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metazoan parasites, such as bilharzia and the spir-optera found by the Danish investigator, Fibiger,associated with cancer of the stomach in rats.Fraenkel regards this variety in origin as practi-cally excluding a parasitic aetiology of cancer, andhe goes on to remark acutely that the same varietyin the predisposing factors renders any attempt ata specific cancer prophylaxis nugatory, apart froma general improvement in the prevention of alldiseases. The rare cases of spontaneous cure ofcancer, and the more numerous instances of successafter incomplete operations, are regarded as of themost happy augury for success in the ultimate

triumph of a rational therapy. Early and completeremoval is emphasised as still the most suc-

cessful method of treatment, full recognition beinggiven at the same time to the brilliant resultsof radiotherapy in suitable cases. Fraenkel then

goes on to an account of the chemo-therapeuticexperiments of von Wassermann -and others,emphasising the necessity of improved methods ofdiagnosis. early in the disease and of research inthis direction. The article concludes with a

severe indictment of the extravagant claims ofAdamkiewicz to have produced a practicallyinfallible cure with his cancroin, the solubletoxin of a supposed protozoan parasite of cancer.The danger to the credulous public from suchirresponsible claims is not less in other countriesthan in Austria, and, shorn of its verbose and floridstyle, an article conceived on similar lines andcirculated broadcast might do something to putdown the raising of false hopes by interestedpeople, and to encourage the efforts of those who,without hope of material reward, are seeking thesolution of one of the most fascinating, as well asone of the most serious, problems in medicine.

INFLUENZA AND TUBERCULOSIS.

DEALING with the death-rate at institutionsunder their supervision the Commissioners of theBoard of Control noted in their report for the year1918 that the increase in the number of deathsamong the insane, as compared with 1917, was duemainly to influenza and tuberculosis, although theydid not suggest any connexion between the twodiseases except in so far as both were regarded asdependent on " weakened physical resistance " dueto war conditions. Some asylum medical officers,however, accept a more intimate relation-e.g.,Dr. F. A. Elkins and Dr. H. H. Thomson in their

paper on the Incidence of Tuberculosis AmongstAsylum Patients in THE LANCET of August 9thinclude as contributory causes " the occurrence ofoutbreaks of influenza and pneumonia during 1917,and more especially in 1918." It is, of course, diffi-cult to eliminate with certainty the post hoc ergopropter hoc fallacy, owing to the extent of theinfluenza epidemic in some institutions, for it wouldbe hard to find among the inmates of older standingany developing tubercle during 1919 who had notsuffered from influenza during the preceding year.An article which has recently appeared in LyonMedical i lends a little more exactitude to theavailable evidence. Dr. Roubier has investigatedthree classes of cases: (1) those in which thereis a prolongation of the illness simulating tuber-culosis ; (2) cases of tuberculosis definitely appear-ing after influenza; and (3) cases of influenzain patients already suffering from tubercle. He

1 Grippe et Tuberculose, par le Médecin-major de 2e classe Ch.Roubier, Lyon Médical, September-November, 1919, Nos. 9-11.

recognises, thus confirming the teaching of ProfessorJ. Teissier and others, that some cases of influenzapresent persistent physical signs of apical bronchitisor basal cavity formation or pneumonia. Among91 patients sent to him with suspicious bronchitisfollowing influenza he found 12 (13’2 per cent.) inwhom a diagnosis of tubercle was confirmed. Insome of these there was a phase grippale witha subsequent stage of apyrexia lasting. for variousperiods up to a month, and finally a regular evolu-tion of tuberculosis on the usual lines. In someinstances the incidence of the tuberculous affectionwas chiefly upon the pleura, but in none was

meningitis observed. As regards the effects ofinfluenza upon patients already suffering from pul-monary tuberculosis, it was found that, whiletheinfluenza exerted a generally unfavourable influence,the results were in some cases negligible.

VOLUNTARY HOSPITAL FINANCE.

THREE meetings vitally affecting voluntary hos-pital finance have been held during the past week.The General Council of King Edward’s HospitalFund for London met on Tuesday at St. James’sPalace. The annual meeting of the League ofMercy fell on Wednesday. The annual meetingof the Metropolitan Hospital Sunday Fund washeld at the Mansion House on Thursday.The time is a critical one for the voluntaryhospital. The private citizen, faced with an

increased cost of the necessaries of life, cuts downhis style and manner of living, unless his incomehas increased proportionately. The income of

voluntary hospitals has not grown in the sameratio as their expenses, but expenditure cannot becut down without failing to carry out the work forwhich hospitals were started. At this stage the Statemight step in with financial backing, and the rightto control as a necessary part of the bargain. Butfor the present neither the hospitals nor the

Ministry of Health desire this solution, one which,moreover, will be distasteful to many medical men.The executive committee of the League of Mercyrecently passed a resolution asking the King’s Fundwhat action that body intended to take in the matter,and, in reply, the executive committee of the fundquoted and endorsed the words of King Edwardwhen he inaugurated it:-

" Public opinion has shown itself upon more than oneoccasion, and I think wisely, in favour of the mainten-ance of the voluntary system for support of our hospitals,combined with an adequate system of representation’

*

of the body of subscribers in their control and manage-ment. It is obvious, however, that if these institutionsare to be saved from State or parochial aid, theirfinancial position must be secured."

.

Towards securing this position in London thethree funds which we have named are this yearmaking exceptional contributions. Lord Revelstokeannounced, as honorary treasurer of the King’sFund, an available balance of £230,000, includingan amount of J317,000 to be handed over by SirWilliam Collins on behalf of the League of Mercy.In addition to this large sum, the British RedCross has allotted ..B250,000 of its surplus as a

special donation to the voluntary hospitals to bedistributed by the committee of the King’s Fundat a different time of year. At the public dinnersheld during the last few days in support of the

building schemes for the Middlesex and the GreatNorthern Central Hospitals feeling was evidentlystrongly against the placing of these institutionsas a charge on public funds. In the one case a