LISTERISM IN MIDWIFERY

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as that from which I quote cases below-viz., seamen,of whom none are refused operation. There is noselection. A hernia even controlled by truss prohibitsa seaman from going to sea and therefore endangershis livelihood, so that operation cannot be refused.

* This fact adds immense weight to Mr. Cole’s resultsas they stand, and in comparison with other reported.series, and makes the filigree properly used almostindispensable in certain cases.

I find that in the last three years at the Seamen’sHospital-and I only quote these cases, althoughI have used the filigree elsewhere, and in my privatework-that I have operated on 121 cases of herniaand in 28 have used filigrees. The filigrees wereemployed in recurrent inguinal hernia, direct inguinalhernia, and large oblique inguinal hernia of longstanding in aged persons with but scanty musculature-cases, indeed, in which one has learnt by experiencethat high ligation of the sac alone or in combinationwith some form of plastic suturing would be insufficient.It is only natural that seamen would return to theirhospital, which has a world-wide reputation amongstthem for the treatment of hernia, if trouble followedthe use of the filigree or if there were recurrence.In the last five years there has not been a single returnfor removal of the filigree for any cause, or for recur-xence in a case where filigrees have been used.

I am, Sir, yours faithfully,London, W., June 1st, 1926. E. T. C. MILLIGAN.

LISTERISM IN MIDWIFERY.

To the Editor of THE LANCET.

SIR,-To the obituary notice of Sir John Williamsin your last issue I should like just to add that he.and I set up Listerian antiseptic midwifery at theGeneral Lying-in Hospital in 1880-the first lying-inhospital in England to adopt Listerism. This is a

piece of history which should not be lost.I am, Sir, yours faithfully,

Uckfield, Sussex, June 4th, 1926. F. H. CHAMPNEYS.

AUTOLYTIC PRODUCTS AND MALIGNANTTUMOURS.

To the Editor of THE LANCET.

SIR,-In Dr. Gye’s communication to the SurgicalSection of the Royal Society of Medicine, reported inyour last issue, and also in his original paper on theorigin of tumours, he fails to call attention to a factwhich has been known for many years-viz., that theautolytic products of tumour tissue contain substanceswhich are stimulating to the growth of tumour cells.These substances are certainly chemical bodies andnot living agents, they act in high dilution, and theyare in all probability end-cleavage products of enzymeaction. We have reason to suppose that they arepresent in other tissues than malignant tumours, suchas embryo tissue, mammary tissue, and placenta, infact in all tissues rich in nuclear structures. Stimula-tion of growth with embryo tissues was obtained aslong ago as 1910 by Haaland and others.

It is evidently of great importance in provingDr. Gye’s argument that the tests he has carried outon his control tubes containing autolysed embryotissue are completely reliable. Dr. Murphy and hedisagree on this point. When two entirely conscientiousexperimenters differ in the results they obtain witha particular group of experiments it usually meansthat both are recording true results, and I shouldhesitate to disbelieve Dr. Murphy’s positive findingsnotwithstanding Dr. Gye’s 150 experiments withnegative findings. The explanation is, very probably,that some slight but important difference of techniquehas occurred. In test-tubes containing autolysingtissue the contents of the tubes are constantlychanging and are changing in different degrees in.different parts of the same tube. I should expect to

find growth stimulants at the bottom of the tubesbut not necessarily in the upper fluid. If one observerhas stirred his tubes and the other has not, differentresults might easily be obtained. Dr. Gye acknow-ledges that his Rous virus may not be actually killedin the chloroformed extracts. It seems thereforethat he is really studying the factors which can

revive an attenuated Rous virus rather than the

" origin of tumours."Dr. Gye has undoubtedly done a great service to

research and I do not question the facts he hasobserved, only the interpretation he has put uponthem. To the researcher there is no problem moreopen to pitfalls or more difficult than the trueinterpretation of results.

I am, Sir, yours faithfully,Watford, June 3rd, 1926. HELEN CHAMBERS.

BIRTH INJURIES TO THE EYE.

I To the Editor of THE LANCET.I

SIR,-In your annotation with this title, publishedin THE LANCET of June 5th, you say, in referringto the corneal scars left after rupture of the posteriorelastic lamina : " These scars are always vertical, orapproximately so, a fact probably related to thedirection of pressure by the forceps."

" You will,we feel sure, allow us to mention that this is not astrictly accurate statement. A reference to our

article, Obstetric Injuries of the Cornea, in theOphthahnoscope for 1905, and on p. 271, will showthat out of ten cases there shown in diagram, theopacity was transverse in one and concentric withthe corneal limbus in another. Further, on the

supplement page which faces p. 267, there is an actualdrawing of the transverse case. It is true that thescars are usually more or less vertical, but we are ofopinion that they may occur in almost any direction.

We are, Sir, yours faithfully,Stirling, June 8th, 1926.Glasgow, June 8th, 1926.

ERNEST THOMSON.LESLIE BUCHANAN.

COMPLIMENTARY DINNER TO PROF. FiBIGER.-Themedical staff of the Cancer Hospital (Fulham-road, London)gave a dinner at the Langham Hotel on June 7th to Prof.Johannes Fibiger, of Copenhagen, in recognition of hiseminent services to cancer research. The chair was takenby Mr. Ernest Miles, senior surgeon to the hospital, andamong those present were Lord Dawson, Sir HumphryRolleston, Sir John Bland-Sutton, Sir Frederick Andrewes,Sir Walter Fletcher, Profs. Muir, Bulloch, Dreyer, Dean,Ledingham, and Lazarus Barlow, Dr. H. H. Dale, Dr. W. E.Gye, Sir James Dundas-Grant, Mr. Cecil Rowntree, Air.Percival Cole, Mr. Cecil Joll, Mr. C. E. Shattock, Dr. StanleyWyard, Dr. H. Robinson, Dr. E. L. Kennaway, Dr. H. J. B.Fry, Dr. J. 0. Harvey, Dr. J. E. A. Lynham, Dr. R. Kliox,Dr. W. Cramer, Mr. L. A. Harwood, Dr. Archibald Leitch,and Mr. A. L. Abel.

PROF. G. M. ROBERTSON ON LUNACY CERTIFICATION.At a lecture given under the auspices of the Edinburghbranch of the British Medical Association on June lst,Prof. Robertson stated that certification was essentiallyconfidential and personal and that action might easily betaken against a doctor on a patient’s release from an asylumor mental hospital, especially as with many patients therecovery was only partial. He urged the necessity of protec-tion by some society. It was usually the second certifyingdoctor, who did not know the patient so well, who bore thebrunt of the action. The provision of the Act was that" reasonable care " should be exercised ; if a second visitwas paid and careful notes taken, this should satisfy anyjury with regard to necessary care. The word " lunatic "

being a medico-legal term denoting a person suffering fronidisease of the mind affecting conduct, a person could notbe deprived of liberty unless he was of unsound mind -affectinghis conduct with regard to the safety of himself or others.The best way out of any difficulty was to persuade the personto enter a mental hospital as a voluntary patient, and thiswas not so difficult as might be supposed ; nowadays, infact, in the higher paying hospitals, 60 to 80 per cent. enteredon this basis, although unfortunately this was not the caseto the same extent in parish-controlled hospitals whereGovernment grant was lost unless a patient were certified.