1035

waa a definite separation of the tumour from the.surrounding tissue.

Most students of cancer find it difficult to under-stand how a disease such as cancer, which is strictlylocalised at its inception, can be caused by the failureof a growth-regulating mechanism which operatestthrough the blood stream. Even in the adult organismprocesses of normal growth are still proceeding-e.g.,in the lymphoid tissues, in the mucous membranes,.and in the genital organs. If the appearance of.cancer was associated with the failure of disturbance,of a mechanism regulating normal growth, one would- expect disturbances of normal growth in the organsjust mentioned. Moreover, one would expect tofind cancer in some of the syndromes of anteriorlobe dysfunction which are described at length byProf. C. G. Lambie and Dr. B. P. Wiesner in the

Edinbu,rgh Medical Journal for November. Theseare a priori objections, but they demand convinc-ing evidence, experimental or clinical, before

- they can be dismissed as irrelevant, and before,the pituitary or any other organ can be implicatedin the aetiology of cancer. With that reserva-

tion it may be admitted that the results obtainedby Dr. Susman are suggestive enough to justifyfurther research along the lines laid down by’him. So those who have had extensive experience,in the treatment of inoperable cancer by the mostdiverse methods know that the first application of anew treatment to a cancer patient will sometimes befollowed by a striking temporary improvement butthat the same treatment will fail completely whenapplied subsequently to numerous other apparentlysimilar cases. This should always be borne in mindin appraising the significance of attempts to influencethe growth of cancer in man by new therapeuticmeasures.

___

THE NOBEL PRIZEMAN,

THE Nobel Prize for Medicine is this year to beawarded to Prof. Otto Warburg, of Berlin. A prom-inent member of the Kaiser Wilhelm Gesellschaftfiir Forderung der Wissenschaften, he was until a

year ago the scientific director of that section of theKaiser Wilhelm Institut fur Biologie at Berlin-Dahlem dealing with cell-physiology; this and

cognate subjects having constituted the main partof his important contributions to science over the

past 20 years. These researches, many of which haveteen embodied in his two volumes of collected work,!:have been conceived on the very broadest foundation,:and are remarkable for the clarity of thought com-’bined with great experimental skill which their author:has brought to bear on a previously obscure section,of biology.

Prof. Warburg’s earlier work was largely concerned"with the study of catalysis, his name being parti-’cularly associated with the applications of this studyto catalysis in living cells, and the problems of theaction of chemically indifferent narcotics on the onehand, and of the specific anticatalysts or catalystpoisons on the other. This work led naturally to hismore recent study on the problems of respiration.and fermentation in living animal and vegetableoells. He formed the view that the processes ofrespiration and sugar-cleavage, among other vitalTeactions, were catalysed by complexes consisting ofa particular type of organic compound of a heavy

1 Uber die Katalytischen Wirkungen der lebendigen Sub-stanz, Berlin, 1928: The Metabolism of Tumours. Trans-lated, with additions, by F. Dickens, Ph.D. London: Constableand Co., 1930.

metal such as iron. In the case of respiration of tissues,he has carried the analysis of the problem further bya recent and characteristically bold investigation,taking advantage of the light-sensitive properties ofcompounds of iron with carbon monoxide, in order todetermine the absorption spectrum of the essentialiron complex or respiratory enzyme. The compound,contained to the extent of only 1 part in 100,000,000in cells, appears to be an iron-porphyrin compound,in which the porphyrin group is more closely relatedto the chlorophyll type than to that present in

haemoglobin. It is therefore not too much to saythat through this work more is known of the probablechemical structure of the respiratory enzyme than ofthat of any other similar active agent present in

living cells-a remarkable triumph when one con-

siders the almost infinitesimal amount which this

iron-complex constitutes of the total mass of thecells.

