1346 THE BIOCHEMISTRY OF HONEY.

per cent. under the most favourable conditions. The

magnitude of this error impresses the pathologistin the post-mortem room ; it is only human naturethat it should not carry the same weight withclinicians. The pure statistician-that is to say, onewho has not had a proper medical training-seemsaltogether unable to appreciate its significance. The

general effect of this fallacy is that the recorded

mortality from cancer varies from locality to localityand from country to country with the efficiency ofthe medical service of the community, and thatnowhere does the recorded mortality from cancer

reach the actual incidence of the disease. When wecompare the incidence of cancer in civilised com-munities with that in uncivilised communities another

fallacy arises. Cancer increases in frequency as ageadvances. In order to make a comparison it is

necessary, therefore, to compare persons of corre-

sponding age. It is of the essence of an uncivilisedcommunity that there are no records available whichwould enable such a comparison to be made. All weknow is that in an uncivilised community people dieat an earlier age, so that in such a community thetotal number of cases of cancer, if they were diagnosedwith the same degree of. accuracy as in a civilisedcommunity, must necessarily be less. It is also of theessence of an uncivilised communitv that there is noefficient medical service.

Appreciation of these statistical fallacies does notrequire a deep knowledge of statistics. It comesfrom common-sense deductions following a knowledgeof the clinical and pathological features of the disease.But common-sense and knowledge are conspicuousby their absence in the equipment of the enthusiastswho spin their hypotheses from the statistical dataon cancer. And it is of such stuff that discoveriesare made. We have been assured that cancer is dueto an excessive intake of the growth-promotingvitamins and we have been told that vitamin-starva-tion is an important setiological factor. We are

informed that the negroes of Central Africa are freefrom cancer. The same freedom is said to be enjoyedby the Eskimaux, and an appeal for funds was maderecently by the British Empire Cancer Campaignto send out an expedition to wrest from those cleversavages the great secret. Quite recently the discoveryhas been made that the mortality from cancer ismuch less among the inmates of lunatic asylums thanamong the general population. The obvious explana-tion that a person afflicted with a chronic diseasewhich is undermining his health is more likely to diefrom the direct or indirect effects of that disease thanfrom another unrelated disease does not seem to haveoccurred to the authors of this " discovery.’’ Civilisedmankind, if it is to be saved from cancer, has, there-fore, now the choice either between living like thenatives of Central Africa and the Eskimaux—adifficult combination-or to adopt the mode oflife of the inmates of a lunatic asylum. Themoderation and restraint which the various writers

impose upon themselves are alike admirable, for thesubject teems with other possibilities. Let us considera few. No cases of cancer have ever been reportedfrom cannibal tribes. This suggests that either theingestion of autologous protein confers immunityagainst cancer or that human flesh contains a protec-tive substance, which, when ingested, confers immunity ’llagainst cancer, although it does not protect the indivi-dual itself in whose body it exists. Again, no cancer ’’,has ever been found in the large man-eating carnivora,such as the lion, the tiger, as long as they exist in their normal habitat and have the opportunity of devouring ’Iman. But when they are kept in a zoological garden I

and thus come in contact with civilisation they havebeen known to develop cancer. This lends furthersupport to the view of the existence of a protectivesubstance in human flesh-perhaps a new vitamin.Common-sense might object that the lack of evidenceconcerning the occurrence of cancer among cannibalsand the large man-eating carnivora is due to the

investigators having been eaten. But such an objec-tion may be brushed aside as being due to prejudiceand inability to follow new lines of thought.

That, at any rate, is the kind of argument by whichDr. F. L. HOFFMAN, of New York, a statistician whois not a medical man and who recently has embarkedon a Cancer Survey of San Francisco, disposes of theobjections to the taking of a cancer census whichhave been raised by statisticians who, we must guess,are impeded by having a first-hand knowledge of thepathological and clinical aspects of the disease. Inthe First and Second Quarterly Reports which havejust been issued, he writes as follows : " Dr. Bashford,while Director of the Imperial Cancer Research Fund,was decidedly opposed to the taking of a cancer census.... but Dr. Bashford never fully explained his objec-tions, based unquestionably largely upon prejudice andindifference to the results available." The objectionsof Dr. BASHFORD are very clearly and explicitly setforth in the Second Scientific Report of the ImperialCancer Research Fund, and the decision not to holda census was arrived at by Dr. BASHFORD in conjunc-tion with the Statistical Subcommittee of the Fundwhich counted among its members the most distin-guished medical statisticians available at the time.In addition to the usual kind of statistical datacollected by Dr. HOFFMAN, he has also sent out

