The abstracts which follow have been classified for the convenience of the reader under the following headings: Experimental Studies; Animal Tumors The Abdominal Wall The Cancer Cell The Digestive Tract General Clinical and Laboratory Observa- The Pancreas tions The Biliary Tract Diagnosis and Treatment Peritoneal, Retroperitoneal. and Mesenteric The Skin Tumors The Eye The Spleen The Ear The Female Genital Tract The Breast The Genito-Urinary Tract The Oral Cavity and Upper Respiratory The Nervous System Tract The Bones and Joints The Salivary Glands The Leukemias, Hodgkin's Disease, Lympho­ The Thyroid Gland sarcoma Intrathoracic Tumors As with any such scheme of classification, overlapping has been unavoidable. Shall an article on II Cutaneous Melanoma, an Histological Study" be grouped with the articles on Histology or with the Skin Tumors? Shall Traumatic Cerebral Tumors go under Trauma or The Nervous System? The reader's choice is likely to depend upon his personal interests; an editor may be governed by no such considerations. The attempt has been made, there­ fore, to put such articles in the group where they would seem most likely to be sought by the greatest number. It is hoped that this aim has not been entirely missed. As abstractors are never perfect, and as the opinions expressed may on occasion seem to an author not to represent adequately his position, opportunity is offered any such to submit his own views for publication. The JOURNAL will not only welcome correspondence of this nature but hopes in the future to have a large number of author abstracts, so that the writer of a paper may present his subject in his own way. If readers of this JOURNAL wish to communicate with the writers of articles abstracted in its pages or to secure reprints, the editorial staff will be glad, so far as possible, to supply the addresses of these authors. Photostats of original articles will also be furnished, if desired, to be charged at cost.

150 ABSTRACTS EXPERIMENTAL STUDIES; ANIMAL TUMORS Variable Sensitivity of Different Sites of the Skin of Mice to Carcinogenic Agents, J. M. TWORT AND C. C. TWORT. J. Path. & Bact. 42: 303-316, 1936. The interscapular skin of mice is usually more sensitive to carcinogenic agents than that covering the sacral or abdominal regions, while the soles of the feet are apparently the most resistant. Animals which are sensitive in one area are usually relatively sensitive in another area. \Vhen skin areas of the same animal are compared, it is found that an area which is more sensitive to the production of benign tumors is usually, but not necessarily, more sensitive to the production of malignant tumors. There is no evidence to show that benign tumors per se in one area influence the production of benign or malignant tumors elsewhere, but there is some evidence that malignant tumors produced in one area retard the development of malignant tumors elsewhere. This may be due to the debilitating effect of the first malignant tumor. Although the average type of tumor varies with different agents, the site of painting appears to have much less effect in determining the type of tumor. The application of carcinogenic agents in one area retards tumor formation in another, the carcinogenic potency being only about one-half to two-thirds that of the control. The debilitating effect of the agent on the animal is presumably the cause. Previous applications of oleic acid to a given site cause an increase in the carcinogenic potency of tar when the tar is applied at the same site as the oleic acid. When the tarred site is different to that previously painted with oleic acid the carcinogenic potency falls below that of the control. This lowering effect is presumably again due to the general debilitating effect on the animal of the oleic acid. WM. H. WOGLmr Relation Between the Growth Rate of Tar Warts in Mice and Their Corresponding Autografts, J. C. MOTTRAM. J. Path. & Bact. 42: 79-90, 1936. Continuing his investigations on the natural history of tar warts. the author finds no close relationship between the growth rate of these warts and that of their auto­ grafts. The reason for this appears to be that many tar warts are composed of groups of cells which are not identical in growth capacity, so that, while one part on inoculation may grow into a benign epithelial cyst, another may result in an epithelioma, or one part may give rise to a slowly, and another to a rapidly growing epithelioma. The paper is illustrated by charts, projection drawings, and photomicrographs. WM. H. WOGLOM

Liposarcoma Produced by 1 : 2-Benzpyrene, CUSHMAN D. HAAGENSEN AND OTTO F. KREHBIEL. Am, J. Cancer 27: 474-484,1936. Haagensen and Krehbiel report the production of five liposarcomas with 1 : 2­ benzpyrene in a mouse and 4 guinea-pigs. The guinea-pig liposarcomas occurred among a total of 13 animals receiving multiple subcutaneous injections of 1 : 2-benzpyrene and surviving as long as 342 days. Of these animals 5 developed 8 tumors, the other 4 being fibrosarcomata. The authors attribute this high incidence of liposarcoma to the thick layer of subcutaneous fat present in the guinea-pig and conclude that lipo­ sarcoma, at least under the circumstances of their experiment, arises from adult fat cells as the result of long-continued chemical irritation and stimulation. Photomicrographs of the tu mors produced are included. Sarcoma Production in Mice by a Single Subcutaneous Injection of a Benzoylamino Quinoline Styryl Compound, C. H. BROWNING, R. GULBRANSEN, J. S. F. NIVEN. J. Path. & Bact. 42: 155-159, 1936. The production of sarcoma is reported in 10 out of 19 mice that lived more than eight months after injection of the dye 2 (p-amino styryl) 6 (p-acetylamino benzoylamino) 151 152 ABSTRACTS quinoline methoacetate, also called styryl 430. In ultraviolet light this substance presents a reddish fluorescence quite unlike the violet color of the carcinogenic poly­ cyclic hydrocarbons investigated by Kennaway and his associates. There are several outstanding features attending the production of sarcoma by styryl 430. In the first place the agent is a water-soluble synthetic organic compound unrelated to the carcinogenic substances so far reported. Secondly, one single injection of an aqueous solution is effective, and thirdly, there is a lack of any immediate local irritation following its deposition in the tissues. Experiments are in progress to see whether styryl 430 will produce carcinoma when applied to the skin, and also whether it has any estrogenic activity. The article is illustrated by photomicrographs. WM. H. WOGLOM

Trichinosis and Cancer, W. SCHMIDT-LANGE. Trichinose und Krebs, Ztschr. f. Krebs­ forsch. 43: 264--271, 1936. After mentioning the 10 known cases of carcinoma associated with trichinosis in man and briefly discussing the relation of parasites to malignant tumors, the author describes a polymorphous-cell sarcoma of the liver in one of a large group of white mice infested during some experimental work on trichinosis. The growth, discovered when the mouse was killed five days after infestation, had destroyed almost the entire organ and had metastasized to the spleen. As the animal was but ten months old, and primary sarcoma of the liver is practically unknown in mice, the author concludes that the growth was initiated by the parasites. The article is not illustrated. [There can be little doubt that the lesion actually was a sarcoma, for the diagnosis was made in Borst's laboratory and confirmed by Fischer-Wasels. But as all the known carcinogenic agents require several months to produce their effect, it seems incredible that the trichinella should need but five days to cause a tumor involving the whole liver and metastasizing to the spleen.] W~1. H. WOGLOM

Malignant Tumors in Strains of Mice Refractory to Spontaneous Cancer Following Combined Hormonal Treatment, A. LACASSAGNE. Turneurs rnalignes, apparues au cours d'un traitement hormonal combine, chez des Souris appartenant a des lignees refractaires au cancer sporrtane, Cornpt. rend. Soc. de bio!' 121: 607-609, 1936. Two litters of mice from two strains refractory to spontaneous carcinoma were given alternate weekly injections of 300 international units of estrone benzoate combined with anterior pituitary extract. In one, a female that died about seven and a half months after treatment had been started. there was found a large mediastinal tumor composed of lymphoid and epider­ moid elements and therefore probably of thymic origin. There was a metastasis in one kidney. One of the ovaries, which were thickly studded with corpora lutea, contained a tumor whose cells resembled those of the granulosa closely enough to make one think of a primary ovarian tumor metastasizing to the thymus. Four litter mates were still living when the report was written. A second female, that died after about five months' treatment, had a squamous-cell carcinoma of the uterus. Four litter mates were still living. Two litters from a strain in which an occasional neoplasm is observed were injected in the same way, but no new growths had appeared when the article was written. The paper is illustrated by a photomicrograph of the uterine tumor. W~1. H. \\'O(;LOM

Effect of Oestrone Administration on the Mammary Glands of Male Mice of Two Strains Di1Iering Greatly in their Susceptibility to Spontaneous Mammary Car­ cinoma, GEORGIANA M. BONSER. J. Path. & Bact. 42: 169-181, 1936. Large doses of estrone administered to males of a cancer-susceptible (Little's line of Bagg albinos) and a cancer-resistant (Little's line of black agoutis, eRA) strain pro­ duced in the former a growth of ducts and localized proliferation of acini, with car- EXPERIMENTAL STUDIES; ANIMAL TUMORS 153 cinoma in 3 cases. In the latter, widespread proliferation of acini and cystic distention of the ducts resulted, but no carcinoma. The findings indicate that only mice of known ancestry should be employed for experiments of this kind. The article is generously illustrated with photomicrographs. WM. H. \\'OGLOM

Cancer of the Mammary Glands Induced in Male Mice Receiving Estrogenic Hormone, W. U. GARDNER, G. M. SMITH, EDGAR ALLEN AND L. C. STRONG. Arch. Path. 21: 265-272, 1936. The authors confirm the observations of previous investigators, having produced mammary cancer after twenty-three weeks in two out of six male litter mates that received weekly subcutaneous injections of 500 international units of keto-estrin benzoate. These mice belonged to a strain in which spontaneous mammary cancer develops in more than 80 per cent of the females. Treatments were begun at the age of twenty-eight days and continued for 101-199 days. In one of the mice there were two tumors, both of which were easily transplanted into other mice of the same strain, but not into two from an unrelated one. The pattern of mammary growth induced in other male mice by the same procedure was abnormal, in that the growth of the duct system was restricted or stunted and the mammary lobules extensively developed, even to the point of adenoma in certain regions. Excessive connective tissue was also observed in some portions of the gland. A footnote says that since the paper was submitted for publication six more mam­ mary tumors have arisen in male mice injected with keto-estrin benzoate, at ages varying from 162 to 362 days and after the administration of 10,OOG-18,000 inter­ national units. Tbe paper is illustrated by 12 photomicrographs. W1tL H. WOGLOM

Development of Sarcoma in Male Mice Receiving Estrogenic Hormones, W. U. GARD­ NER, G. :\1. SMITH, L. C. STRONG AND EDGAR ALLEN. Arch. Path. 21: 504-508, 1936. Spindle-cell sarcomas developed in all of 5 male mice from two different litters of the

C3H strain which had received subcutaneous injections of 10 rat units of theelin daily for from 68 to 102 days, followed by weekly injections of 500 international units of keto-estrin benzoate for periods of from twelve to twenty-five weeks. These sarcomas grew rapidly in the original mice and also after implantation into other mice of the same strain. WM. H. WOGLOM Comparison of the Changes Induced by Some Pure Oestrogenic Compounds in the Mammae and Testes of Mice, HAROLD BURROWS. ]. Path. & Bact. 42: 161-168, 1936. Changes produced in the mammary glands and testes of mice by several pure estrogenic compounds are described. Estrone, 9 : 10-dihydroxy-9 : 10-di-11-propyl-9 : 10-dihydro-1 : 2 : 5 : 6-dibenzanthracene, equilenin, and estrone methyl ether caused an extension of the mammary duct system with little development of acini and had a comparatively slight effect on the interstitial tissue of the testis. Equilin and estradiol caused relatively little extension of the mammary duct system, but induced a vigorous development of acini and led to pronounced changes in the interstitial tissue of the testis. The paper is generously illustrated with photomicrographs. W~1. H. WOGLOM

Localisation of Response to Oestrogenic Compounds in the Organs of Male Mice, HAROLD BURROWS. ]. Path. & Bact. 41: 423-429, 1935. The specific action of estrone and certain allied compounds is confined to organs which (a) in some way serve the purpose of reproduction, (b) are morphologically but not otherwise associated with reproduction (e.g., male mamma), or (c) are embryological representatives of the reproductive system (e.g., possible remnants of Muller's duct in the male). The epithelial changes induced by estrogens pass through definite successive stages, 154 ABSTRACTS namely (a) arrest of function, (b) hyperplasia, (c) metaplasia with ultimate keratiniza­ tion, (d) suppuration. Gradients of susceptibility to estrogens are seen. Vestigial cysts, if present, are first affected, and next the coagulating glands, seminal vesicles, and prostate in that order. \Vhen the supply of estrogen ceases, recovery in these organs takes place in the reverse order of their susceptibility. In the coagulating glands, seminal vesicles, and prostate the metaplasia commences at definite foci, from which it spreads through the glands. Recovery on cessation of the supply of estrogen takes place in the reverse order. Suppuration is a sequel to keratinizing metaplasia; it occurs most readily in those structures which are the slowest to undergo metaplasia and least readily in those which respond earliest to estrogenic compounds. The paper is illustrated by 6 photomicrographs. WM. H. WOGLO}I

Influence of Hormones on Breast Hyperplasia and Tumor Growths in White Rats, JACOB HEIMAN AND OTTO F. KREHBIEL. Am. J. Cancer 27: 450-473, 1936. Several series of observations are recorded which indicate that the variations oc­ curring in transplanted benign fibro-adenomata of the white rat's breast cannot be attributed solely to variations in the implant, but that endogenous endocrine factors in the host probably playa role. An endocrine factor was also indicated by experi­ ments on castrated animals, castrated males showing an increase in the rate of growth and number of takes of transplanted fibro-adenomas, while the tumors in castrated females showed a diminished growth energy. Injections of antuitrin S and theelin increased the incidence of tumor growth in both male and female castrates. The morphology of the transplanted tumor was not changed in animals receiving injections of antuitrin G, antuitrin S, or theelin, alone or in combination. In normal rats eighteen months old antuitrin S or antuitrin G in combination with theelin produced a definite increase in breast hyperplasia, leading to the formation of benign fibro-adenomata. Transplantation of these fibro-adenomata resulted in growths closely resembling those arising from transplants of spontaneous fibro-adenoma. After growing in young sexually immature rats, the transplanted fibro-adenoma becomes a cellular fibroma or sarcoma. After passing through several generations, the cellular fibroma or sarcoma retains the same morphology even when implanted in adult or old animals. Charts and photomicrographs illustrate this paper. A bibliography is included.

Reactivity of Malignant Neoplasms to Bacterial Filtrates. I. The Effect of Spontaneous and Induced Infections on the Growth of Mouse Sarcoma 180, GREGORY SHWARTZ­ MAN. Arch. Path. 21: 284-297, 1936. It has been observed by a number of investigators that bacterial factors capable of eliciting the phenomenon of local cutaneous reactivity to bacterial filtrates also produce, on intravenous injection, selective hemorrhagic necrosis in certain transplantable animal tumors. No such lesions are produced, however, in spontaneous or slowly growing transplantable neoplasms, malignant tumors rapidly growing in heterologous hosts, embryomas, or granulomas. In this paper the author describes the effect of infections upon the development of mouse sarcoma 180. Spontaneous infection with B. enteritidis and infection induced with rough B. enteritidis of low virulence were found to exert a striking inhibitory influence on the development of this neoplasm. There was a definite correlation between the ability of a filtrate of a given micro-organism to elicit cutaneous reactivity in rabbits, and the restraining effect of the infecting micro-organism on the development of sarcoma 180 in mice. WM. H. WOGLOM

Reactivity of Malignant Neoplasms to Bacterial Filtrates. II. Relation of Mortality to Hemorrhagic Necrosis and Regression Elicited by Certain Bacterial Filtrates, GREGORY SHWARTZMAN. Arch. Path. 21: 509-523, 1936. Comparative studies on the lethal effects of certain bacterial filtrates on normal mice and on those bearing twelve-day-old sarcoma 180 showed that the preparations employed EXPERIMENTAL STUDIES; ANIMAL TUMORS 155 were decidedly more toxic to tumor-bearing than to normal animals. As filtrates that did not affect the tumor were also highly toxic, it was evident that necrotic and hemor­ rhagic reactions in the neoplasm were not directly responsible for the high death rate. Rather, this appeared to be due to incidental secondary infections. Attempts were therefore made to obtain preparations that would destroy the tumor without killing the host. It was found that the addition of homologous neutralizing horse serum gave decided protection, yet did not interfere with the production of hemorrhagic necrosis and the subsequent complete regression of the tumor. In one experiment, regression occurred in 21 of 23 surviving mice, as compared with the usual 1.33 per cent of spontaneous regressions noted by the author in this tumor strain. WM. H. WOGLOM

On the Possible R~le of Diet in Tumour Formation, D. D. CHATTERJEE. J. Indian M. A. 5: 5-7, 1935. Seventeen out of 20 white rats fed on autoclaved rice and 6 out of 40 maintained on a diet that was deficient in vitamin B complex developed papillomatous growths in the stomach. Two out of 200 pigeons fed on autoclaved and milled rice had papillomatous growths in the skin. As a non-hemolytic streptococcus was found in the stomach much more frequently in rats that had been kept on an incomplete diet, the author suggests that vitamin B deficiency allows these organisms to flourish until ultimately they induce cellular infiltra­ tion and tumor formation. The article is illustrated by photomicrographs and photographs of gross specimens. WM. H. WOGLOM

Influence of Diet on the Growth of Transplanted Tumors. 9th Communication. Influence of Condiments, W. CASPARI. Ober den Einfluss der Kost auf das Wach­ sturn von l mpfgeschwulsten. IX. Mitteilung. Einfluss von Gewilrzstoffen, Ztschr. f. Krebsforsch. 43: 255-263, 1936. Fresh garlic, when added to the diet, inhibited definitely the taking and growth of transplanted mouse tumors. Allyl mustard oil had, perhaps, some slight retardingaction, but the juice of garlic and of horse-radish were inert in this respect. WM. H. WOGLOM

On the Effect of a Temporary Stoppage of the Blood Supply of Rat Tumours, H. CHAMBERS AND G. M. SCOTT. J. Path. & Bact. 42: 265-269, 1936. Stoppage of its circulation by from two to four hours' compression often caused the Jensen rat sarcoma to disappear (73 tumors out of 251 = 30 per cent). Spontaneous cure is out of the question here, as this tumor regresses but rarely in untreated rats of the authors' strain. WM. H. WOGLOM

Ezperimental Studies on the Transplantability of Hepatoma Produced by Ortho­ amidoazotoluol. n. Intraperitoneal and Intrahepatic Trausplautation. In1Utrative Growth and Metastases of Hepatoma Implants, T. hKUBO. Experimentelle Studien uber die Transplantabilltat des mittelst o-Amidoazotoluols erzeugten Hepatoms. II. Mitteilung: Intraperitoneale und intrahepatische Transplantation. Infiltratives Wachstum und Metastasenbildung des subkutan iibertragenen Im­ pfhepatorns, Gann 30; 157-169, 1936. The author has previously reported the successful subcutaneous transplantation of hepatoma produced in rats by o-amidoazotoluol (Gann 29: 79, 1935. Abst. in Am. J. Cancer 25: 659, 1935). He now records successful intraperitoneal and intrahepatic transplantation of these tumors. Of six hepatomas, two were successfully implanted intraperitoneally. Six subcutaneously and intraperitoneally implanted hepatomas were re-implanted into 26 rats intraperitoneally and positive results were obtained in four. These intraperitoneally implanted tumors grew rapidly and infiltrated the muscles and subcutaneous tissue. In general the tumor localized in the omentum. In the case of intrahepatic implantation, the author obtained success with one out 156 ABSTRACTS of four original hepatomas, and two out of four subcutaneously and intrapcritoncally implanted hepatomas, (15 rats were used). At 103 days after implantation one of the tumors measured 30 X 2:i X 13 mm. The histologic picture of the intraperitoneal and intrahepatic tumors was identical with that of the original hepatoma. Transplanted hepatomas metastasized to the lungs and lymph nodes. This article is illustrated with seven photographs of gross material and six photo- micrographs. K. SumURA

Observations on the Natural Healing Phenomena in Transplantable Malignant Tumors from the Standpoint of Diathesis and Their Bearing on the Immunity Problem, Z. COTO AND S. !\'!IYAMOTO. Gann 30: 170-192, 19.~6. The authors made 870 transplantations in susceptible mice (group A) and 970 trans­ plantations in non-susceptible mice (group B) with the Miyamoto mouse sarcoma, and obtained 99.5 per cent positive results in the former group and 0.7 per cent in the latter group. A similar experiment with the Goto mouse sarcomatoid carcinoma on 157 group A and 210 group B mice showed results nearly identical with those obtained with Miyamoto mouse sarcoma. One thousand and sixty-four non-susceptible mice were transplanted from two to eight times with the Miyamoto mouse sarcoma or the Goto mouse sarcomatoid carcinoma, but none of them gave positive growth, although many of the implants grew for two weeks and then gradually regressed. This phenomenon, which appears in almost all the cases of first transplantation, gradually decreases with repetition of transplantation, and finally almost disappears after the fifth transplanta­ tion. The author thinks that the group A and group B mice should be regarded as actually different species from the standpoint of tumor transplantation. The article js illustrated by three photographs of gross material and four photomicrographs. K. SUGIURA

Fate of Intravenously Injected Tumor Cells, SHIELDS WARREN AND OLIVE GATES. Am. ]. Cancer 27: 485-492, 1936. Warren and Gates, using Walker carcinoma 256 in the Sloniker strain of white rats, compared the results obtained with artificial and natural suspensions of tu mor cells injected intravenously. The uninjured cells in natural suspension gave earlier and more numerous pulmonary tumor nodules. The mechanism of establishment of metastasis was the same with both types of inocula, the most important factor in metas­ tasis being the growth potentiality of the individual cells. Blood was found to have no toxic effect on tumor cells. Involvement of extravascular tissue rarely occurred by direct penetration of the arteriolar wall, but usually by growth through the less resistant capillary walls. Hyaline thrombi appeared early and disappeared early without organization. There was no reaction of the endothelium to tumor tissue. This paper is illustrated by photomicrographs and a bibliography is appended.

