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tenets of psycho-analysis, and that ideal, of course,lies behind the intelligent part of the support extendedto this teaching. And, in this connexion, it is worthwhile calling attention to the synthetic work ofBlondel (too little known in this country) wherein itis attempted to reconcile the points of view of Freud,of Jung, of Adler, and of the Church by the adoptionof a formula which implies the origin of every " con-flict " in " la conscience morbide." Dr. Crookshankwrites with clearness and learning on matters whosedifficulty calls for just those qualities if they are tobe dealt with in any useful manner.

IMPAIRED RENAL FUNCTION.THE investigation of early renal disease and of

minor degrees of renal deficiency has received con-siderable impetus in recent years from the introductionof more perfect methods of chemical investigation.Whether these methods have led to marked improve-ment in early diagnosis and increased accuracy inprognosis is more questionable. Even now, unhappily,the methods in use only give information when therenal damage has already become extensive. It hasbeen estimated that a faint trace of albumin in theurine at the age of 40 or over represents a death-ratefrom nephritis ten times higher than the normal,a trace increases this rate to 30 times the normal,whilst with large amounts plus casts the rate is about50 times the normal. Every physician has seenamongst his patients cases with a trace of albuminuria,associated with a normal blood pressure, in whomblood analysis and such tests as the urea-concentrationtest proved indecisive, when, nevertheless, ursemiaor fatal arterial changes followed in a surprisinglyshort period. It would seem that neither the clinicnor the laboratory can yet give us the informationwe require concerning these cases. An interestinginvestigation with a view to improving our knowledge

. in this direction has been recently published by Dr.Nellis B. Foster,l of New York. In nine patientswho had had one kidney removed he carried out verycomplete tests. The patients selected were all under40 years of age, without signs of disease in theremaining kidney, and the inquiry was in each caseundertaken within three weeks of the removal ofa diseased kidney. In this way it was hoped toexclude kidneys with changes due to disease or

senility and also without suspicion of compensatoryhypertrophy; but as tuberculous disease in theremaining kidney can never be wholly ruled out,Dr. Foster rightly stresses the results given in thesecases where the trouble for which nephrectomy hadbeen performed was not tuberculous. The testschosen were, first, Volhard’s water-excretion test,consisting in the administration of 1500 c.cm. ofwater drunk in half an hour before breakfast, a totalexcretion of at least a litre during the followingfour hours being considered necessary to establishnormality; secondly, the patients were for 24 hoursgiven an ordinary diet without any fluids-that is,neither drinks nor soups of any kind-but otherwisea normal diet. In such circumstances a normal manwill at the end of the test period usually void urineof a specific gravity of 1030 or higher ; in thenephrectomised cases only one case yielded a urineof such density as to be considered absolutely normal.The third test employed was that of ascertaining theratio (urea in one hour’s urine) =(urea in 100 c.cm.of blood) which, according to Addis and Drury,2 2averages 50 and should not fall below 34 in normalpersons even when the urea in the blood has beenartificially increased. The cases investigated byDr. Foster were given 30 g. of urea in a litre of waterbefore the test, and it was then found that in everycase the ratio given fell below Addis’s standard ofnormality. In cases where the test was repeated ata later date the result indicated a considerable returntowards the normal, a result which points either tosome hypertrophy of the remaining kidney or to thekidnfv having suffered some toxic df’TI1’f’ssion at the

1 Arch. Int. Med., 1925, xxxvi., 884.2 Jour. Biol. Chem., 1923, lv., 105.

time of the original test. Reviewing the results asa whole, the author feels that the demonstration ofrenal deficiency in persons with only one kidney isonly doubtfully revealed by these tests, the ratioafter giving urea being the only test pointing at allconsistently to any limitation of kidney function.

THE DEFENCE OF EXPERIMENTAL MEDICINE.AN account of the history of the Research Defence

Society, founded 18 years ago, is given in the currentnumber of the organ 1 of the Society, and may berecalled for the benefit of those of our readers towhom the story is not familiar. It arose out of a com-mittee organised by Prof. E. H. Starling to collectevidence for the Royal Commission on Vivisection.When all the evidence had been set out and published,enthusiasts such as Mr. Stephen Paget were not

prepared to let good machinery be broken up.A society was formed in order to bring about a betterunderstanding of the value of medical research, andto expose false statements made with the object oflimiting and hindering those animal experiments onwhich its progress so largely depends. The Societythrove progressively during the first six years of itslife, and in 1914 numbered over 5000 members andassociates. The war years demonstrated the valueof prophylactic methods in protecting whole armiesfrom disease, and broke down much of the prejudiceagainst the use of experimental animals for theproduction of sera, for the standardisation of biologicalproducts, or for the testing of remedies. While theobjects of the Society were thus being realised, itsmembership decreased and during the war its activitieswere necessarily curtailed. A revival of these appearsto be taking place, for three debates are reported inthe January issue of the journal. Probably a bettermethod of propaganda also employed by the Society isthe popular lecture, because the public are eager tolearn of new discoveries in medical science even

when these have no immediate bearing on preventionor treatment of a specific disease. The modern doctortends to take for granted the need for observationson animals and sometimes neglects to equip himselfto meet the arguments still advanced against them.The Research Defence Society exists to uphold anddefend experimental medicine and ought to havea membership as wide as the Medical Register.

NEOPLASMS OF THE TESTICLE.SINCE the classic paper of Wilms in 1896, it has

been generally recognised that the mixed tumoursof the testicle are teratomata. Data have slowlyaccumulated to show that, with the single exceptionof the rare testicular " dermoid," the teratomata ofthe testicle are extremely malignant, and this malig-nancy has been held to be a carcinomatous or sarco-matous degeneration of a previously benign tumour.From the study of some 95 tumours of the testicle,Mr. H. W. B. Cairns, first surgical assistant at theLondon Hospital, has decided that this view isincorrect. Primary tumour and its metastases,he states, exhibit the same remarkable power ofdifferentiating to form histologically benign tissues,exactly similar in structure to the tissues of thenormal foetus. The teratoma retains its biologicalcharacters in its metastases and is, therefore,inherently malignant. Mr. Cairns laid his conclusionsbefore the Royal College of Surgeons in a Hunterianlecture on Feb. 12th. The series of cases he hascollected is unusually large and the opinions formedare of corresponding importance. Only three casesof true hypertrophy of the breast accompanyingtumours of the testicle have previously been recorded ;Mr. Cairns’s series contains another three. Thishypertrophy is of interest as an indication of thefoetal nature of teratomata of the testicle ; furtherevidence is afforded by the occasional discoveryof chorionic remnants in the tumours. Considerablecontroversy has raged over the nature of the commonspheroidal-celled tumour of the testis, variously

1 The Fight against Disease. Macmillan. 6d.