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became very steep in most cases at a later stage.There were parallel changes in the sodium of blisterfluid and cerebrospinal fluid and evidently sodiumwas lost from other extracellular fluids as well asfrom blood-serum.The blood ’changes were rapidly corrected by

administration of desoxycorticosterone acetate

(D.O.C.A.). This drug also had a beneficial action oncirculatory failure-an action which, though some-times definite and occasionally dramatic, was incon-stant. It was shown that the circulatory failureassociated with shock after burns was not due merelyto the low level of serum-sodium nor to any otherchange in blood-chemistry. Animal experimentssuggested that the sodium loss from extracellularfluids took place in injured tissues and was inde-pendent of any action of the kidneys or of the centralnervous system. The sodium loss was also not dueto any inhibitory action on the suprarenal cortex.The evidence at present available suggested thatsodium was lost into the cells of damaged tissues,but some of the loss could be accounted for by thepassage of sodium into the red blood corpuscles.The action of desoxycorticosterone acetate in restoringthe sodium of extracellular fluids and in correctingthe other blood changes was confirmed by animalexperiment. This action was found to be surprisinglyrapid-normal levels were reached within forty-fiveminutes of intramuscular injection.

Mr. Wilson and Dr. Stewart also gave an accountof blood-chemistry changes and the effect of D.O.C.A.in other surgical conditions associated with gravecirculatory failure, including acute intussusception ininfants, acute intestinal obstruction following general-ised peritonitis, and acute pyelonephritis. Theyshowed that when circulatory failure was due mainlyor solely to bacteriological intoxication D.O.C.A. hadno obvious effect on circulatory efficiency, althoughif the serum-sodium were previously low a normallevel was rapidly regained. In other instances, par-ticularly in acute intussusception and acute intestinalobstruction without overwhelming bacteriologicalinfection, D.O.C.A. appeared to exert a favourableinfluence on the peripheral circulation.

FACULTY OF RADIOLOGISTS

AT the first annual meeting of the faculty, whichwas held in Liverpool on June 9 and 10, with Dr.R. E. ROBERTS, the president, in the chair, a paper on

Some Problems of Diseases of Bone

was read by Dr. J. L. A. GROUT. He pointed out thatthe diagnosis of bone conditions is particularly difficultbecause there are no appearances which are abso-lutely typical of any disease or even of any group ofdiseases. Radiography shows the changes that havetaken place-osteoporosis, increased density or thelaying down of bone beneath the periosteum-butcannot show the mechanism which has producedthese changes. It is never wise to say that a par-ticular picture is always associated with a particularpathological change, for subsequent operation or anunexpected response to treatment will too often provethat such a diagnosis given with great confidence isincorrect.

Bony Changes in Anaernia and LeukaemiaDr. C. G. TEALL read a paper on a radiological

study he had made of the bones in children withblood diseases based on Parson’s classification. Inhis opinion demonstrable changes are only found in

the subacute and chronic blood diseases when theyare due to secondary changes in the bone-marrow.The hsemolytic anaemias are those where blood changesare seen and the earliest radiographic sign is osteo-porosis at the metaphysial end of the long bones, achange which it is not easy to distinguish. Cooley’sansemia, said to be found only in children of Medi-terranean parentage, and the sickle-cell anaemia ofnegro children, are two conditions in which typicalbony changes are seen. These are absorption, expan-sion of the shaft of long bones, and, in the skull,osteoporosis in the frontal region with striations onthe vault. Secondary leuksemic deposits appear inthree forms-streaky bone-absorption followed bygeneralised osteoporosis and cortical absorption, sub-periosteal infiltration with new bone formation, and arare condition difficult to explain where there is adecrease in density behind the metaphysis similarto that seen in the ansemias and scurvy, probably aresult of interference with growth.