Intermediate Metabolism in Animals Bearing Transplanted Tumors, B. PURJESZ AND S. LAJOS. Ober interrnediare Stoffwechseluntersuchungen an !mpftumortieren, Ztschr. f. Krebsforsch. 43: 280-283, 1936. ! n rats bearing the]ensen sarcoma disturbances of metabolism were found that closely resembled the anomalies accompanying experimental infections. The blood sugar and the total carbohydrates or glycogen in liver and muscle were lowered, while fats and lipoids were increased. WM. H. WOGLOM

The Brown-Pearce Rabbit Tumor as a Test Object for Experimental Cancer Research, K. H. BAUER AND K. DECKNER. Der Brown-Pearce-Tumor des Kaninchens als ein Testobjekt experimenteller Geschwulstforschung, Beitr. z. klin. Chir. 162: 513-533, 1935. The authors review the biological and histological characteristics of the Brown­ Pearce rabbit carcinoma, a growth which they find far more malignant than most human neoplasms. It is peculiarly adapted to experimental investigation by reason of the EXPERIMENTAL STUDIES; ANIMAL TUMORS 157 ease with which it can be transplanted into almost any breed, its early and extensive metastasis, and its constant behavior, The growth is best cultivated by the intra­ testicular or intravenous inoculation of metastases, other sites (brain, anterior chamber of the eye, or subcutaneous tissues) being much less suitable. This tumor is a wholly immature carcinoma of the skin, almost devoid of stroma, which in conformity with its tempestuous growth soon undergoes necrosis. It metas­ tasizes by way both of the lymph channels and the blood stream. The paper is illustrated by photographs of gross specimens and photomicrographs: and closes with an extensive bibliography. W?>1. H. \\'OGLOM

Inhibition of Brown-Pearce Rabbit Tumor with Filtered Homologous Tumor Material, ALBERT E. CASEY. Proc. Soc. Exper. BioI. & Med. 34: 111-112, 1936. In the course of some experiments with the Brown-Pearce rabbit carcinoma an unusual inhibitory effect was noted following a single treatment with 0.3 c.c. of a Berke­ feld " V" filtrate of the fresh growth given two weeks before tumor inoculation. In all six of the animals thus injected the graft failed, although implantation was successful in 36 other rabbits of the same source inoculated on the same day with an equal amount of the same tumor. Thus the filtrate appears to have contained an inhibiting agent suggesting that found in normal tissues and chicken tumors by various investigators, and attempts to confirm this preliminary observation are to be undertaken. WM. H. WOGI-OM

The Bone Marrow in Brown-Pearce Carcinomatosis of the Rabbit, JOHN \V. ORR. ]. Path. & Bact. 42: 105-112, 1936. Hyperplasia of the bone marrow was found in everyone of 29 rabbits with metastatic dissemination of the Brown-Pearce carcinoma. This process affected predominantly the neutrophile granulocytes and their non-granular precursors, and the most advanced grades were associated with a loss of erythropoietic tissue. Anemia, without qualitative alteration in the circulating erythrocytes, frequently accompanied the hyperplasia. It is suggested that the hyperplasia may be due to continued absorption of necrotic products from the tumor. The paper is illustrated by 8 photomicrographs. WM. H. \VOGI-OM

Infectious Fibroma of Rabbits. m. The Serial Transmission of Virus Myxomatosum in Cottontail Rabbits, and Cross-Immunity Tests with the Fibroma Virus, RICHARD E. SHOPE. J. Exper. Med. 63: 33-41, 1936. Virus myxomatosum, when injected into the testicles of cottontail rabbits, produced only a localized fibromatous or myxomatous orchitis, quite unlike the acute fatal illness which it caused in domestic rabbits. Ten serial passages through cottontails during a period of 140 days did not alter the pathogenicity of the virus for domestic rabbits. Although it proved impossible to convert the myxoma virus into fibroma virus by this means, it was found that the cottontail rabbits, after recovery from myxoma, had developed a solid resistance to infection with the fibroma virus. Furthermore, their serum neutralized against both viruses, and a similar cross-immunological relation­ ship was observed in domestic rabbits that had survived an attack of infectious myxoma. WM. H. WOGLOM

Infectious Fibroma of Rabbits. IV. The Infection with Virus Myxom,atosum of Rabbits Recovered from Fibroma, RICHARD E. SHOPE. ]. Exper. Med. 63: 43-57, 1936. The serial passage of Virus myxomutosum through domestic rabbits that had recovered from fibroma did not alter its pathogenic properties, whereas that injected into the testicles of domestic rabbits immune to myxoma was promptly inactivated. The failure of domestic rabbits that had recovered from fibroma to destroy the myxoma virus, and the absence from their serum of neutralizing antibodies for this virus are regarded as evidence against the identity of the fibroma and myxoma viruses. 158 ABSTRACTS

The rapidity with which rabbits that had recovered from fibroma developed neutral­ izing antibodies following infection with Virus myxomatosum is considered to be a possible factor in their acquired resistance. It is believed on the basis of all the evidence that infectious fibroma of rabbits is a definite disease entity and not merely a mild form of infectious myxoma. WM. H. \\'OGLOM

A Change in Rabbit Fibroma Virus Suggesting Mutation. I. Experiments OD Domestic Rabbits, C. H. ANDREWES. J. Exper. l\led. 63: 157­ 172. 1936. n. Behavior of the Variant Virus in Cottontail Rabbits, RICHARD E. SHOPE. Ibid. 63: 173-178, 1936. m. Interpretation of Findings, C. H. ANDREWES AND R. E. SHOPE. Ibid. 63: 179-184, 1936. In the first of these papers Andrewes reports that strain IA (inflammatory A) of the Shope rabbit fibroma produced, from the moment when it was received in England, acute inflammatory lesions very different from the fibromatous growths which it had originally elicited in Shope's inoculations of American rabbits. Furthermore, many of the English rabbits developed a generalized pock-like eruption on the skin. A similar but less extensive change in the virus was noted concomitantly in America by Shope. The OA (original A) strain, which had been preserved by Shope in glycerol before the appearance of any inflammatory lesions, produced, in English rabbits, fibroma-like lesions similar to those which Shope had first described in America. The new inflam­ matory strain cross-immunized with the normal virus but not with various others. Efforts to change one strain into the other were unsuccessful. A third strain, the "changed strain," which produced mixed inflammatory and fibromatous alterations. continued to behave in this manner through numerous passages. An artificial mixture of inflammatory and fibromatous viruses behaved in all respects like the changed strain. Andrewes' paper is illustrated by 3 photomicrographs. In the second paper of the series Shope describes a variation of the rabbit fibroma virus in America, similar to but less complete than that observed by Andrewes in England, by virtue of which it produced inflammatory rather than the original fibro­ matous lesions. The transformation occurred at about the eighteenth serial transfer in American domestic rabbits. Passage of this altered virus through American cotton­ tail rabbits resulted in a transient recovery of the capacity to produce fibroma, while similar passage of Andrewes' inflammatory virus (IA) sent by him from England, was without effect. In the third paper the English and the American investigator join in a discussion of their individual observations. They believe that the "changed virus," which produces partly fibromatous and partly inflammatory lesions, represents an admixture of the original fibroma virus (OA) with one (IA) causing only necrotic and inflammatory lesions. Strain IA is not a contaminant, but probably arose as an abrupt, discontinuous, and inherited alteration which the authors feel justified in calling a mutation. As to the nature of this transformation, it is suggested that strain OA attacks the cells less vigorously, causing them to proliferate but not killing them for some weeks, whereas the IA strain attacks with greater virulence or is met by a more violent response, so that rapid cell death results. [See also Faulkner and Andrewes (Brit. J. Exper. Path. 16: 271, 1935. Abst. in Am. ]. Cancer 26: 798, 1936), who tried to test this hypothesis experirnentally.] WM. H. WOGLOM

Relation of Leukosis to Sarcoma of Chickens. n. Mixed Osteochondrosarcoma and Lymphomatosis (Strain 12), J. FURTH. J. Exper, Merl. 63: 127-143, 1936. An osteochondrosarcoma that developed in a chicken inoculated with leukosis (Strain 2) gave rise in successive passages by intramuscular transplantation to (a) osteochondrosarcoma without leukosis. (b) leukosis without osteochondrosarcoma,' or (c) osteochondrosarcoma with leukosis. EXPERIMENTAL STUDIES; ANIMAL TUMORS 159

The sarcoma cells of this strain have the morphological characteristics of osteoblasts. Implantation of tumor from chickens with lesions (a) and (c) yielded both osteo­ chondrosarcoma and leukosis, while blood from chickens with leukosis produced only leukosis. Hence it is very probable that Strain 12 is a mixture of the agent of Strain 2 leukosis with an agent that produces osteochondrosarcoma. Strain 12 was readily transmitted by material containing the living malignant osteoblasts, but transfer was seldom successful with virus that had been freed from living cells by desiccation or by freezing and thawing. This virus produced neoplasms only when brought into contact with bone or cartilage. The paper is illustrated by photographs of gross specimens and photomicrographs. WM. H. WOGLOM

Relation of Leukosis to Sarcoma of Chickens. m. Sarcomata of Strains 11 and 15 and Their Relation to Leukosis, J. FURTH. J. Exper, Med. 63: 145-155, 1936. Two transmissible sarcomas of the fowl are described, one (no. 15) of which orig­ inated in a chicken injected with neurolymphomatosis of Strain 5. Its virus produces metastasizing sarcomas that are characterized by peculiar giant cells different from those of other known chicken sarcomas. The tumors of Strain 11 resemble the spindle-cell sarcoma of Rous and other in­ vestigators. The primary growth occurred in an uninjected control chicken, and the virus produces sarcoma unassociated with leukosis. Both strains are easily transmissible with material freed from viable cells by desicca­ tion or filtration, and their virus can be preserved by drying in the frozen state. The viruses of Strain 1 leukosis and Strain 11 sarcoma retain their identity after injection into the same bird and can be easily re-isolated, The paper is illustrated with photographs of gross specimens and photomicrographs. WM. H. WOGLOM

Attempts to Grow the Agent of Transmissible Fowl Leukemia in Vitro, J. VERNE, CR. OBERLING AND M. GUERIN. Tentatives de culture in vilro de I'agent de la leucernie transmissible des poules, Compt. rend. Soc. de biol. 121: 403-405, 1936. Cultures of bone marrow from leukemic fowls reproduced the disease only three times 0Ul: of many attempts, and it is probable that these represented a survival of the etiological agent rather than its multiplication. WM. H. WOGLOM

A Factor in Malignant Tissues Which Increases the Permeability of the Dermis, E. BOYLAND AND D. MCCLEAN. J. Path. & Bact. 41: 553-565, 1935. Aqueous extracts of various rapidly growing transplantable mammalian tumors contain a factor which, on intracutaneous injection into the rabbit, increases the per­ meability of the dermis and causes diphtheria toxin or India ink to diffuse over a larger area than it otherwise would. This agent is present in an amount approximately pro­ portional to the growth rate of the tumor. The more vigorously growing neoplasms yielded much larger amounts of the diffusing principle than any normal tissue except mammalian testis, extracts of which are active in high dilution, as Claude and Duran­ Reynals (J. Exper. Med. 60: 457, 1934) had also found. Extracts of fowl sarcoma No. I, did not increase diffusion in the dermis, whereas those of the Fujinami myxosarcoma produced an increased diffusion comparable to that caused by the more vigorous mammalian growths. Extracts prepared from rat embryo or placenta contained moderate but variable amounts of the diffusing factor. The parallelism between growth rate and content of diffusing factor in the different strains of tumors suggests that this factor may control their growth, and it is a matter of considerable interest that extracts of rapidly dividing normal cells (testis, embryo, placenta) should contain an agent with the same physiological action as that produced by extracts of rapidly growing tumors and culture filtrates of invasive strains of bacteria. The significance of these observations is discussed. WH. H. WOGLOM 160 ABSTRACTS

Experimental Studies on the Nutrient Arteries in Implanted Tumors of Rats and the Effect of X-ray Irradiation on These Arteries, K. FUTAGAMI. Experimentelle Untersuchungen tiber die Ernahrungsarterien implantierbarer Geschwillste bei Ratten und die Einflusse der Rontgenbestrahlung auf dieselben Arterien, Gann 30: 209-238, 1936. An arteriographic study of transplanted rat sarcoma and carcinoma is reported. The nutrient arteries of the transplanted sarcoma are formed from blood vessels which are physiologically distinct at the time of tumor implantation, and not by special tissues. This change can be observed seven days after implantation. As the tumor grows, the near-by branched arteries enlarge and become the nutrient arteries of the tumor; in general they are found at the periphery of the growth. The formation of the nutrient arteries in rat carcinoma is practically the same as in sarcoma, except that they are less abundant and develop more slowly. [For a much more complete study of the topog­ raphy of the vessels in inoculated tumors of animals see Goldmann, E. E.: Beitr. z. klin. Chir. 72: I, 1911.J The tortuosity of nutrient arteries as well as of main arteries is more marked in the x-rayed than in unirradiated tumors. After irradiation, the nutrient arteries collapse. The degree of change in the vessel-picture of the sarcoma and carcinoma depends entirely upon the number of roentgens used and the time elapsed after irradiation. The article is illustrated by one schematic diagram and 17 arteriograms. K. SUGlURA

Localization of Leishmania donovan! in Normal and Cancerous Bile-duct Epithelium, L. NATTAN-LARRIER AND J. DUFOUR. Localisation des Leishmanias dans les epithl!liums des canaux biliaires normaux et cancereux, Com pt. rend. Soc. de biol. 121: 13-17, 1936. After experimental infection of a hamster with Leishmania donovani the organisms were found both in the normal liver and in the parenchyma and stroma of a carcinoma involving this organ. Two photomicrographs accompany the article. WM. H. WOGI.OM

Pigmentary Responae in Phoxinus Laeria. Effect of Blood from a Patient with Melano­ sarcoma, E. B. ASTWOOD AND C. F. GESCHICKTER. Am. J. Cancer 27: 493-499, 1936. Injection of blood from a patient with melanosarcoma into the minnow, Phoxinus laevis, resulted in the development of the so-called nuptial coloring characteristic of this fish during the spawning season. Of various drugs, tissue extracts, and endocrine preparations investigated, the only other one producing this phenomenon was the ex­ tract of the pituitary. The authors conclude, therefore, that the minnow response is specific for a hormone of the intermediate pituitary lobe and that this hormone was present in the blood of the patient described. A color plate shows the response. A photograph and photomicrograph of the melanosarcoma are also included. A bib­ liography is appended.

Production of the CBA Strain of Inbred Mice: Long Life Associated with Low Tumour Incidence, L. C. STRONG. Brit. J. Exper. Path. 17: 60-63, 1936. Spontaneous tumors in mice of the CBA strain, produced by brother-to-sister mating since 1920, have been very rare. But before these mice could be regarded as highly resistant it would be necessary for them to live well beyond the cancer age or, in other words, longer than sixteen months. A selection experiment toward longevity was therefore set up, only the descendants of that mouse in each generation which lived longest being continued. The females of this strain proved comparatively resistant to mammary carcinoma up to eighteen months of life, only 2 out of 71 females having developed it (at 732 and 557 days re­ spectively). Two other females had adenoma of the liver (at 602 and 581 days). WM. H. WOGLOM EXPERIMENTAL STUDIES; ANIMAL TUMORS 161

Tumor Incidence in Reciprocalll'1 Hybrid Mlce-A XD High Tumor Stocks, J. J. BITTNER. Proc. Soc. Exper. BioI. & Med. 34: 42-48, 1936. Reciprocal crosses between strains D and A, both with a high mammary tumor incidence, indicated that: (a) the mean tumor age in F1 breeding females was more nearly related to that of the maternal stock; (b) the proportion of animals developing tumors in the F 1 generation was considerably greater than in the maternal stocks; (c) the relative correlation of the tumor incidence between the maternal strain and the hybrid generation was approximately the same. A small number of observations suggest that lung tumor susceptibility may possibly be transmitted by parents of either sex from the high lung tumor race (A). WM. H. WOGLOM

Constitutionalll'actor in the Incidence of M~ary Tumors, STAFF OF THE ROSCOE B. JACKSON MEMORIAL LABORATORY. Am. J. Cancer 27: 551-555, 1936. Studies on groups of mice (1) in which the genetic constitution was constant but ovarian and mammary function was variable and (2) in which the functional activity was controlled but the genetic constitution variable indicate that the constitutional factor is the basic one in tumor incidence, though it is subject to varying stimulation or inhibition by internal secretions.

Spontaneous Incidence of Lung Tumors in Relation to the Incidence of Mammary Tumors in an Inbred Strain of Albino Mice (Strain A), JOHN J. BITTNER. Am. J. Cancer 27: 519-524, 1936. ' This is a further report (see Am. J. Cancer 25: 113, 1935) on tumor incidence in the inbred strain of albino mice known as Strain A, being concerned especially with pul­ monary tumors. Females of the inbred A strain of mice inherit the susceptibility to both breast and lung tumor formation. Parity results primarily in mammary tumors. The pulmonary tumor incidence is approximately the same in males as in virgin females and compares with the mammary incidence in breeding females.

Hemoglobin Levels in Various Degrees of Susceptibility to Spontaneous Tumors, LEONELL C. STRONG. Am.]. Cancer 27: 500-509, 1936. The author studied the hemoglobin level in 8 stocks of mice developing spontaneous cancer at different ages and found a precocious drop in the hemoglobin level in those mice which are known genetically to be more susceptible to the development of spon­ taneous carcinoma as compared with those mice which are more resistant. This defect, he believes, is probably hereditarily determined. I t may reflect a premature aging involution process in the cancer-susceptible mice. A bibliography is appended.

