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injurious dust is so fine that it floats in the air and isdiffused far from its point of origin to become a sourceof danger to neighbouring workers. Evidence isadduced in favour of intermittent exposure, even

though the second process followed has its own differentdust risk. The efficiency of methods of dust preventionby the application of water at the grinding point, orof dust removal by localised exhaust draught, or of dustdilution by general ventilation, was estimated by dust-counts. The whole work provides a sound basisfor administrative action and has added to scientificknowledge.

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BRITISH JOURNAL OF ANÆSTHESIA.

WE welcome the first appearance of the B1’itishJournal of Ancesthesia, a publication that it is proposedto produce quarterly,1 the contents of which are to beconcerned entirely with anaesthetics and the practiceof this special branch of medicine. The EditorialBoard, the names of which appear on the cover,comprises representative anaesthetists from the greattowns of England and Scotland. It is, however, theambition of the promoters of the journal to makeits scope Empire wide, and they hope to bring intoassociation with themselves representatives of theBritish Dominions beyond the seas. The first numberaugurs well for the future success of the journal.It starts appropriately with an historical articlefrom Sir D’Arcy Power, and this is followed by along account of some clinical experimental work onthe use of drugs in combination by E. P. Donovanand J. T. Gwathmey. W. J. McCardie writes on

broncho-pulmonary complications following anaes-

thesia, J. Blomfield gives a digest of his experienceof sacral analgesia, and there is an account of newanaesthetics by C. Langton Hewer and a comprehensiveabstract and bibliography of current anaestheticliterature. It will be realised that the magazine is amost useful one for any practitioner much concernedwith anaesthetics, and we have no doubt that if thejournal goes on as it has begun it will be a valuableaddition to periodic medica literature.

FREE INSULIN.

A MESSAGE from Toronto announces the freedistribution of insulin to diabetics in the province ofOntario who present a certificate from their medicalman that they are unable to meet the cost of thetreatment. As a matter of cold argument there isdoubtless much to be said on both sides of the questionwhether this is a sound social procedure. Doles ofAll kinds are objectionable. Those who have are

already taxed sufficiently for the benefit of those whohave not. Diabetes is not a catching disease, so thatthe reasons which have led to the free distribution ofdiphtheria antitoxin and salvarsan do not apply.Things which are to be had for nothing are generallyused wastefully. The cost will rise progressively bythe very success of the treatment in prolonging thelives of diabetics. Contrariwise, it is the business ofthe State to preserve its lives and to recognise thatit is a paying proposition so to do. The public is z,entitled to enjoy the benefit of discoveries whichhave been made wholly or in part with the aid ofpublic funds. Monopolies are held conditionally onno one being injured by their existence. Such and ’,such are the pros and cons which are bandied about ’,for dialectical exercise. The medical profession willrecognise that they are almost wholly beside the ’’,point. The entire hospital system is a plain monument !,to the ideal that the sick have a call on the service Iof the sound, that the needy are entitled to the help i,of those who have what they require, and that thosewho are sick as well as needy are a charge uponeveryone. So long as mankind clings to itsimmemorial axiom that life on any terms is betterthan no life at all, it will be unthinkable that a potent

1 Published by Messrs. Sherratt and Hughes. Manchester.Annual subscription, £2 post free; single copies, 10s. 6d.

and valuable remedy should, as a piece of actualpractice, be withheld from anyone merely becausehe has not got enough money to pay for it. Thepublic notoriety which has been achieved for insulinmakes it particularly impossible that it should beleft as a class remedy. There were inhumanity anddisappointment and pain enough through the periodwhen everyone with diabetic children and friendsknew all about it and very few could get it. Nowthat it is available in ample amounts, there ought tobe no more difficulties. Whether free insulin shouldbe supplied by some analogue of the Surgical AidSociety or by the public authorities is a minor questionof technique. There is not so much difference betweenthe two nowadays, and the State seems to be theobvious and simple medium. But the guidingprinciple is clear. It is the motto of Guy’s Hospital-dare quam accipere. ____

THE HISTOLOGICAL STUDY OF NEOPLASMS.

RECENT developments in the experimental studyof the origin of tumour growth have in great partdiverted attention from the results of the traditionallines of investigation rendered illustrious by the workof Waldeyer, Virchow, Cohnheim, and Ribbert. Dr.G. W. Nicholson’s studies in tumour formation, ofwhich No. VIL1 has just appeared, come as a usefulreminder of the prime necessity of accurate histologicalwork as the basis of knowledge in all cellularproblems. Dr. Nicholson has come to the conclusionthat tumours arise in displaced or dislocated cells orcell-groups of the tissue of origin, and in Study VII.extends this conception to the heterotopic new growthsin which the histological differentiation departs fromthat of the surrounding organ. With an extensive andexact knowledge of the literature and a skilful choiceof well-executed figures the author marshals theevidence to the conclusion that the heterotopictumours arise from normally differentiated cells by anintrinsic transformation of which there are manyexamples apart from tumour growth. Withoutabating one jot of our admiration for the author’spainstaking devotion to a laborious specialty, it is

permissible to venture the suggestion that the ultimatesolution of the problems of neoplasia will come from acombination of the methods of descriptive and experi-mental pathology, rather than from their pursuit asseparate disciplines. ____

CARDIO-VASCULAR COMPLICATIONS OF

KYPHOSCOLIOSIS.

j Dr. Ernest P. Boas, 2 medical director of theMontefiore Hospital for Chronic Diseases, New York,who reports an illustrative case with a review of theliterature, remarks that the functional disturbancesof the respiration and circulation connected withkyphoscoliosis have not received the attention towhich they are entitled. Although the frequency ofdyspnoea in such patients was known to Hippocrates,Bouvier in 1874 was the first to show that dilatationof the right chambers of the heart was a very frequentfinding in scoliosis. The most complete investigationis to be found in a monograph published in 1899 byBachman, based on 197 personal cases of scoliosis orkyphoscoliosis which came to autopsy, as well as

79 cases recorded in the literature. Of the total276 cases 247, or 89-5 per cent., presented an organiclesion of the heart or pericardium, but only 13 hadorganic valvular defects. Among 154 cases in whichthe heart was examined more carefully to determinethe nature of the hypertrophy or dilatation 87, or56-4 per cent., had hypertrophy and dilatation ofthe right ventricle, 27, or 17-5 per cent., of the leftventricle, and 40, or 25-9 per cent., of both ventricles.Bachman also noted that displacement of the heartupward and in an opposite direction to the scoliosiswas very frequent, giving rise to a tortuous and angular

1 Guy’s Hospital Reports, vol. iii., fourth series, No. 3, 1923,p. 298.

2 American Journal of Medical Science, July, 1923.