighty tree inan Aylesbury garden, and I left him with none of myconflicts resolved. Yet over the months they meltedaway, as perhaps he intended they should. Years before,when I had been tortured by doubts, he had joyouslyput me on the right road ; when he finally saw, he sawwith great clarity.Dear Egbert... to have worked for you and with

you was a joy which time dims not at all. To skip andpicnic again with you and Mary in the Elysian Fieldsbeyond the Chilterns robs death of its last remainingsting.E. M. C. writes : Your obituary notice of Dr. Morland

gives a vivid picture of his many-sidedness. I knew himfor many years, but he still had a few surprises up hissleeve, and of course lots for the unwary who thoughthim merely eccentric or affected. We once had thegreat joy of a holiday shared with him, his wife andfamily, and several young relatives. Led by him, theyounger end of the party set off over the Gross Glocknerpass to spend the night in the hut and go on to see thesunrise. By then we were well acclimatised to the sun,but I had had little experience of summer sun off thesnow, and by the evening my face was a mess withsunburn. Next day, after one look at it, Egbert saidquietly,

" You and I are going to walk home by thevalley, and leave the young ones to go over the top."This was a great disappointment, but I couldn’t questionhis judgment for I knew he was right. What I did notknow was what a treat was in store, for his knowledgeof Alpines was encyclopaedic. I shall never forget thatwalk, taking it easy and stopping to look at first one andthen the next little masterpiece, held out for me to seeor just lifted up from the edge of the snow. He felta little guilty not to have warned me about the sun theday before, but, characteristically, it was the plants withwhich he was tender.

AppointmentsANNELS, E. H., M.B. Lpool, D.P.H.: deputy county M.O., Flintshire.KOHN, JOACHIM, Med. Dipl. Lwow. D.C.P.: consultant in pathology,

Queen Mary’s Hospital, Roehampton.MOYNAGH, D. W., M.c’.. M.B. Lond., D.P.M.: whole-time senior asst.

psychiatrist, Mapperley Hospital, Nottingham.RALPH, L. L., M.B. Sheff.. D.M.R.D. : part-time consultant radiologist,

Chesterfield and Mansfield groups of hospitals.SALFIELD, D. J., as.D. Dusseldorf. D.P.M.: whole-time children’s

psychiatrist, Derbyshire county council.North East Metropolitan Regional Hospital Board:ARNOTT, D. C., M.B. Lond.. D. PHYS. MED., D.C.H.: part-time

consultant physician in physical medicine, Queen Mary’sHospital for the East End and St. liarr’s Hospital, Plaistow.

FOXELL, A. W. H., M.B. Lond. : consultant pathologist, grouplaboratory, Mile End Hospital.

GRUNBERGER, GEORGE, M.D. Basle, D.L.O.: part-time consultantE.N.T. surgeon. Queen Mary’s Hospital for the East End.

PAUL, RICHARD, M.B. Lpool, D.Ni.it.1). : part-time consultantradiologist, St. Leonard’s Hospital.

Appointed Factory Doctors:EusHES. F. G., M.B. N.U.1l.: Tuxford, Nottingham.MCCALLUM, E. L. R., M.D. Toronto : Richmond, York.Rtyys-D,,,viEs, N. t’., M.R.C.S.: Milborne Port, Somerset.WADE, 0. T., M.H.C.S.: ltadcliffe, Nottingham.WILSON, A. H. L., M.B. Glasg. : New Abbey, Kirkcudbright.

Colonial Appointments:BUTLER, G. C., M.B. N.u.i.. D.P.H.: senior M.o.,.sleeping-sickness

service, northern region, Nigeria.CHAMBERS, H. D., M.D. Aberd. : senior M.o., Jamaica.CURRIE, J. R., M.R.O.S.: pathologist, Sierra Leone.FRANKS, P. 1., M.R.c.s., D.o.M.s. : specialist officer (ophthalmo-

logist). Federation of Malaya.FUNG, 0. C., M.B. Lond., F.n.c.s. : M.o. (grade B), Trinidad.JONES, D. J., M.B. Wales: M.o., Federation of Nigeria.RITCHIE, JEAN K., B.M. Oxtd, M.R.C.P., D.M.R.T.: radiologist,

Singapore.SCHEURER, W., M.D. : M.O.. Gold Coast.THOMAS, M.O., L.R.C.P.i. : M.o., Sierra, Leone.

Births, Marriages, and DeathsDEATHS

ANNAND.—On May 6, at 7, St. Andrew’s Road, Coventry, WilliamFruer Annand, M.D. Lond., aged 75.

Diary of the Week

MAY 15 TO 21Monday, 16thUNIVERSITY COLLEGE, Gower Street, W.C.1

4.45 P.M. Prof. E. L. Smith (Utah) : Mode of Action of Proteo-lytic Enzymes. (Second of three lectures.)

UNIVERSITY OF ST. ANDREWS, Queen’s College, Dundee.5 P.M. Dr. R. Heim de Balsac (Paris) : Vascular Factor in{the

Radiology of the Lung-fields.

