It was shown by Stocks (1950) Legon (1951Legon ( , 1952 in attempts to correlate the geographical variations in the mortality from gastric cancer with variations in the organic content of the soil.It occurred to one of us that there might be a correlation between the high northern incidence of cancer of the stomach and the genetic differences which are reflected in the ABO blood groups, the frequency of blood group 0 being greater, that of A less, in northern than in southern populations, B and AB being similar in all geographical areas in England and Scotland.Previous published work on the association of the ABO blood groups with cancer has been on very small series of cases without adequate controls. The results have been diverse and without statistical significance (Alexander, 1921 ; Johannsen, 1925;Goldfeder and Fershing, 1937). MethodA collection was made of cases of cancer of the stomach from a number of hospitals in England and Scotland, and the distribution of the ABO blood groups in patients with stomach cancer from each hospital was compared with the distribution of ABO blood groups in an equal number of patients chosen at random from the same hospital. The criterion of diagnosis has in most cases been a histological

No abstract

WE have seen three examples of a tumour of the foot which does not appear to be described in the literature. Probably, as we shall see, it is no more than a carcinoma of the skin. But two at least of our cases (One we Only know as a specimen) caused both clinicians and pathologists concerned considerable difficulty in diagnosis and treatment, and we and characteristically sickly smell of sebum oozed out of these sinuses like toothpaste from a tube. The mass extended right through the foot, and appeared on the size and extent it did not appear to be destroying bone, tendon, nerve, or any other important structure. It had been present two years, and had recurred after an excision elsewhere a year earlier. Several biopsies had failed to provide a firm diagnosis. Search for possible very unusual variant on the old theme of squamous dorsum (Fig. 279) between the toes, but despite its FIG. 278.-Care I . Plantar view of the foot when first The small depressions on the summits of several of seen. the hossy projections are sinus openings.have some evidence that similar tumours, though rare, have been seen elsewhere and caused similar difficulties ; we believe therefore they deserve description. CASE REPORTSCase I.-CLINICAL HISTORY.-A man of 64 presented himself to one of us (I. A.) in 1950 with a very curious swelling of the fore part of the left foot (Figs. 278, 279). It formed a bulbous mass on the sole, covered with skin but with many sinuses, most of the latter opening each at the apex of a separate bulge. It was ' squashy ' in consistency, and on pressure greasy material with the appearance FIG. z79.-Cuse I . Dorsal view. (The small black lesion is a benign melanoma, unrelated to the main tumour.)infective agents proved fruitless. Finally, the mass continuing to enlarge and the foot being useless, mid-leg amputation was carried out. Convalescence was complicated by fracture through an area of Paget's disease in the tibia of the opposite leg, but the patient was ultimately able to walk well and is now, three years after the operation, fit and free from metastases. PAmoLoGY.-Several biopsies were available for study, but they add no information, and description will be confined to the amputation specimen. This showed no abnormalities except for the mass in the foot. The external appearance of this corresponded to the clinical description. The foot was frozen and then sawn into sagittal slices (Fig. 280). The tumour was then seen to be well-defined, filling and expanding the soft tissues of

No abstract

The use of birthing pools during labour is increasing in the United Kingdom. This is without good scientific evidence of their efficacy or safety. To further investigate the value and safety of intrapartum hydrotherapy, an historical cohort study was performed in a District General Hospital in Liverpool. The study group consisted of 100 women of low obstetric risk who used the birthing pool at some stage during their labours and the control group consisted of 100 women who were matched in terms of age, parity and obstetric history but laboured and delivered in air. The main outcome measures were operative delivery rates, duration of labour, analgesic requirements, perineal trauma and Apgar scores at 1 and 5 minutes. The results showed that nulliparas who used the birthing pool had significantly reduced operative delivery rates, a shorter second stage of labour, reduced analgesic requirements and a lower incidence of perineal trauma. In multiparas there were significant reductions in analgesic requirements.