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hour is materially reduced; (b) the elimination ofwater altogether in the four hours after ingestion isdecidedly below that taken in, showing that elimina-tion is more or less retarded; (c) corresponding withdiminished volume there is little decrease in specificgravity. On the basis of these characteristics threetypes of abnormal behaviour to the test may bedistinguished. (1) Retarded type, in which even

though all the water introduced is eliminated infour hours, there is delay in the elimination of thegreater portion ; the initial rapid rise of diuresis iswanting. This condition indicates disturbed renalfunction. (2) Dangerous type, showing grave functionallesion, in which each portion eliminated is smalland equal, even sometimes absent. In the four hours

only a few hundred cubic centimetres are eliminated,while the specific gravity is scarcely lowered. (3) Extrarenal type, which is met with in cases where, althoughthe renal function is intact, the water tends to passinto the tissues and serous cavities. Although theinitial diuresis is rapid and the amount of the firstportion eliminated is conspicuous, yet almost allelimination ceases after two hours. But the eliminationin four hours is incomplete, because a good deal ofwater has already penetrated into the tissues andcannot be eliminated by the kidneys. The concentra-tion test is simple. Half an hour after the completionof the dilution test, and again six hours later, a fullmeal is given without liquid. The urine is collectedevery two hours, and its specific gravity taken. Ahealthy kidney under these conditions shows a rapidincrease in urinary specific gravity. Should this besmall or lowered, renal insufficiency is indicated. Bycarrying out these two tests in rapid succession it issaid to be possible to obtain sufficiently preciseinformation of the total functional renal efficiency.From the diagnosis the next step to prognosis iseasy, and it is made possible for the obstetrician tojudge how the state of maternity will be supportedby the organism. Dr. Barco pleads for a more

extended and routine use of these tests. To neglectthem would be equivalent to neglecting percussionof the lungs and heart on the ground that the resultsare capable of varying interpretations and be subjectedto influences which may diminish their value. Therelative simplicity of the test is certainly a strongreason in favour of its being tried on an extensivescale, and the problem is so grave that trial of suchmethods is to be strongly advocated.

THOMAS HODGKIN, PATHOLOGIST ANDPHILANTHROPIST.

To the current issue of Guy’s Hospital Reports ISir William Hale-White contributes an informingpaper on Thomas Hodgkin, whose name is indissolublyconnected with a disease of lymphatic glands.Hodgkin was a notable man in many ways. Hisfather, John Hodgkin (1766-1845), was a grammarianand a tutor to the children of wealthy families.Thomas, born in 1798, was educated at home,becoming fluent in Latin, Greek, French, Italian, andGerman. He learned his medicine at Guy’s Hospitaland abroad, graduated M.D. at Edinburgh in 1823,after having, in 1822, attended clinical instructiongiven by Laennec at the Necker Hospital, to whichcircumstance is due the introduction of the stetho-scope to Guy’s Hospital on his return from Paris.Hodgkin visited Germany and also Rome, where helodged with a Dr. Viale, who was surgeon to theInquisition. In 1827 Benjamin Harrison, treasurerof the hospital, determined to make really good theMedical School of Guy’s Hospital, now separated fromthat of St. Thomas. He saw the importance ofmorbid anatomy and appointed Hodgkin as lecturer,a post which he held until 1837, when the death ofDr. Henry Cholmeley created a vacancy upon themedical staff. For this post Hodgkin and Babbingtonwere candidates and the latter was appointed. Hodgkinthen left Guy’s Hospital and started in privatepractice. In 1842 he was appointed lecturer on the

theory and practice of medicine to St. Thomas’sHospital School, but his lectures, says Sir WilliamHale-White, were very diffuse, " and it is difficult toimagine that they fixed the attention of his audience."Besides medicine Hodgkin was always deeply inter-ested in philanthropic works ; he was one of thefounders of the Aborigines Protection Society, andfor many years he used to travel with Sir MosesMontefiore in the East to aid Jews and relieve theirmiseries. It was on one of these journeys that hecontracted dysentery of which he died in 1866 atJaffa, where his grave is marked by an obelisk ofsyenitic granite. The work by which Hodgkin ischiefly remembered rests upon a paper read by himin 1832 before the Medical and Chirurgical Society,entitled " On Some Morbid Appearances of theAbsorbent Glands and Spleen," which attracted littleattention at the time. This is not to be wondered at,for only four of the cases mentioned in the paperwere examples of what we now know as Hodgkin’sdisease, and the writer seems to have laid but littlestress upon this case. It was not until Bright, andafter him Wilks, in 1856 recognised the importanceof Hodgkin’s paper that the discovery was properlyattributed to him. Wilks, indeed, discovered the diseaseindependently, but directly he found, after readingBright, that Hodgkin had forestalled him, he hastenedto acknowledge his precedence. Among other worksof Hodgkin was a volume " Lectures on the Meansof Promoting and Preserving Health," delivered at amechanics’ institute about 1830, and setting forth theharm which flows from filth, overcrowding, badsanitation, horrible houses, drunkenness, bad food,want of vaccination, lack of fresh air, and exercise.Sir William Hale-White has succeeded in makingThomas Hodgkin live again in the minds of the present