Tuesday, 17thUNIVERSITY COLLEGE

5.15 P.M. Dr. J. D. N. Nabarro: Adrenal Cortex and RenalFunction. (Cushny lecture.)

ROYAL SOCIETY OF MEDICINE3.30 P.M. (London School of Hygiene and Tropical Medicine,

Keppel Street, W.C.I.) Epidemiology and PreventiveMedicine. Meeting to celebrate centenary of publicationof Snow’s work on cholera.

4.30 P.M. (1, Wimpole Street, W.1.) Proctology. Mr. HaroldEdwards; Dr. E. N. C. McAmmond (Vancouver), Dr.Raymond W. McNealy (Chicago), Mr. Stanley Aylett:

_

Diverticulitis of the Colon.WRIGHT-FLEMING INSTITUTE OF MICROBIOLOGY, St. Mary’s Hospital

Medical School, Paddington, W.25 P.M. Mr. A. T. R. Mattick, PH.D. : Lactobacilli and some

Streptococci.INSTITUTE OF DERMATOLOGY, St. John’s Hospital, Lisle Street,W.C.2

.

5.30 P.M. Dr. S. C. Gold : Drug Eruptions.

Wednesday, 18thPOSTGRADUATE MEDICAL SCHOOL OF LONDON, Ducane Road, W.12

2 P.M. Prof. G. Payling Wright : General Pathology of Tubercu-losis. (Last of three lectures.)

ROYAL SOCIETY OF MEDICINE8.30 P.M. General Practice. Lady Barnett, M.B. : T.V. and the

General Public. ’

INSTITUTE OF DERMATOLOGY

5.30 P.M. Dr. J. 0. Oliver : Prevention of Hospital Infection.SOUTH WEST LONDON MEDICAL SOCIETY

8.30 P.M. (Bolingbroke Hospital, Wandsworth Common, S.W.ll.)Mr. A. Dickson Wright : Varicose Veins. (Bolingbrokelecture.)

HYPNOTHERAPY GROUP8 P.M. (1, Wimpole Street, W.I.) Dr. A. Fry, Dr. N. S. Sherrard,

Dr. R. M. Harrison, Dr. R. B. L. Ridge : Hypnotherapyin General Practice.

Thursday, 19thROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields,

W.C.25 P.M. Mr. H. R. S. Harley : Subphrenic Abscess.

POSTGRADUATE MEDICAL SCHOOL OF LONDON4 P.M. Dr. C. M. Fletcher : Atmospheric Pollution and Disease.

UNIVERSITY COLLEGE4.45 P.M. Professor Smith: Mode of Action of Proteolytic

Enzymes. (Last of three lectures.)BRITISH INSTITUTE OF RADIOLOGY, 32, Welbeek Street, W.l

8.30 P.M. Mr. J. A. C. Fleming : Position and Scientific Rôle ofthe Institute. (Presidential address.)

ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 26, PortlandPlace, W.I

7.30 P.M. Prof. A. Corradetti : Studies on Comparative Pathologyand Immunology in Mammal and Bird PlasmodiumInfections.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY8.30 P.M. (Royal College of Physicians, Pall’Mall East, S.W.I.)

Sir Charles Dodds, F.R.S.: Renaissance of Treatment.(Cavendish lecture.)

HONYMAN GILLESPIE LECTURES5 P.M. (University New Buildings, Teviot Place, Edinburgh, 8.)

Dr. J. H. Wright: Unilateral Renal Hypertension.UNIVERSITY OF ST. ANDREWS, Medical School, Small’s Wynd,

Dundee5 P.M. Prof. Alan Kekwick : Obesity.

-Friday, 20thUNIVERSITY OF LONDON

5 P.M. (St. Thomas’s Hospital Medical School, S.E.I.) Prof. V.F,rspamer (Bari): Biological Significance of 5-hydroxy-tryptamine and Related Substances.

POSTGRADUATE MEDICAL SCHOOL OF LONDON2 P.M. Mr. A. L. d’Abrcu : Surgery of Congenital Heart-disease.4 P.M. Dr. Ian Douglas-Wilson : Words without End.

UNIVERSITY COLLEGE5.15 P.M. Dr. Harry Harris : Genetic Aspects of Tubular Function.

(C,Llsliiiy lecture.)ST. MARY’S HOSPITAL MEDICAL SCHOOL, W.2

5 P.M. Dr. F. S. W. Brimblecombe : Lactation and Breast-feeding.FACULTY OF RADIOLOGISTS, 45, Lincoln’s Inn Fields, W.C.2

4.30 P.M. Dr. S. Whately Davidson : Anomalies of the RespiratorySystem, (Skinner lecture.)

.

OSLER CLUB ’ ;8 P.M. (Royal Army Medical College, Millbank, S.W.I.) Sir

Gordon Gordon-Taylor : Reminiscences of Some Famous. Surgeons of the 1914-18 War.UNIVERSITY OF ST. ANDREWS, Queen’s College, Dundee .

2.30 P.M. Dr. J. H. Wright, Dr. R. W. D. Turner, Prof. RobertWalmsley, Dr. K. G. Lowe : Pulmonary Stenosis as anIsolated Lesion and with associated Atrial Septal DefeQt(Fallows trilogy).

’ ,