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that was not fully debated at that earlier meeting.At another session James Ewing (New York) discussedproblems in histological tumour diagnosis in an

informative paper. He advocated the wider adop-tion of tumour registries such as already obtain inthe United States. The examination of tumours byaspiration biopsy, using an eighteen gauge needleon a strong suction syringe and staining the resultingplug of tumour cells on a glass slide after fixation, is,in Ewing’s opinion, a method that might be morefrequently used in the interests of rapid diagnosisand the welfare of the patient. He also pronouncedthe opinion that specialised tumour pathologists arenow required to deal with the vast field of tumourmorphology. Such pathologists should work in closecontact with the radiologists in order that they mayfollow the stages in treatment and accurately gaugedifferent grades of malignancy and also degrees ofradiosensitivity of tumours.The carcinogenic potentialities of solar radiations

and steps in the chemical mechanism by which suchcancers are produced were discussed by A. H. Roffo(Buenos Aires). In particular the part played bycholesterol and its acquisition of radio-active pro-perties were stressed both by this worker and byF. Vies (Strasbourg) and A. de Coulon (Lausanne),the latter workers pointing out, however, that thishypothesis had not yet been experimentally demon-strated and that other possibilities, more intimatelyconnected with the ultra-violet component of luminoussources, must also be considered in such investiga-tions.

X Ray and Radium TherapyAn important section of the congress was devoted

to the discussion of X ray and radium therapy. Areview of the progress achieved in X ray work sincethe Madrid Congress in 1933 was presented byF. Carter Wood (New York). The necessity of scien-tific precision in applying this type of therapeuticagent should need no emphasis but has not yet beenwidely enough recognised; the use of drosophilaeggs and, in some laboratories, the eggs of other

species of fly, as biological indicators representsa step forward in this direction. Carter Wooddiscussed low and high voltage radiation, and sug-gested that the construction of more 1,000,000 voltapparatus was unwise until evidence had beenobtained that the very great cost involved waswarranted. He advocated the Regaud-Coutardtechnique, and emphasised the importance of adheringstrictly to the author’s method if this form of therapyis adopted and the avoidance of so-called " modifica-tions " of the technique. He expressed the opinionthat this method of treatment when employed withvery short wave-lengths will unquestionably enableus to attack types of neoplasms which have nothitherto benefited.The dangers of indiscriminate and uncontrolled

drinking of radio-active mineral waters was pointedout by B. Rajeswky (Frankfurt a.M.), who demon-strated, in two human subjects, the accumulationof considerable quantities of radium in the organsand more particularly in the vertebrae and long bones.The part played by hormones in the productionof tumours was discussed at several sessions. A.Lacassagne (Paris), a pioneer in this branch of cancerresearch, described the comparative effects of cestrone,equiline, and equilenine in producing adenocarcinomain mice of the Girard strain. He found that similareffects were produced in all groups, but with equilineand equilenine a longer period of time was neededto achieve the same effect as that produced byoestrone. He has also confirmed the observation

made by W. Cramer and E. S. Horning in this

country of the production of hypophyseal tumourscontaining an excess of chromophobe cells in micetreated with these substances.

In retrospect two main impressions emerge fromthe papers read at this important congress. As regardstreatment, much hope must be attached to futuredevelopments in X ray therapy; with growth inknowledge concerning the application, combined withscientific standardisation of the dosage, this mode ofattack appears to carry the greatest promise. Inthe laboratory the present recognition of a greatvariety of carcinogenic agents of an extrinsic characterseems to mark a definite stage in research, and thefeeling is widespread that efforts must now be directedtowards the discovery of some more fundamentalintrinsic factor or factors which may determine thedevelopment of cancer in the presence of one of theseknown extrinsic agents.

ABERDEEN ROYAL INFIRMARY

ON Sept. 23rd the Duke of York opened the splendidnew buildings of the Royal Infirmary, Aberdeen.This venerable hospital dates back two hundred years.The old infirmary buildings, originally built on theoutskirts of the city, are now in a congested site inits centre. The buildings have been altered and

enlarged at intervals since 1739, but the time camewhen the directors were confronted with the problemof running a hospital altogether inadequate for theneeds of the citizens and for the training of medicalstudents, and incapable of further extension owingto the limitations of the site. Other medical insti-tutions in the city were equally in need of enlarge-ment and up-to-date accommodation, and it was dueto the vision of the late Prof. Mathew Hay that thesolution was brought about. He conceived the ideaof a concentration of hospitals and teaching facilitieson some elevated site on the edge of the city wherethe patients could be treated under the most favour-able conditions. In due course a new sick children’s

