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than three years would seem necessary, especiallysince the average expectation of life after the onsetof cancer of the breast, when the disease runs its owncourse, is estimated at three and a half years. Bearingthese limitations in mind, the outcome of Dr. LANECLAYPON’S inquiry remains of great interest. Sheconcludes that after the complete operation 50 percent. of patients pass the three-year period, and 33 percent. will be alive at the end of five years. Makingallowances for the natural death-rate of persons atthe cancer age and other corrections, the deduction isarrived at that the mean duration of life from the

"complete" " operation is five years eight months.Now, on the average, patients do not come to operationuntil one year after they are aware of the onset ofthe disease. Hence with the complete operation theexpectation of life is six years eight months, so thatthe result of operation is to prolong life by morethan three years of actual time. If we turn to

patients operated upon in the early and most favour-able stages of the disease, the gain is seen to be muchgreater, for they live on an average ten years longerthan the operated cases. With regard to the use ofX rays and radium as auxiliary measures to surgery,the author declares that practice has not been

sufficiently standardised for data which lend themselvesto statistical inquiry to be available.The whole report is full of interesting facts which

emerge from the inquiry. Thus the belief that cancerin young people follows a more malignant course isshown to be erroneous, and numerous other question-able points which have long been in doubt are settled.The active surgeon must feel gratification in thedemonstration that, though his results in this diseasefall far short of perfection, yet he is the means ofprolonging life for considerable periods and certainlyameliorates the unhappy lot of those unfortunate

women who inevitably fall victims to the late manifes-tations of it. It is clearly brought out also that theprognosis is incomparably better when the patientsapply early for surgical relief. The hope for improve-ment in the future lies in this direction rather than infurther extension of the operation, which seems tohave been pushed to its practical limits.

The Services.CIVIL CONSULTANTS TO THE ROYAL NAVY.THE following Civil Consultants to the Royal Navy have

been recently appointed by the Admiralty:--Sir HumphryD. Rolleston to be Consulting Physician; Mr. ArthurEdmunds to be Consulting Surgeon ; Dr. C. Hubert Bondto be Consultant in Mental and Neurological Diseases.

ROYAL NAVAL MEDICAL SERVICE.

Surg. Comdr. R. H. St. B. E. Hughes is placed on the ’,Retd. List with the rank of Surg. Capt. ’

C. H. Savory (late Tempy. Surg. Lt. R.N.) to be Surg.-Lt.E. J. K. Weeks to be Surg. Lt. ’I

TERRITORIAL ARMY (R.A.M.C.).Col. J. Clay, T.D., K.H.S., resigns his commn. and retains

the rank of Col. with permission to wear the prescribeduniform.

Lt.-Col. J. M. Gover, from R.A.M.C., T.A., to be Col. andAssistant Director of Medical Services, 50th (Northern)Division, T.A., vice Col. J. Clay.

Capt. W. E. Hodgins resigns his commn. on appt. to theR.A.F.

G. H. R. Gibson (late Canadian Army Medical Corps) tobe Capt.

Capt. J. Robertson (late R.A.M.C., S.R.) to be Capt.Surg. Lt. N. Braithwaite (late Royal Navy) to be Lt.D. F. Hocker to be Lt.

ROYAL AIR FORCE.

Flight Lt. E. D. D. Dickson and Flying Officer J. G.Russell are granted permanent commns.

Annotations.

VOLUNTARY BOARDERS IN MENTALHOSPITALS.

" Ne quid nimis."

THE story was told many years ago by a medicalofficer of one of the large mental hospitals in Scotlandthat one day he was standing at the main entrance ofthe hospital in the company of a head attendant whohad grown grey in the service of the institution. Asthey were chatting together and looking down thecarriage drive, a man carrying a portmanteau was seento approach. The head attendant, who was ratherproud of his clinical sagacity, remarked : "Herecomes a new patient, and he must be very bad indeedas he comes by himself." The speaker may haveintended his remarks to have been taken as a sampleof pawky humour, yet they were no doubt in sympathywith current trained opinion and would be echoed bythe ordinary layman at the present time. The averageman would say that a patient must be very insaneindeed if he were of his own free will to seek admissionto a mental hospital. Yet what are the facts ? Everyyear large numbers of voluntary boarders apply for