Gross and Microscopic Diagnoses in Mouse Tumors at the Site of the Mammary Glands, ARTHUR M. CLOUDMAN. Am.]. Cancer 27: 510-512, 1936. Extrachromosomal Infiuence in Relation to the Incidence of Mammary and Non­ Mammary Tumors in Mice, WILLIAM S. MURRAY AND C. C. LITTLE. Am.]. Cancer 27: 516-518, 1936. Cloud man reports a histologic study of the tumors occurring in hybrids of a reciprocal outcross between a strain (B) in which mammary tumors are almost unknown and one (d) having an incidence of 50 per cent mammary tumors in virgin females and about 80 per cent in breeding females reaching the cancer age. By this study it proved pos­ sible to separate tumors of epithelial origin from those of non-epithelial origin, thus strengthening the theory of extrachromosomal influence in the incidence of spontaneous mammary tumors in mice. Murray and Little also report on the tumors occurring in the offspring of reciprocal crosses between the C57 Black or B strain and the dilute brown or d strain. They conclude that mammary tumors of epithelial origin are transmitted largely by means of extrachromosomal influences, but that some other tumors do not follow this law. 162 ABSTRACTS

Further Studies on the Relation of Functional Activity to Mammary Carcinoma in Mice, HALSEY]. BAGG. Am. J. Cancer 27: 542-550, 1936. In experiments with a low-tumor strain of mice the author found it possible to pro­ duce adenocarcinoma of the mammary gland by rapid breeding and consequent in­ creased activation of the reproductive system. In hybrid female mice rapid breeding and non-suckling apparently lowered the threshold for the growth of spontaneous mam­ mary gland tumors so that an extrachromosomal influence such as has been reported by Murray and Little, if present, was not shown in the results obtained.

Influence of Complete Blockage of the Nipple on the Incidence and Location of Spon­ taneous Mammary Tumors in Mice, ELIZABETH FEKETE AND C. V. GREEN. Am. ]. Cancer 27: 513-515, 1936. . Experiments recorded by Fekete and Green indicated that blockage of the mammary ducts with resulting milk stagnation was influential in determining the site and the time at which mammary tumors appeared in a genetically susceptible strain of mice but did not in itself cause tumors, since it was unable to overcome the hereditary resistance in animals of a strain in which such tumors normally do not develop.

Attempts to Retard the Incidence of Cancer (Lymphosarcoma) in Mice, L. MERCIER AND L. GOSSELIN. Essais en vue de retarder l'apparition du cancer (lymphosarcome) dans une lignee de souris, Com pt. rend. Soc. de bioI. 121: 125-126, 1936. The repeated injection of magnesium hyposulphite and of a mixture of thyroxin, adrenalin, and extract of anterior hypophyseal lobe, did not alter the incidence of lymphosarcoma in mice or the age at which the tumors appeared. WM. H. WOGLOM

Experimental Studies on the Development of Spontaneous Tumors in Animals with a High Degree of the So-called Immunity to Transplantable Tumors, ]. GOTO AND S. MIYAMOTO. Gann 30: 193-208, 1936. The authors discovered two cases of spontaneous tumors in mice which were non­ susceptible to repeated subcutaneous transplantations. The first spontaneous tumor developed in the left. axillary region of a mouse refractory to the Miyamoto mouse sarcoma. It was an adenocarcinoma and was not transplantable. The second tumor arose in the peritoneal cavity of a mouse refractory to the Goto mouse sarcomatoid carcinoma. Histologically this tumor was an endothelial tumor and was transplant­ able. The article is illustrated by one photograph of gross material and four photo­ micrographs. [Similar observations were recorded long ago, by Bashford, Murray and Cramer (Third Scientific Report, Imperial Cancer Research Fund, 1908, pp. 322 and 396) and also by Thorel (Verhandl. d. deutsch. path. Gesellsch. 12: 60, 1908).J K. SUGlURA

THE CANCER CELL

Tumor Specificity and Tumor Genesis, HANS ]. FUCHS AND HUGON KOWARZYK. Tumorspezifitat und Tumorgenese, Klin. Wchnschr. 15: 289-292, 329-332, 1936. The Fuchs reaction is sometimes positive in patients with chronic inflammatory lesions only, because the cancer cell is the equivalent, after all, of an embryonal cell in which differentiation has come to an end at some intermediate stage, and its antigenic properties are therefore identical with those of the corresponding phase in normal development. In other words, embryonal cells pass through a "malignant zone," in which the Fuchs reaction cannot distinguish them from cancer. As similar antigenic properties appear in regenerative processes, these may be sero­ chemically equal to embryonal tissue, or to cancer. There is some unknown factor produced by tumor cells which holds back their metabolism at a certain embryonic level, keeps them in a state of constant division, and prevents their differentiation. In the case of the Rous and the Shope tumors, for GENERAL CLINICAL AND LABORATORY OBSERVATIONS 163 example, this" ens malignitatis" resembles bacteriophage in some respects, and the authors suggest that it arises primarily in some such way as bacteriophage. WM. H. WOGLOM Destruction of the Cancer Cell by Ferments and the Constitution of the Blood Serum, W. RAAB. Fermentative Carcinomzellenzerstorung und Serumeiweisskomplex, Klin. Wchnschr. 14: 1633-1635, 1935. One of the most striking features about the pathology of malignant disease is the almost complete absence of carcinoma in the duodenum and its increasing frequency throughout the gastro-intestinal tract in direct proportion to the distance from this exempt segment. The simplest explanation is the constant presence of trypsin in the duodenum, for the cancer cell has long been known to be especially susceptible to attack by this ferment, a characteristic substantiated by the author in his own experiments. Yet the intravenous injection of trypsin, which proved by no means so toxic as the older accounts would suggest, had no effect upon the growth of the Brown-Pearce rabbit carcinoma. This failure was anticipated for several reasons, which are discussed in detail, but it is suggested that trypsin may still find a use in superficial cancers, where its effect will not be so largely counteracted by the antitryptic power of the blood serum. WM. H. WOGLOM Permeability and Growth (Remarks on the Paper by Else Knake, Ztschr. f. Krebs­ forsch. 42: 329), W. HEUBNER AND G. ORZECHOWSKI. Permeabilitat und Wachstum (Bemerkungen zu der Mitteilung von Else Knake, Z. f. Krebsforsch. 42, S. 329), Ztschr. f. Krebsforsch 43: 284-290, 1936. The authors believe that Else Knake's data (Ztschr. f. Krebsforsch. 42: 329, 1935. Abst. in Am. J. Cancer 26: 407, 1936) do not justify her conclusions. The growth differences between fibroblasts and epithelium in vitro, which she ascribes to variations in permeability, are more probably a result of the different response of these two cell types to changes in the structure of the nutrient medium. WM. H. WOGLOM

Nuclear Measurements of Mammary Carcinoma of the Mouse, THEODOR HEINKELE. Kernmessungen an Mammacarcinomen der Maus, Ztschr. f. Krebsforsch. 43: 323­ 336, 1936. In lactating mouse mamma and a series of spontaneous and transplantable tumors the largest diameter of the nucleus and a diameter at right angles to this were measured. The arithmetical mean (d) was taken as the diameter of a sphere whose volume (V) would correspond approximately to that of the nucleus. In functioning mamma the values were as follows: d = 5.0 - 5.6~ (V = 125-160). The figures for one of 3 spontaneous adenocarcinomas corresponded to those for the mammary gland. For the other two they were distinctly smaller. This is no proof, however, that the nuclei in carcinoma are smaller than those of the mother cell for, as is the case in man, the cells of some mammary glands may be smaller than those of others. In the transplantable tumors the values were variable. Nuclear size evidently depends partly upon host influences and partly upon conditions in the tumor cell itself that are still unrecognized. The article is accompanied by a number of tables and curves. WM. H. WOGLOM

GENERAL CLINICAL AND LABORATORY OBSERVATIONS

Tumors and Associated Problems, F. K. SOUKUP. U. S. Nav. M. Bull, 33: 348-358, 494-510, 1935. This is a concise review of the clinical and pathological aspects of the majority of tumor types, without illustrations or bibliography. While nothing new is contributed, it provides a valuable working summary for the average practitioner. THEODORE S. RAIFORD 164 ABSTRACTS

The Nature of Cancer, J. P. SIMONDS. Scient. Monthly 40: 535-540, 1935. A general discussion of the problem of cancer with no new material. CHARLES A. WALTMAN

Malignant Growths in 3000 Australian Post Mortem Examinations, J. B. CLELAND. J. Cancer Research Com., Univ. Sydney 6: 171-178,1935. In a series of 3000 autopsies performed at the Adelaide Hospital in Sydney, Aus­ tralia, from 1920 to 1935, there were found 398 carcinomatous growths and 39 other malignant tumors such as sarcomas and melanomas. This gives an incidence of 31.2 per cent for carcinomatous growths and 14.5 per cent for all malignant growths excluding gliomas. Skeletal metastases were found in 21 of the carcinoma cases: 5 of the breast, 4 of the prostate, 2 each of the lungs and colon, and 1 each of the esophagus, stomach, pancreas, ovary, palate, and penis. There were also a metastatic melanoma, probably from the penis, and one metastatic tumor of doubtful origin. The vertebrae were involved in 10 cases, the ribs in 7, the femur in 2, and the scapula, innominate bone, cranium, calvarium and base of the skull, middle cerebral fossa and dura mater, and base of the skull in 1 case each. Metastases to the brain were present in 2 cases of carcinoma of the lung, 1 of carcinoma of the breast, and 1 of seminoma of the testis. BENJAMIN R. SHORE

Industrial Cancer, JOSEPH MAISIN. Intoxications professionnelles et cancer, Le Cancer, 11: 111-131, 1934. Maisin opens his discussion with the statement that while tar cancer has usually been called the first industrial type of the disease, this title might more properly be applied to Bilharzia cancer of the Egyptian field workers, who unquestionably suffered from cancer of the bladder or rectum 7000 years ago. Mummies with bone sarcoma offer proof that this form of neoplasm was also present in ancient Egypt. From para­ sitic cancer the author passes to cicatrices of burns and the neoplasms developing in them. The latter have seldom been recognized as a compensable type, though they should be, for many burns are received in the course of activity in foundries, steel mills, and other factories. Cancer due to light radiation has been observed in those who work much in the open air, but while it has been possible to produce such neoplasms in albino animals by expo­ sure to sunlight or ultraviolet light, and while the less pigmented human races also suffer from an excess of cancer of the face, presumably due to light, no generalizations can be made, since animals with pigmented hairs do not develop cancer on exposure to ultra­ violet light nor does the pigmented inhabitant of the tropics. On the contrary, the darker races are said to suffer oftener from cancer of the feet and legs following injury and infection than from cancer of the skin of the face. Maisin suggests that it is difficult to correlate exposure to x-ray with the so-called professional leukemias, though cancer of the skin following exposure has been common in the past. A new generation of cancer sufferers, scarcely to be included in the professional group, is made up of indi­ viduals who have been injected with thorotrast, which has been shown to produce sarcoma of the bones in animals and will unquestionably do the same thing in human beings. Martland's work showed that it might take many years before such a dis­ astrous result made its appearance (see Am. J. Cancer 15: 2435, 1931). The industrial cancers due to chemicals were first noted in 1885 among dye workers, but even today the exact type of substance which is responsible for the development of the neoplasm has not been determined. Interesting statistics are given of the localization of cancers of tar and pitch workers and cancer produced by lubricating oil. A good deal of space is devoted to the recent work of Kennaway and Cook with car­ cinogenic chemicals, and, as Maisin says, II the conception of the plurality of neoplastic diseases is somewhat questionable in the face of the fact that a single one of these chemi­ cals may produce squamous, cylindrical-cell or glandular carcinomata, sarcomata, and leukemia, depending only upon which type of cell happens to be irritated." We are still in ignorance of what this irritation is. Several workers have shown that compounds of the phenanthrene group interfere with glycolysis and the cells absorb much less GENERAL CLINICAL AND LABORATORY OBSERVATIONS 165 oxygen in their presence. .. Is there a protective substance in the body whose effective­ ness is injured by these chemicals, thus releasing forces as yet unknown, and is this phenomenon' related to the oxidation-reduction mechanism, as seems possible from some experimental work?" These are some of the questions which Maisin asks, but he points out that there is as yet no answer. The following discussion, much abbreviated by the abstractor, followed the pre­ sentation of Maisin's paper. De Laet: Although Dr. Maisin refers the Schneeberg pulmonary carcinoma to radio­ active dust, I have not seen a case of carcinoma of the lung in twelve years' industrial experience in Belgium, where, nevertheless, radium is prepared for almost the entire world. Nor have I encountered tar cancer in a group of 1200 telephone and telegraph linemen, though I have treated many of them for burns from molten paraffin or boiling pitch. .Firket: Cancer of the lung seems to be increasing in Belgium, as in other countries, but I find it difficult to correlate this rise with atmospheric pollution. I should like to hear the opinion of industrial physicians on this point. Murdoch: The relation between atmospheric dust and pulmonary carcinoma is undeniable. The Schneeberg carcinoma proves it. Firket: I realize that 65 per cent of Schneeberg miners die of primary carcinoma of the lung, but is this not because of some special chemical peculiarity of the dust in these mines? The question of immediate interest seems to me to be this: Does the dust of our ordinary industries cause pulmonary cancer? Langelez: Schneeberg cancer is evidently a special case. In Belgium the relation between pulmonary carcinoma and the dust of ordinary industries has received but little attention, except in the case of pitch. This often causes cancer of the lung. I myself must have seen about ten cases. I should like to ask Dr. Maisin his opinion respecting the r6le played by arsenic in pitch cancer. This appears to me to be a question of some importance. He has said, and rightly, that the nature of the coal, and consequently of the tar and pitch derived from it, plays an important part in carcinogenicity and could report no instance of cancer elicited by wood tar. I myself know of none and should like to ask whether any one here present has encountered such a case. I will now ask Dr. Maisin to reply to the other questions that have been asked. Maisin: M. De Laet has said that none of the workmen under his observation has developed cancer. The management of the factory is to be congratulated, as they have, no doubt, taken the necessary measures to prevent the workers from inhaling radio­ active dust. De Laet: They are literally covered with dust and absorb it all the time, especially by mouth. They are yellow from head to foot, and will not wear the masks provided for them. And this has been going on for years. Maisin: The twelve years during which you have had these men under observation is not long enough to permit judgment. Some of them, I believe, will eventually develop cancer. There is no doubt that radio-active dust is carcinogenic. Daels and I have produced experimentally, with radio-active materials, cancers resembling those elicited by the x-ray. De Laet: In man? Maisin: No, in animals. De Laet: That is the whole point. Maisin: You have not seen cancer in your workmen because the exposure period has been too short. A year to a year and a half is required in the guinea-pig, which would correspond to twenty or thirty years in man. De Laet: That may be so. Maisin: Cancer among radiologists appears only after years of exposure. The reason why you have seen no pitch cancer among lineman may be that the product which they are using contains no carcinogenic agents. I myself, however, have encountered cancer of the skin in railway mechanics, engineers, and linemen, no doubt because the substances which they were using contained carcinogenic agents such as benzpyrene. 166 ABSTRACTS

As for arsenic, I do not believe that it plays any part in tar cancer. Langelez: I am of the same opinion. Coquelet: I should like to ask Dr. Maisin to discuss the relationship between humoral factors and the local action of an irritant. Maisin: I believe that some constitutional change is required-perhaps an alteration in the oxidation-reduction mechanism, perhaps an intoxication of some sort-before a cancer can develop, but I cannot describe the relation between the two. Coquelet: That is not quite what I meant. What I wanted to ask is this: Are the changes in glucose metabolism, in pH of the blood, etc., that have been described in cancer patients a cause or a result of their disease? Maisin: I cannot give a definite answer to that question. Reding: The humoral changes are primary, not secondary. Maisin: I am inclined to agree with Dr. Reding, but do not regard the question as in any way conclusively settled. WM. H. WOGLOM

Two Cases of Tar Cancer, ]. MARGAROT, P. RIM BAUD, AND ]. ROCHE. Deux cas de cancer du goudron, Bull. Soc. franc, de dermat. et syph. 42: 1498-1502, 1935. The authors present two cases of "carcinoma" of the scrotum in men who had worked with tar for many years. The first patient was fifty-six years old and all his life had been a day laborer, generally working with coal. Five years previously he had had a small tumor of the right naris removed, three years previously one of the retro­ maxillary region, and a year later one of the suprahyoid area. On admission he pre­ sented, besides the small tumor of the scrotum, three small nodules in the mastoid and auricular areas. All the nodules were firm and crusted, the largest one, on the scrotum, being the size of a pea and slightly pedunculated. Histologic examination of the scrotal tumor showed it to be an epithelioma, fairly well differentiated in the center but undifferentiated at the periphery. The skin of the patient's face, forearms, and scrotum was deeply pigmented and covered with comedones. The second patient, only thirty-two years old, had worked for four months each year for fourteen years as a boat caulker. His tumor had appeared only two weeks before admission and had grown rapidly to the size of a small nut. Histologically it was a very hyperplastic papilloma without malignant degeneration, but the authors believe that it would have become cancerous had it not been excised so early. All of the tumors were treated with electro-cautery excision. There are no illustra- tions, and no bibliography is included. THEODORE P. EBERHARD

Contact Spread of Cancer and Progressive Carcinogenesis in situ, nlustrated in the Colon, D. A. WELSH J. Cancer Research Com., Univ. Sydney 6: 220-226, 1935. Epithelial cells in the marginal contact zone of a cancer may pass through more or less indefinite phases into a definite and recognizable cancer phase while they still occupy their normal sites in the architecture of the tissue in which the cancer is spreading. In other words, these epithelial cells have become cancerous in situ before they begin to invade. This phase of carcinoma will continue to develop until it becomes incor­ porated in the general cancer mass and sooner or later becomes invasive. This represents a form of cancer spread additional to and absolutely distinct from the recognized invasive spread of cancer. The causes of these reactions within the ex­ panding margin of an established cancer are not known. It is suggested, however, that the continued growth and spread of the cancer are largely due to something that comes from the cancerous growth itself. One case of carcinoma of the colon showing these contact changes is reported and illustrated with photomicrographs. [These opinions in a slightly different form have been expressed many times before but are now generally abandoned. See, for example, Hauser (Virchows Archiv 138: 482, 1894), who maintained that cancer spread by a wave of malignant alteration of the surrounding healthy tissues. Adami approved this opinion in his Principles of Pa­ thology (Lea and Febiger, Philadelphia, 1910, vol. 1, p. 836). Verse applied the idea to the spread of carcinomata of the gastro-intestinal canal (see his Die Entstehung, GENERAL CLINICAL AND LABORATORY OBSERVATIONS 167

Bau und Wachstum der Polypen, Adenome und Karzinome des Magen-Darmkanals, Arb. aus der Path. Inst., Leipzig, 1908, Bd. I, Heft 5, and for the opposing view, Borst in Die Lehre von den Geschwiilsten, Wiesbaden, vol. 2, p, 686, 1902.J BEN]AMIN R. SHORE

A Possible Explanation of the Contact Spread of Cancer, D. A. WELSH. J. Cancer Research Corn., Univ. Sydney 7: 44-45, 1935. Welsh suggests as a possible explanation of the contact spread of cancer (see pre­ ceding abstract; also abst, in Am. J. Cancer 26: 203, 1936) the concentration in the cancerous tissue of a carcinogenic agent presumably produced by disturbances in the sterol metabolism.

A Further Report on the Cancer Family of Warthin, I. J. HAUSER AND CARL V. WELLER. Am. J. Cancer 27: 434-449, 1936. This brings to date the history of the family described in 1913 and 1925 by Warthin (Arch. Int. Med. 12: 546, 1913;'J. Cancer Research 9: 279,1925). It now presents 43 primary carcinomas in 41 individuals from a total population of 305. Since only 174 have attained the age of twenty-five years, this gives a cancer incidence of 23.6 per cent in those reaching that age. In two branches of the family cancer has never appeared. Anatomical location of the primary lesion is more significant in this study than total incidence, 26 carcinomas having occurred in the gastro-intestinal tract and 15 in the endometrium. While no conclusions as to the mendelian implications appear to be justified, this family is considered as providing strong presumptive evidence for an inheritable organ-specific predisposition to carcinoma. Numerous charts and photomicrographs illustrate the paper.

