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recriminations, but what is the best course under the circum-stance to pursue in order to obtain them, and thus be able inas efficient manner as possible to administer to the sick andpoor the medical benefit which the originator of the Bill hadin his mind. It may be worth while reminding my readers thatMr. Lloyd George stated as one of the chief attracti ons ofhis Insurance Bill that he was offering to the insured

" good doctoring without doctors’ bills" (and, by the way,without coming to terms with the doctors). Now, to mymind "good" doctoring can only be obtained as the resultof mutual confidence between doctor and patient-con-fidence on the part of the patient that he is receiving thebest of attention and skill, confidence on the part of thedoctor that he is receiving fair and adequate remunerationfor services rendered. No system can possibly be good, orcan supply a good article, that does not meet thess require-ments. The doctors laid down six demands as the minimumwith which they would be satisfied ; the Bill has been passedand the profession’s minimum has not been satisfied. To mymind it is as important to the insured as to the doctors thatthe bargain should be a complete one; how otherwise arethey to expect "good " doctoring ? Now I went to the meeting on Tuesday, as I have before

remarked, hoping that some course might be devised by whichthe demands of the profession might h3,ve been satisfied.I wanted bread and was offered a stone. The stone was toturn out the Council of the British Medical Association andattempt to induce Mr. Lloyd George to introduce an

amending Bill which would include the unsatisfied demandsof the profession. What a chimera ! What fatuity I Mr.

Lloyd George already sees by such meetings as these that themembers of the medical profession are already cutting oneanother’s throats, sees that he has only to wait and watch,and the profession will eventually, like the Kilkenny cats,murder one another, and lie, a victim to suicide, in thehollow of his hand. Distrust, disunion, is playing his

game; the want of unity, of solidarity, of cohesion, is

playing havoc with any chance we have of united action, andhope deferred of a united profession is making the heart ofthe poor humble practitioner sick. By such meetings aswere held on Tuesday we are not likely to be any"forrader," and recrimination is no remedy. We poorpractitioners want unity, unity, and again unity ; for unionalone makes strength.-I am, Sir, yours faithfully,

RICHARD BEVAN, L.R.C.P. Lond., D.P.H.

THE MORBID DIATHESES.To the Editor of THE LANCET.

SIR,-In THE LANCET of Jan. 6th Sir Dyce Duckworth,who honoured me by attending my Bradshaw lecture, writeswith his usual courtesy in defence of the Morbid Diatheses,which I maintained were gradually disappearing undermodern investigation, that had proved various diseasesformerly believed to be of constitutional origin to dependon the inroads of external pathogenetic microbes. I couldbut feel as I was lecturing that I was treading withelepbantine weight on many of his inoffensive pedal digits,and I was, therefore, the more gratified to receive from hima cordial appreciation of my lecture, with many points inwhich I felt sure he was not in agreement.

In the letter addressed to you Sir Dyce Duckworth states thatmy views on the medical diatheses, though rather startling," he had reason to believe were shared by " the younger patho-logists and surgeons." In this I am inclined to think he iscorrect ; but he goes on to depreciate, in a manner I neverdreamed of, the workers of the past or passing generation."The older physicians are to be regarded as rather unwise ’,men with feeble powers of observation " is a sentence whichthere is nothing in my lecture to warrant. On the contrary, II spoke of I the giants in observation " who were misled bya predominant theory. I do not deny the influence of soil,but I deny that it is essentially a family product, or thatit is of "equal importance" with the seed, as Sir DyceDuckworth terms the invading microbes.To illustrate my position, I will mention a case that was

brought under my notice as recently as Saturday last. Thehead fettler on a local railway, a very strong man, with ahealthy wife and a family of five, left his cottage two orthree years ago for a larger one, in which the previous

occupant and his sister had died from phthisis. Soon after,his second son, a boy of 15 years, was noticed to be ailing andhe is now in an advanced incurable stage of consumption.Thus a family, all of whom were previously healthy, byentering an infected cottage were subjected to a tuberculartest which picked out the weakest.

I am, Sir, yours faithfully,R. CLEMENT LUCAS.

To the Editor of THE LANCET.SIR,—Amidst the many and complex problems of present-

day views of mental and physical disease we are not verymuch nearer the truth than were our forefathers. Certainly,advancing strides have brought about important changes inthe line of treatment, but are these not constantly changingin detail ? Everyone has some part of his mental or physicalside defective. It is our duty to search out these defects onexperimental principles and provide a suitable environment.And if we observe closely the environment of the insane,and not least the feeble-minded, we shall recognise pro-gression. Given any pattern of mind and body a suitableenvironment can invariably be found. It is interesting tonote, too, that institutional care and management of mentalcripples is preventive of appendicitis. That is to say, it isa physical disease very rarely seen in asylums. But we haveno proof that the cæcum and its appendix, nay, the intes-tinal tract, is of a superior build among the insane than isto be found outside asylum environment.

