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two other papers 2 Lessen, Cournand, and Richards,offer damaging comments on certain of the measure-ments made of the respiratory gases in a closed-breathing circuit. They show, for example, thatwhen a normal person breathes for several minutesin a small closed circuit in which the oxygen con-centration is steadily decreasing, a state of equilibriumis reached and maintained in which the concentra-tion of the nitrogen expired is less than that of thenitrogen inspired. This is due to the progressiveincrease in inspired-nitrogen concentration witheach breath, to mixing of inspired air in the lungswith air previously inhaled, and to the exhalation ofmixed samples. In the determination of residualair volumes by quiet breathing, in a closed-circuitapparatus, use of alveolar air samples, obtainedbefore and at the end of the breathing period, enablesa correction to be made for the inequality of con-centrations of inert gases through the system. Thiscorrection may amount to several hundred cubiccentimetres in normal subjects. In patients withemphysema, with a poor distribution of tidal air andhypoventilation through a large part of the pulmonaryair spaces, the errors may be even greater if theresidual lung volumes are determined by methods ofquiet breathing in a closed circuit. This fallacy ofwhat these authors call " nitrogen lag " is one demand-ing serious attention, since it may well prove to beone of the reasons why similar, but not exactly thesame, spirometric experiments in different centresseem to give widely different results.

TUMOURS OF THE HAND

THE swellings other than acute infections thatmay arise in the hand are discussed by M. L. Mason 3(Chicago) with reference to origin and prognosis afterremoval. Ganglia he regards as being probably dueto a gelatinous degeneration in the fibrous sheaths ofthe tendons or joint capsules, and not to synovialherniation as was previously held. Epidermoid cystsare attributed for the most part to implantation ofepithelial cells, while a few may develop from

congenital inclusions. Xanthoma is a tumour peculiarto the extremities, whose origin is not settled. Itoccurs as a firm slowly growing nodular mass, mostoften on the volar surface of the thumb or finger.The tumour is made up of lobules of yellow, orange,brown, and grey tissue, bound together by septa,and surrounded by a thin capsule. Microscopicallyit is seen to be composed of giant cells, large roundcells, spindle cells, and foamy cells ; it does not recurafter complete removal. Fibromas and lipomasin the hand behave as they do elsewhere in the body.An interesting tumour is a telangiectatic granuloma,which follows infection in an abrasion. It bleeds

freely, and recurs if not completely excised. Subungualmelanoma and carcinoma are described, likewisecarcinoma arising in- an irritative lesion, as afterburns, thermal and radiological, or chemical irritants.The prognosis of these is bad. Chondromata are

common in the metarcarpals and phalanges. Angio-mata of various types occur in the hand. A tumourof recent recognition is called a glomus tumour,arising under the nail bed, and sometimes elsewherein the hand. It is said to be developed from theneuromyo-arterial glomus of Masson, and is made

up of blood-vessels with thickened walls, the mediabeing replaced with epithelial cells, smooth muscle-fibres, and myelinated and unmyelinated nerve-

2 Lassen, H. C. A., Cournand, A., and Richards, D. W., Jr.,Ibid., pp. 1 and 9.

3 Surg. Gynec. Obstet. 1937, 64, 129.4 Masson, P. (1924) Lyon Chir. 21, 257.

fibres. When this tumour is removed complete itdoes not recur.

Such detailed studies of regional surgery providea useful pathological background for guidance iiitreatment.

CANCER OF THE LUNG

THE faint ray of hope that has flickered into theprognosis of carcinoma of the lung made it a suitablesubject for the Silvanus Thompson lecture deliveredat the British Institute of Radiology’s congress lastDecember. This lecture, which we summarised atthe time, appears in full in the March issue of theBritish Journal of Radiology. The lecturer was