Primary Carcinoma of the Extremities, E. M. BICK. Ann. Surg. 103: 410-414, 1936. Twenty-one cases of primary carcinoma of the extremities have been collected from the Hospital for Joint Diseases, Mount Sinai and Montefiore Hospitals in New York City. There were 6 basal-cell epitheliomas, 4 squamous-cell carcinomas, 9 un­ classified epitheliomas, and 2 melanocarcinomas. Eleven of the patients were men and 10 women. Five of the tumors followed burns and 5 followed infection in old operative scars. Ulceration was present in 12 cases, but whether it was secondary or primary was difficult to determine. The treatment of primary carcinomas involving the digits is amputation followed by irradiation of the adjacent tissue and regional lymph nodes. With primary carcinomas of other parts of the extremities, either wide excision of the tumor or amputation followed by irradiation of the local area and regional lymph nodes should be instituted. Wide excision or amputation is chosen after the grade of malig­ nancy is known. This must be determined by the history of the case and histologic study of the biopsy specimen. Melanosarcomas should be treated by immediate amputation and irradiation of the regional lymph nodes. The article is not illustrated. BEN]AMIN R. SHORE

Thymoma and Thymic Hyperplasia in Myasthenia Gravis with Observations on the General Pathology, E. H. NORRIS. Am. J. Cancer 27: 421-433, 1936. Thymic lesions have been observed in 50 per cent of the cases of myasthenia gravis reported since 1901. Bell analyzed the 27 cases reported prior to 1917 and added a case of his own (J. Nerv. & Ment. Dis. 45: 130, 1917). The present author summarizes the five cases published since that time and adds 2 cases in which a high degree of hyperplasia of the thymus was found. Two cases are briefly presented in which there was no evidence of thymic involvement. Two types of thymic lesion are recognized as occurring with myasthenia gravis, extreme epithelial hyperplasia and moderate epithelial hyperplasia. Neither, according to the author, is to be regarded as a true neoplasm. The paper is illustrated by photomicrographs. A bibliography is appended. 168 ABSTRACTS

Sacro-coccygeal Cysts and Tumours, R. W. RAVEN. Brit. 1. Surg. 23: 337-361, 1935. This is a general review of the embryology and histology of sacrococcygeal cysts and teratomas. Abstracted histories of 16 illustrative cases with numerous photographs and photomicrographs are included. BENJAMIN R. SHORE

Sacrococcygeal Cysts, A. VALERIa. Kystes dermordes fistulises sacro-coccygiens, Lyon chir. 32: 49-52, 1935. On the basis of 226 cases of sacrococcygeal cysts with multiple fistulae, the author advocates their removal under local anesthesia and claims that cicatrization occurs in ten days. His series included 198 males and 28 women. No follow-up of these cases is reported, and no statement is made as to the number of recurrences. The paper is without illustrations or bibliography. CHARLES A. WALTMAN

Generalized Primary Angiosarcomatosis of the Lymph Nodes, P. J. MELNICK. Arch. Path. 20: 760--766, 1935. The author reports a case of generalized primary angiosarcomatosis in an Italian laborer of sixty-four years, involving practically all the lymph nodes of the body. Biopsies of four nodes revealed the same picture, namely, that of an angioblastic tumor centrally located in the lymph nodes, fairly well encapsulated, and apparently indepen­ dent of the lymphatic tissue. At the time of the report, thirty months after the first appearance of node enlargement, the patient was well and the nodes had increased only slightly in size in the past fifteen months. The impression was gained that the tumor in this case had arisen from independent multiple angioblastomatous anlagen such as occur in Osler's disease and Kaposi's angioearcomatosis of the skin. A photograph of the patient and 2 photomicrographs are included. There is a short bibliography with references to two previous cases.

Three Unusual Cases of Abdominal Tumor: Sebaceous Pancreatic Cyst; Retroperi­ toneal Fibroma; Benign Pancreatic Cyst, W. WALTERS AND N. W. THIESSEN. Surg. Clin. North America 15: 1159-1162, 1935. The authors report three unusual cases of abdominal tumor. One was a sebaceous pancreatic cyst: the second a retroperitoneal fibroma: and the third a benign pancreatic cyst. These cases illustrate well the advisability of exploratory laparotomies in all cases of abdominal tumor providing the patient's condition warrants the procedure. Before operation, all three of the cases were very suggestive of inoperable abdominal malignancy; yet the patients were in such good general condition that exploration seemed advisable. A successful result was obtained in each instance. There are no illustrations. BENJAMIN R. SHORE

Multiple Tumor Syndrome in the Male. Carcinoma of the Breast, Pleomorphic Sarcoma of the Thigh and Neurofibromas of the Skin; Report of a Case, G. G. DAVIS, H. A. HANELIN AND T. C. MOUZAKEOTIS. J. A. M. A. 106: 1359-1363,1936. The authors report the case of a fifty-seven-year-old man with a carcinoma of the left breast, a pleomorphic sarcoma of the left thigh, and neurofibromas of the skin. The growths were treated by radical surgical methods and postoperative roentgen irradiation. The patient has remained well for approximately four months after operation. Photographs and photomicrographs illustrate the article. BENJAMIN R. SHORE

Notomelic Teratoma in a Child with Spina Bifida Dorsalis Occulta, WILHELM HER­ MANNS. Ueber ein notomelisches Teratom bei einem Kind mit Spina bifida dorsalis occulta, Centralhl. f. allg. Path. u, path. Anat, 64: 1-5, 1935-36. Report of a teratomatous accessory limb that sprang from the back between the shoulder blades. The growth contained nerves, glia, ependyma, epithelium, connective tissue, serous and mucous glands, smooth muscle, and cartilage. The paper is illustrated by pictures of the patient, of the gross specimen, and by roentgenograms.' WM. H. WOGLOM GENERAL CLINICAL AND LABORATORY OBSERVATIONS 169

Positive Frei Reaction in a Woman Haviq a Large Tumor of the Iliac Fossa With Lesions of the Pelvic Bones. Speculations as to the Nature of the Tumor, A. G. WEISS AND J. KUNTZMANN. Reaction de Frei positive chez une femme atteinte d'une tumeur volumineuse de la fosse iliaque, avec lesions du bassin osseux. Con­ siderations sur la nature possible de cette tumeur, Bull. Soc. franc, de derrnat. et syph. 42: 1668-1670, 1935. A patient presented herself at the age of fifty-one years complaining of vague pains in the left leg for several months and occasional edema of the leg. Examination re­ vealed a large tumor filling the left iliac fossa and roentgenograms showed rarefaction of the lower part of the ilium. The Aron test for cancer was strongly positive, as were also three Frei tests with different antigens. A biopsy of the tumor itself revealed only lymphoid tissue with non-specific chronic inflammation. The questions arise as to whether the tumor was a real neoplasm which was missed by the biopsy, whether it was a mass of lymph nodes resulting from lymphogranulomatosis inguinale, whether Nicolas-Favre's disease can cause bone destruction, and whether either the Frei test or the Aron test is really specific. The authors promise to report later on the ultimate fate of the patient. The report is unillustrated and without bibliography. . THEODORE P. EBERHARD

Syphilitic Origin of Adenolipomatosis. Recent Case of Adenolipomatosis Simulating a Lymphadenitis, in an Old Syphilitic, Healed by Bismuth Treatment, PAUL CHEVALLIER. L'origine syphilitique de l'adenolipomatose. A propos d'un cas d'adenolipomatose recente simulant une lymphadenie, survenue chez un vieux syphilitique et gueri par Ie traitement bismuthique, Bull. Soc. franc, de dermat. et syph. 42: 1572-1575, 1935. This case of supposed adenolipomatosis in a sixty-one-year-old man was reported originally in Sang 8: 714--718, 1934 (Abst. in Am. J. Cancer 24: 157, 1935). The patient had a great deal of tuberculosis in his family and gave a history of syphilis, although serologic tests were negative. The large masses in the anterior lower cervical region when biopsied showed themselves to be composed of fat around degenerated lymph nodes. Following antiluetic therapy they promptly disappeared and the present report notes an eighteen-month cure, In the discussion MM. Milian and Gougerot plead for more exact terminology, suggesting that these masses are not lipomata but only" lipomatous syphilitic gummata." There are a few references to similar cases and to Gougerot's writings on his neval theory of the origin of true multiple lipomata. There are no illustrations. THEODORE P. EBERHARD

Disturbances of Lipoid Metabolism in Malignant Disease, M. ASCOLI. Storung des Lipoidhaushaltes bei malignen Tumoren, Klin, Wchnschr. 14: 1593-1597, 1935. From the serum (dried on filter paper) of patients with malignant disease there can be extracted by ether, in the cold, lipoids with a number of unsatisfied valences such as have not been found in other diseases or in health. Of these substances with available bonds, cholesterol and its esters make up only a small part. '1 .. ." ( total unsaturated valences d . The" avai ability quotient Q = '1 bl· d 1 expresse 111 c.c, avai a e unsaturate va ences of n/l00 thiosulphate), which normally is about 6 (e.g., Q = ~:~~ = 6.03), preserves this same value not only in the most varied assortment of diseases, but even in those where, as in icterus and nephrosis, the lipoid metabolism is disturbed and available unsaturated valences are definitely augmented; for the total unsaturated valences are then raised proportionately. It is quite otherwise in malignant disease. Here the total unsaturated valences remain unchanged while the available, or labile, unsaturated valences increase, so that the quotient falls to about 2 or 3. In other words, the connection between some of the unsaturated bodies and those substances to which they should be firmly anchored in the serum is unnaturally loose. This abnormality, which so far appears to be characteristic of malignant disease, is 170 ABSTRACTS not confined to the serum but prevails also in the blood corpuscles and other tissues. Thus, for example, the liver of sarcoma-bearing rats has an availability quotient of about 1, indicating that almost all the unsaturated valences have become available. The presence of these more or less free valences in the serum suggested its examina­ tion after the addition of an unsaturated fatty acid and, this having been done, it was found that ricinolic acid could not be extracted with ether from the serum of normal persons or of patients with diseases other than cancer, whereas the serum of those with tumors had lost its power to bind the acid. The test can be made more simply by determining the pH of the undried serum; this value will be changed by ricinolic acid in the case of tumor patients, but in the absence of malignant disease will remain un­ altered by the addition. Bilirubin or ox-gall are similarly bound by the serum of those without cancer and not by the serum of cancer patients. The ready availability, during malignant disease, of unsatisfied valences or, in other words, the presence of easily oxidized substances, led to the suggestion that these might attract oxygen away from its ordinary tasks in the cell and thus bring about diminished oxidation and increased glycolysis. The expectation was realized, for erythrocytes from cancer patients were found to produce more than the normal amount of lactic acid in the presence of oxygen, behaving in this respect like the malignant cell, except that they liberated only twice or thrice, instead of up to 50 times, the customary amount. After discussing certain problems raised by these observations, the author closes with some remarks on the possibility of using them as the basis of a diagnostic test. Bilirubin, ox-bile, and ricinolic acid as purchased were found so variable in their activity that they could not be relied upon; as for glycolysis, the gasometric technic is com­ plicated, and although there are chemical methods for determining lactic acid with high precision, they are hardly suited to a general laboratory. All these reactions having thus been found unsuitable for one reason or another, there remained only estimation of the unsaturated valences in ethereal extracts by means of the iodine number, ex­ pressed in c.c. of n/100 thiosulphate. A beginning has already been made in this direc­ tion and the results so far achieved appear to be promising. WM. H. WOGLOM

Disturbance of the Lipoid Metabolism in the Bearers of Malignant Tumors, R. INDOVIN A AND S. FIANDACA. Disturbo del ricambio lipidicio nei portatori di turnore maligne, Acta Cancro!' 1: 605-616, 1935. The technic of the test carried out by the authors was as follows: from a sample of fasting blood 2 c.c. of serum were taken, and 1 c.c. dried on each of two squares of filter paper. One series of the squares of filter paper were extracted with ether at a low tem­ perature and the iodine number determined, thus giving an indication of the unsaturated lipoid compounds present. The other series of squares of filter paper were extracted for three hours in the Soxhlet apparatus with a mixture of one part of ether and three parts of alcohol. The extracted liquid was then reduced to 5 c.c, in a vacuum and its iodine number determined. This second procedure gave an indication of the displace­ able unsaturated lipoid compounds present. The authors ran these tests on a series of 31 patients, 6 of whom were normal, 6 pregnant, 6 diabetic, 4 nephritic, 3 jaundiced, and 6 with cancer. They claim that the relationship between the unsaturated lipoids and the displaceable unsaturated lipoids in the blood serum is changed in cancer, the displaceable unsaturated lipoids being relatively more prominent. C. D. HAAGENSEN

Morphology of the Fats in Tumors, BELA KELLNER. Zur Morphologie der Fette in Geschwulsten, Frankfurt. Ztschr. f.. Path. 47: 454-461, 1935. The author has investigated a large number of tumors, both benign and malignant, for the fat content. He finds that in almost every malignant growth fat is present in considerable quantity and is equally present in the metastases. The major quantity of the fat is distributed in limited areas, quite different from the distribution occurring in normal organs and tissues. Sarcoma and carcinoma show equal quantities of fat, while in the benign tumors the fat is often limited in amount. The presence of fat is so GENERAL CLINICAL AND LABORATORY OBSERVATIONS 171 regular that the author believes that the type of fatty degeneration may be of use in the identification and classification of some tumors. Fat appears in those portions of a malignant growth which are most poorly nourished. For this reason in very small tumors or metastases and in the peripheral portion of the malignant growth-in other words, in regions where nutrition is ample-there is no fatty degeneration. The author expresses the opinion that some of these fatty degenerated cells may have something to do with metastasis and that their quantity suggests the possibility of metastasis. These are the cells which are found free in the tissues. There are no illustrations, and no bibliography is included.

Diameter of the Erythrocytes in Cancer Cases. I. Diameter of the Erythrocytes in Gastric Cancer, K. SU!lUI. Uber den Durchmesser der Erythrocyten der Krebs­ kranken. I. Mitteilung. Durchmesser der Erythrocyten bei Magenkrebs, Gann 30: 239-286, 1936. n. Diameter of the Erythrocytesin Cancer of Various Types, K. SUMII. II. Mitteilung. Durchmesser der Erythrocyten bei sonstigen verschiedenen Krebsarten, Ibid. 30: 287-324, 1936. The author determined the diameters of the erythrocytes in 20 healthy Japanese according to age and sex by the Bilrker-Collatz method. The normal mean diameter varied between 7.56 and 8.06 microns, giving an average value of 7.83 microns. No difference was found due to age or sex. The minimum diameter varied individually from 6.06 to 7.20 microns, and the maximum from 8.49 to 9.56 microns. The author then measured the diameters of the erythrocytes in 50 patients with various stages of gastric carcinoma. He found a mean diameter of 7.48 to 8.65 microns. Twenty patients gave a normal figure, 29 a high figure, and one a low figure. There was no increase in the size of erythrocytes in the early period of gastric cancer. It is pointed out that the morphological change in the erythrocytes is not due to the anemic condition of the patients. The diameters of the erythrocytes were also determined in 119 cases of malignant tumors other than gastric carcinoma. Among these 119 patients, 57 showed a high figure, 59 showed a normal figure, and only 3 showed a low figure. A high diametric value was associated with neither bone metastases nor disturbance of liver function. In mammary carcinoma, of which there were 19 cases; no deviation from normal was observable. In carcinoma of the rectum (20 cases) the erythrocyte picture was practi­ cally the same as in gastric cancer. The relationship between the size of the erythro­ cytes and anemia appeared to be especially complicated in uterine cancer (20 cases), but often large erythrocytes appeared in the presence of slight anemia. In oral cancer (18 cases) and skin cancer (7 cases) the diameters were usually above normal. 0 6 patients with cancer of the colon 5 had a normal and one had a high diametric value. In one of 3 cases of supramaxillary cancer and one case of bile-duet cancer the figure was also high. Two cases of supramaxillary cancer and one each of pancreas and pulmonary carcinoma showed normal measurements. These papers are accompanied by numerous charts. K. SUGIURA

Variations in Polypeptidemia among Cancer Patients Treated by Intravenous Injections of Salts Derived from Vitamin C (Ferriscorbones), F. ARLOING, A. MOREL, A. ]OSSERAND, M. CHAM BON AND S. CELLI ERE. Variations de la polypeptidemie chez des cancereux traites par des injections intraveineuses de sels complexes derives de la vitamine C (ferriscorbones), Compt. rend. Soc. de biol. 121: 683-685, 1936. The intravenous injection of " ferriscorbones" (combinations of the first oxidation product of ascorbic acid and various metals associated with iron), like radium therapy or roentgen therapy, often increases the blood polypeptides. WM. H. WOGLOM

~oentgen Investigations of the Structure of Animal Tissues, H. YAM AKAWA AND T. NAKAMURA. Rontgenologische Feinstrukturuntersuchungen von tierischen Ge­ weben, Gann 30: 22-28, 1936. Microscopic investigations allow identification of the structure of particles from a minimum of H,' centimeters diameter. With the help of roentgen diffraction, particles 172 ABSTRACTS of 10-1 can be studied. I t should be possible, therefore, by spectral investigations to distinguish physiologic and pathologic changes in the tissues. The authors studied roentgenologically the structure of human blood sera and various organs of rabbits, by the Debye-Scherrer-Hull method. [This has been suggested by others, notably Clark, Bucher and Lorenz (Radiology 17: 482, 1931), but the proposal was not warmly received by the pathologists present at the reading of the paper. They pointed out that the authors did not realize when they spoke of a fibroma of the uterus that they were working with a material which contained both muscle fibers and connective tissue. Since they spoke of spacings appearing corresponding to the osseous tissue, it is possible that the fibromyoma which they used was calcified.] In the present investigation blood sera of 10 normal subjects and 10 cancerous subjects gave a diagram with two rings, the inner sharp, the outer less sharply defined. The article is illustrated with nine schematic drawings of roentgen spectra and twelve roentgen diagrams. [An extensive discussion of this subject with numerous illustrations will be found in Clark's Applied X-Rays, 2d edition, McGraw-Hili Co., N. Y., 1932.] K. SUGIURA

DIAGNOSIS AND TREATMENT

Experiments with the Freund Carcinoma Reaction, Preliminary Communication, BERTA BENDA AND JOHANNES KRETZ. Ueber Erfahrungen mit der Freundschen Krebsdiagnostik, Vorll1ufige Mitteilung, Wien. klin, Wchnschr. 49: 174-176, 1936. Among 440 patients averaging fifty years of age, the Freund-Kaminer reaction for carcinoma corresponded with the clinical findings in 374, or 85 per cent. Among these 374 there were 137 with carcinoma who gave a positive reaction and 237 without carci­ noma who gave a negative reaction. In 27 cases, or 6 per cent, the test and the diagnosis did not correspond (4 negative reactions in the presence of carcinoma and 23 positive in the absence of demonstrable carcinoma). There were 14 patients, or 3 per cent, in which the test was doubtful, while 25, or 6 per cent, that gave a Freund-Kaminer sar­ coma reaction are excluded from the reckoning. The authors are more than ever convinced that the test is a simple, and therefore practical, means of diagnosing carcinoma even in its early stages. WM. H. WOGLOM

Vaccine of Doctor Aman in the Early Diagnosis and Treatment of Malignant Tumors, R. NICOLE. Vakzine Dr. Aman zur Fruhdiagnose und Therapie bosartlger Gesch­ wulste, Schweiz. med. Wchnschr. 17: 16-17, 1936. Aman's vaccine was tried as a diagnostic aid in 60 cases: 14 malignant tumors, 13 supposedly normal individuals, 15 patients with staphylococcus infections, and 18 with other diseases. Positive results were obtained in 18 of the 14 malignant cases, 3 of the normal individuals, 2 of the staphylococcus infections, and 6 of the heterogeneous group. It is concluded from this study that this vaccine is useless in the diagnosis of cancer. BENJAMIN R. SHORE