I am. Sir, vours faithfullv.JOHN FREDK BRISCOE.

UNICELLULA CANCRI.To the Editor of THE LANCET.

SIR,-In the two lectures given by Sir Henry Butlin, andwhich appeared in extenso in THE LANCET of Nov. 25th andDec. 2nd, 1911, the author leads up to the conclusions that thecancer cell is derived from, and in a general way inherits themorphology of, the cells of the part in which it takes itsorigin ; that the "vital difference" between it and thenormal cell is that it will survive if implanted whilst thenormal cell will die; that the difference in the conduct ofthe cells is due to the fact that the cancer cell has becomeaf endowed with the gift of life," which constitutes it an

independent creature ; that the cancer cell is, in short, a newgenus of organism vastly removed, phylogenetically, fromthe complex creature in which it originates.

Practically all students of the cancer problem are agreedthat the cancer cell is derived directly from the normal cell,and the great majority of them are satisfied that no para-sitic micro-organism plays any essential part in bringingabout the change. The explanation of the difference inbehaviour, within the body, of the progeny of the cancercell and the progeny of the normal cell is, at present, thecentral problem of malignant disease. That cancer cells willsurvive and that normal cells will not survive when implantedis a generalisation to which there are so many obviousexceptions that it is improbable that such a peculiarity is theactual vital difference " between the two sorts of cell. Thesuccessful transplantation followed by orderly growth ofcutaneous epithelium and certain other tissues, and thephenomenon of the implantation cyst, prove that normalcells may survive if transplanted. The constant distinctionbetween normal and malignant cells does not appear to beone of structure, composition, or metabolic activity, butrather one of conduct with respect to environment. The

progeny of normal epithelial cells will divide and progress ,

only in a direction away from the connective tissues ; theprogeny of carcinomatous cells are indifferent as to thedirection in which they multiply.That epithelial tissues are normally restrained and directed

in their growth by purely physico-chemical processes has notbeen proved, yet the anticipation that it will be so provedseems to have engendered in many minds the belief thatsuch is actually the case. This premature conclusion hasdistracted our attention from the otherwise obvious fact thatin every living cell we encounter the incomprehensiblephenomena of life and instinct. All the phenomena of thecosmos are not comprised within the domains of the physicalsciences.

In my essay on Light, Pigmentation, and New Growth

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(July, 1909) I postulated the existence in every normal cellcapable of reproducing itself by fission of a psychic elementakin to instinct. I opined that it is this element whichcontrols and directs the behaviour of the cell in accordancewith the particular traditions" " of its genus ; and I gavereasons for my suggestion that the abnormal conduct ofcancer cells with respect to their environment is due to an

impairment or loss of this psychic principle. It certainlyseems more probable that malignant disease is due to the lossof some controlling influence rather than to the accession ofa quality novel and little short of supernatural in itscharacter. I say little short of supernatural because it isagainst the order of nature that a new genus of unicellularanimals should be repeatedly springing into existence andthat the same genus should on every occasion be entirelyexterminated. I am, Sir, yours faithfully,

WILFRED WATKINS-PITCHFORD, M.D. Lond.,F.R. C.S. Eng.

A PRESCRIPTION FOR COLITIS.To the Editor of THE LANCET.

SIR,—Although I am not now in practice perhaps you willpermit me to offer the profession through your courtesy apiece of therapeutic information that I have gained.Many years ago I had a patient whom I generally attended

on a midnight summons, suffering from abdominal pain,vomiting, and constipation. There was a history of diffuseperitonitis in childhood, and my diagnosis was a peritonealadhesion which became inflamed by diet, chill, &c. I senthim to a distinguished surgeon, who said that he undoubtedlyhad appendicitis, and proposed an operation. This, however,the patient would not submit to.

In this case, of course, careful attention had to be bestowedupon the action of the bowels, and I tried many laxativeswith more or less success. It finally struck me that a localemollient would be an excellent treatment and I wrote the

following prescription :-R P. gum. acacias 3 iv.

Syr. cascarae sag. ii.Terrol. ii.

Ft. pasta. 3ii.This kept my friend for ten years perfectly comfortable ; heceased taking it about one year ago as he does not now

require any treatment. It was known as "Falkiner’s tablevarnish " among our inner circle.The other day I saw an old patient and friend of mine who

is the widow of a distinguished London surgeon whom Iconceived to be suffering from colitis, and sent the pre-scription to her, and being a great sufferer myself from thelatter complaint when asking the chemist to send the copy ofthe prescription ordered a bottle for myself. I have

only been using it for three days, but I have almost

complete ease from the wearying sensation of colitis,which is so exhausting physically and mentally, and I alsofind that the hydrocarbon acts as a powerful intestinal dis-infectant and deodoriser, and that it reduces the productionof gases. Trusting that my experience may be of utility andenable many of my professional brothers to give relief introublesome cases,

I am, Sir, yours faithfully,NINIAN M. FALKINER.

