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symptoms indicating gall-stones had been present and in allbut one of these 17 cases there was no naked-eye evidence ofmalignant disease, while in the remaining case microscopicalexamination showed carcinoma. Of the 16 cases where

symptoms had been present nine gave definite evidenceof the presence of malignant disease, but in the other sevencases, though macroscopically " chronic inflammatorythickening" was present, no histological examination wasmade. Thus we see from these figures that in 30 per cent.of all cases of gall-stones malignant disease was presentas it was in 56 per cent. of all cases where gall-stoneshad caused symptoms during life. It is very probable thatthese figures understate the frequency of the association ofgall-stones and cancer, for several of the cases where the

cystic wall was thickened were not investigated microscopi-cally and may very possibly have been malignant. Ifit be admitted, then, as admitted it must be, that thesetwo conditions are causally connected, it remains to be de-cided which of the two is the cause and which the effect ; orit is possible that both may be alike effects of a commoncause. The supposition need not detain us, though it hasbeen held that as some are inclined to ascribe gall-stones toan excessive diet of meat, so others have been equally certainthat malignant disease has a similar origin. Inasmuch as inalmost all the cases of carcinoma gall-stones were present,while in as many cases gall-stones were present in the gall-bladder but there was no evidence of malignant disease, weare bound to acknowledge that it is almost certain that the

gall-stones give rise to the cancer and not the cancer to thegall-stones. In elucidation of the question, How can gall-stones cause malignant disease ? we have the fact shown bystatistics that carcinoma is especially likely to accompanygall-stones if they are rough and irregular on the surface.Therefore, it is probable that, as in other parts of the body,local irritation tends to excite, or to assist in exciting,malignant disease. What additional cause is necessary we ,,

do not know. Recent bacteriological research has shownthat many morbid hepatic conditions are microbic in originwhich were formerly looked upon as of other etiology. Thisfact of itself might suggest that possibly in malignantdisease of the gall-bladder also we have a micro-organism asa causative factor in addition to the local inflammation. Bethis how it may, we can feel assured that we are not in errorin ascribing carcinoma of the gall-bladder to the chronicirritation and injury caused by gall-stones with some

additional etiological element at present unknown to us.

The practical bearing of the close association of gall-stonesand malignant disease of the gall-bladder is obvious. If it

be true that over 50 per cent. of all cases of gall-stone endin malignant disease, and this must certainly be admitted,it should follow as a necessary corollary that total removal ofthe gall-bladder in cases of cholelithiasis would be preferableto mere cholecystotomy and evacuation of the stones, providedalways that the increase of the danger of the operation wasnot enough to counter balance the improved prognosis shouldthe operation succeed. In the hands of a skilled operatorthe increase in the risk is but small and when cholecystec-tomy is performed there is the additional advantage thatthe chance of a biliary fistula is obviated. The physiologicalvalue of the gall-bladder is slight, so that its loss is not feltso far as we are aware. Dr. Slade’s paper (which is

published at p. 1059 of our present issue) is a good exampleof the utility of careful statistical inquiries and we hopethat he will continue his investigations into this importantmatter.

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INFANTILE MORTALITY.AT a recent meeting ot tne rrestwich board or guarmans

the third report of Miss Pollitt, the inspector under theInfant Life Protection Act, was read. She said that therewere 29 infants on her register; 20 were illegitimate, 14 of

them being entirely supported by their mothers who weredomestic servants. She stated that instead of decreasing therate of infantile mortality was increasing, notwithstandingall the improvements in the conditions of life. She could

only put it down to the ignorance and the neglect of th&mothers. We may well wonder whether, with all the costlyand elaborate arrangements for teaching accomplishments inour elementary schools, it will ever occur to doctrinaireeducationists that there are practical matters affecting thelife and the well-being of poor people which will not be

solved satisfactorily until more attention is given to subjectsbearing on health and everyday duties.

OIL IN TOBACCO.