Dr. A. C. Christie of Washington, and under thehead of diagnosis he makes it very clear that earlierrecognition is essential if treatment is to have achance of success in more than a minute proportionof cases. When a patient of 40 or over complainsof persistent cough with a small amount of sputum,sometimes blood-stained and accompanied bymoderate dyspnoea and pain, the suspicion of carci-noma should at once be raised. Physical signs areof little value, and in reaching a diagnosis there mustbe careful correlation of information obtained byvarious means of which the most important are

radiological and bronchoscopic. Once recognised,there is now a possibility of complete eradication ofthe growth and for this purpose total pneumonectomyis tending to take the place of lobectomy. Althoughit is at present applicable only in a small proportionof cases, the fact that any cures are possible shouldstimulate interest in early diagnosis to such anextent that these operable cases cease to be suchrare exceptions. Radiation therapy has on thewhole been disappointing in lung cancer, and it mustbe admitted that highly differentiated tumours inthis region are almost completely radioresistant.With less differentiated tumours Dr. Christie considersthe results more encouraging, especially when,after careful localisation of the tumour, it is irradiatedthrough several relatively small portals.

A CONFLICT OF PHILOSOPHIES

A LITTLE book written with obviously sinceremoral and religious convictions attacks what havebeen called, and perhaps properly, the " pretentions "of science in the philosophical and moral fields.In particular it attacks, on the one hand, the crudematerialism implied if not expressed in many popularbiological writings, and, on the other, the somewhatpatronising attitude taken towards theology inmodern books of cosmology and physics. One canunderstand the irritation aroused by this attitudein persons of a theological turn of mind whosehumanistic background stretches beyond Heisenbergand Einstein to Spinoza and Jonathan Edwards.It is not unreasonable to regard the " indeterminacyprinciple " as a device of the physicist to get himselfout of an awkward situation of his own making.Stepping-stones have, before now, in science, beenmistaken for foundation-stones. The modern philo-sopher-physicist might well feel some misgivingsthat illustrations from " Alice in Wonderland "

come so glibly from his tongue. Even " free-will "

theologians of the sterner sort will hardly appreciateconcessions that might equally be given as an excuse

1 The Philosophy of Religion versus The Philosophy of Science.An exposure of the worthlessness and absurdity of some conven-tional conclusions of modern science. By Albert Eagle, lecturerin mathematics in the Victoria University of Manchester.Printed for private circulation and obtainable through all book-sellers from Simpkin Marshall Ltd. 1935. Pp. 352. 5s.

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for believing in any nonsense. Mr. Eagle is a trainedmathematician and physicist and as such is obviouslymore at home in physics than in biology, psychology,or economics. His attack on the relativity theory,though it could no doubt be parried by an expertrelativitist, is at least a pungent statement of thereactions of the ordinary man to the theory. Themain fault in this book is that the author attackstoo much and too wildly and the reader becomesbewildered by his divagations through relativityand indeterminacy, evolution and embryology,psychology, capitalism, communism, and the rest.A philosopher must not be blamed for exercising hisproper function as a critic of universal knowledge," but it needs happy moments for this skill," andit is hardly work for the amateur. Mr. Eagle does,however, succeed in reminding us how many slip-shodphilosophical notions reach the ordinary reader in theform of " asides " in popular scientific writings.This is difficult to avoid as the ordinary reader cravesfor general and sensational ideas and a gop must bethrown to him from time to time. How far he is-misled, and how far it matters if he is, are nice

problems in the ethics of popular education. Heat least gets plenty of opportunity of hearingboth sides of the argument, even if the argument isa bad one, and it is unlikely that Mr. H. G. Wells’sfervent materialism will do him any more harm thanSir Arthur Eddington’s light-hearted theology. Inother respects, he will be unquestionably the betterfor such books as " The Science of Life " or " TheNature of the Physical World," which after all were notprimarily written to teach him philosophy but to revealto him some of the wonders of modern discovery.