questionnaires to every practitioner in San Francisco.It is not stated how many hundreds or perhapsthousands of these forms have been sent out, butthere is a statement how many have been returned- 25. On the basis of these 25 questionnaires, Dr.HOFFMAN writes as follows : " The availablequestionnaires justify some very striking anddefinite conclusions, emphasising the overshadowingimportance of a superabundant meat diet, an excessiveamount of sugar, excessive habits of smoking, andexposure to gas and fumes on the part of men incertain occupations. The questionnaires further

emphasise the practically universal coexistence of

dietary and metabolic disorders, with resulting intes-tinal complaints. The replies also seem to provedefinitely that in many cases there was a coexistent,or a concurrent, rheumatic affection." Has itoccurred to Dr. HOFFMAN that experienced surgeonsmay see a hundred and more cases of cancer in one yearand that so far their clinical experience, extending overthousands of cases of cancer, has failed to establishsuch simple relationships ?

THE BIOCHEMISTRY OF HONEY.

I IN a letter which appears in our correspondence’ columns, Dr. G. N. W. THOMAS calls attention to thevaluable properties of honey in providing a readilyabsorbable food. The properties of this ubiquitoussubstance do not appear to be set out in the usualworks of reference.l The composition of honey isnot only very complex, but differs widely accordingto its source. The water content may vary as much as12 per cent., the average gravity being 1-46 at 15° C.

1 Information is given in—(1) Abderhalden’s Handbuch derbiologischen Arbeitsmethoden ; Nahrungs- und Genussmittel-Untersuchungen, pp. 977 to 1050. (2) Abderhalden’sBiochemisches Handlexikon, vol. ii., p. 179. (3) O. Hänle :Die Chemie des Honigs, Strasbourg, 1892. (4) O. Hänle andA. Scholz : Zeitsch. f. Untersuch. der Nahrungs- u. Genuss-mittel, 1903, vi., 1027.

1347SPLANCHNIC ANALGESIA.-PATENT MEDICINES.

An average of 30 analyses of different specimensgave the following percentage result :-Water...... 17,2 Malic acid...... 0,30Lævulose..... 39-1 Acetic acid .... 0-20Dextrose ...... 34-0 Wax ..... 0-90Dextrin...... 0’45 Proteins ...... 1.80Sucrose ...... 0-40 Mineral salts .... 0-75 5Formic acid.... 1-10 I Undetermined residues 3’80The mineral salts included Ca, Fe, Mg, PO radicles and a

trace of iodine ; among the undetermined residues were resins,gums, pigments, and volatile oils.

Honey is thus seen to consist of a complicatedmixture of carbohydrates, of which monosaccharidesform by far the greater part. Laevulose and dextrose í

present, taken together, exceed a hundredfold thedextrin and sucrose. Owing to the relatively lowwater content, the caloric value of honey is veryhigh ; 1 ounce corresponds to about 100 calories,nearly as much as the same amount of pure cane-sugar. Of the origin of the various constituentslittle is known. The laevulose, and to a certain extentthe dextrose, are derived directly from the nectarand juices of the plant. The origin of the dextrin isstill obscure, although it seems to be one ot the simplerbodies of its kind with the formula (C6H10O5)3, and issaid to be readily absorbed from the alimentary canal.The proteins are derived from the pollen of plants.The wax appears to be a specific product of beemetabolism, and the production of honey and waxvary inversely; as soon as the quantity of waxincreases, the supply of honey begins to fall off.The most important constituent of wax is a palmiticester of myricyl alcohol, C3oH61OH. Other esters,such as those of cerotic acid and various fatty acids,also occur. The percentage of organic acids, suchas malic, acetic, and formic acids, is high and mayamount to as much as 2 per cent. in some specimens.With regard to the vitamin-content, it has beenstated that honey contains both the fat-soluble andwater-soluble principles, and is efficient in warding offdeficiency diseases. Various enzymes, such as inver-tase, are present. The nectar, containing fairly highproportions of sucrose, is digested in the crop of thebee by means of invertases secreted by glands in thehead and thoracic region. This digestion, however, isincomplete in the bee itself, and continues after thehoney has been deposited in the hive.On these findings honey constitutes a valuable food,

since it contains carbohydrates in a form suitable fordirect absorption. The claim is made that honeynever gives rise to fermentation in the alimentarycanal, since the dextrose and laevulose, being mono-saccharides, are absorbed so rapidly that there is notime for bacterial action. This would commend itfor infants and children. The fatty acids may havetheir use in stimulating peristalsis and digestion.Honey, therefore, compares favourably with glucoseB.P., which contains only about 35 per cent. of mono-saccharide in the form of dextrose and lacks thevaluable proteins, fats, and inorganic salts which arepresent in honey. It would appear, therefore, thatDr. THOMAS’S plea for the extended use of honeyhas sound biochemical basis.