The Prophyluis of Cancer, A. THEILHABER. Die Verhtltung des Krebses, Wien. med. Wchnschr. 86: 222-223, 1936. The prophylactic measures ordinarily advised, in the belief that cancer is a result of local causes, have not diminished appreciably the incidence of the disease. The author, in 1908, was the first to suggest that cancer is partly due to defects of the internal organs, and especially of those concerned in hematopoiesis (spleen, thymus, lymph nodes, bone-marrow, etc.), The most valuable measures for activating the hematogenic tissues are bleeding, diathermy, and the implantation of fresh spleen and thymus or, where this is discoun­ tenanced by the patient, the intramuscular injection of freshly made press-juice from the spleen and thymus of a young pig. Commercial preparations have been disappointing and the author, in the hope of finding a simple and convenient method of immunizing against cancer, is investigating the activity of suppositories and salves containing spleen, as in such preparations the carcinolytic property seems to be preserved better than in fluids. DIAGNOSIS AND TREATMENT 173

The supplementary treatment consists of vigorous exercise. avoidance of alcohol and tobacco, severe restriction of table-salt, sun and air baths, and a vegetarian diet. WM. H. WOGLOM

Therapeutic: Problem of Malignant Tumors, P. BUISSON. SuI problema terapeutico dei tumori maligni, Arch. d. radiol. 10: 354--363, 1934. Buisson maintains that present resources of surgery and radiation are so often futile in the treatment of malignant tumors that a new method of attack must be developed. Some method like that of Heublein's in which the whole body is irradiated might prove helpful, for Buisson believes that cancer is a general rather than a local disease and cites a number of irrelevant examples to support his argument. [Unfortunately such general irradiation as he suggests does not cure cancer.] C. D. HAAGENSEN

Electrosurgery in Advanced Carcinoma, T. DE CHOLNOKY. Ann. Surg, 103: 415-421, 1936. The author reports the histories of four patients with advanced inoperable carci­ nomas in which satisfactory palliative results were obtained by electrosurgical methods. p'hotographs of the patients before and after treatment illustrate the article. BENJAMIN R. SHORE

Present Status of Radiation in Treatment of Malignant Conditions, J. ARONS. J. Am. Inst. Homeopathy 28: 548-553, 1935. The Coutard method of roentgen irradiation is reviewed by the author. Several photographs accompany the article. W. S. MACCOMB

Practical Consideration in Radium Therapy, R. E. FRICKE. Surg. Clin, North America 15: 1293-1302, 1935. This is a general discussion of the use of radium based upon the study of 315 benign lesions and 684 malignant tumors of all parts of the body. BENJAMIN R. SHORE

Results of the Radiation Treatment of Malignant Tumors in 1034, H. R. SCHINZ, A. lUPPINGER, R. SARASIN AND R. BAUMANN. Bilanz uber die Bestrahlungsreaultate bei malignen Tumoren im Jahre 1934, Rontgenpraxis 7: 217-222, 1935. This is the fifth annual report concerning the results of treatment secured at the Roentgen Institute of the University of larich and covers the patients treated in 1934. The general radiologic principles of treatment and the indications have not changed essentially during the past year. The greater number of the patients were treated by the simple fractional or the protracted fractional method of roentgen dosage, while a smaller number were treated by the combined useof x-rays and radium, the external application of radium, the interstitial use of radium. and a single large dose of x-rays, Altogether there were 774 patients. Of these, 44 per cent remained symptom-free at the end of the year: 2 per cent were symptom-free but died of intercurrent disease; 2 per cent were symptom-free, developed recurrences, and have remained well after further treatment; 2 per cent developed recurrences which could not be controlled by further treatment: 4 per cent are locally symptom-free but have distant metastases: 12 per cent showed temporary improvement but later progression of the disease; 12 per cent were improved and then remained stationary: 10 per cent showed no improve­ ment; 8 per cent were treated too recently for the effect to be known; 4 per cent dis­ continued treatment before it was completed; and 0.5 per cent have been lost to foIlow-up. In a table the tumors treated are grouped by organs. There has been a gradual but definite improvement in symptom-free patients from 1930 to 1934; in 1930 there were 23 per cent symptom-free patients; in 1931, 29 per cent; in 1932, 38 per cent; in 1933, 41 per cent; and in 1934, 44 per cent. For permanent results the authors refer to their special coIlected reports on different tumor types. BEN] AMIN R. SHORE 174 ABSTRACTS

Radiosensitivity of Carcinomas Increned by Short-wave Diathermy, G. FUCHS. Zur Sensibi1isierung strahlenrefraktll.rer Carcinome durch Kurzwellen, Klin. Wchnschr. 14: 1582, 1935. Also in StrahlentherapieSS: 473-480, 1936. The author advocates the use of short-wave diathermy over malignant tumors to increase their sensitivity to roentgen irradiation. This is based upon the theory that arterial hyperemia in malignant growths increases their radiosensitivity. BENJAMIN R. SHORE Late Radio-Necrosis: a Warning, H. H. MORAN. J. Cancer Research Com., Univ. Sydney 6: 211-216, 1935. The author describes a chronic ulceration of the anterior abdominal wall which oc­ curred four years following the administration of an unstated amount of roentgen irradiation to a supposedly inoperable malignant retroperitoneal abdominal tumor. This" radionecrosis" was undoubtedly precipitated by the repeated slight injuries caused by scratching and by friction of ill-fitting corsets [as is often the case}. BENJAMIN R. SHORE On Reduction in MultipUcation of Protozoon (Bodo caudatua) Caused by Ezposure to Gamma-ray Irradiation with Study of Sensitive Periodin Life of Cell, M. ROBERTSON. Brit. J. Radiol. 8: 502-527, 1935. . A Study of the Behaviour of Cultures of Bodo caudatus upon Release from Irradiation with Gamma Rays and of the :Effect Upon the Growth of Interrupted or Repeated Irradiations, M. ROBERTSON. Ibid. 8: 570-587, 1935. In the earlier of these papers the author showed that exposure to gamma-ray radia­ tion interfered with the division of the younger cells in the culture of the flagellate protozoon Bodo caudatus so that the rate of increase was reduced to 20 or 30 per cent of the normal. If the radiation was prolonged, a recovery in multiplication took place so that later generations were produced in less time than in the cultures irradiated for a short time. In the later investigation, as in the earlier one, 400 mg. of radium were used in plaque form, containing 10.38 mg. of radium per square centimeter. The Bodos were placed 5 to 7.5 mm. from the radium. After re-irradiation the rate of multiplication begins to accelerate above the normal until, if sufficient time is allowed to elapse, the number of cells equals the normal control. The larger organisms return to normal dimensions. There was no radium immunity observable and re-irradiation was always effective in some degree. After the cells approached normal, they showed the same effect in rate and rise in size as in the first exposure. The phenomenon of the gradual rise in the rate of multiplication of irradiated cells was exactly that observed by Canti and Spear in tissue cultures (Proc, Roy. Soc. ser. B. 102: 92, 1927; 105: 93, 1929). The culture after short irradiation either shows' no effect or returns to normal, other things being equal, more rapidly than after one of long duration. Interrupted irradiation seems to be as effective as continuous, providing the spacing is such so that not more than one generation of cells can be produced in the interval.

Autotransfusion in the Course of a Disarticulation of the Hip, TIXIER AND ARNULF. Auto-transfusion au cours d'une d~rticulation de la hauche, en utilisant Ie sang du membre enleve, Lyon chir, 32: 443-445, 1935. A patient with a large burn of the thigh developed an epithelioma in the existing ulcer. Hip amputation was performed. After the removal of the extremity it was placed on another table and the blood was withdrawn from the member by an assistant; 400 c.c, thus obtained were reinjected into the patient. The authors believe this helped prevent postoperative shock. CHARLES A. WALTMAN

Unusual Results in the Treatment of Cancer, L. SCHONBAUER. Einige eigenartige Beobachtungen bei der Behandlungdes Karzinoms, Wien. klin. Wchnschr. 86: 62-63, 1936. The outcome of treatment in malignant disease does not always conform to the clinical, operative, and histologic findings, radical operation being often followed by THE SKIN 175 prompt recurrence and merely palliative operations occasionally by a long period of freedom. Thus the forecast cannot be always correct, a statement which the author upholds by several case reports. The most instructive is perhaps that of the patient with gastric carcinoma who continued in excellent health for six years after an operation which was shown by microscopic study to have been incomplete. Of this it is said that had the man received any of the medical or dietary treatments now so widely recommended his improvement would undoubtedly have been ascribed to the measures employed. WM. H. WOGLOM THE SKIN

Aetiology of Cancer of the Skin, with Special Reference to Occupation, ALEX. R. SOMERFORD. Brit. M. J. 1: 1305-1310, 1935. This study of skin cancer is based on 613 cases seen in the Manchester and Salford Skin Hospital in England, which serves a large industrial area. In the great majority of patients the tumor was carcinomatous from the beginning, no history of a previous benign wart or pigmented nevus being obtained in the series. The greater proportion of the tumors were on the face, though the tendency to this location was more pronounced in the case of the basal-cell tumors than in the squamous variety. A history of exposure to occupational irritants was frequent, as would be expected in a cotton manufacturing district. These irritants the author groups as follows: mineral oil, pitch and tar, weather conditions such as constant outdoor employment. dry heat. and chemicals. The only one of these irritants to which women were exposed was oil; 19 of 45 women with squamous carcinoma and 78 of 242 having basal-cell tumors gave a history of such exposure, either past or present. Of 103 males with squamous carcinoma 29 gave a history of exposure to oil, 16 to pitch or tar, 22 to weather condi­ tions, 11 to dry heat, and 2 to chemicals. Of 200 males with basal-cell tumors, 79 gave a history of exposure to oil, 5 to pitch or tar, 51 to weather, 12 to dry heat. and 3 to chemicals. Thus, though more than half of the entire series, 327 of 613, had been at some time exposed to some type of irritant, there remained an almost equal number in which no history of irritation could be obtained. In view of this fact and the observation that facial tumors, except in tar workers, arose on skin which showed no keratotic or other changes which could be attributed to industrial irritation, the author believes that some other factor must be involved. In this connection he quotes J. Robertson (J. Indust. Hyg. 9: 217, 1927), who attributed scrotal cancer in mule-spinners not to oil, but to constant irritation by the coarse overalls worn by the workers. Reference is also made to the relatively small number of squamous tumors occurring in other industries than cotton spinning in which oil is used. It is suggested that the heat of the spinning room, 80 to 1000 F., may be of some significance, for there are no doubt a certain quantity of oil particles suspended in the atmosphere at these temperatures. As preventive measures the author suggests the use of non-carcinogenic oils as recom­ mended by the Manchester Committee (see Abst, in Am. J. Cancer 27: 361, 1936), the exclusion of persons with congenital abnormalities of the skin from employments involving exposure to carcinogenic substances, and compulsory periodic examination for the detection of signs of irritation.

Note on Cutaneous Cancer in Cotton Mule-Spinners, E. D. IRVINE. Brit. M. J. 2: 996-997, 1935. In this contribution, inspired by Somerford's suggestion (see Abst. above) that cancer in cotton mule-spinners may not be due primarily to the oils employed in the industry, Irvine refers to his own study on Cancer of the Skin in Males in Blackburn Registration District, 1837-1929 (Thesis, Liverpool Univ., 1931). His figures showed in 1921 an incidence of 26 non-scrotal and 62.6 scrotal cancers per 1000 cotton mule-spinners, while the corresponding figures for other groups were as follows: cotton weavers 4.4 and 0.3; other textile workers 5.6 and 0.6; others, 6.5 and 176 ABSTRACTS

0.7; all occupied males 6.5 and 1.8. The occupational character of scrotal cancer in mule-spinners is generally admitted. The excessive incidence of non-scrotal cancer in this group would also seem to be indicative of an occupational factor, and there can be no doubt that the mineral oil that has been used in cotton-spinning processes is carci­ nogenic. It seems highly improbable that friction alone, in the absence of exposure to mineral oil, would cause scrotal cancer in spinners. Certainly the disease occurred in these workers before the introduction of colored and stiffened overalls. It may be that while exposure to mineral oil is the main factor in the initiation of skin cancer in such workers, some other factor, such as continued friction, and injury, a burn, or local anatomic peculiarities, etc., may determine the site of the growth or may hasten its appearance. In a reply (Brit. M. J. 2: 1132, 1935) to Irvine, Somerford states his position as being not opposed to the occupational character of mule-spinner's cancer. He holds rather that cancer in a mule-spinner did not make it necessarily an occupational disease, but that some further evidence of an irritative factor should be present before such a diagnosis is made.

Trauma as a Cause of Skin Cancer, E. RIECKE. Hautkrebs als Unfallfolge, Derrnat. Wchnschr. 101: 1410-1414, 1935. The author reports the case of a thirty-one-year-old man in whom an epithelioma developed on the right cheek at the site of a pigmented nevus following protective inoculations in the thigh for typhoid fever and cholera. Following these injections the head and face became red and swollen and the skin over the nevus broke. This wound did not heal and two years later the diagnosis of epithelioma was made. In spite of the apparent relation between the injections and breaking of the skin over the nevus, the former are not considered as a cause of the cancer. There are no illustrations. BEN] AMIN R. SHORE

Arsenic Medication as a Cause of Cancer, S. FASSRAINER. Arsenmedikation als Ursache von Krebsbildung, Zentralbl. f. Chir. 63: 23-29, 1936. The case is reported of a fifty-three-year-old man who took Fowler's solution (amount unstated) for six weeks in 1910 and 1919 for an eczema of the hand. In 1915 he first noted small warts on the hands and in 1919, at the time of the second course of arsenic medication, these growths increased in size. In 1930, an ulcerated tumor developed on the left index finger. This was diagnosed as a basal-cell epithelioma in 1933, after histologic study of a biopsy specimen. The index finger was amputated and the left axilla was dissected in January 1935. Histologic study of the axillary lymph nodes showed metastatic carcinoma. A recurrent tumor in the left axilla was removed six months later. At this time the growth had many of the histologic characteristics of a squamous-cell epithelioma. The article is illustrated with a photograph and four photomicrographs. BEN]AMIN R. SHORE

Potential and Skin Cancer, W. J. YOUNG. Kentucky M. J. 33: 429--435,1935. The author suggests the term potential skin cancer for those lesions commonly spoken of as precancerous. The benign and malignant skin lesions are discussed in some detail, with special regard to therapy. Some excellent photographs accompany the paper. W. S. MACCOMB

Development of Squamous-ceU Cancer on Old SyphiUtic Gummas, M. PINARD, FL. COSTE, S. HERTZ AND ARAGER. Apparition de cancer spino-cellulaire sur de veilles gommes syphilitique, Bull. Soc. fran\;. de dermat. et syph. 42: 1547-1556, 1935. The authors present a case of a seventy-three-year-old woman who rather suddenly developed many nodules on all parts of the body, firm, fixed, sometimes ulcerated. In spite of a negative serologic test, and the absence of any history suggestive of syphilis, they made the diagnosis and instituted bismuth therapy, whereupon the serology became positive. Three of the lesions were biopsied and a diagnosis of squamous-cell carcinoma developing on the basis of gummas was made. Following intensive anti­ luetic treatment the lesions disappeared, although some induration remained. THE SKIN 177

In the discussion, M. Touraine announced his pleasure at hearing of another case of epithelioma which had been cured by antiluetic treatment. In answer, M. Gougerot emphasized that the diagnosis of cutaneous cancer is open to many pitfalls for the best of pathologists and that there are several other diseases, such as the verrucae, which will show not only epitheliomatous structures but apparent metastases to regional nodes and will still be cured by antiluetic or anti-tuberculous treatment. He urged strongly that writers should use the term .. epitheliomatiform reaction of syphilis" and not .. syph­ ilitic epithelioma" in describing these cases. Levy-Franckel, Civatte, Milian, and Thibaut joined him in this stand, pointing out the harm that may be done to sufferers from true carcinoma if the impression becomes widespread that cancer can be cured by salvarsan and bismuth. There are some references to Gougerot's writings on the subject. No illustrations of the case in question are given. THEODORE P. EBERHARD

Large EpitheUoma Developing on an Old Bum in a SyphiUtic Patient, A. TOURAINE AND J. SAMBRON. Vaste epitMlioma sur brulare ancienne chez une syphilitique, Bull. Soc. franc. de dermat. et syph. 42: 1655-1658, 1935. A woman fifty-three years old had suffered a deep burn of the right posterior thigh when a child. At about the age of twenty-three she contracted syphilis. At forty-three the scar became ulcerated and crusted in the center but not sufficiently 80 to incon­ venience her until ten years later. Biopsy showed the presence of squamous-cell carci­ noma growing in scar tissue in which' there was marked perivascular infiltration and endarteritis. A" resection of the hip" was done, and further sections confirmed the biopsy diagnosis. There is a brief histologic description, without illustrations. THEODORE P. EBERHARD

Large Papillomatous Tumor of the Nose Developing on a Tuberculous Lupus, A. ULLMO. Vaste tumeur papillomateuse du nez developpee sur un lupus tuberculeux, Bull. Soc. franc. de dermat. et syph. 42: 1708-1711, 1935. This is the report of a case of lupus which had been followed since 1928. The pa­ tient was fifty-five years old at that time and presented a rather severe lupus of the face and nose. She was treated with quartz lamp irradiation and galvanocautery at intervals for the next six years. In 1929 a small papilloma appeared at the right border of the nose and was electrocoagulated. Recurrent growths appeared five times and were coagulated. In 1932, after remaining apparently well for three years, the patient dis­ appeared and did not return until October 1935. By that time she had a large papil­ lomatous tumor involving the entire right side of the nose and part of the left, from the glabella to the tip, and extending down over almost the entire upper lip. No nodes were palpable. A biopsy showed no evidence of malignant degeneration and extensive sec­ tioning after wide excision revealed no evidence of carcinoma, the entire picture being that of giant papilloma. There are two photographs of the patient and a good patho­ logical description is given, but there is no bibliography and no photomicrograph THEODORE P. EBERHARD

BenilD Recurrence of a Pipented Verrucous Nevus in Two Places in the Ezcision Sear of a Large Nevus of the Same Type, GOUGEROT. Recidive benigne de naevus verruqueux pigmente en deux points sur la cicatrice d'ablation d'un gros naevus du merne type. Conception des naevi neoplasiques benignes en ~volution, Bull. Soc. franc, de dermat et syph. 42: 1604-1605, 1935. I'he author states that this case proves anew the truth of his theory that the benign pigmented nevi may evolve from normal tissue and are not fixed, immutable congenital dystrophies. A girl with hereditary syphilis had had several pigmented nevi which developed over a period of about ten years on her arms, abdomen, and breast. The largest one, on the abdomen, was excised in 1925. Two years later along side of the scar and separated from it by about 1 em. were two new pigmented areas. These became darker but did not enlarge, and were still apparently innocent when seen in 1935. For a more elaborate discussion of the evolutive character of these lesions and their causation by syphilis, trauma, and many infections, the reader is referred to seven 178 ABSTRACTS articles by Gougerot. There is no further bibliography. No histologic details are given, nor are there any illustrations. THEODORE P. EBERHARD

Intraepidermoid Bztenaion of Cancer (Paget's Diseue), K. ZIELER. Uber die soge­ nannte Pagetsche Krankheit und die intraepidermoidale Krebsausbreitung, Dermat, Wchnschr. 101: 1441-1445, 1935. So-called Paget's disease of the skin is simply a clinical and anatomical expression of the intraepidermoid extension of an underlying carcinoma. The growth in the skin may progress to such an extent that the underlying tumor may be overlooked. There are no illustrations. BENJAMIN R. SHORE