WE have received from the Scottish Anti-tobacco Societya communication in which it is suggested by Mr. RutherfordHill that the irritating effects of tobacco smoke may be

largely due to the combustion of oil. Tobacco, of course,contains a natural oil but for the purpose of manufacture the

practice of adding oil is on the increase, as was shownin the last report of the principal chemist of the Govern-ment laboratory. The oil used is stated to be best Florence

oil, which on imperfect combustion would yield the in-

tensely acrid and irritating vapour, acrolein. While we

quite agree that the formation of acrolein in this way wouldbe a contributory factor to the irritating property of tobaccosmoke, yet it must be borne in mind that the products of thedestructive distillation of the tobacco leaf, even free fromadded oil, contain a great number of substances of a similarlyacrid character. Such, for instance, are pyridine, furfural,butyric and valeric acid, ammonia compounds, and so forth.The addition of glycerine which is also practised wouldagain give rise to the formation of acrolein, while glucosewould give irritating products on partial combustion. The

proportion of added oil, glycerine, or glucose is, however,in most cases small and probably insignificant having regardto the proportion of tobacco smoked. We object, however,to the principle in general of adding any foreign substancewhatever to tobacco and the less tampering there is with

the leaf the better and the less injurious is it likely to be.But it seems to us that we do not require to resort to anenumeration of the various constituents, good or bad, of

tobacco to prove that smoking by juveniles is a perniciouspractice. Any movement to suppress the habit amongstchildren has our complete approval.

THE DANGERS OF THE STREETS.

A CORRESPONDENT in addressing us upon the subjectof the dangers to pedestrians in the London streets

includes in his indictment the hat-pins of the women-"unclean imitations," he terms them, "of the ladies’

dagger of the Middle Ages,"-and the bad language of themen. There is much force in his contention that both

hat-pins in women’s heads and oaths in men’s mouthsdo form public dangers. Among a certain class hat-pinsare constantly used as weapons of offence and when theyare not employed in this manner by the design of the wearerthey often threaten the eyes of others in a really dangerousway. It ought to be possible for an ingenious milliner todevise some less dangerous method of fixing on the hat.Nor is the modern headgear of women without its patho-logical significance. On a windy day the leverage on theroots of the hair when the large and flapping headgear isendeavouring to sail away is one of the causes of the

headache of which most women complain after a buffetingby the elements. 1l jatd soqtffrip pour être belle is an old

saying, but many women do not know that they have onlytheir hats to thank for their headaches, while the aphorismdoes not suggest that the eyesight of other people should

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suffer for beauty’s sake. The evil caused by thoughtlessmen who do not sufficiently restrain themselves in their useof unseemly language cannot be exactly estimated. It can

only be guessed at, but the fact remains that it is

quite impossible for women to pass along many of our

streets without their ears being assailed by expressionswhich must insensibly affect them. In puerperal and

even in other forms of insanity nothing astonishes the

friends more than the indecent expressions and the oathsused by the patient. They cannot understand where

and how these phrases have been acquired. There are,

unfortunately, too many opportunities for the incorpora-tion into the mental life of objectionable elements which,at first latent, declare themselves in all their objectiverepulsiveness when the patient becomes a reflex machine,as it were a phonograph reproducing the impressions of thesestreet vulgarisms.

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THE DISCOVERY OF THE DISCOVERED.

M. 0. van Schoor in an essay in the Jo2crnal dePharmaeie for March on the evolution of medicineaccentuates the truth of the adage, Nil novi s2eb sole.Some of his illustrations are worth giving. Hippocrateswas aware of the patches in the intestines the discovery ofwhich is ascribed to Peyer (1680), and Caspar Aselli (1600)is wrongly said to have discovered the chyliferous vessels towhich Herophilus and Erasistratus drew attention (250 B.C.).The pancreatic duct, the discovery of which is attributed toHoffman and Wirsung (1630), is mentioned by Eudemus,a contemporary of Galen. Again, Alcaeon, who livedin the fourth century before Christ, refers to the auditoryduct which afterwards bore the name of Eustachiantube. The same thing has occurred in therapeutics.Many remedies that were employed in remote antiquityfell into disuse and were again introduced into practice at alater date. Thus, arsenic was used as a febrifuge byLentilius and Hippocrates recommended it for cancerous

affections. The most recent researches have resulted in the

employment of arsenic for the same purpose in the form oforganic compounds-e.g., the cacodylates and arrhenal.

