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a. child four years old, an age greater than that at whichthe condition usually occurs. The child fell about 20 feet.

Left hemiplegia was present with complete aphasia and some

paresis of the left third nerve and a hernia cerebri developed.After operation the patient made a good recovery, the hernia- cerebri soon disappearing, and two years later speech wasalmost perfect, except for some slurring during excitement ;the weakness of the left leg was nearly gone, though the lefthand was still paralysed.Not many years have elapsed since lumbar puncture

was first performed but now it has almost taken

a place in the routine examination of certain cere-

bral and spinal cases in which the diagnosis is difficult,such as meningitis, when it is desirable to distinguishbetween the tuberculous and the non-tuberculous varieties.

Lumbar puncture has also been used to a great extent forthe purpose of producing what has been called " spinalanaesthesia," and the method has many advantages, thoughit has also several dangers and difficulties which were

unsuspected by its introducers. Mr. BALLANCE has pointedout that lumbar puncture may also prove of value in

traumatic lacerations of the substance of the brain when the

patient is passing into the stage of cerebral irritation and he

gives a very instructive instance. A man, 21 years of age,was thrown from a horse. The skull was not broken but he

was unconscious for ten days. The right arm was paralysedand left ophthalmoplegia was present. The un:}onsciousness

passed off but he became restless, irritable, and sleepless.By lumbar puncture from two and a half to three ounces ofred-stained cerebro-spinal fluid were drawn off and on each Boccasion four hours of quiet sleep followed. Thus lumbar

puncture may help both in diagnosis and treatment.

When blood is poured out between the dura mater and

the skull, as in injury to a meningeal artery or a venoussinus, the cerebro-spinal fluid obtained by lumbar punctureis clear and free from blood, but in cases of laceration of

the brain substance or haemorrhage between the dura materand the brain, the fluid, as in the case related, is stainedwith blood. The lumbar puncture was also of distinct valuein lessening intracranial pressure and so inducing sleep.Mr. BALLANOE is thus led to suggest that it may, perhaps,be advisable in some cases of ordinary apoplexy to relieve

by lumbar puncture the pressure of the clot and serum onthe nervous centres. We think the suggestion is happy and

though it may prove to be of value in only a few cases it

might assist in tiding over the time during which the brainis endeavouring to resume its functions. It is possible, too,that lumbar puncture might prove of service in temporarilydiminishing intracranial pressure in case of cerebral tumourin which for any reason it is needful to postpone operationfor a time. The operative treatment of internal hydrocephalusis also discussed and several cases are detailed in which

this condition has been successfully treated, though it is

hardly necessary to say that in these cases the mortalityis great. Still, the fact that some of these cases recover

after operative interference is very encouraging and shouldstimulate surgeons to persevere in attempting to improvethe surgery of the meninges.The second lecture on abscess of the brain was of great

importance but it must yield in interest to the third whichdealt with the surgery of tumours of the brain. It is hardly

recognised by the general body of medical men how great hasbeen the advance in recent years in this branch of surgery.Not many years have elapsed since the surgery of cerebraltumours began to exist and even now much of the progressthat has been made seems to be unknown to a large pro-portion of the profession. Many of those who listened tothat lecture must have been astonished at the enormous

advance in this department of surgery. It cannot be

denied that even now the mortality is heavy but in this

connexion it must not be forgotten that every case,

or nearly every case, is affected with a disease which, if

left untreated, is certain to prove fatal. In many cases

where recovery from the operation occurs the result is

perfect and even when complete recovery does not ensuethe improvement is often great or the progress of the diseaseis stayed. Moreover, statistics show clearly that the mor-

tality is steadily decreasing. Oar knowledge of cerebral

technique is yearly improving ; the surgeon can now with

impunity undertake operations which would have been

beyond his hopes at one time. We have undoubtedly stillmuch to learn. All operative procedures on the brain

disturb greatly its circulation and in hardly any other

organ in the body is the maintenance of an equable circu-lation of so much importance. We are learning to knowwhat can and what cannot be done and if the progress in

the next ten years is at all on the same scale as that of the

preceding decade we shall indeed see enormous progress.The future is full of hope but even the possibilities of thepresent are not adequately appreciated.