generation. _____

OSMICS.1

THIS is the second number of a useful little produc-tion. The first number of Osmics, containing anintroduction and 500 bibliographical references, wasissued in 1922 and was found useful by many engagedin researches into the difficult subject of olfaction inits many bearings. Between the two issues hasappeared the entertaining book by Dr. Dan McKenzie, 2which has interested many people in what was regardedas an abstruse topic. The issue of a second number ofOsmics has been prompted by the hope that a furtherbibliography of the literature on the organs and sense ofsmell, and on odorous substances, will facilitate andencourage research into the various problems involved.The entries are made without comment of any sortupon the value of particular books or papers, but fullreferences are given, leaving the reader to ascertainwhether he has found what he wants. Nothing morehas been attempted in the first two issues, but theauthor suggests that further numbers will appearand possibly summaries of original research intothe various aspects of osmics, provided there is anadequate demand for such a

" clearing-house."We hope the demand will be obtained, for the valueof the publication will be enormously increased bythe inclusion of some critical information. Smellhas been the least cultivated of the senses, so thatthere is reason to hope that, if the subject receivessomething of the attention which has been given tothe senses of hearing and sight, the study of odoursshould reach a higher scientific plane. But one prac-tical point constitutes a difficulty at the beginning.The classification of smells suffers from the absenceof the mathematical analysis which can be employedin optics and acoustics. There is consequently noaccurate nomenclature of smells, though manyattempts have been made to establish some systemhere comparable to the classification which has beenset up in regard to seeing and hearing. Arising out of

1 Osmics : The Science of Smell. By John H. Kenneth, M.A.Edinburgh: Oliver and Boyd. 1924. 2s. net.

2 Aromatics and the Soul, reviewed in THE LANCET, 1923,ii., 1086.

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a report on the treatment of war wounds made bythat distinguished veteran, Prof. W. W. Keen, in 1917at the request of the National Research Council ofAmerica, a correspondent in THE LANCET pointedout how extremely convenient it would be if it waspossible to name the smell of a wound in such aprecise way that exactly what was intended could berecognised by investigators at a distance. But theconclusion was arrived at that this would imply thebringing together of smells into a system of scalesor octaves which had so far only been attempted withmoderate success and in a limited manner, the allusionbeing to the work of Septimus Piesse in classifyingperfumes. Reference is given in Osmics to thiswork, which was published originally some 20 yearsago. In it there is set out a series of odours inparallel with the musical scale, the attempt being toshow how it should be possible to make a bouquetcorresponding to a chord. The gamut of odours thusconstructed did suggest a law of octaves according tothe investigator’s ingenious arrangement, but, as hasbeen pointed out, however, in these columns before,while some persons associate certain colours withsmells and others speak of certain musical notes assuggesting corresponding colours, the occurrences arenot proved to have any scientific interest.

HOUSING CONDITIONS IN GERMANY.

PRIOR, to the war, housing facilities in Germany werevastly better in the larger towns than in the villagesand country generally, especially from a sanitarypoint of view. Here the rooms of dwellings weresmall and frequently overcrowded. Nevertheless,on the whole, a quantitative lack of accommoda-tion did not exist, and a qualitative lack only inold-time buildings; any untoward influences werecounterbalanced by the presence of open spaces.Since the war, however, owing to the generaldepression and lack of material building has almostceased ; the housing shortage has been accentuated bythe advent of over a million refugees from cededterritories, whilst the birth-rate has, if anything,increased. A comprehensive review of the housingconditions in their relation to social and industrialhealth has recently been published by Prof. E.Friedberger,l director of the Institute of Hygieneat the University of Greifswald. Greifswald is inPomerania, and the writer considers it a typicalexample of a small German town. Here the post-warshortage is one of smaller dwellings; only 21’5 percent. of middle- and lower-class families seekingaccommodation were successful in 1920. Studentswere, and still are to a very great extent, poorlyprovided for, though a few are given sleepingfacilities by well-to-do families. In a large numberof labouring-class dwellings and municipal houseschosen at random, it was established that theaverage room-space was only 7’2 cubic metres(approx. 267 cub. feet) per person, and the window:floor area varied from 1 : 14 to 1 69. The roomswere damp, and those used as kitchens were