admission, and there are mental hospitals in Englandand in Scotland where those received in this wayactually exceed in number those that are certified.In England voluntary boarders can be received onlyin registered hospitals and licensed houses. BethlemRoyal Hospital and Holloway Sanatorium are examplesof the former, and " licensed house " is but anothername for " private asylum." The large mentalhospitals managed by committees of county councilsor county borough councils are not permitted by lawto admit voluntary patients. It is pleasant, however,to be able to record that there are two exceptions tothis statement. A special Act of Parliament empowersthe Maudsley Hospital, which was built by thegenerosity of the late Dr. Henry Maudsley and isunder the control of the London County Council, toreceive voluntary boarders only. Just recently theRoyal Assent has been given to the City of London(Various Powers) Act, 1924, under which voluntaryboarders can be received at the City of London MentalHospital, Dartford. By the same statute the words" mental hospital " replace the word " asylum " inthe official title of the institution.

SUBOCCIPITAL PUNCTURE IN MENINGITIS.IN a recent number of the Münchener Medizinische

Wochenschrift Dr. Adolf Hartwich, assistant in theMedical Clinic of Halle University, reviews the litera-ture and records his experience of suboccipitalpuncture for removal of fluid from the cisternamagna in meningitis. Apart from 81 occasions onwhich he has employed the method for diagnosis hehas recently used suboccipital puncture with successin two cases of cerebro-spinal fever. The first patientwas a girl, aged 12, in whom suboccipital puncturewas performed 13 times in the course of 25 days,20 c.cm. of anti-meningococcus serum being injectedon each occasion after removal of 30 c.cm. of cerebro-spinal fluid. The injections were well borne, althoughthe patient complained of headache regularly aftereach injection. Recovery took place in five weeks.On several occasions lumbar and suboccipital punc-tures were carried out at the same t:me, and com-parative observations were made of the globulinreactions, the cellular content, and the pressure ofthe column of cerebro-spinal fluid. Except c n

one occasion more cells were found in the fluidremoved by lumbar than by suboccipital puncture.The globulin reactions were the same in both fluid?.The pressure of the cerebro-spinal fluid was, as arule, higher on suboccipital than on lumbar puncture.In the second case, which occurred in a man aged 22,suboccipital puncture was performed 11 t.mes inthe course of three weeks and anti-meningococcusserum, the exact amount of which is not stated, was

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injected. Lumbar puncture in this case was verydifficult owing to the narrow space between thevertebræ, and only a few c.cm. of turbid fluid couldbe obtained by aspiration, whereas 20-30 c.cm. werereadily withdrawn by suboccipital puncture. Com-parative examinations of the fluids obtained bysuboccipital and lumbar punctures were made withsimilar results to those in the first case. Recoverytook place in six weeks. No bad effects from sub-occipital puncture, nor failures such as " dry taps," ormixture of blood with the cerebro-spinal fluid, wereobserved in either case. Dr. Hartwich claims thatsuboccipital puncture causes less discomfort to thepatient and is more easily carried out than lumbarpuncture. It is of special value in cases in whichlumbar puncture yields no result owing to the forma-tion of fibrin clots during the acute stage or ofadhesions during the stage of recovery. He alsopoints out that owing to the necessity for repeatedpunctures, both in meningococcic and tuberculousmeningitis, it is important to have more than one sitefor puncture at one’s disposal. Moreover, in otogenicor other local variety of meningitis suboccipital

’

puncture may prevent further spread of infection.

PHOSPHORESCENCE OF FISH AND MEAT.

A SERVICE correspondent wnres i,nat ne was

consulted recently about a smoked haddock brought toconsulted recently about a smoked haddock brought tohim because it was luminous in the dark. Was it fitto eat ? Although the streak of luminosity was quitedefinite there was no unpleasant smell, and as therewas nothing else immediately available for breakfast,our correspondent passed it as sound. When cookedthe luminosity had completely disappeared and thefood gave rise to no unpleasant symptoms. Thephenomenon of light production in dead tissues is

very interesting; it appears to be due almostexclusively to the presence of photogenic bacteria, a’fact which was recognised by Pnuger as long agoas 1875. The first isolation of one of these formsin pure culture was made by Fischer, who describedits properties in 1887. Since then there has been alarge amount of rather spasmodic and unconnectedwork expended on these curious species and a goodmany facts concerning them have become known.In nature they are generally found upon marineproducts, although also seen occasionally uponbutchers’ meat. They are also found invadingcrustacea and small marine metazoa in which theycause the phenomenon of phosphorescence and, notimprobably, lead a symbiotic existence ; they alsoappear to be the cause of the phosphorescence some-times seen at sea. Photo-bacteria are widely distri-buted over the world’s surface and have been foundin India, Europe, and Australia. On at least twooccasions human subjects have been described as