Important contributions have also been made byProf. Warburg to the problems of photosynthesisand carbon dioxide assimilation by green plants. Inthe field of medicine, however, for practical reasons,the main interest centres inevitably around his workon the metabolism of cancer tissues. It was not until1923 that the remarkable extent to which livingtumour cells are able to convert carbohydrates intolactic acid was discovered. In that year Warburgfound that these cells may produce as much as one-tenth of their own weight of lactic acid in one hour,an observation that has since received abundantconfirmation. The significance of this aerobic lacticacid production is as yet incompletely realised, andit is not possible to do justice to its implications ina short space. It seems likely, however, that it mayfurnish an additional source of energy, at the expenseof which the tumour cells can survive under condi-tions where normal cells would perish.A year ago Prof. Warburg was appointed director

of the new Kaiser Wilhelm Institut fur Zellphysiologieat Dahlem. This building was supported by the fundsof the Rockefeller Foundation, in order that hemight there continue his work on the fundamentallife-processes which eventually may well prove as

important to practical medicine as it has alreadyshown itself to be in the fields of pure biological andbiochemical research.

____

VACANT BEDS IN LONDON HOSPITALS.

THE statistical review of the work and financeof the London hospitals,! just published by KingEdward’s Hospital Fund for London, shows thatvoluntary gifts to hospitals, including legacies, in-creased from ;E1,689,000 in 1928 to 1,836,000 in 1930.There was, it is true, some decrease in 1930 comparedwith 1928 and 1929 in the amount received from thegeneral body of subscribers and donors, but this wasmore than set off by the receipt of a large singledonation of 100,000. Notwithstanding an advanceof 131,000 in the total running expenditure, due toprogress in various directions, including the upkeepof 350 additional beds, the aggregate surplus of incomeover expenditure in 1930 was 80,000. The reportcontains a valuable appendix on unoccupied beds,in which it is pointed out that any improvementin the percentage of beds occupied would in effectbe as valuable as the building of additional bedaccommodation. During the year 1929, with an

average complement of 15,952 beds in London

1 To be obtained from the office of the Fund, 7, Walbrook,E.C. 4. Post free 1s. 3d.

1036

voluntary hospitals, on an average 519 were closeddaily, and 2057 were vacant daily between the dis-charge and admission of patients. The causes ofclosure in the first and smaller group included building,reconstruction, difficulty of providing nurses, cleaning,repairs, infection, and staff holidays. Closure ofthis kind is not regarded as an index of efficiency.Beds vacant numbered four times as many as bedsclosed, and were distributed thus among the variousclasses of hospital beds.

Percentage of beds vacant between discharge and admission.Medical .... 10-4

1 Accident .. 17-5

Surgical .... 11-0 Isolation, observa-Medical and surgical 15-8 tion, and septic.. 36-9Maternity.... 10-3 Pay beds.... 25.1Gynaecological .. 9.6 Staff beds .. 53-0

It is of course to the interest of the hospital thatcertain classes of beds-e.g., isolation, septic, andstaff beds, should be as empty as possible. If a hospital,too is to make adequate provision for accident andother emergency cases it is essential to reserve acertain number of empty beds for them. The highratio of vacancy in pay beds which exists at mosthospitals is ascribed to the facilities in this directionnot being yet sufficiently well known. In generalthe causes leading to vacant beds may be divided intothree categories : (1) The main cause in the morehighly organised hospitals is to be found in the

apportionment of beds for special classes of cases forwhich the demand is variable, without a definitesystem of admission of other cases to these beds ascircumstances may demand, when such admissionis practicable. In some cases the vacancies may becaused by the postponement of a patient’s admissionto suit the time-table of a surgeon. In other cases the

vacancy may be due to failure on the part of thehospital to control as far as possible the loss of bed-days due to causes originating with the patients.(2) Failure to accept or delay in accepting admissionwhen notified of a vacancy. Linked up with this isdisinclination on the part of many patients to be inhospital during holiday periods. (3) Vacancies maybe due to the necessity of providing beds for which avariable demand may exist and which cannot be ’,allocated to other purposes, either on account of thenature of the case-e.g., beds in a fever hospital, orbecause the demand is only known from day to dayas it emerges-e.g., the daily provision of beds foraccidents. By drawing attention to the results ofthis inquiry the Fund hopes to effect some improve-ment in the percentage of beds occupied.