hospital was built and opened in 1928 containing140 beds, constructed entirely on the pavilion system,and equipped on up-to-date lines. This hospital shouldsatisfy the needs of the community for many years tocome. Immediately adjacent lies the new maternityhospital which is completed and will soon be occupied.Almost in continuity is the new Royal Infirmary.A hundred yards to the north is the UniversityInstitute which is in course of construction andshould be finished within a year. It provides com-plete accommodation for teaching and research forthe departments of medicine, surgery, midwifery,pathology, bacteriology, biochemistry, and pharma-cology. The medical student of the future willspend the last three years of his medical course inthe buildings comprising the joint hospital scheme.Well within a mile to the west of the Royal Infirmaryis Woodend Hospital, a municipal institution of 350beds, which is also used for clinical instruction, whileabout half a mile to the east lies the Aberdeen RoyalMental Hospital.The new Royal Infirmary building occupies a central

position on the southern slope of the joint hospital site.It has been planned to accommodate 500 patients inthree separate ward blocks of four storeys. The maincorridor runs east and west. On the north side are

administrative offices, kitchens, storerooms, and quartersfor certain resident officials.The ward blocks are situated on the south side of the

corridor and consist of a medical block containing 146

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1. Medical block. 2. Administrative section. 3. Surgical block. 4. Special departments. 5. Maternity hospital.The nurses’ home is not shown but lies to the right of the medical block, while the sick children’s hospital (also not shown) lies to the

left of the maternity hospital. The University Institute lies in front of the administrative section. The photograph wassupplied by Mr. Gloyer of Aberdeen, by kind permission of the Aberdeen Press and Journal.

beds, a surgical block with 252 beds, and a block forspecial diseases (eye, ear, nose, and throat, and skindiseases) containing 102 beds. In the medical and surgicalblocks, the constructional arrangement is such that eachunit occupying a floor has a sub-corridor parallel to themain corridor, giving the maximum accommodation forside-rooms and service-rooms, and making the units self-contained. Sanitary accommodation is within the mainwalls and accessible both from the main ward and thecorridors of the side wards.The medical block houses three medical units, each of

32 beds. The fourth floor is designated " special medicalward " and part of the accommodation has been arrangedfor a metabolic unit with dietetic kitchens and biochemical

laboratory. The fifth floor accommodates 18 beds in smallwards, and is intended for the treatment of cases ofsickness occurring in the staff of the institutions in thescheme.The surgical block houses three main surgical units, each

of 56 beds each ; a gynaecological ward of 34 beds in onemain and several small wards ; an orthopaedic unit of30 beds similarly arranged; and a genito-urinary unit of20 beds. Twin operating theatres, joined by a centralsterilising and preparation room and flanked by anses-thetic rooms, are attached to each unit. They are

situated on the north side of the corridor, access beingobtained by a short passage-way.In the special diseases block the ward units are of

34 beds, with separate theatres for each department.The topmost storey has a self-contained dental unit withaccommodation for operative work and rooms for specialskin treatments. The ground floor of this block housesthe X ray, radium, and physiotherapy departments.Special attention has been given to the equipment of theX ray department, which is considered to be unusuallycomplete and abreast of recent developments in bothdiagnostic and therapeutic work.

Except in the X ray department, natural ventilation hasbeen secured throughout. The medical block, which wasthe first section of the building to be undertaken, isheated by hot-water radiators. The remainder of the

building is heated by roof panels. Ward floors are ofwood blocks ; corridors have rubber flooring with terrazzoedgings. The entrance halls are laid with terrazzo and,in certain sections, walls are faced with the same material.Tile work is confined to the theatres, kitchens, and sanitaryannexes. Corridors are finished in plaster and flatenamelled. Theatre flats have light blue tiling ; wardsare in shades of light green and verandahs are paintedin warmer sunlight colours. Considerable use has beenmade of steel tubing and stainless steel in ward andtheatre equipment. A considerable amount of accom-modation is allocated for teaching and research work.There are three main lecture rooms. Each ward has awell-fitted clinical laboratory for microscopic and chemicalinvestigations.The nurses’ home has been provided in the north-west

corner of the site. Lecture rooms, study and demonstra-tion rooms, and public rooms are on the ground floor, while258 bedrooms occupy the four upper storeys. Fittedwash-hand basins with hot and cold water and built-infurniture have been provided in each bedroom, and a largerecreation hall has been provided.

In deference to the strongly expressed wishes of thecommunity, the buildings have been constructed of granite,of which 40,000 tons were required. The mass of granitemakes animpressive building and has needed no architecturalembellishment.

The new Royal Infirmary cost approximately525,000. This sum has been raised entirely byvoluntary subscriptions. This effort is the more

(Continued at foot of next page)

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(Continued from previous page)praiseworthy inasmuch as the population of Aberdeennumbers only 170,000 persons, while the total popula-tion of the area served by the hospital is underhalf a million. It is of interest to recall that theoriginal subscription list for the building of the

Royal Infirmary in 1739 amounted to £ 10 9s. 7d. ;the number of patients admitted in the first yearwas 21, of whom 2 died, 9 were declared cured, and10 incurable.The architect is Mr. James B. Nicol, F.R.I.B.A., in

conjunction with Messrs. Pite, Sons, and Fairweather asconsulting architects.