Annotations."Ne quid nimis."

THE NATURE OF INFECTIVITY IN RELATIONTO TUMOUR GROWTH.

THE problem of the origin of cancer has always had amarvellous fascination for us all, and the theories that areadvanced are almost as numerous as the facts on whichthose theories must be based. The latest contribution to the

subject was contained in an address given by Dr. D. A.

Welsh, professor of pathology in the University of Sydney,delivered at the First Australian Dental Congress in

February last. An abstract of it appeared in our

last issue. Mr. H. T. Butlin pointed out in theBradshaw lecture at the Royal College of Sargeons of

England that, whatever may be the ultimate etiology of

cancer, as soon as a cancer cell is fully formed it behaves asa parasite. No longer is it obedient to the laws governingthe organism in which it appears, no longer does it work forthe good of its original owner, but it lives only for itself and,like a parasite, it flourishes at the expense of its host. Dr.Welsh in the address we have mentioned has carried the

analogy a little further. He shows that in all tumours,both innocent and malignant, the analogy with infective

processes is extremely great. In an infective process caused

by bacteria we may in some cases find a merely localisedinfection which has no, or hardly any, tendency to spreadbeyond the pcint first infected. The infective process may,however, tend to spread locally ; it infiltrates neighbouringtissues and has no well-defined limits. Other infective

processes may be still more widespread. They do not limit’ themselves to the spot or neighbourhood where the germ

first found entrance but by the channel of the lymph orblood stream reach distant parts of the body. To all these

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varieties tumours present very close analogues. The localisedabscess caused by the local infection of a bacterium may belikened to the simple, benign tumour. It has a well-definedwall and it has no tendency to stray beyond the site of itsfirst appearance, though it may increase in bulk. The localinfiltration of a septic process bears a very close analogy tosome tumours of a certain but slight degree of malignancywhich spread locally, infiltrating the neighbouring tissues,but have no tendency to form secondary growths elsewhere.The virulent infective processes of pysemia and septicaemiaare very closely comparable with the very malignant growthswhich spread far from the original site, attacking distantstructures by the medium of the blood and lymph streams.In these cases the "infective" agent is the living cell of thetumour, derived from the body in which it lives and notintroduced from without. As to the cause of this suddenlyacquired activity on the part of a cell of the body, Dr.Welsh has something more to say. He dismisses the idea of

any lowly organism parasitically attacking and entering thecell and so causing it to assume the r6le of a cancer cell,and he tells us that the hypothesis has the demerit of beinghard to reconcile with some of the known facts of tumour

growth, though he does not tell us what these facts are.The theory which he advances is based mainly on the ob.3er-vations of Farmer, Moore, and Walker, that the nucleardivisions observed in some cancer cells are similar to those

seen in the reproductive cells and not those which

take place in ordinary somatic cells. It is further

supported by the observation that some leucocyteshave been seen to enter developing cancer cells. These are

the foundations of Dr. Welsh’s theory. He suggests that thefully developed cancer cell may be the product of the con-jugation of a fixed tissue cell and a wandering leucocyte,both cells having undergone the nuclear metamorphoses ofreproductive tissue. It has further been shown that develop-ing cells may be induced to undergo increased and abnormalnuclear divisions when the chemical reaction of theirenvironment is altered and especially when the alkalinityof the medium is increased, and there is some evidence thatthe body fluids of cancer patients commonly exhibit thisincreased alkalinity, and to this increased alkalinity he looksfor the stimulus required. The theory is interesting andwould go far to explain many of the phenomena of malignant idisease but unfortunately some of its foundations are hardly Ias firm as could be wished. The work of Farmer, Moore,and Walker on the mitoses of cancer cells was doubtlessof great interest but, as we pointed out at the time,its importance could easily be overrated, inasmuch as wewere, and are, absolutely in the dark as to thereal meaning of the special form of mitosis foundin reproductive cells. Moreover, Victor Bonney has clearlyshown that " gametoid " mitoses are not specially character-istic of the cells of malignant growths. They occur in

perfectly innocent growths, such as the venereal wart.

