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library to Yale, where after the war Klebs’s own bookswill join it. Masterly studies of herbals and plague-bookswere steps towards the ideal catalogue which now we shallnever see. In 1937 however Klebs published a shorttitle list of all known editions of scientific incunabula

(Y3000 and a few more "), the fruit of thirty years’intensive study and an irreplaceable tool for his followers.In a preface of characteristically veiled incisiveness heacknowledges the friendship and help of an American,Fielding Garrison, a German, Karl Sudhoff, a French-man, Louis Polain, and " the most perfect technical aid "of an Englishman, Mr. Victor Scholderer of the BritishMuseum. Klebs was often in London, where he enjoyedthe friendship of D’Arcy Power, who contributed to thebook of essays dedicated to Klebs in 1940. He was lasthere in April 1939 on his way home from a one-day hopto America for Cushing’s 70th birthday party.

CARCINOGENIC ACTION AT A DISTANCEAN important aspect of experimental carcinogenesis

with chemical compounds is the unexpected appearanceof tumours at a distance from the point of application.Explanations are probably to be found in the path thechemical takes once it is absorbed into the body and inthe relative cell sensitivity of tissues it encounters on theway. The chemical constitution of the compound mayalso undergo some essential change during this passage.An example of the phenomenon of action at a distance isrecorded in the report for 1942-43 of the YorkshireCouncil of the British Empire Cancer Campaign. J. W.Orr has found that, in mice of known pedigree which havenever previously borne mammary tumours, intranasaltreatment with methylcholanthrene led to the appearanceof mammary tumours in two-thirds of the mice at riskand these appeared earlier than skin tumours. Asimilar result due to skin painting with methylcholan-threne was obtained earlier by Maisin and Coolen.1Another familiar example is the production of, bladdertumours in dogs by -naphthylamine when given bymouth. The importance of these and many similarobservations lies in directing attention to possible distantand indirect causes of cancer. The reason for the rise in-recent years in lung cancer has been sought chiefly amongsubstances likely to be inhaled, and no entirely satis-factory explanation of all the facts has been found.Here also the cause may be acting from a distance.In the Yorkshire report failure of a substance to actexcept directly was found by H. N. Green when pellets ofacetylaminofluorene implanted under the skin caused notumours to develop in the liver. Carcinogens applied byH. E. Harding over long periods directly to the mucosaof the cat’s stomach, jejunum and colon failed to producetumours or to alter the characters of the cells, thougheither effect might have been expected.

INJURED BUT ABLE

THE Central Council for the Care of Cripples havepublished a memorandum criticising the Tomlinsonreport 2 on the rehabilitation and resettlement of dis-abled persons. In many respects, they feel, the reportis worthy and constructive, but they take exception tothe three proposals : that employers should be requiredto take a- quota of disabled people ; that certain occupa-tions should be scheduled for the benefit of the disabled ;and that a register of people handicapped by disablementshould be drawn up. They feel the register and theschedule would focus attention on the disability ratherthan the man ; for as they state :

" It is a common error to suppose that the most importantthing about the man with an amputated limb is that he hasan amputated limb, whereas on a proper view of the casethe most important thing is that he is still a man, and stillhas three intact limbs, together with a brain and other

1. Maisin, J. and Coolen, M. L. C.R. Soc. biol. Paris, 1936, 123, 159.2. See Lancet, 1943, i, 113 and 119.

valuable faculties, all in good condition (if he has been pro-perly treated while in hospital) and even his amputated limbhas been so well fitted with an appliance (in ’the use of whichhe has been so well taught) that its functions are largelyrestored. Thanks to these remaining qualities, and to thefacts of applied physiology, his working capacity may belittle, if at all, impaired. If he is to be ’registered’ at all,then it is misleading to take account only of the anatomicaldefect."

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If any register is to be compiled, the council considerthat it should be one of employers who have takenthe trouble to study the industrial efficiency ofvarious kinds of handicapped workers. The scheduleof occupations might have the effect of fixing the targetof the disabled, and preventing them from trying toachieve full working capacity. The council agreethat those who cannot stay the course of a full

working week may need sheltered conditions likethose to be found at Papworth and in various epilepticcolonies ; but in the main they feel that the injured manshould be encouraged to take his ordinary place in

industry, quoting the finding of Ford that " there aremore places in industry that can be filled by cripplesthan there are cripples." They suggest that the statetight give a lead by relaxing the present stringenthealth requirements for civil servants.The council’s own solution for the problems of,re-

habilitation is embodied in the conclusions of the memo.

They would like to see : an educational campaign amongdoctors, nurses, masseurs, physiotherapists, employersand legislators in the principles of adaptation of medicineto industry so that they will understand what facultiesare needed for different kinds of work ; a better advisoryservice for disabled people ; and abolition of the presentWorkmen’s Compensation Act in favour of a compre-hensive health service.

SULPHONAMIDE THERAPY FOR THE FŒTUS

WHEN sulphanilamide is administered by any of theusual routes to a pregnant woman, it is distributed inmore or less equal concentration throughout the wholebody including the foetus and the amniotic fluid. Other

sulphonamides (sulphapyridine, sulphathiazole, sulpha-diazine, sulphacetamide, but not azo-dyestuffs like redprontosil) behave in the same way,l 2 and the concentra-tion in the blood of the foetus approximates to that of themother. The concentration in the amniotic fluid dependson that in the foetal urine, which often contains a lot ofthe drug, and consequently it may be higher than in thematernal blood. This ready passage across the placentaopens up the possibility of administering sulphonamidesto the foetus. Speert 2 administered a single 5 g. dose ofsulphathiazole or sulphadiazine by mouth to women inlabour and found that under these circumstances absorp-tion was poor, the blood concentrations in both motherand foetus being very low. He then gave a single intra-venous 5 g. dose of sodium sulphathiazole or sulphadia-zine. Considerable amounts appeared in the foetal bloodwithin 15-30 minutes, and concentrations of 5-7 mg.sulphathiazole per 100 c.cm. foetal blood (5-20 mg. inmaternal blood), or of 9-11 mg. sulphadiazine per 100c.cm. foetal blood (10-20 mg. in maternal blood) weremaintained during the next few hours. The foetal bloodlevel went higher and was sustained longer after sulpha-diazine than after sulphathiazole, so that sodium sulpha-diazine seems the preferable compound for this purpose..The foetal indications suggested by Speert for this pro-cedure are, first, cases of prolonged labour with rupturedmembranes, in order to prevent bacterial invasion of thefoetal. vessels ; and secondly, cases in which gonococcalinfection of the mother is suspected, in order to protectthe foetus against intrapartum infection. The chances ofbenefit to the foetus must be weighed against the chances

1. Kayser, H. W. Kiln. Wschr. 1941, 20, 510.2. Speert, H. Amer. J. Obstet. Gynec. 1943, 45, 200.