The Adult and Foetal Circulation

Dr. A. E. BARCLAY gave a demonstration of thecirculation by means of cineradiography and serialradiograms. The umbilical veins of foetal sheep andcats just delivered by csesarean section had beeninjected with Thorotrast, Lipiodol or Uroselectan-B.The femoral artery and vein and the vena cava hadalso been injected. The circulation in the adultanimal was shown by injecting the superior and thenthe inferior vena cava. The course of the opaquesubstance in the foetus showed the relationship ofthe ductus arteriosus to the normal vessels and alsothe blood passing through the ductus. Considerabledifficulty was at first experienced, but the accidentalinjection of the femoral artery in attempting to iindthe vein in a small foetus showed the opaque materialflowing up the artery and passing through the ductus.It was also possible to demonstrate the crossedcirculation in the right auricle. Injection of theinferior vena cava showed that circulation was fromthe right auricle to the right ventricle and thence tothe conus arteriosus and through the pulmonarystem, but at the same time some opaque materialoutlined the aorta, showing that it must have passedthrough the ductus. Dr. Barclay thought that thisshowed conclusively that although the foramen ovaletends to close at birth the ductus remains patentuntil the lungs are well expanded.

’

The Cancer ProblemOn the second day of the meeting different aspects

of cancer were discussed by Prof. HENRY COHEN asa physician, Sir ROBERT KELLY as a surgeon, Prof.W. M. FRAZER as a public-health official and Dr.RALSTON PATERSON as a radiotherapist. Prof.COHEN said that the diagnosis of cancer still dependson the care with which a history is taken and on theclinical examination. No specific test for cancer hasyet been found and if there were one it would probablyonly be used when clinical signs had attracted atten-tion, and it might lead to much distress before theprimary site was discovered. At present the radicaltreatment of malignant disease may be described asanatomical, or, on the analogy of a battle, it may besaid that surgery aims at removing the entirebattlefield, aggressor and defender alike. The physicianmust search for another line of approach, and forthis it is necessary to review recent research. The

production of experimental cancer by carcinogenicagents, the curious phenomena of tumours producedby a virus, particularly the Shope papilloma and thepart played by heredity, all suggest that ultimately

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cancer may be prevented rather than cured. Thechemical changes studied by Warburg, who demon-strated glycolysis in the absence of oxygen in cancerand other rapidly growing cells suggest possible thera-peutic methods. More recently the demonstrationthat, whereas the hydrolysis of normal cells producesonly Isevorotatory amino-acids, hydrolysis of malignantcells produces high proportions of dextrorotatoryamino-acids, the change increasing with the degreeof malignancy, suggests an intrinsic and essentialchemistry of malignancy. There are also certainclinical symptoms, such as the condition known asthe Plummer-Vinson syndrome, which are definiteprecursors of cancer and which can be prevented bytreatment of the underlying condition, in this caseby the administration of iron. In conclusion Prof.Cohen said that although much is known and progresscontinues the key of the gate leading to the path tocomplete success in cancer therapy has yet to befound.

Sir ROBERT KELLY was particularly interested inthe unanswered questions of malignant disease. Whywhen the rest of the alimentary tract is so oftenaffected should the small intestine be almost immune tWhy should the lower lip be a common site and theupper lip a rare one T How can an early diagnosisalways be expected when it may be necessary to waitfor months after a secondary manifestation has beenfound before the primary declares itself ? Y Thedifficulty of diagnosis and the uncertainty of prog-nosis, he said, are facts very difficult to influence.

Prof. FRAZER discussed the probable effect of theCancer Bill on the care of the cancer patient. He

looks forward to improved cooperation between thedifferent branches of medicine, and believes that thescheme of special clinics and the responsibility ofthe local authorities will lead to great improvements.He pointed out, however, that the effect of adminis-trative advances is always determined by the state ofmedical knowledge, and improved facilities for treat-ment can only ensure that the patient gets the besttreatment at present available.