THE ACTION OF RADIUM ON MALIGNANTGROWTHS.

To the Editor of THE LANCET.

SIR,-My attention has been drawn to a letter whichappeared in THE LANCET of Jan. 6th under the above titleby Dr. F. L. de Verteuil, Surgeon, R.N. (retired), who, inreferring to the different theories that have been advancedon the essential therapeutics of such radio-active agencies asradium and the X rays, ascribes priority in regard to one ofthem to Mr. Deane Butcher-namely, that of the inductionof auto-vaccination by the X rays, as revealed by a series ofindependent estimations of the opsonic index against theparticular pathogenic micro-organism concerned in thoseinfectious maladies in which the lymphatic glands become

involved. As Dr. de Verteuil is, in this respect, under a slightmisapprehension, I. beg leave to refer him to a contributionmade by me to THE LANCET in 1907 (Vol. I., p. 215), aswell as to the Arohives of the Roentgen Ray for June, 1910,p. 2, where Mr. Deane Butcher urges a plea for the pressingrequirement of a continuance and repetition of the line ofresearch previously adopted by me.

I find that, up to date, my observations and experimentsin the afebrile types of tuberculosis have been repeated inde-pendently by Dr. Lawrence and Dr. Crane, of the UnitedStates, both of whom corroborated and confirmed them. Alsoby Messrs. Paoli and Nuncioni, of Italy, who applied theX rays to the lymphatic glands involved in primary syphilis,confirming my views. In this country this fascinatingresearch has been neglected, partly because radiologists orradiographers are more concerned with the electro-mechanicsof apparatus construction, and the getting of mere results,than they are with pathology or clinical medicine. The looseand unscientific use of the term " vaccination " in the abovereference is, in my opinion, calculated to give offence to theintelligence of both pathologists and clinicians.

Surely the term " vaccination," in its modern acceptation,connotes the introduction into the human organism of acertain number of killed and sterilised pathogenic micro-organisms, which specifically pertain to a particular malady,for the purpose of producing an increased resisting poweragainst that particular micro-organism by evoking one ormore precise physiological reactions in place of the patho-logical reactions, manifestations of which exist at the site ofthe lesion and in the system. By the term " auto-vaccination " it was intended to connote the further develop-ment or completion of the physiological process, consequentupon an infection, in conformity with the protectivemechanisms of the organism, it being recognised that a

pathological manifestation resulted from an incoördination inthe chain of processes taking place during a reaction.To speak of the X rays causing a "vaccination" " or of

"producing antitogins " by stimulating leucocytes, can

never appeal to the pathologist, and at the meeting of theannual congress of the British Medical Association held atthe Imperial Institute, 1910, I felt obliged to make a gentleprotest in this reference. On that occasion an instructive

paper was read by Dr. W. S. Lazarus-Barlow, entitled"Radiation and Biological Processes ; with Some Referenceto the Skotographic Action of Animal Tissue." Dr. Lazarus-Barlow is, above all other things, a pathologist, and hisobservations are highly interesting as regards those minutefiner changes in protoplasm which are more of a molecularnature than of a mere chemical change. I would recom-

’ mend this paper and its study to Dr. de Verteuil, who seemsto be attracted by the tertiary grosser changes of the tissues.These finer changes are far beyond the power of any micro-scope to reveal. I am, Sir, yours faithfully,

H. D. McCULLOCH,

LOCAL REACTION IN TUBERCULINTREATMENT.

To the Editor of THE LANCET.

SiR,-In THE LANCET of Dec. 30th, 1911, Dr. E. E. Prestcontributes a letter on Some Points in the Treatment of

Pulmonary Tuberculosis. Dr. Prest states he noticed "thatcases in which there is a well-marked local reaction to an

injection of tuberculin have relatively a favourable prognosis."With reference to this statement, it is noteworthy that as

long ago as 1897 Dr. Carl Spengler, of Davos, emphasised thehigh importance of local reactions in the administration oftuberculin. He showed that the bactericidal action, indirectlyinduced by tuberculin, varies with the intensity of the localreactions. Further, from his extensive researches he pointedout that the intensity of the local reaction at the seat ofinjection corresponds with the intensity of the local reactionat the foci of disease. (See Carl Spengler’s article, " ÜberTuberkulinbehandlung," published in 1897 by F. Schuler,Chur.) Obviously, the intensity of the local reactions mustbe carefully regulated.When Carl Spengler in 1904 introduced the use of tuber-

culin derived from bovine tubercle bacilli, the importanceof local reactions became even more evident. Withoutattention to these the wrong kind of tuberculin must often beused. Of course many cases are unsuitable for tuberculin