LONDON HOSPITALS AND CENTRAL CONTROL.

333 money which should go into his pockets into the coffers of alms in accordance with a plan which would increase both the central and 10c’Ll contributions towards medical charities the chemist and druggist. I should also like to add from many years’ experience in in London and would provide at once a measure of effective control ?7 The size of the board appointed by the three funds one of the poorest districts in London that such a scheme would be quite impracticable in working class districts. The is not material to the scheme. One delegate from each fund, working man is the backbone of a great many practices in if one member with adequate leisure and experience could be the larger towns and his ld. a week club payment or the found in each committee, would suffice. But whatever its size He - and we can trust to the common sense of the appcinting small surgery fee he pays includes his medicine. certainly will never pay a fee to the medical man and a committees not to make it too large for its work-this second fee to the druggist and the practitioner in such board would possess the power of the purse and should be districts will be unable to exist. This would inevitably lead, able as an independent body to perform the important as Dr. Oliver points out in his letter, to still greater overfunctions assigned by "Hospital Surgeonto his proposed orowdirg of the already overcrowded out-patient departments commission. If the County Council or any other municipal of our hospitals and charitable dispensaries, an evil which or State authority were disposed to adopt the proposal to even now cries aloud for a remedy. give certain hospitals free rates or to contribute to certain I am, Sirs, yours faithfully, hospitals in proportion to the sums collected by the hosW. F. GRANT. pitals themselves it would be possible for such authority to make this board its almoner. I venture to explain my suggestion a little more fully To the Editors of THE LANCET. because I believe that the central authority proposed SIRS,-Dr. James Oliver has, I think, very wisely drawn fulfils in nearly every respect the requirements of the kind of attention to this extraordinary idea of interfering with the board desired by "Hospital Surgeon " and in the hope that liberty of medical men. That such a proposition should be more within the region of practical politics than a advanced at a time when there has been so great an exposure being commission appointed by the State it may secure his of the falsification of prescriptions, and while prescriptions powerful advocacy.-I am, Sirs, yours faithfully, are so extensively abused both by patients and druggists, is LAURISTON E. SHAW. not only extraordinary but astonishing. The medical man is absolutely responsible that his patient should have the exact drug, of proper quality, of the preIN WHAT DOES CANCER CONSIST? scribed dosage, and for the right period. Under existing To the Editors of THE LANOET. conditions he delegates this grave responsibility to others and cannot be assured in many instances that these requireSIRS,-Under the above heading you published a letter ments are fulfilled. The present system has grown up owing from me in your columns on August 25th 1888, p. 395. to the complexity of dispensing, but if our pharmacopceia Researches carried out during the intervening 15 years have were brought up to the present-day standard the greater part tended to confirm both positively and negatively the thesis of this difficulty would vanish. Instead of giving advertise- there advanced. Pathologies are coming to look more and ment to the advertising proprietary medicine vendors the more to the natural history and tendencies of the cell and medical man with little trouble and great saving of time to less and less to vegetal parasitism as aSording a solution of himself and patient could avoid resort to these undesirable the mystery of cancer. The thesis to which I allude was methods. thus stated in my letter of August, 1888 :I believe that this delegation of responsibility has done If, then, we believe that in her wildest vagaries of pathological much to lower the reputation of the profession in many ways. neoplasm nature makes no jumps; if we recognise a transition One common example is the cheap criticism of the dispensing between the simple and the specific, the innocent and the malign, chronic inflammation and cancerous infiltration, sarcoma and carcidruggist on prescriptions and that of the patient and friends. noma,-in what, then, does cancer consist ? In generation, in inflamIf the liberty of the medical man needs curtailing it should mation, in repair, in caicincmata and sarcomata, the individual factor be in the opposite direction-viz., that "no prescription is morphologically apparently identical; what differences there may are latent, not expressed. In inflammation, repair, and in maligshould be put in the hands of a patient"and that no be nant growths, then, there is areversion to embryonal cell type. In the medicament should be supplied to a patient except on the two former processes there is either organisation of embryonal cells into tissue or liquefaction into pus. In the neoplasms, on the other direct responsibility of a medical man." is an indisposition of the component cells either to there hand, I am, Sirs. yours faithfully, differentiate into tissue or to suppurate. They lack the influence HENRY RAYNER, M.D. Aberd. which makes for organisation ; their instincts are of the lowestare amoeboid, in fact. They possess the fecundity of cells unfit, ed for "colonial" life and share their vagabond propensities. Herein lie the factors of malignancy, the causes alike of the rapid growth and the infectivity ot cancer It may also be, LONDON HOSPITALS AND CENTRAL as Dr. Creighton with acumen and felicity has put it, that these cells possess a veritable "seminal" influence; that is, by their conCONTROL. tact they cause other cells to generate, and make the effspring like To the Editors of THE LANCET. themselves; witness a sarcoma of the ciliary bory infecting the very substance itself. The recent asserted discovery in cancer cells of SiBS,—If you regard this subject of sufficient general lens nuclear structure akin to such as is only foui7d in spermatoblasts may interest to warrant you in giving me a little more space I possibly afford a morphological peg on which this theory may be should be glad to reply briefly to the letter of’’ Hospital suspended. it be inquired whence this influence is which makes for malignancy Surgeon" in THE LANCET of Jan. 23rd, p. 254. He has, I andIt what determines its initiation, it can only be replied that we are for of a confuted the estabiishment think, my proposal "the heirs of all the ages" of the lowly amoeba no less than of our central board with proposals recently made by other writers parents. That as we believe with von Bafr that the history of the I agree with " Hospital Surgeonthat individual repeats the hiatory of the race, so we carry within us on the same subject. (happily not all in the same degree) the idiosyncrasies which pertained any board composed of delegates appointed by the hospitals to the life-history of our earliest progenitors. That, while h the prothemselves would be as useless to control the hospitals as is cesses of repair and of organising it flammation we see a survival of the present Central Hospitals Council or as is the General tendencies mbented from a later generation, a generation which had Medical Council to control the examinational activity acquired colonial habits and a lower grade of feeuxdtty, and which we as beneficent in the life-history and tendencies of the cancer of the univerities and colleges which appoint the majority regard cell we see occasional persistence of (Cobnheim) or reversions to, that of its members. The two policies which seem to have still earlier type of structurelesb cell, inapt at 8l,cclalisation, indisposed secured the ch’ef support from recent writers on this subject to colonial collahoration, and multiplying by fisMon with that terrific rapidity characteristic of the lowliest of hvit g things. are either to strengthen the existing council by adding to the I am, Sira, y.urs faithfully, number of hospitals represented upon it or to invoke State aid W. J. COLLINS. and with it State regula’ ion. The first, I believe, willrove the second is with a disfavour ineffectual ; regarded great by majority of hospital administrators, whilst all practical men "MANUAL TREATMENT IN TYPHOID recognise that it is unlikely to be carried out during the lifetime of the pies’nt generation. Meanwhile the establishFEVER AND DIPHTHERIA." ment of central tunds to col!ect money for the hospitals is To the Editors of THE LA1BCET. making it more and more difficult for the hospitals themselves to obtain individual support and at the same SIRS,-I am very much obliged to you for your criticism on time shows no prospect of making such local and individual my book (’’The Elements of Kd}gn-n’s Manual Treatment") support unnecessary. Is it too much to ask that these three which appeared in THE LANCET uf Jan. 9tb, p. 100. 1 feel, collecting funds should intrust to a board appointed by however, called upon to reply to two of your remarks. You themselves the distribution of a small proportion of their state that I I We. have our doubts as to the wisdom ofheart "’-.

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