MaUpant Tumors of the Facei W. INTHORN. Zur Pathologie und Klinik bosartiger Gesichtstumoren, Zentralbl. f. Chir. 63: 130--133, 1936. The first case reported by Inthorn is that of a girl two and one-half years old, from whom a small firm tumor situated in the subcutaneous tissues of the left nasolabial fold was removed in October 1932. 'Histologic study showed areas resembling a cylindroma and others resembling a lymphangioma. The growth was already infiltrating the sur­ rounding muscle. A recurrent tumor was removed one month later, but returned al­ most immediately. The tumor increased rapidly in size, involving the entire left cheek and eye, and the child died in September 1933. Autopsy disclosed metastases to the cervical lymph nodes, mediastinum, and pericardium. Histologically the tumor was thought to have arisen from the endothelium of either the blood or lymph vessels. The second patient was a five-year-old girl from whom a small tumor arising on the bulb of the left eye was removed in April 1935. Histologic study of this growth showed it to be a sarcoma with many mitotic figures. A recurrent tumor involving the con­ junctiva of the same eye was removed nine weeks later. Two months after this, a metastatic growth in the left parotid lymph nodes was excised. A rapidly developing recurrence resulted in a fatal outcome nine months after removal of the original tumor. It is believed that in these two cases cures could have been obtained if the small primary malignant growths had been radically and adequately treated in the beginning. Three photographs illustrate the article. BENJAMIN R. SHORE

Superficial EpitheUomatosi8, J. DORFFEL. Uber die superfizielle Epitheliomatosis, Dermat. Wchnschr. 101: 1437-1441, 1935. There were 18 cases of superficial single or multiple epitheliomas in 200 cases of skin cancer seen at the University Dermatologic Clinic in Konigsberg from 1925 to 1935. These tumors are usually situated on the trunk of the body, especially in the sacral region; they may be single or multiple, affect women more often than men, and are relatively benign. They grow slowly, may exist for twenty years or more, and may heal from the center. The treatment is surgical excision followed by roentgen or radium irradiation. On account of their morphological and biological peculiarities, these tumors have received a variety of names, for instance, epithelioma of the trunk, carcinoid, benign erythematoid epithelioma, pagetoid epithelioma, and superficial epitheliomatosis. On a histological basis they may be grouped as a variety of the common basal-cell epithe­ lioma, but they arise much more frequently from multiple centers, remain very super­ ficial, and are locally more benign than the average basal-cell epithelioma. The basal cells form small buds or flat layers springing from the basal-cell layer of the epidermis. The proli£eration may also take place intraepidermally and remain in this situation for years. Five photomicrographs illustrate the lesions. BENJAMIN R. SHORE

A Ca.. of Caldfted BpitheUoma with So-Called Botryomycoais, J. YAMAZAKI. Ein Fall von verkalktem Epitheliom mit sog. Botryomykose, Jap. J. Derm. & Urol. 38: 982-989, 1935. A thirty-four-year-old woman had an oval tumor 1.0 em. long and 0.5 em. wide situated on the outer aspect of the right upper arm. Histologic study of the excised growth shewed a pedunculated granuloma with areas of calcified epithelioma. In THE SKIN 179

isolated portions of the epithelium, pigmented areas containing iron were demonstrated. The diagnosis of a calcified epithelioma with so-called botryomycosis was made. A photograph of the gross lesion and five photomicrographs illustrate the article. (Taken from the author's abstract in German.) BENJAMIN R. SHORE

Melanomas and Melanosarcomas, J. W. DULIN. J. Iowa M. Soc. 25: 497-498, 1935. A series of 25 cases occurring over a period of fourteen years is reported. Attention is drawn to the frequency of incomplete surgical removal of supposedly benign lesions. W. S. MACCOMB

Malignant Melanoma in Coloured Races: the Role of Trauma in Its Causation, T. F. HEWER. J. Path. & Bact. 41: 473-477, 1935. Malignant melanomas are less common in the American negro than in the white population, but are of frequent occurrence in natives of the Anglo-Egyptian Sudan. In the present series 59.5 per cent of these growths were on the foot and a further 15 per cent on the leg. The feet of Sudanese natives are constantly exposed to wounds from thorns, and the absence of such trauma in the American negro is advanced as a probable explanation of the disparity. In the Sudan the tumors are at least as common in coal-black negroes as in the lighter skinned Arabs, so that trauma appears to be a more important predisposing factor than skin color, though in view of the American statistics the latter cannot be entirely ignored. WM. H. WOGLOM

Malignant Melanoma Developing Upon a Hyperchromic Congenital Pigmented Nevus, L. M. PAUTRIER AND FR. WORINGER. Melanome malin developpe sur un naevus pigmentaire congenital hyperchromique, Bull. Soc. fran~. de dermat, et syph. 42: 1711-1716,1935. A woman fifty-one years old had had several pigmented nevi since birth, the largest and darkest being on her right calf. Until the age of forty-five it was about 2 em, in diameter. Then it began to grow, slowly at first and finally very rapidly, until it was a tumor 4 x 9 em. and raised about 0.6 em. above the surface, jet black, soft and meaty, with a moist, crusted surface. No enlarged lymph nodes are mentioned. Two biopsies showed the tumor to be a rapidly growing malignant melanoma, and it was immediately treated by electrocoagulation. There is a good histologic description, accompanied by a photograph of the tumor in situ and two full-page photomicrographs. There is no bibliography. THEODORE P. EBERHARD

Radium Dosage and Technique in Carcinoma of the Skin with Special Reference to Interstitial Irradiation with Platinum Iridium Needles, H. N. COLE AND J. R. DRIVER. Am. J. Roentgenol. 33: 682-689, 1935. For platinum iridium needles of 1, 2, or 3 mg. radium element, with 0.5 mm. wall thickness, in the treatment of squamous and basal-cell epitheliomata of the skin, the authors claim the following advantages over other methods of using radium. (1) They afford homogeneous irradiation of the entire malignant area. (2) Treatment is carried out over a long period. (3) A single treatment is given, avoiding the development of radioresistance. (4) Severe caustic reactions are absent. (5) As a rule, there are no demonstrable complications when the needles are used over bony prominences or about the eyeball and cartilages of the eye, ear, and nose. (6) Accurate calculation of the dose is possible. The only disadvantage is the necessity of hospitalizing the patient. The method of inserting the needles and estimating dosage is described. The article is well illustrated by photographs. W. S. MACCOMB

Radium in the Treatment of Metastatic Epidermoid Carcinoma of the Cervical Lymph Nodes, D. QUICK. Am. J. Roentgenol. 33: 677-681, 1935. Radon seeds are preferred by Quick, in the treatment of metastatic epidermoid carcinoma of the cervical lymph nodes, to the external application of radium. The 180 ABSTRACTS

necessity for the withdrawal of element needles at a time when surgical wound healing is well under way is a considerable disadvantage. Interstitial irradiation is indicated in all instances except in growths of the extreme grade IV group, unless the case falls in the class proper for surgical dissection or is extremely advanced. Even in some neoplasms of grade IV, which are liable to renewed growth activity a few months after seeming complete regression following external therapy, implantation of radon seeds is of value. Surgical dissection of the neck is unilateral but radical, and is limited to cases of fully differentiated epidermoid carcinoma with unilateral palpable involvement, in which the capsules of the node or nodes are presumably intact, in patients who are in good physical condition and in whom the primary growth is either controlled or gives promise of complete control. The strictly anaplastic or totally undifferentiated growths are left to roentgen palliation alone, as are the extremely advanced metastatic lesions, regardless of the histologic type. The author has found a dosage of 3000 me, hrs, of radon irradiation by implantation (seeds 1 to 2 mcs. each) to be a fair minimum dosage. This should be used if implanta­ tion is to be done at all, even though the particular node in question does not call for so large an amount. Ten thousand millicurie hours is considered a maximum, although larger doses have been used. This represents a dosage intensity of 10 S. E. D. to a tumor 5 em, in diameter or 6 S. E. D. to a mass ranging from 6 to 7 cm. in diameter. W. S. MACCOMB

Repair of Postoperative Defects Involving the Lips and Cheeks Secondary to the Re­ moval of Malignant Tumors, G. B. NEW AND F. A. FIGI. Surg., Gynec. & Obst, 62: 182-190, 1936. The opportunity for repair of defects about the mouth which result from the removal of malignant tumors varies with the nature, activity, previous treatment, situation, and extent of the lesion, and with the age and general condition of the patient. Generally speaking, reconstruction should be delayed somewhat longer following treatment of a squamous-cell epithelioma than after treatment of a basal-cell growth and longer after the removal of a highly malignant lesion than after the removal of an inactive one. A tumor that has been treated previously, especially with irradiation, may recur much later than one that has not been treated previously or that has been removed surgically. This is because malignant cells may lie dormant in the dense scar tissue for a longer time. Lesions involving bone secondarily may gradually extend along the periosteum and recurrence become manifest much later than in the cases in which tumors affect only the soft tissues. Most recurrences following the removal of malignant neoplasms take place within six months to a year. Accordingly, in elderly individuals with tumors of low-grade malignancy repair is justifiable after the patient has been well for six or eight months, while with more active and extensive growths, especially in young patients, reconstruc­ tion is better delayed for at least a year. By this time, devitalizing bone will have separated, the inflammatory reaction will have subsided, and the margins of the perfora­ tion will have healed. If local recurrence or metastasis is to occur, it will usually have become evident within this period. Recurrence of a malignant growth which develops after repair is well under way or completed presents a serious problem. Such a recur­ rence, which occurs beneath the graft, cannot, as a rule, be recognized until welt ad­ vanced and it then necessitates sacrifice not only of the transplanted tissues but of much adjacent tissue as well. The article is illustrated with photographs of patients before and after treatment and with drawings showing technic. BENJAMIN R. SHORE

Nodular Fibromas Simulating CUnica11y the Nodular Atypical Myzedemaof ]adassohn­ Doessekker, MILIAN AND L. PERIN. Fibromes nodulaires simulant cliniquement Ie myxoedeme tubereux atypique de Jadassohn-Doessekker, Bull. Soc. franc, de dermat, etsyph. 42: 1614-1619, 1935. A woman forty-seven years old had had on the left side of her neck for about ten years some small, firm, non-tender nodules. They were located in the skin and freely THE EAR 181 movable over the deep tissue. During the last few months some new nodules had ap­ peared. General examination was essentially negative except for a small nodular goiter. Histologically, the nodules consisted of moderately cellular masses of connective tissue, poorly localized, remarkable principally for their yellow color with the Van Gieson stain in contrast with the red of the normal connective tissue. The authors present the case because, although histologically different from the edematous, acellular, loose structure of myxedema, the nodules clinically were identical with the atypical nodular myxedema of Jadassohn-Doessekker, and because Mlle. G. Eliascheff in her thesis, Myxoedeme tubereux atypique de Jadassohn-Doessekker, Paris, 1930, had included such a case as an old fibrosed one. At the time of writing they were applying the therapeutic test of thyroid extract by mouth. There is one illustration, and four references are appended. THEODORE P. EBERHARD

THE EYE

Diagnosis of Intraocular Metastatic Sarcomas, W. KREIBIG. Zur Kenntnis intrao­ kularer Sarkommetastasen, Ztschr, f. Augenh. 87: 265-284, 1935. During the past year 6 cases of metastatic intraocular tumors have been seen in the First University Woman's Clinic in Vienna. The primary growths were located in the breast in 3 cases, in the intestine in 2 cases, and the adrenal gland in 1 case. This apparent increase of intraocular metastatic tumors is believed to be due to the fact that more carcinoma patients are living longer, as well as to the fact that diagnostic eye methods have improved. The diagnosis of metastatic intraocular growths is extremely difficult and may be impossible without an accurate clinical history or histologic study of the growth. The article is illustrated with several photomicrographs. BENJAMIN R. SHORE

Sarcoma of the Choroid and Di1fuse Sarcomatosis of the Meninles, M. KLEIN. Chori­ oidealsarkom bei diffuser Sarkomatose der weichen Hirnhaute, Ztschr, f. Augenh. 86: 287-299, 1935. The case is reported of a four-year-old boy with diffuse involvement of the lepto­ meninges with a round-cell sarcoma which had probably arisen from the choroid of the right eye. The meningeal growths could be recognized grossly only as punctate hemor­ rhagic nodules, and the diagnosis was made only after histologic study. Several photomicrographs illustrate the article. BENJAMIN R. SHORE

THE EAR

Early Asymptomatic Acoustic Tumor, M. HARDY AND S. J. CROWE. Arch. Surg. 32: 292-301, 1936. Small asymptomatic acoustic tumors were found in 6 of 256 cases in which serial sections of the temporal bones were made. Each growth was entirely within the internal auditory canal. The largest was 5 mm. in diameter and the smallest about 0.25 mm. The vestibular nerve was involved by 4 and the cochlear nerve by 2 of the tumors. Irritative symptoms were not reduced by the growths, and compression symptoms were absent due to the size of the tumors. The article is illustrated with drawings, photo­ graphs, and photomicrographs. BENJAMIN R. SHORE

Dermoid Teeth in the Enemal Auditory Canal, with Comments on Teratomas and Dermoids in ~eneral, G. G. MARSHALL. New England J. Med. 214: 202-204, 1936. Marshall reports the case of a fifteen-year-old patient from whom two imperfect molar teeth were removed from the right external auditory canal. They were con­ sidered to have arisen in a dermoid tumor. A photograph of the teeth illustrates the article. BENJAMIN R. SHORE 182 ABSTRACTS

THE BREAST

The Evidence for an Endocrine Factor in the Etiology of Mammary Tumors, HOWARD C. TAYLOR, JR. Am. J. Cancer 27: 525-541,1936. This is a comprehensive review of the evidence for an endocrine factor in the etiology of mammary tumors as found in the work of various investigators, particularly from the clinical aspect. From the various studies reported it appears that breast tumors are dependent upon the ovarian hormone to the extent that this hormone is essential for the development and preservation of the epithelium of the mammary gland. This explains the absence of cancer in the breasts of early castrates and untreated male mice. Ovarian function is apparently essential for the common types of chronic mastitis and fibro­ adenoma, the development of which is practically limited to the years of mature sexual life. This is not true of carcinoma, which may appear long after the menopause. With the neoplastic disease once established, a marked response to variations in glandular function, such as those incident to pregnancy and the menopause, is noted in chronic mastitis and fibro-adenoma. A moderate reaction to these changes is observable in some cases of carcinoma. Some evidence of a glandular dysfunction can be found in certain cases of chronic mastitis, but hormone states comparable to those necessary to produce mammary carcinoma in mice by the injection of estrogenic hormone are unknown in women. There is no clinical evidence yet of any specific endocrine dysfunction as the cause of human breast cancer. A comprehensive bibliography is appended.

Malipancy of the Breast, H. G. JARVIS. New England J. Med. 214: 501-503, 1936. The author bases his discussion upon a series of 650 malignant breast tumors ob­ served in the Hartford (Conn.) Hospital. Of this number, 320 treated at least five years ago were selected for discussion as to results of treatment. Of these, 266 or 80 per cent were operable. In the 54 inoperable cases follow-up data were obtained in all, with 100 per cent mortality within five years. Of the operated cases, 82.5 per cent were followed for five years or more, and of this number 32 per cent were living and free from cancer at the end of the period; 8.3 per cent were living with persistent or recurrent cancer at the end of the five-year period; 53.4 per cent were dead from recurrent cancer, and 6.3 per cent were dead from other causes. The length of time any patient will remain free from cancer depends first upon the type of malignancy and second upon the early detection and adequate treatment of the disease. The author's criteria for inoperability are (1) attachment to the ribs or ster­ num; (2) involvement of the supraclavicular lymph nodes; (3) fixation ana confluency of the axillary lymph glands; (4) fulminating and acute disease; (5) cancer en cuirasse; (6) distant metastases in lungs, pleura, abdominal viscera, and bones; (7) poor general condition of the patient. From his study of these cases the author concludes that if the patient has a grade I carcinoma she has a 90 per cent chance of a five-year cure, while if the lesion is grade II I the prognosis is very bad and the chances of five-year survival are practically nil. Carcinomas graded II vary extremely as to prognosis. In general the results of radical operation for mammary cancer have improved little if at all during the past fifteen years. It is emphasized, however, that the greater the number of breasts explored and found benign, the greater the number of malignant cases which will be found without metastases. Statistical tables are included. There is no bibliography. THEOboRE S. RAIFORD

Cancer of the Breaat,]. J. MORTON AND S. J. STABINS. New York State]. Med. 35: 1137-1142, 1935. The authors review 180 malignant tumors of the breast observed in the Strong Memorial Hospital between the years 1926 and 1934. Radical operation was done in 80 of these, palliative operations in 14, and in 86 inoperable cases palliation was provided by either irradiation or drug therapy. During the same period 92 benign tumors were THE BREAST 183 observed. The operative technic is reviewed briefly. The authors do not favor primary closure after operation if the lesion has ulcerated. There is a brief resume of the results of treatment. There are no illustrations. THEODORE S. RAIFORD

Thirty Cancers of the Breast, R. FINALY. A propos d'une trentaine de cancers du sein, Scalpel 88: 1507-1512, 1935. The author reports- 28 cases in which operation was done for carcinoma of the breast and 2 cases in which operation was refused by the patient. The usual clinical features of such cases were observed, but there were several points of particular interest. One patient, forty-four years old, was nursing a child on the right breast in spite of the fact that this organ was the site of a carcinoma. She had nursed the child for more than two years and had noticed the tumor for only four months. Another patient, forty years old, was pregnant for four months when she applied for treatment. She had a tumor of the left breast of three months' duration. Immediate operation was proposed, but was refused. Two weeks later the tumor had doubled in size. The patient was operated on successfully and was delivered at term. Unfortunately, no further follow-up of this case is reported, but.the author concludes that pregnancy and lactation accelerate development of cancer of the breast. Six patients were operated on under local anesthesia. Of the 30 patients, 20 are still alive. Four are without recurrence after five years. The remaining 16 were free of recurrence for a period of four years or less. Two patients had both breasts removed for carcinoma. In one the second amputation was done nine years after the first and the total follow-up period is fourteen years. This patient did not receive any radiation. In the second case the second amputation was performed five years after the first and the total follow-up period was nine years. This patient had received radiation treatment. One photomicrograph is included. There is no bibliography. CHARLES A. WALTMAN

Carcinoma of the Breast. Survival for Twenty-Four Years with Local Recurrences and Metastases in the Opposite Breast and AziUa, M. C. TOD AND E. K. DAWSON. Surg., Gynec. & Obst. 62: 91-92, 1936. A radical mastectomy for a carcinoma was performed on Ii forty-seven-year-old patient in 1910. Twelve years later two recurrent nodules of scirrhous carcinoma were removed from the scar. In 1931, radium irradiation was given to a tumor nodule in the opposite axilla; local excision of a thickened area in the left breast and the nodules in the axilla was done three months after this. Histologic study of the tissue from the left axilla showed a carcinoma of the same type as the original growth in the right breast. The article is illustrated with a photograph of the patient and photomicro­ graphs. BEN] AMIN R. SHORE

Two Caselof II Crossed Metastales Jt in Breast Cancer, T. ROTH. Ober zwei Falle von "gekreuzten Metastasen " beim Mammacarciriom, Deutsche Ztschr. f. Chir. 246: 380-383, 1936. Roth reports two cases of carcinoma of the female breast in which metastases to the opposite axilla took place without involvement of the breast on that side. The author attributes this to congestion of the lymphatics and reversal of flow of lymph incident to the radical operation. The article is illustrated with two drawings of the lymphatic system of the breast. BEN] AMIN R. SHORE