MEASLES,DURING the past four years in London measles has

caused eight times as many deaths as scarlet feverand one and a half times as many as diphtheria.During each biennial epidemic some 50,000 childrenare affected and about 10,000 of them have to beadmitted to the London County Council’s hospitals.This season’s outbreak, if it follows the usual plan,will begin during the late autumn, reach its meridianduring March and take six or seven months to completethe circuit of London. Faced with this immense

problem the authorities have begun by drawingpublic attention to the dangers of the disease andby circulating certain excellent rules for its manage-ment. " Every effort," they say, " should be madeto postpone the contraction of the disease until afterthe third or preferably until after the fifth year ofage, for the younger the child the greater is the riskof serious illness arising from broncho-pneumonia

or other complications. Adequate medical, nursing,and hygienic care are the most important means forpreventing complications and a fatal outcome.The disease is particularly fatal among childrenunder-nourished and living under unfavourable condi-tions. Special methods of control must be appliedto prevent or ameliorate the disease in such children."These statements will, we hope, help to correct manyof the misapprehensions about measles which are

so common. But there still remains an unnecessarycloud of pessimism among the public at large. It,seems extraordinary that our most influential news-paper should be able to tell its readers (on Tuesday)that measles " remains almost wholly unpreventable " ; ;:for in last week’s LANCET (p. 977) Dr. S. P. Bedsonwas able to show that this is a disease unusuallyeasy to prevent or modify. In 1926,1 in discussing its.prophylaxis by serum and whole blood, we devoteda good deal of attention to the academic problem ofwhether it would be wise to eliminate measles andthus perhaps reduce the national immunity. Butat the present rate of progress this does not seem to b&a pressing danger. ____

MR. BERNARD LAMB.

MEDICAL men throughout the country will regretto hear of the death which occurred, after an operationfor appendicitis, on Oct. 30th, of Mr. J. BernardLamb, who was for over 40 years the secretary of theLondon office of Epsom College. Mr. Lamb devoted his.life to the Royal Medical Foundation attached to EpsomCollege, and his signature at the foot of appealsfor funds represented but a small part of his duties,as he interpreted them. His extraordinary sympathywith those who desired to introduce their claims

upon the Foundation involved him in inquiries of themost delicate sort, and when those in whom the

responsibility was vested of adjudicating upon theseclaims had to inquire into the merits of the case, it.was always found that he could supply the fullestinformation for their guidance. It is no exaggeration.to say that the impartiality with which the benefits.of the Foundation have always been administeredwas made possible mainly by Mr. Lamb through hiassiduity, his deep compassion for the hard case,and his shrewd appreciation of the measure of thathardness. It is sad to think that he died withinone month of his retirement on a pension. A RequiemMass was said for him at St. Dominic’s Priory,Southampton-road, N.W., on Nov. 3rd.

THE next session of the General Medical Councilwill commence at 2 P.M. on Tuesday, Nov. 24th, whenthe President, Sir Donald MacAlister, will take thechair and give an address.

1 THE LANCET, 1926, i., 669.

CLOSING OF HiGHBUBY WAR HOSPITAL.-InJanuary the Ministry of Pensions will close Highbury,King’s Heath, the last of the Birmingham war hospitals,partly as a measure of economy and partly by reason ofthe decreasing number of men requiring treatment. High-bury was originally the residence of Mr. Joseph Chamber-lain, and was sold by his family to trustees charged,when it is no longer needed for its original purpose, touse it for such public purposes as they and the corporationof Birmingham may determine. From March 1st, 1919,to Sept. 30th last the hospital received 12,868 patients.There now remain only 65, whose destination has not yetbeen decided upon.