unhygienic and small, serving as bedrooms as well.Ten per cent. had no window at all ; in the majority ofcases there was no kitchen range. There was onewater-tap between five families, representing about40 persons; bathing facilities were unavailable andsanitary arrangements thoroughly bad. Lighting wasprovided for by means of petroleum in less than 12 percent. of cases, in 7 per cent. by calcium carbide, 19 percent. by tallow candles, 9 per cent. by some oil sub-stitute, in the remainder there was no provision. On anaverage there were 2’6 persons per bed, for which in35 per cent. there was no linen. The incidence ofdisease has decidedly increased, though the relativepercentage of tuberculosis is lower than usual, asdeath occurred rather from enfeeblement due to wantof nourishment. Amongst children rickets is butslightly increased, as they are constantly in the sun

1 Untersuchungen über Wohnungsverhältnisse. Jena : GustavFischer. Pp. 112. 3 gold marks.

and air; but their physique is exceedingly poor.The measures adopted by the authorities to combatthe housing shortage were planned in 1920. and con-sisted in building a small number of houses adapted toone and more families. Each dwelling comprises tworooms and a kitchen, which, perhaps not ideal, are atany rate light and dry, and can be heated. Additionally,a small garden is attached, where some live-stock canbe kept and a modest amount of vegetables grown.Electric light and water are laid on. The sewage isretained in tanks below the ground, and is used as gardenmanure. Investigation on the birth-rate showed anaverage of 6’3 pregnancies per family ; 90 ’5 per cent. ofthe expectant mothers were unable to avail themselvesof the local clinics, owing to their being compelled towork right up to the day of their confinement ; 70 percent. of the total pregnancies ended in live births, theremainder of the infants died shortly before or afterdelivery; 70’5 per cent. of the infants were nursed bytheir mothers for varying periods ; the same percentagewas obliged to be fed at 15 months of age on food par-taken of by adults. The hygiene was similarly unsuit-able. Such are the conditions under which the presentgeneration in Germany is growing up, and their effectswill be only patent in the next few decades.

EPITHELIOMA OF THE TONSIL.

AT the last annual meeting of the Medical Societyof the State of New York Dr. Leon H. Smith read apaper on epithelioma of the tonsil based on the studyof 40 patients who had been treated at the BuffaloState Institute for the Study of Malignant Disease.The cases were divided into the four following groups :(1) cases with the new growth confined to the tonsiland excellent general condition (4 cases); (2) caseswith early cervical metastases and good generalcondition (10 cases); (3) cases with well-markedmetastases and poor general condition (14 cases),(4) hopeless cases with advanced toxic cachexia(12 cases). Thirty-six of the patients were males and4 females. The ages ranged from 28 to 82. the averageage being 55. As regards the earlier medical history,only 12 stated that they had had previous attacksof sore-throat or tonsillitis ; 75 per cent. admittedexcessive indulgence in tobacco, and only three hadnot used nicotine in any form. Ten had well-markeddental caries, and seven moderate dental cariesaccompanied by pyorrhoea. In three there were

upper and lower plates. In only two patients was theWassermann reaction positive. The chief complaintswere sore-throat and discomfort which were presentin at least 50 per cent. A biopsy was performed oneach patient, care being taken to remove only a smallportion of tissue if dental caries or oral sepsis waspresent. In the differential diagnosis the followingconditions had to be excluded : gummata, tubercu-loma, papilloma, sarcoma, and Vincent’s angina.The possibility, however, of the coexistence ofsyphilis or tuberculosis with cancer should not beoverlooked. The earlier patients were treated byX rays, but the results in the vast majority wereunsatisfactory, retrogression of the neoplasm andimprovement of the general condition being onlytemporary. During the last three years a combinedmethod of treatment has been adopted. Radiumemanations in glass beads are inserted into the growthwhere they are allowed to slough out or remainencysted, and deep X rays or the new radium packare applied to the cervical regions. Apart from casesof a fulminating type, patients in whom the symptomshad lasted one to three months only were favourablesubjects for treatment. After the lapse of threemonths the cases became more refractorv to treat-ment and after six months altogether inoperable.Seventeen patients in the present series died fromhaemorrhage, two from general sepsis, four fromsuffocation due to oedema of the glottis, and threefrom profound toxaemia. In conclusion, Dr. Smithemphasises the importance of early diagnosis and theprompt institution of radiation therapy.

1 New York State Journal of Medicine, March 7th, 1924.