Value of Radiation Therapy in the Treatment of Carcinoma of the Breast, R. G. HUTCHI­ SON. Surg., Gynec, & Obst. 62: 653-664, 1936. The author has made a statistical survey of the British, European, and American literature dealing with the treatment of mammary cancer. It is apparent from this study that surgery per se is no longer unchallenged 8S the treatment of choice, even in early cases without node involvement. Minor improvements in operative technic may yet take place but generally speaking it would appear that the resources of surgery have 184 ABSTBACTS been exploited to their limit. That this is so is borne out by the very slight improvement in the surgical results during the last twenty years. The combination of x-ray therapy with surgery offers a better chance of cure than does surgery alone. In the early cases the advantage of this technic is not striking, but in the later cases, and when total cases are considered, the improvement in the results is seen to amount to about 20 per cent at the three-year period and 15 per cent at the five-year period. This improvement is so great that it cannot reasonably be attributed to chance. It is noted that the very advanced cases do not appear to reap any advantage from the combined technic. This indicates to the author that irreparable damage has been done by encroachment with the knife upon malignant tissues. Although the figures for x-ray treatment alone of breast cancer are few compared with those for surgery or for the combined procedure, it must be conceded that in the hands of the expert, when the technic has been evolved from experience and is applied in a scientific manner, radiation alone gives results equal to or surpassing those of any other method, even in early cases. It is impossible, however, to emphasize too strongly that such results are obtained only when scientific methods prevail and not by the random application of x-rays of unknown quality and intensity and in unknown amounts. Not least striking are the results in the very advanced cases, where it is seen that radiation alone improves, not only upon surgery, but also upon surgery plus x-rays, This would appear to offer an interesting commentary on the danger of transgressing surgically upon malignant tissues. The results obtained from the survey of the literature are reviewed in tabular form. BENJAMIN R. SHORE

Radiation of Inoperable Carcinoma of the Breast, P. DESAIVE. Considerations apropos du traitement par les radiations des formes inoperables de cancers du sein, Scalpel 88: 1629-1640, 1935. Seventeen cases of inoperable carcinoma of the breast treated by x-rays and radium are reported. Pulmonary or visceral metastases were not present at the beginning of treatment. The cases were divided between grade II and grade III, according to the Steinthal classification. A brief history and description of the treatment with results are given for each case, and in nearly every case a biopsy report is included. Besides the stage of the carcinoma, medical complications such as hypertension and diabetes were considered as contraindications to treatment. In 8 cases there was a complete disap­ pearance of the neoplastic manifestations for periods of two and a half years, two years, one year and seven months, one year (3 cases), three months, and two months after the end of treatment up to the time of publication. Two patients had small recurrences after one year. The author regards these results as encouraging for patients with inoperable carcinoma of the breast. Twenty-one references to the literature are listed. CHARLES A. WALTMAN

Improved Technique for the Introduction of Radium Needles in the Treatment of Carcinoma of the Breast, R. BROOKE. British]. Surg. 23: 501-504, 1936. The author describes a metal frame for holding trochars containing radium in position during the time necessary for irradiation of breast carcinomas. It has the advantage over other methods in that parellelism of the needles is assured and that there are no gaps in the radiation. The trochars are inserted and the frame applied with the patient under general anesthesia. Several photographs illustrate the article. BENJAMIN R. SHORE

Results in Mammary Cancer at the ElUott Hospital, G. C. WILKINS AND G. F. DWINELL. New England J. Med. 214: 503-507, 1936. This is a review of 86 cases of carcinoma of the breast with regard to the results of treatment. Radical operation was performed in 74 cases, palliative mastectomy was done in 5 instances, 6 cases received irradiation only, and 1 case was untreated. Sixty­ two cases were available for end-results, and of this number five-year cures were ob­ tained in 50 per cent and ten-year cures in 18 per cent. The surgical technic is briefly discussed. There are two statistical tables but no illustrations. THEODORE S. RAIFORD THE BREAST 185

Sarcoma of the Female Breast and Tumors of the Male Breast Seen in the University Surgical Clinic in Leipzig, J. ROSE. Die Sarkome der weiblichen und die Gesch­ wulste der mll.nnlichen Brustdrilsen nach dem Material der chirurgischen Klinik zu Leipzig, Deutsche Ztschr. f. Chir. 246: 151-187, 1936. From 1913 to 1934, 16 sarcomas were observed among 660 malignant tumors of the female breast seen in the University Surgical Clinic in Leipzig, an incidence of 2.1 per cent. There were all kinds and types of sarcomas, including one melanoma, but various forms of fibrosarcoma predominated. The average age of the patients was forty years. Eleven were married and 5 were single. As a general rule, patients with sarcoma of the breast are in somewhat better physical condition than are those with carcinoma. The left breast was involved 9 times and the right 7. Generally speaking, sarcomas of the breast develop in size more rapidly than do carcinomas. The overlying skin was involved in 5 of the cases and the axillary lymph nodes in one case. Five-year cures following radical mastectomy with dissection of the axilla were secured in 9 cases. The male breast was involved 18 times in 745 tumors seen from 1913 to 1914, an incidence of 2.4 per cent. There were 12 carcinomas, 2 sarcomas, and 4 adenofibromas. The carcinomas were adherent to the skin in about 75 per cent of the cases and to the pectoral muscles in about 66 per cent. Ulceration of the skin was observed in one-third of the cases. The axillary lymph nodes were involved with tumor in 60 per cent. Five­ year cures following radical operations were obtained in 3 cases. The details of the cases reported of sarcoma of the female breast and malignant tumors of the male breast are presented in tabular form. BENJAMIN R. SHORE

Relation of Chronic Mastitis to Certain Hormones of the Ovary and Pituitary and to Coincident Gynecological Lesions, H. C. TAYLOR, JR. Surg., Gynec. & Obst, 62: 129-148; 562-584, 1936. This study is based upon 261 cases of diffuse breast disease observed during the three-year period, 1931-1933, in the Breast Clinic at the Memorial Hospital and the Gynecologic Department of the Roosevelt Hospital, New York. The cases fall into three groups. (1) In the first group were placed the 183 cases with tender areas of induration or nodularity. Among these patients were many who complained of a temporary premenstrual swelling but none with permanent enlargement or discharge from the nipple. (2) Thirty-one patients, all of whom had permanent enlargement of the breasts, usually with cyclic pain and swelling but without discharge from the nipple, constituted the second group. (3) The third group consisted of 47 patients with a dis­ charge from the nipple, which necessarily included many with pain and 6 with hyper­ trophy. Hormonal studies were done as follows: (1) determination of the urinary excre­ tion of estrin; (2) determination of the blood estrin i (3) estimation of the urinary excretion of prolan; (4) estimation of the serum prolan; (5) examination of the endo­ metrium in 31 cases. In the definitely nodular type of mastitis, the ovarian hormone is certainly a neces­ sary factor, but it has not been possible by present laboratory methods to demonstrate any specific abnormality of ovarian or anterior pituitary hormone function. The conception of the disease as primarily a vascular disturbance with changes occurring in the interstitial tissue of the breast based on abnormal nervous stimuli explains many of the clinical aspects. Such a view must be accepted with caution, however, because it requires the assumption of a physiologic mechanism largely undemonstrated. Breast hypertrophy occurs in at least two forms. In one group in which there is a simple painless enlargement of the breasts of relatively uniform consistency an endocrine factor is clearly prominent. This includes the hypertophy developing in childhood and in old women in the presence of specific ovarian neoplasms, such as the granulosa-cell tumors and adenomas. Breast swelling has also been observed in the presence of per­ sistent corpus luteum and follicle cysts and ascribed to a polyhorrnonal amenorrhea. The painful hypertrophies of this study were not of this type and resembled closely the tender nodular breasts, both in regard to their physical characteristics and the conditions under which they occurred. Hormone analyses of a series of these cases gave normal blood estrin values, rates of monthly excretion of estrin a little higher in the cases of the painful breast but still probably within normal limits, and no increase in the prolan 186 ABSTRACTS

excretion. Irradiation of the ovaries led to a disappearance of the pain and to a reduc­ tion in the size of the breasts but the use of ovarian hormone by mouth or hypodermi­ cally was ineffectual. The article is illustrated with photographs and photomicrographs. An extensive bibliography is appended. BENJAMIN R. SHORE

Simple Dermoid Cysts of the Breast, J. G. MENVILLE. Ann. Surg. 103: 49-56, 1936. In a series of 3000 breast lesions studied in the Surgical Pathological Laboratory of Johns Hopkins Hospital there were 36 cases of dermoid cysts. Of these, 29 were benign and 7 malignant. The benign dermoid cysts of the breast occur almost always in women, and are usually subcutaneous, freely movable, and painless. Single cysts were found in 75 per cent of the cases and multiple cysts in 25 per cent of the cases. The lining is composed of proliferating squamous epithelium. When malignancy becomes apparent, the cyst shows a marked tendency to rapid increase in size with the formation of new cysts. The malignant growths are firm, irregular, infiltrating, and have a tendency to metastasize early. The treatment of simple dermoid cysts of the breast is simple local excision, while that of malignant dermoid cysts is radical amputation. Irradiation is valueless in malignant dermoid cysts in which the epithelium is of the squamous type. The article is not illustrated. BENJAMIN R. SHORE

THE ORAL CAVITY AND UPPER RESPIRATORY TRACT

Malicnant Diseases of the Mouth and Throat, F. A. FIGI. Surg. Clin. North America 15: 1233-1240, 1935. With few exceptions malignant lesions of the lips are squamous-cell epitheliomas. The upper lip is involved in less than 2 per cent of the cases. In a series of 1310 patients with carcinoma of the lower lip, almost 99 per cent were males. Of this group, more than three-fourths were between forty and seventy years of age. About 84 per cent of the lesions were of either a low or moderate grade of malignancy, which is probably the outstanding reason for the good prognosis when proper treatment is carried out in this group of cases. Other factors which influence favorable prognosis are the prominent situation of the lesion, the fact that it early produces symptoms which cause the patients to consult a physician promptly, the ease of recognition, and the ease with which the primary growth and the lymphatic structures which drain the regions may be removed. Five per cent of the patients have more than one definite epithelioma of the lip when first seen. Local excision is recommended when possible. Dissection of regional lymphatic structures is carried out when the growths are of a grade of malignancy greater than I. If the lymph nodes are involved, block dissection is done on the same side, followed by roentgen irradiation. In 942 cases of carcinoma of the lower lip, extremely extensive lesions were present in more than 50 instances. In this group of cases with extensive involvement, more than 27 per cent of the patients survived for five years. In the group in which no invoivement of lymphatic structures was found at the time the lymph nodes were removed, there were almost 92 per cent three-year cures and 90 per cent five-year cures. In the group of cases in which the lymph nodes were involved, there were 45 per cent three-year and 39 per cent five-year cures. Malignant lesions arising on the inner surface of the cheeks correspond in activity and behavior to those of the lips. Treatment of the primary growth usually is carried out most satisfactorily with surgical diathermy. Regional removal of.the lymph nodes is recommended except for the extremely active tumors. Malignant lesions of the tongue and floor of the mouth are largely squamous-cell epitheliomas and as a group are more highly malignant than are those arising on the lips, cheeks or jaws. Of 162 patients who had been operated on for lingual cancer, 156 were traced; of these, 37.2 per cent were living five or more years after operation. Fifty­ eight of the 156 patients did not have any involvement of the lymph nodes at the time of operation and half of these 58 patients were alive five years later. In the cases in ORAL CAVITY AND UPPER RESPIRATORY TRACT 187

which the lymph nodes were involved at the time of operation, however, only 14 per cent of the patients were alive at the end of five years. Malignant tumors of the nasopharynx occur more frequently than is generally supposed. They are chiefly highly malignant squamous-cell epitheliomas and lympho­ sarcomas and originate most commonly in the fossa of Rosenmuller, Because of the activity of these growths, the difficulty of determiriing their extent, and their inaccessi­ bility, irradiation is the treatment of choice. Palliation only is likely to be obtained, although the growths often can be held in check and the patient kept in comparative comfort for several years; in a few instances complete arrest of the disease for periods of six and seven years has resulted. The malignant tumors of the base of the tongue and hypopharynx are very largely highly malignant squamous-cell epitheliomas, lymphosarcomas, and adenocarcinomas. Irradiation is the treatment of choice in the great majority of these cases. On the other hand, most of the tumors which spring from the subglottic portion of the larynx, includ­ ing the epiglottis, are epitheliomas and fibrosarcomas of low grade and are best treated surgically. The article is not illustrated. BENJAMIN R. SHORE

Seven Observations of Glandular Cheilitis, Five of Them With Cancer, TOURAINE, SOLENTE, SAMBRON, AND DUPERRAT. Sept observations de cheilite glandulaire, dont cinq avec cancer, Bull. Soc. frane, de dermat. et syph. 42: 1539-1547, 1935. The mucous glands along the vermilion border of the lower lip, according to the authors, not infrequently become distended and infected, forming small cysts or ab­ scesses. Once this condition is established, it becomes chronic and may persist for many years. If not infected, the obstructed glands will not usually attract the patient's attention and may only befound by the physician as tiny hard nodules in the substance of the lip and as minute crater-like depressions along the inner mucocutaneous junction. Crusting of the lips is common in both forms, removal of the crust leaving an ulcerated, weeping or bleeding surface. The authors present 7 case histories and summarize a total of 11 cases which they have seen since January 1933. Eight of these patients had squamous-cell carcinoma. However, it should be noted that of the 7 described in detail in this article, the 3 stated not to have had cancer were not biopsied and at least one was seen only on one occasion, so that the incidence of malignant degeneration in this condition may be even higher than is stated. All the patients are said to have had poor teeth and severe mouth infection. Several references are given, of which the most important would seem to be the monograph by J. Puente (La queilitis glandular simple, Mercatali, Buenos Ayres, 1934. 72 pages), in which are collected 52 cases, many with co-existent carcinoma. THEODORE P. EBERHARD

Results of the Treatment of Tongue Cancers, A. A. EpSTEIN (EpSHTEYN). Gegen­ wiirtige Methodik und Dauererfolge del' Behandlung des Zungencarcinoms, Arch. r. klin. Chir. 184: '502-518, 1936. From October 1926 to December 1934, 341 patients with carcinomas of the tongue were seen in the Leningrad Onkologic Institute. One hundred and forty-nine, or 43.7 per cent were totally incurable and were discharged without treatment, while 192, or 56.3 per cent, were suitable for treatment. In the latter group there were 128 men and 64 women. One-fourth of the patients gave a history of the disease of from four to six months. According to the extension of the disease, the patients were divided into three groups. Group I included those patients with primary carcinomas of the tongue less than 2 em. in diameter and without palpable cervical lymph nodes. In Group II were those with primary tumors over 2 em. in diameter without extension to the cheek or floor of the mouth but with movable, operable, enlarged lymph nodes on one side. Group III comprised those with large tumors involving contiguous structures and with inoperable cervical metastases on one side or operable metastases on both sides. Thirty­ nine, or 20.3 per cent, were in Group I; 90, or 46.9 per cent, in Group II; and 63, or 32.8 per cent, were in Group III. Radical extirpation of the tongue was performed ip 9 cases 188 ABST1lACTS and various forms of combined electrocoagulation, implantation of radium, and radical dissection of the neck in the remaining cases. Of ninety-seven patients under treatment for from three and one-half years, 17 of 22 in Group I, 16 of 63 in Group II, and none of 12 in Group III are well. Fifty-seven of the original 341 patients are well for from a few months to as long as eight and one-half years, giving an absolute curability of 16.7 per cent or a relative curability of 12.5 per cent of 134 patients treated radically. It is concluded that the results in the treatment of cancer of the tongue do not depend as much upon the method of therapy used as upon the stage of tumor development when first seen. BEN]AMIN R. SHORE

Pibrochonclroma of the Mandible, DIDIER BRUN. Tumeur pediculee du menton; fibro­ chondrome, Bull. Soc. d'obst. et de gynec, 24: 402-403, 1935. A new-born female infant was found to have a pedunculated tumor as large as an orange, attached to the midline in the region of the symphysis of the mandible. It was readily removed after ligation of the base. Histologically it was made up of cartilage containing a good deal of fibrous tissue. JOHN S. LOCKWOOD

Parabuccal Tumour Invading the Mandible, W. GILMOUR AND D. ROBB. J. Cancer Research Com" Univ. Sydney 6: 179-180, 1935. The case is reported of a forty-four-year-old woman from whom an adamantinoma of the mandible was surgically removed in April 1932. A recurrent tumor was excised surgically in February 1933, and again in September 1934. This report was made shortly after the excision of the second recurrence. There are no illustrations. BEN]AMIN R. SHORE

Intranasal MaUgnant Growths, W. HARTZ. Laryngoscope 45: 844-853, 1935. From a review of the literature and a few personally observed cases, the author has summarized the salient clinical features of intranasal malignant neoplasms. He regards pain about the face of any type as suggestive of malignancy and as calling for prompt measures to rule it out. In general, malignant growths respond better to ir­ radiation than surgery, but while the latter treatment is less effective in the region of the sinuses than elsewhere in the body, it usually sufficesfor the treatment of benign growths. The value of biopsy is a moot point, some investigators believing that it is conducive to rapid metastasis, while others feel that it -is a valuable procedure. A short bibli­ ography is appended. There are no illustrations. THEODORE S. RAIFORD

Osteomas of the Nasal Accessory Sinuses, T. v. MATOLCSY. Uber Nebenhohlen- osteome, Arch. f. klin. Chir. 184: 451-458, 1936. Sixteen cases of benign osteomas involving the nasal accessory sinuses are reported. Four tumors arose in the frontal sinus, 7 in the sphenoid sinus, 2 in the ethmoid cells, and 3 in the maxillary sinus. These tumors are all essentially benign in character and a cure was obtained by local excision in all except one case, in which a local recurrence resulted. The article is illustrated with roentgenograms. BENJAMIN R. SHORE

Osteoma of the Ethmoid; Report of a Case, B. L. BRYANT. Laryngoscope 45: 854-857, 1935. The author reports the successful removal of an osteoma of the right ethmoid from a twenty-three-year-old man. The postoperative course was complicated by a purulent discharge from the frontal and sphenoid sinuses and a moderate degree of osteomyelitis of the frontal bone. The infection cleared up rapidly, however, and convalescence was satisfactory. There is one illustration. THEODORE S. RAIFORD

Carcinoma of the Upper Pharyu, C. L. MARTIN. Am. J. Surg, 30: 36-45, 1935. The author discusses briefly surgical excision as opposed to irradiation in the treat­ ment of carcinoma of the upper pharynx. Since the former is often mutilating and the results frequently discouraging, irradiation is the preferable treatment. The divided dose x-ray technic with interstitial radium offers a better chance of cure and provides ORAL CAVITY AND UPPER RESPIRATORY TRACT 189 marked palliation in incurable cases. Four successfully treated cases are reported and statistics of other clinics are cited from the literature. There are six illustrations and a short bibliography. THEODORE S. RAIFORD

Hard Papilloma of the Hypopharynx, F. MOSSBOCK. Zur pathologischen Anatomie und Klinik des harten Papilloms des Hypopharynx, Ztschr, f. Hals-, Nasen- u. Ohrenh. 39: 85-89, 1935. The author describes a hard papilloma of the hypopharynx which had spread to the larynx and caused interference with breathing. There was no evidence of meta­ static nodes. Biopsy showed the histology of a papillary fibro-epithelioma. The author evidently considers the tumor as malignant since the prognosis is stenosis of the trachea and esophagus. Radical removal of the lesion is therefore indicated. A photograph shows the appearance of the growth on laryngoscopy. Two photomicro­ graphs are also included. There is a short bibliography. CHARLES A. WALTMAN