CORRESPONDENCE

ROYAL MEDICAL BENEVOLENT FUND:AN APPEAL

To the Editor of THE LANCETSiR,—I have hesitated this year in making my

usual appeal to your readers for the Christmas giftfund of the Royal Medical Benevolent Fund, becausewe have had a generous response from many membersof the medical profession to our Centenary appealfor new subscribers and for donations. My hesitationwas, however, dispelled by the following letter fromone of our annuitants, a spinster lady of 75, whohas been lame since she was 15. When submittingthe last return of her very small income, she wrote :

" The kind Xmas gift of El 10s. must be added to myincome. It comes, a regular gift, but I know you mightnot be able to send it to me. Every Xmas I am just alittle expecting and very much hoping to receive it."

This letter made me feel that our annual Christmasgift fund must not suffer. We have between 700and 800 names on our books and as in previous yearswe hope to send each a Christmas gift of 30s.

I ask for very generous help from all.I am, Sir, yours faithfully,

THOS. BARLOW,11, Chandos-street, Cavendish-square, President.

London, W.1, Sept. 28th.

THOS. BARLOW.President.

ROCHDALE AND AFTER

To the Editor of THE LANCETSIR,-The true maternal mortality-rate is the

number of deaths of women from pregnancy per1000 pregnancies. This rate can never be known tous, for we have no certain criterion of pregnancy.What we call the maternal mortality-rate-thenumber of deaths of women from causes connectedwith reproduction per 1000 live births-gives us thecost in maternal life of producing citizens. If thisrate is cast accurately, as it can be done (and canonly be done) by accepting the New South Walesconvention, " The death of every female betweenthe ages of 15 and 45 shall be attributed to repro-duction unless it is proved otherwise," we obtain aproduct free from error which gives facts of greatvalue to social medicine. Dissection of this rate and

inquiry into each death tell us what we want to

know-namely, what does kill our mothers, fromwhich we can deduce how to reduce the toll.

Attempts to obtain a rate of maternal mortalitymore acceptable to medicine fail because they alwaysentail factors none of which can be freed from

ambiguity.The success of the Rochdale experiment was not

due to any special method employed, for everythingthat was done in Rochdale has been in operationelsewhere and many places can show a persistently

low maternal mortality through the employment ofmethods quite different from those used at Rochdale.What caused the success was the strength of thedetermination to coordinate all facilities locallyavailable; it was the fruit of good administration.We are told that 50 per cent. of maternal mortalityis avoidable. Actually everything above 2 per 1000,and, theoretically, above 1 per 1000 is avoidable.But this does not mean that half or more of maternaldeaths are due to bad practice, negligence, or

stupidity ; for comparatively few deaths are so

caused. The main cause of fatality, that which is

preventable, is failure to bring without delay thehelp that is available to those who need it. Thoughmaternal disease is, of course, the primary cause ofall maternal deaths, nearly all maternal diseases areamenable to remedy if treatment is given at the

right time. Most of our failures are due to delayand most of the delay is due to faulty administration.Medical administration depends little upon schemesand schedules ; its essence is individual field work tobring the benefits of medicine to the people for thepeople by removing all obstructions to its carriage.

I am, Sir, yours faithfully,DUNSTAN BREWER.

Public Health Department, Swindon, Sept. 28th.

THE OXFORD GROUP AND THE MEDICALPROFESSION

To the Editor of THE LANCETSiR,-May I make some comment on the admirable

letter of Dr. Claxton which appeared in your issueof Sept. 19th, particularly in the light of the com-ments made upon it in the current one. The unsignedletter in my opinion reflects upon your judgment inpermitting Dr. Claxton’s letter to be published atall; moreover, the writer’s use of the word " sec-tarian" is entirely inaccurate; further, I woulddirect his attention to Dr. Claxton’s statement thatin regard to certain of his patients who have madecontact with the group he has noted " a strikingdifference in their mental and physical health";also he says that from the same source there grows"a new vision of the purpose of medicine-namely,that the treatment of the whole of man’s threefoldnature rather than concentration on the physicalaspect is the secret of real health." I think everythoughtful person will approve at least the relevanceof Dr. Claxton’s letter to the practice of medicine.

In this connexion might I direct attention to thevaluable analysis made by Lord Horder when speak-ing at the recent meeting of the British Associationon the subject of strain in modern life. He pointedout that one of the serious contributory causes islack of adequate development on the spiritual side,and clearly indicated that remedy must come inthis direction. Dr. Claxton has known it to happen;so have I. Dr. Troup writes in a more sympatheticway, and I would ask him to take Dr. Claxton’sadvice " to make honest investigation and inquiry

"

into this movement. If he studies it in this way,and particularly by direct personal contact, he willno longer be able to repeat the essentially untruestatement about " sumptuous hotels."The medical profession is conservative and rightly

so ; but with that healthy and protective side goesa curious slowness in accepting new ideas. Dr.

Troup congratulates Dr. Claxton on his courage.That word recalls to my mind a certain incident.About 1905 I wrote a timid and tentative paper