A NATIONAL FOOD POLICY

IN his broadcast last week the Minister of Healthdescribed the report of the Advisory Committee onNutrition as the most valuable document on the

subject yet issued, and went on to set out the actionhe had already taken on it. He had, he said, thatday communicated with all the maternity and childwelfare authorities in the country asking them toreview their arrangements for the supply of milk andother protective foods to mothers and young children.He deprecated the time-limits placed on the supplyof milk to expectant mothers and young children, andsuggested as a simple criterion the supply of sufficientmilk or other food whenever the provision is necessaryfor the maintenance of the health of the mother or

young child. He had asked local authorities toreview the scales of income at present in force andto frame them in such a way as not to render itdifficult for mothers to take advantage of theauthorities’ arrangements. Wherever possible the

milk-supply should be efficiently pasteurised, andwhere this was not practicable the medical officerof health should approve the source and quality ofthe milk-supply. He regretted the abandonment invarious places of the organised system of supplyingmeals because of the difficulty in securing theattendance of sufficient mothers or young children,and expressed a hope that the successful solution ofthe difficulty in certain large towns would be morewidely followed. The new Act, raising the blockgrants to local authorities and redistributing thegrants so as to give a larger share to authoritieswhose need was greatest, should, he thought, helpto do away with local hesitation on grounds offinancial stringency. Existing services deserved to bemore widely known and he emphasised the sharewhich the Ministry is taking in the autumn campaignto make the services better known and more fully

availed of. Finally he offered to discuss with repre-sentatives or officers of the local authority anydifficulties in the way of a fuller realisation of thecommittee’s recommendations.

WHAT IS OSTEOPATHY ?

OSTEOPATHY began as, and still is, an Americancult. The founder of the faith,- Andrew TaylorStill, was a remarkable man born in Virginia in 1828and in 1874 the recipient, according to his ownaccount, of a divine revelation of the true science ofhealing which he called osteopathy. What is osteo-

pathy ’? Two doctors, Charles Hill and H. A. Clegg,have tried to answer this and relevant questions in amost readable book.1 The authors are perhapsbiased: they are doctors. Yet seeing that osteo-

pathy deals with human disease, and doctors are theonly class in the community who can lay claim tohaving studied the subject scientifically, that is nodrawback and the fact that neither of the authorsis engaged in medical practice ensures that their bias,if it exists, is not due to fear of direct professionalrivalry. Their positions in the British MedicalAssociation give them a broad outlook on medicineand a benevolently critical attitude towards theirbrethren ; and in addition to a scientific trainingthey have developed a more than usually wide

knowledge of the public and legal aspects of the

healing art. It is not their fault that the reader willfind a certain amount of confusion when he comes tothe part of the book where they try to give a

description of the cult; for Hill and Clegg are in thesame predicament as an artist trying to produce apicture of a versatile chameleon: the beast changescolour while you look at it. In the history of diseasethere has been a progressive unfolding of the truth,and even a

"

revolutionary " discovery in con-

nexion with a particular disease is found sooner orlater to harmonise with such earlier knowledge as

existed. But osteopathy, like the chameleon, appearsto change colour for protective reasons. Still believedthat all disease could be ascribed to displacementsof the spine, ribs, or hips. One would imagine thathe would have hailed the advent of X rays withshouts of joy. Not a bit of it: no concerted attemptwas made to employ the new diagnostic weapon andwhen it was found that osteopathic displacementscould not be demonstrated radiographically, and thateasily demonstrable displacements of the spine andhips did not lead to other more remote diseases asthe osteopaths taught, the osteopathic " lesion " wasborn, something much more subtle and elusive, toreplace the discredited " displacement." It is a

remarkable and instructive fact that this nebulouslesion found its way recently into the august seclusionof our House of Lords. A Bill for the registration ofosteopaths was introduced in 1935, and after attaininga second reading was referred to a Select Committee.Although the subsequent investigation was expensiveand time consuming, the resulting exposure of the

osteopaths has done nothing but good. Dr. Hilland Dr. Clegg allow the committee’s report to speakfor itself : it shouts condemnation. This, for example :" The only existing establishment in this countryfor the education and examination of osteopaths wasexposed, in the course of evidence before us, as beingof negligible importance, inefficient for its purpose,and above all in thoroughly dishonest hands."Throughout the book, indeed, the evidence has been

1 What is Osteopathy ? By Dr. Charles Hill, deputy medicalsecretary, British Medical Association; deputy Editor, BritishMedical Journal; and Dr. H. A. Clegg. London: J. M. Dentand Sons. 1937. Pp. 217. 7s. 6d.