Dr. RALSTON PATERSON pointed out that theprevious speakers had all agreed that at presentsurgery, radium and X rays are the only recognisedmethods of treatment. The place of surgery andradiotherapy is now becoming clear, and it is possibleto define which types of malignant disease shouldprimarily have surgical and which radiation treat-ment. When the possibility of cure is considered itis clear that the sites for which much can be expectedare breast, mouth, uterus and skin ; in other sitescure can be looked for in favourable cases, but theproportion seen in an early stage is so small that thecure-rate is very low. Dr. Paterson therefore thinksit important to regard the treatment of cancer asdivided into two methods, curative and palliative.Where curative treatment is undertaken severe

reactions may be justified by the possibility of cure,but palliative therapy must be planned as such fromthe beginning and should not increase the discomfortsuffered by the patient.Mr. G. F. STEBBING thought the speakers rather

pessimistic and hoped for better results.-Mr. B. W.WiNDEYER urged the need for convalescent accom-modation for patients after radiation treatment.

REVIEWS AND NOTICES OF BOOKS

The Dysenteric DisordersBy PHILIP MANSON-BAHR, C.M.G., M.D. Camb.,F.R.C.P., senior physician to the Hospital forTropical Diseases, London; consulting physicianto the Colonial Office and Crown Agents for theColonies. London: Cassell and Co. 1939. Pp. 613.25s.

IN this volume Dr. Manson-Bahr has undertakenwith amazing zeal a comprehensive review andanalysis of the dysenteries, the various forms of

colitis, sprue, the helminthic diseases of the bowel,and the different diarrhoeas which form such a

complex assembly in practical medicine. Theimportance of such a work requires no emphasis.During the last few decades it has become recognisedthat many diseases of the bowel, presenting similarsymptoms, may be caused by entirely differentagents, and that successful therapy depends on theiraccurate differentiation.The opening section is concerned with methods of

investigation, including a useful chapter on thesigmoidoscope, and with a historical and geographicalsurvey of the dysenteries. The next section dealssystematically with true bacillary dysentery, with theprotozoal infections, amoebic, ciliate, flagellate,coccidial, plasmodial and leishmanial, with thehelminthic infestations, and with the infectivediarrhoeas such as food-poisoning and cholera. Theauthor next discusses the steatorrhceas and thevarious forms of colitis. The final section covers thefurther causes of dysenteric diarrhoea and the mani-festations of malignant disease of the colon, polyposis,actinomycosis, tuberculosis, syphilis, lymphogranu-loma and Crohn’s disease, with a chapter on themechanical causes of diarrhoea. There is an appendixby the author’s assistant on the intestinal protozoa

and on technical methods for the isolation, cultivationand identification of the various pathogenic agents,and, finally, there is a useful classified bibliography.The work is largely based on Dr. Manson-Bahr’spersonal experience, but the work of others receivesdue emphasis. The volume is well illustrated withphotographs, drawings and coloured plates, many ofwhich testify to the author’s artistic ability.

Personal Aggressiveness and WarBy E. F. M. DURBIN, B.A.Oxfd, and JOHN BOwLBY,B.Chir. Camb. London: Regan Paul, Trench,Trubner and Co. 1939. Pp. 154. 5s.MOST of us these days find it hard to take an

objective view of the causes and nature of war,and any help that psychology can give us will becorrespondingly welcome, though not necessarilyagreeable. The authors of this book write withan admirable detachment calculated to bring theconception of war into both historical and socialperspective. Their first part is an essay in which they" describe and analyse the general psychologicalforces lying behind the timeless and ubiquitousurge to fight and kill." In their second part, whichhas the lion’s share but is still modestly describedas an appendix, as when it appeared in the symposium" War and Democracy," they give in detail thepsychological evidence for their theories.They examine the contentions that either capitalism

or nationalism may be the fundamental cause of war,and find war to be of more primitive origin than either.War, they think, is " due to the expression in andthrough group life of the transformed aggressivenessof individuals," and its cure is not therefore to besought in remedying the symptoms of transformedaggression such as class-hatred or nationalism, but