Further, Bashford and Murray have come to the conclusionthat the appearances in cancer cells, which were believedto indicate the occurrence of a trae "reducing division,"i.e., a mode of division resembling that found in repro-ductive cells, are deceptive, and that the mitoses of cancercells are really of the ordinary type found in somatic cells.Thus one of the foundation-stones of the theory proves to beincapable of yielding any support and without its aid wefear the theory must come to the ground. All that we know

at present is that the forms of cell division in cancer cellsare irregular; why or how we cannot explain. Such theoriesas that put forward by Dr. Welsh are of value in that theyincite us to examine afresh the grounds for the opinionswhich we hold, to test thoroughly the bases on which ourtheories rest, and to revise from time to time the viewswhich are generally accepted.

LIVINGSTONE COLLEGE.

SITUATED on the borders of Epping Forest at Leyton is afine old country mansion now known as Livingstone College,which exists for the purpose of giving instruction in theelements of medicine and surgery to men who are alreadymissionaries or who are preparing to become missionaries toisolated posts abroad. The need for some simple teachingthat will enable missionaries to take care of their own healthin places where medical aid is far distant was the keynote ofseveral speeches made by missionaries at Livingstone Collegeon June 5th, Commemoration Day, when the buildings werethrown open to public inspection. But it is not only themissionaries themselves who receive benefit from the teach-

ing given at this college but also the natives of the countryin which they may be working. Of course, it is only themore simple diseases which can be treated, for the course atthe college is concluded in nine months, while those whoenter for the course are required to sign a declaration thatthey will not take the title of ’’ medical missionaries" orotherwise assume the position of a qualified medical man.It must be difficult for those who live in civilised countriesand are able to call in medical attendance at a moment’snotice to realise the position of those who are sick in a

strange land far removed from medical aid, but if a man willtravel 50 or 70 miles through forest and jungle to havea tooth drawn, as stated by two of the speakers, itis not difficult to imagine the position of one sufferingfrom more serious complaints. In his report the Principalof the college, Dr. C. F. Harford, pointed out that

there were on the committees of the college 12 medicalmen, six of whom had served abroad in connexion withsix different missionary societies, so that they claimedto have some knowledge of the needs of the missionfield. He claimed that Livingstone College should be sup-ported on ethical, economical, and educational grounds.Ethical, because missionaries going to dangerous and isolatedstations ought to be taught to care for their own health aswell as to relieve the sufferings of the ignorant natives bywhom they might be surrounded. Economical, because hebelieved that the college training would increase theusefulness of missionaries and save money spent inmedical expenses and invaliding. Educational, becausehe considered that the scientific training was of im-

mense importance to a missionary and prevented himfrom working in too narrow a groove, and he claimed thatmissionaries should be able to impart simple instruction inthe laws of health to the people amongst whom they mightbe placed. He pointed out that a considerable proportionof the students at present at the college came from SouthAfrica and from the continent of Europe, and though theywere most heartily welcomed he earnestly appealed to thegreat denominational missionary societies to make more useof the college. There was a deficiency of over E500 in thecollege accounts and further help was urgently neededin order that the work might be carried on with true

efficiency. --

A SCHOLARSHIP IN DENTAL MECHANICS.

THE British Dental Association announces the foundationof the " Smith Turner scholarship in dental mechanics " ofthe annual value of .130. This scholarship is founded in

honour of the memory of the late James Smith Turner andhas for ts object to help those students who, in the opinionof the fund committee, have financial difficulty in com-pleting the dental curriculum. The scholarship is open toany registered dental student who has not completed thecurriculum required for a dental qualification, willbe awarded after examination, and will be tenable forone or two years at the discretion of the com.

mittee. We particularly approve of the very general