giving off luminous sweat, and it is probable thatthere has been an invasion of the crypts of thesebaceous and sweat glands by photogenic organisms,pursuing a saprophytic existence on the surface ofthe body. Phosphorescence of consumable articlesdoes not indicate unfitness for human food. Most ofthe known species flourish at low temperatures andcan live and produce their specific effect at thetemperatures employed for the storage of fish andmeat at which ordinary putrefactive bacteria are notactive. It is stated, indeed, that these organismsperish when active decomposition takes place in thematerial upon which they are living. They are readilyculturable upon ordinary media, and experimentalinoculation of animals has proved them to be non-pathogenic. In his monographl on the Nature ofAnimal Light, Prof. E. N. Harvey, of Princeton,mentions some ways in which luminous bacteria havebeen made of service to man. Beijerlnck has usedthem for testing the permeability of bacterial filters ;Dubois and Molisch have suggested them as an

illuminant in powder magazines where any sort of

1 Monographs on Experimental Biology. Edited by Loeb,Morgan, and Osterhout. J. B. Lippincott Company.

flame would be dangerous. It is certainly possiblein emergency to read the time in the dark by the lightof a glow-worm, but so far, at any rate, low tempera-ture illumination by living things has not been

exploited to any great extent.

THE LIMITATION OF HARMFUL DRUGS.

IN view of the forthcoming Second InternationalConference on Opium, which has been summoned inGeneva for Nov. 17th to consider the best means ofsuppressing the abuse of morphine, cocaine, and otherdangerous drugs, there is a special interest in a recentreport of the International Institute of Agriculture inRome on the question of the substitution of othercrops for the opium poppy and the coca leaf. Thisreport is the result of an investigation undertaken bythe institute at the request of the League of Nations,and deals with an important side of the problem.It will be the work of the November conference todraw up a convention limiting the world’s productionand manufacture of harmful drugs to the world’smedical and scientific needs. Undoubtedly the mostdifficult problem facing the conference is that of thelimitation of production, since the largest of thegreat opium-producing countries—namely, China-has very little control over its own people, and theopium poppy is so valuable a crop. It has been foundthat the coca plant, from which cocaine is derived,could be replaced by the cinchona tree, the tea plant,the coffee tree, and the rubber tree : but whereas anarea planted with coca will yield £146, the same areaplanted with cinchona produces 134, with tea 98,with coffee jB80, and with rubber only £49. Further-more, land suitable for coca cultivation is not alwaysentirely suitable for cinchona cultivation. As regardsthe opium poppy, statistics are less reliable, owing tothe varying contents of morphine in the opium grownin different countries. It is also a very valuable crop,and none of the plants which have so far been suggestedfor substitution would be as profitable. The best

substitutes involving the least financial loss are

plants producing valuable essential oils such as thecitronella, geranium., rosa, and perilla (lemon grass).In the meantime, the League’s Advisory OpiumCommittee has succeeded in drawing up certainconcrete proposals, which are to serve as a basis for thediscussions of the November conference, and whichhave now been circulated to all the States taking partin it, including non-members of the League. Amongstother suggestions, it is proposed that each countrybecoming a party to the convention should furnishevery year an estimate of the raw material andmanufactured drugs which it would require during theyear and undertake further not to import more thanwas specified in its yearly estimates. These estimates,together with other statistics, would be sent to acentral board, which would thus be in a position tofollow the course of the international traffic, and see toit that the exports or imports into any country did notexceed the original estimates furnished by thatcountry. A number of important provisions designedto strengthen the existing Hague Convention of 1912will also be considered by the conference. The systemof import and export Government licences institutedby the League, and already enforced by many Govern-ments, whereby an export licence is only issued by theGovernment of the exporting country on the produc-tion of a certificate from the Government of theimporting country, will be further extended. Pro-visions are also proposed to ensure that drugs whichare brought into free ports do not escape control, andspecial arrangements are suggested for safeguardingthe " entrepot " trade as carried on by means ofbonded warehouses. Other proposals are that thecoca leaf shall be brought within the Hague Conventionand that the definition of cocaine shall also include theartificial product obtained by chemical synthesis.

Finally, the Advisory Committee has appended tworecommendations for the consideration of Govern-ments. The first of these is based on a provision inBritish law, which has been found extremely useful in