Pythagoras recognised the diuretic value of squill but its

use lapsed for a long period. Opium has been found in thedwellings of the inhabitants of the lake villages of Switzer-land as well. as in ancient Egyptian tombs, but afterwardsit appears to have been forgotten during several centuries.Hippocrates employed this drug freely as a sedative and

afterwards it had a vogue in the Middle Ages. Even

Paracelsus did not scruple to use this vegetable drug inthe case of one Kornel von Lichtenfels who had vainlytried other practitioners without being cured. Paracelsus

speedily effected a cure but it is of interest to note thatthe patient refused to pay the fee which had been agreedupon before the treatment was begun. The case was triedbefore the court at Basle, with the result that the fee wasreduced to a few florins. This so angered Paracelsus thathe reproached the judge and so brought about his banish-ment and the loss of the chair which he occupied in theuniversity. A remedy known to Galen was the male fernwhich after the lapse of centuries was brought to thenotice of Louis XIV. by a quack. In surgery it is no lesstrue that some of the methods employed by modernadvanced surgeons were known to the ancients. Thus

Hippocrates mentioned intubation of the larynx and CoeliusAurelianus gave instances of the successful operationof tracheotomy. Praxagoras ventured to perform a laparo-tomy and employed intestinal sutures. Operations for herniawere performed 250 B.C. and Serapion removed diseased

kidneys. Puncture of the thorax in empyema was rediscoveredin 1650, after having been forgotten apparently for centuries.That the practice of asepsis is not entirely modern is shown

by the fact that contemporaries of Hippocrates were in thehabit of dipping their instruments in boiling water. In thethirteenth century it was customary before operating to

administer to patients by means of sponges placed in thenose the juices of sedative plants-e.g., stramonium, bella-donna, and mandragora, consciousness being regained by theapplication of vinegar compresses. Among other methodsof treatment now in vogue hydrotherapy, gymnastics, andthe open-air treatment were practised by the Romansand the Greeks. Hypnotism was thought highly of by thepriestly physicians in the temples of Isis in ancient Egypt.Perhaps one of the oldest forms of medication is organo-therapy, which after a period of decline has again come intovogue. In medicine and surgery, as in all the arts and

sciences, methods become general, then lapse into disuse, tobe revived possibly at a later period and then to achieve apopularity which attaches to a supposed new thing.

THE QUEEN’S JUBILEE HOSPITAL.

THE simultaneous resignation of the majority of themembers of the medical staff of a hospital always shouldafford material for inquiry, even though no difficulty shouldhave been experienced in filling the vacancies thus created.It will be remembered that the Queen’s Jubilee Hospital hasof late been attracting attention and to those who are

acquainted with its early history the marvel has been thatthe trouble has not made an earlier appearance. The initia-tion and the foundation were questioned from the first and

many protests were raised against calling a new hospital intoexistence with a name which, though attractive, was

scarcely warranted. The local need of the hospital was notapparent, since within reasonable distance a larger andbetter equipped hospital had been established for some years.Through all the appeals it was evident that the conceptionof the need of the hospital and of the suitability of its nameoriginated with a general practitioner who was ready to

contribute largely and to identify himself with the under-taking. In the natural course of events a medical staffbecame associated with him and a board of management wasformed. The work has not, however, progressed smoothlyand on Feb. 8th the late medical staff, with the excep-tion of Mr. R. F. Benham and the dental surgeon, resigned,the new staff taking over the work on or about March 8th.’On March 13th the chairman, Mr. G. R. Everitt, wroteto the authorities of King Edward’s Hospital Fund, askingthem to make inquiries "in connection with the recenttrouble at this hospital and if possible to make arrange-ments for such investigation." Eventually Mr. FrederickM. Fry and Mr. J. Danvers Power were appointed to

make an inquiry. Two visitors of the hospital-namely,Sir Thomas Smith and Mr. H. C. Smith-were also invited toserve on the inquiry but the former was unable to attendand the latter was out of England. Mr. Fry and Mr. Powerheld three sittings at the hospital, on April 6th, 7th, and 8th,and paid a visit of inspection on April 10th. The board ’of

management was represented by Mr. Tom Green and Mr.Bavin and the late medical staff by Mr. R. P. Brooks,from whom, fays the committee of inquiry, "we receivedevery assistance." The report of the committee contains 23clauses of which the last four are recommendations. Thesalient points of the report are as follows. As regards Mr.Benham it may be assumed that he continues to act on thestaff for reasons personal to himself. " Unless these areconnected with his recognised professional eminence, as

distinct from academic qualifications, the only conclusion wecan draw is that he occupies his position as a member of themedical staff in virtue of his being the founder of the

hospital. Should this be the case his position is a false one."As regards thenew staff the report says : " Individually andcollectively the new staff may have acted quite correctly for