THE High Commissioner for Southern Rhodesia,Sir Francis Newton, has recently submitted to theLondon School of Hygiene and Tropical Medicine aproposal which was made originally on the initiative ofthe Medical Director for Southern Rhodesia, Dr.Andrew Fleming. The school authorities have agreedto send out research workers to investigate diseasescommon to Rhodesia and to tropical and subtropicalSouth Africa. The Government of Southern Rhodesiafor its part has undertaken to make a generous con-tribution to the school for the purposes of thisresearch work, and to provide laboratory accommo-dation and equipment. By its recognition of theimmense importance of research into the causes ofthose tropical diseases which now bar the way to thefull development of the highlands of Central and Equa-torial Africa, the Government of Southern Rhodesiahas given a lead to other Colonial Governments.

Annotations.

SPLANCHNIC ANALGESIA.

THE merits of splanchnic analgesia for severe

operations in the upper abdomen were well shown bypapers read before the Section of Anaesthetics of theRoyal Society of Medicine on Dec. 12th by Mr. 0. S.Hillman and Mr. R. F,. Apperly. Following the workof Kappis and of Labat the method has been alreadyfairly extensively employed on the continent, but thepapers referred to are the most notable contributionto the subject as yet brought forward in this. country.The cases on which these papers were founded num-bered 91, and it is noteworthy that they included onlyone fatality from post-operative chest complications.This and operative shock are the chief dangers inextensive operations on the upper abdomen. Shockis also most decisively decreased by blocking thesplanchnic nerves. The method has shown conclusivelythat afferent impulses do pass from the viscera, alongthe nerves in the mesentery, and these impulses areeffectively blocked by splanchnic injection. Comparingtwo series of cases of partial gastrectomy the authorsshowed that without nerve-blocking the mortalitywas 12-9 per cent. but with it only 3-2 per cent.Again, blood transfusion was needed in 14 cases whenthere was no nerve block ; only in two cases when thismethod was employed. The authors are in favour ofa light ether anaesthesia during which injections aremade to block the anterior abdominal field and then theposterior splanchnic areas. The solution employed is1 per cent. novocaine without adrenalin. Generally,25 c.cm. are injected into each splanchnic area. Thepoint of injection is 7 centimetres outside the firstlumbar spine. An important point in the techniqueis to aspirate with the syringe before injecting. If bloodis aspirated, showing that the needle has pierced avessel, no injection is made until the needle has beenreintroduced. The fatal effects of injecting novocaineinto a vein were well shown by experiments relatedby Mr. Stanford Cade in the discussion which followedthe papers. The authors had at first relied entirelyon local injections, preceding these by two injectionsof morphine and scopolamine. They find that betterresults are obtained by using a light ether anaesthesiawhich is preceded only by one injection of morphineand atropine. Post-operative headache and backachehave occurred. It is important to avoid raising theshoulders after the injections have been made. Mr.Gordon Taylor, who had operated on many of the casesreported on, spoke enthusiastically of the merits ofsplanchnic analgesia for severe operations on the upperabdomen. The series included cases in which, in hisopinion, operation could not have been attemptedwithout its aid. ____

PATENT MEDICINES.

Sir Thomas Horder, in an article entitled " SecretRemedies " published in the current issue of theCambridge University Medical Society Magazine, com-ments on the lack of concerted effort since the waron the part of the press to check the evil of quacknostrums. During the ten years just prior to the war,however, a vigorous effort was made by the medicaland the lay press alike to check the abuse, whichhad grown to huge dimensions, of the manufacture,advertisement, and sale of secret remedies. Follow-ing shortly upon this campaign-doubtless in largepart due to it--the House of Commons appointedin 1912 a Select Committee "to consider and inquireinto the question of the sale of patent and proprietarymedicines and appliances, and advertisements relatingthereto, and to report what amendments, if any, inthe law are necessary or desirable." Unfortunately forthe effectiveness of the Committee’s work, this reportwas ordered to be printed on August 4th, 1914,when the greater problem of the quackery of " Kultur"