Cancer of the Larynx. A Study of 202 CaseB with End-Results, S. W. GARFIN. New England j, Med. 213: 1109-1123, 1935. Two hundred and two unselected and consecutive cases of cancer of the larynx treated at the Collis P. Huntington Memorial Hospital over a period of fourteen years from 1919 to 1933 are reported. During this period, there were 12,466 cancer patients, making the incidence of carcinoma of the larynx 1.6 per cent. Seventy-one. or 34.6 per cent, of the patients were between fifty and sixty years of age. The youngest was twenty and the oldest was eighty-six. There were 182 men and 20 women. In 45 cases the duration of the symptoms before the first visit was less than six months; in 46 cases from six to twelve months; in 34 cases from one to two years; in 16 cases from two to three years; in 5 cases from three to four years; in 3 cases from four to five years, and in one case from six to seven years. The chief complaint of the patients with the intrinsic type of growth was hoarseness in the early stages, and increased hoarseness and aphonia or dyspnea later. Pain was usually a factor in this type of lesion. In the extrinsic type the symptoms varied greatly with the site of the lesion and its extension. There was at first some vague discomfort in the throat, such as feeling a lump or perhaps some slight difficulty in swallowing. As time went on, these symptoms increased in severity and pain was more common. In 22 patients the sole complaint was a swollen neck with no other discom­ fort. Among the male patients, 81 growths were of the intrinsic type and 87 were extrinsic; in 19 cases the site was not stated. In the women, 14 growths were of the extrinsic variety, 5 intrinsic, and in one case the exact location was not stated. Total laryngectomies were performed in 7 cases, laryngofissures or hemilaryn­ gectomies in 12 cases, partial operations, with radium, in 20 cases; radium therapy was given alone in 33 cases, x-ray alone in 37 cases, radium and x-ray in 40 cases; resection of the cervical lymph nodes was done, with irradiatioll, in 6 cases, resection of the nodes only in 2 cases; partial operations were carried out in 2 cases; tracheotomy was done alone in 17 cases, and no treatment was given in 19 cases. In one case radium seeds were applied to cervical lymph nodes and in one a branchial cleft operation was done, with radium to the neck. In the remaining 4 c&IeI treatment was given elsewhere and data are not available. Three of the 7 patients on whom laryngectomy was done are living four, two, and two years respectively after operation. Of those dead, one survived three months, one five months, one four years, and one four years and ten months after operation. Four of the 12 patients with laryngofissure and hemilaryngectomy are living fifteen, twelve, ten, and five years, and one is alive three months without recurrence. Five of the 20 patients on whom partial operations were done, with irradiation by radium, survived more than three years. The results secured by irradiation alone were palliative in character only, except in one case, where a cure of five and one-half years was obtained. It is concluded that surgical removal of the growth in the early, operative, intrinsic type of tumor offers a good chance of permanent cure, while in certain types of not entirely operable growths which are highly radiosensitive, the combination of surgery and irradiation may produce good results. BENJAMIN R. SHORE 190 ABSTRACTS

Cancer of the Larynx in Youth and Old Age, VAN DEN WILDEN BERG. Cancer laryngien chez les jeunes et chez les vieillards, Scalpel 88: 1305-1310, 1935. Five cases of cancer of the larynx are reported in patients less than thirty years of age and one in a patient of thirty-four. One patient twenty-eight years old was well six years after the operation. One fifteen years old had a squamous epithelioma of the larynx treated by operation, with recurrence five months later. Two patients, of thirty and twenty-six years, survived less than one year after operation. In the other two cases the follow-up did not exceed two months. Four patients of seventy or more years lived over six years after partial laryngectomy. Six total laryngectomies were performed on patients in this advanced age group. One of these died postoperatively. One patient of eighty-seven is still well sixteen years after operation. Another died three years after operation from recurrence. A fourth has been well six years and two others are well after two years. No photomicrographs are included, nor are there pathological reports of any of the cases described. There is no bibliography. CHARLES A. WALTMAN Two Cases of Early Carcinoma of the Larynx and a Number of Cases of So-called Adenoma of the Bronchi-Apparently Cured by Diathermy, ]. D. KERNAN. Laryngoscope 45: 76(}-'768, 1935. The author reports two cases as carcinoma of the larynx, though in neither was the diagnosis substantiated. Both patients were well after local excision under direct laryngoscopy, but there is no note as to the late result. Ten cases of bronchial adenoma are also mentioned which were favorably treated by diathermy. Two of the ten pa­ tients, however, underwent subsequent lobectomy for bronchiectasis with fatal out­ come. There are no illustrations. THEODORE S. RAIFORD

Rhabdomyoma of the Vocal Cord. Report of a Case, ]. D. KERNAN AND A. J. CRA­ COVANER. Laryngoscope 45: 891-893, 1935. The authors report the removal from the left vocal cord Ofa rhabdomyoma, believed to be the sixth of its kind reported. Diagnosis was established by biopsy, after which the entire growth was removed by punch forceps under direct laryngoscopy. Ten months later the patient had a normal voice and there was no evidence of recurrence. There are two illustrations. THEODORE S. RAIFORD

Treatment of Cancer of the Larynx and Hypopharynx, R. S. PENTECOST. Canadian M. A. J. 33: 411-415, 1935. Also in Bull. Acad. Med., Toronto 9: 62-70, 1935. This is a general discussion of the diagnosis and treatment of cancers of the larynx and hypopharynx. The preferred treatment at the present time is complete surgical removal of these growths when possible, followed by irradiation in selected cases. Although primary irradiation without surgery has been advocated, at least five years must elapse before judgment can be pronounced on this method of treatment. One photograph of a gross specimen illustrates the article. BENJAMIN R. SHORE

Series of Cases of Total Laryngectomy for Cancer, R. E. BUCKLEY. Laryngoscope 45: 769-775, 1935. In spite of the title of this article, the author cites no specific group of cases, but merely discusses the advantages of total laryngectomy for carcinoma of the larynx. There are no illustrations. THEODORE S. RAIFORD

X-Ray and Radium Treatment of Laryngeal and Pharyngeal Carcinoma, K. A~Il\RSnACH AND KRAUS. Klinisches und Histologisches zur Frage der Rontgen-Radium­ bestrahlung des Kehlkopf-Rachen-Carcinoms, Ztschr. f. Hals-, Nasen- u. Ohrenh. 38: 207-212, 1935. . The authors report two cases of laryngeal tumor treated by the Coutard technic. In one case there was no effect on the tumor, although 6000 r had been given. In a patient with a less malignant lesion a small part of the tumor remained after heavy irradiation. Tracheotomy had been necessary during the treatment in both cases. THE SALIVARY GLANDS 191

The point is raised that even though radiation had destroyed the tumor, the damage to the normal tissue was so extensive that one could anticipate late reactions. Further investigation is necessary to demonstrate a method whereby local and general damage from radiation may be reduced. Both patients showed at autopsy severe damage to the adjacent pharyngeal and laryngeal tissues. The paper is unillustrated and there is no bibliography. CHARLES A. WALTMAN

Early Results with Teleradium Radiation in Carcinoma of the Larynx and Hypopharynx, 1931-1933, LARS EDLING. Uber Fruhresultate von Teleradiumbestrahlung bei Karzinom des Larynx und Hypopharynx in Lund 1931-1933, Strahlentherapie 52: 206-215, 1935. Also (in English) in Radiology 25: 267-273, 1935. Edling reviews the early results in carcinoma of the larynx and hypopharynx treated with the 2-gram radium pack during the past three and one-half years at Lund, Sweden. The pack is of the Sievert type, with a filter equivalent to 2 mm. lead, and is used at a distance of 5 em. The total dosage has varied between 52,000 and 90,000 milligram hours, given in two two-hour treatments each day, and over a total period of from six­ teen to twenty-four days. Five of the 8 patients with laryngeal carcinomas treated by this method are symptom­ free, and 3 of the 10 with hypopharyngeal cancer are well. The time since the com­ pletion of treatment has been too short, however, to permit of any definite conclusions regarding this method of therapy. C. D. HAAGENSEN

Radium Treatment of Carcinoma of the Vocal Cord by Means of "Windowing," R. MULLER. Uber die Radiumbehandlung des Stimmbandkarzinoms vermittels der Fensterung, Strahlentherapie 52: 216-220, 1935. Muller reports his experience with the method of treating carcinoma of the vocal cord devised by Halberstaedter and Sieffert (Strahlentherapie 35: 518, 1930). A window is cut in the cartilage of the larynx over the tumor and a radium plaque applied over the window. Muller has used a plaque containing about 6 mg. of radium element, and filtered with 1 mrn. lead. The plaque is left in situ for from eight to nine days, giving a total dose of about 1300 milligram hours. During 1933 and 1934 11 cases were treated in this manner. In one of these cases the larynx was extirpated for an unknown reason before the radium effect had developed; the remaining 10 patients are all well for from one to two years after treatment. Al­ though considerable edema of the larynx developed following the treatment, trache­ otomy was not required in any of the cases, and the function of the larynx has been preserved in all. Sixteen cases treated by this method during 1929 have given 75 per cent of cures of from five to six years' duration. Twenty-three' cases treated during 1930 have given 60.9 per cent of cures of from four to five years' duration. Eleven cases treated during 1931 have yielded 45.4 per cent of cures of from three to four years' duration. During 1931,14 cases were treated and 71.4 per cent of the patients remain well after from two to three years. Muller believes that this method has advantages over other methods of radiation therapy for carcinoma of the vocal cord. He emphasizes the fact that in none of his cured cases has metastasis to regional lymph nodes developed, although the lymph nodes have received no treatment. C. D. HAAGENSEN

THE SALIVARY GLANDS

Radical Excision of Tuberculous Cervical Lymph Nodes and Local Excision of Car­ cinoma of Parotid Gland, Six-year Follow-up, BEVERLY C. SMITH. Ann. Surg. 103: 450-455, 1936. Smith reports the case of a thirty-six-year-old man in whom a carcinoma was found in the tip of the parotid gland removed at the time of dissection of the neck for tuber­ culosis of the cervical lymph nodes. A radical neck dissection was performed following the discovery of this primary parotid carcinoma. No additional tumor was found in 192 ABSTRACTS the parotid gland subsequently removed or in the lymph nodes. The patient has remained well for six years. Two photomicrographs illustrate the article. BENJAMIN R. SHORE

THE THYROID GLAND

Thyroid Carcinoma with Metastasis in the Ciliary Body, Report of a Case, H. C. ORR AND I. L.]OHNSTONE. Brit.]. Ophth. 19: 593-597, 1935. The author reports the case of a sixty-year-old man from whom the left eye was enucleated for a tumor situated on the temporal side of the ciliary body. Examination of this growth showed it to be a carcinoma, probably from the gastro-intestinal tract. Roentgen examination of the stomach and intestines, however, failed to show evidence of malignancy. Examination of the neck disclosed a fixed lump in the thyroid gland which was said to have been present for the last eight years. Histologic study of this excised growth showed it to be a columnar-cell carcinoma of the same type as the metastasis in the eye. This is the first case on record of a metastatic carcinoma of the thyroid gland involving the ciliary body. Three photomicrographs illustrate the article. BENJAMIN R. SHORE

Cancer of the Thyroid in a Substernal Goiter, LEON BERARD AND MARCEL BERARD. Cancer thyroidien suffocant coexistant avec un goiter endothoracique pulsatile. Operation radicale. Suites satisfaisantes, Lyon chir. 32: 362-365, 1935. A report of a large substernal goiter with carcinoma, removed after a difficult operation. There is an x-ray photograph but no photomicrographs are shown. CHARLES A. WALTMAN

INTRATHORACIC TUMORS

~ary Carcinoma of the Lung. A Diagnostic Study of 135 Cases in Four Years, A. ARKIN AND D. H. WAGNER. J. A. M. A. 106: 587-591, 1936. During a four-year period the authors have studied 135 cases of primary carcinoma of the lung, most of which were seen at Cook County Hospital, Chicago. Seventy-four were confirmed by necropsy, 26 by biopsy, and 13 by bronchoscopy; in 22 instances the diagnosis was made from the characteristic clinical and roentgen manifestations. Seventy-two per cent of the patients were between forty-one and sixty years of age, while 12, or about 9 per cent, were from twenty-one to forty years of age. Ninety per cent of all the patients were chronic smokers, and this was considered to be an important factor in producing the chronic irritation which subsequently led to epithelial metaplasia. There were 125 men and 10 women in the series. The 74 autopsied cases included 21 adenocarcinomas, 18 squamous-cell carcinomas, and 31 undifferentiated round-cell or spindle-cell carcinomas. Of these 74 cases, all but one presented metastases. Eighty-eight per cent showed metastases in the hilar nodes, 38 per cent in the abdominal lymph nodes, 40 per cent in the liver, 32 per cent in the kidney, 43 per cent in the suprarenals, 28 per cent in bone, and 24 per cent in the brain. The chief associated lung changes were pleural effusions in 47 per cent, bron­ chiectasis in 43 per cent, acute pneumonias in 28 per cent, chronic pneumonias in 20 per cent, abscess or gangrene in 20 per cent, and purulent bronchitis in 19 per cent. In 51 per cent of the cases the signs and symptoms were predominantly outside the lungs. Of the 135 patients, 21 presented symptoms relative to the skeletal system, 13 to the central nervous system, 12 to the heart, and 11 to the gastro-intestinal tract. Enlarged supraclavicular, cervical or axillary lymph nodes were predominant in 9 cases, and an enlarged liver, often accompanied by jaundice, was present in 24 per cent of the cases. Roentgenographic study of the chest alone makes the diagnosis of carcinoma of the lung possible in at least two-thirds of the cases. The bronchoscope is of great value in confirming the diagnosis, but most cases can be recognized without it. There are no illustrations. BENJAMIN R. SHORE INTRATHORACIC TUMORS 193

Primary Carcinoma of the Lung or Bronchus, E. A. GRAHAM. Ann. Surg. 103: 1-12, 1936.

This is the" Balfour Lecture II delivered before the University of Toronto School of Medicine on April 25, 1935. It is a general discussion of the symptomatology, diagnosis, and treatment of primary carcinoma of the lung. There are no illustrations. BENJAMIN R. SHORE Carcinoma of the Lung, L. LOVISATO. II carcinoma polmonare, Minerva med. 2: 525­ 533, 1934. Lovisato describes various clinical types of carcinoma of the lung and presents case histories illustrating them. The types described are: that in which pleural effusion is the presenting sign; that in which hemoptysis is the most prominent symptom; the unusual type in which retraction of the intercostal spaces furnishes an indication of the situation of the tumor; the type which simulates early apical tuberculosis, and that in which cavitation develops and suggests advanced tuberculosis; the type in which metas­ tasis to the spine is the first sign of the disease, and finally the type which simulates lung abscess. Twelve reproductions of roentgen films as well as a short bibliography are included. C. D. HAAGENSEN

Clinico-Pathological Clalaification of Carcinomas of the Lung, S. E. MOOLTEN. J. M. Soc. New Jersey 32: 639-645, 1935. This is a general discussion, unillustrated, of the symptomatology, diagnosis, and operability of cancer of the lung. BENJAMIN R. SHORE

Primary Carcinoma of the Lung-Peroral Endoscopic Study, H. B. ORTON. J. M. Soc. New Jersey 32: 635-638, 1935. Twenty-one abstracted histories of patients in whom bronchoscopy was done for primary lung cancer are reported. The bronchoscopic findings in these cases have been of unquestionable aid to the thoracic surgeon and internist. BENJAMIN R. SHORE

Primary Carcinoma of the Lung; Early Diagnoail and Treatment by Pneumonectomy, R. H. OVERHOLT. New England J. Med. 214: 93-100,1936. The author reviews 23 cases of primary carcinoma of the lung observed in the Lahey Clinic in Boston. Two forms of the disease are differentiated, the bronchial and the pneumonic forms, and symptoms suggestive of each type are briefly discussed. The earliest symptom in either type is usually an unexplained cough, while expectoration, wheezing, and hemoptysis may also be present in the early stages. Among the various diagnostic aids, x-rays, bronchoscopy, Iipiodol visualization, pneumothorax and intra­ pleural thoracoscopy are most helpful. Irradiation haa proved to be of little or no value and the only hope of successful treatment lies in surgical resection. Five successfully treated cases are reported, three of malignancy and two of suppurative disease. There are eight illustrations and a short bibliography. THEODORE S. RAIFORD

Roenqen Diagnoais of Primary Carcinoma of the LUJII, W. KLEIN. J. M. Soc. New Jersey 32: 631-634, 1935. This is a general article concerning the roentgen diagnosis of primary carcinomas of the lung. The author discusses: (1) endo- or intrabronchial tumors; (2) the submucosal or peribronchial growths; (3) the parenchymal type. Three cases of each are reported. Drawings and roentgenograms illustrate the article. BENJAMIN R. SHORE

Roentgen Therapy of Primary Carcinoma of the LUDI, M. FRIEDMAN. J. M. Soc. New Jersey 32: 648-649, 1935. Friedman has never seen a primary carcinoma of the lung cured by irradiation and has no first-hand knowledge from other radiologists of such a cure. On the other hand, palliation, such as arrest of hemorrhage, lessening of pain, amelioration of cough, and prolongation of life, may be accomplished by this form of treatment. BENJAMIN R. SHORE 194 ABSTRACTS

Further Experiences with the Roentgen Treatment of Malignant Tumors of the Bronchi and Lungs, G. HERRNHEISER. Weitere Erfahrungen mit der Rontgenbehandlung maligner Bronchus- und Lungengeschwillste, Strahlentherapie 52: 425-459, 1935. Since 1931, Herrnheiser has been making an energetic attempt in Prague to influence malignant tumors of the bronchi and lung. He has treated a total of 16 cases, in 5 of which a regression of some months' duration has been obtained. In only one of these 5 cases was the diagnosis proved by biopsy, however. In the others it was made by bronchoscopy, bronchography, or from the roentgen picture. In the one biopsied case the diagnosis was "vascular, infiltrating mesenchymal tumor." The four proved squamous-cell carcinomas and the three proved immature small-cell carcinomas included in the series failed to yield to the treatment. Herrnheiser followed the plan of giving fractionated doses through either two or three fields. He used 170 kilovolts with a filtration of from 1.2 to 2 mrn. copper, at a distance of 40 em. In the 5 cured cases, a total surface dose of at least 9000 r was given during a period of a month or more. The details of treatment and the clinical course of each of the 16 cases are presented in tabular form. A bibliography is included. C. D. HAAGENSEN

Surgical Treatment of Primary Carcinoma of the Lung, R. H. DIEFFENBACH. J. M. Soc. New Jersey 32: 645-648,1935. This is a general discussion of the surgical treatment of carcinoma of the lung. There are no- illustrations. BENJAMIN R. SHORE

Carcinoma of the Right Lung; Pneumonectomy in One Stage, H. H. M. LYLE. Ann. Surg. 103: 124-129, 1936. Lyle reports the case of a sixty-one-year-old patient on whom a one-stage pneu­ mectomy for primary carcinoma of the right lung was performed in February 19,,5. There was extensive involvement of the right upper lobe with direct extension to the chest wall. The hilar lymph nodes were firm and contained tumor. Histologically the growth was of the squamous type. On April 24, 1935, when this report was made, the patient was well except for a small draining sinus of the chest wall. One photograph of the gross specimen and three roentgenograms illustrate the article. BENJAMIN R. SHORE

Total Removal of the Left Lung for Carcinoma, J. B. FLICK AND J. H. GIBBON, JR. Ann. Surg, 103: 130-134, 1936. The authors report the case of a forty-six-year-old man on whom a total left pneu­ mectomy was performed in one stage for a primary carcinoma involving the upper lobe and regional lymph nodes. He died seven months after this operation following a hemorrhage from the anterior chest wall. Autopsy showed a local recurrence of the growth about the left bronchial stump and involvement of the adjacent lymph nodes. A photograph of the gross specimen and a roentgenogram illustrate the report. BENJAMIN R. SHORE

The Fate of Embolic Cancer Cells in the Lung, GERHARD F. W. KOST. Das Schicksal eingeschwemmter Krebszellen in der Lunge, Ztschr. f. Krebsforsch. 43: 291-305, 1936. The comparative rarity of pulmonary metastasis has often been the subject of comment since M. B. Schmidt (Die Verbreitungswege der Carcinome, jena, Gustav Fischer, 1903) first suggested an explanation. In the lungs of 2 persons, among 12 dead of cancer, the author found metastases. In 5 cases there were no daughter tumors and no cancer cells were seen in the pulmonary capillaries. In the remaining 5 also there were no metastases, but cancer cells were present in the blood vessels, either enclosed in thrombi and degenerating or of normal healthy appearance. In reflecting upon this power of the lung to suppress the growth of embolic tumor cells, one soon begins to doubt whether organization deserves the significance attached to it by Schmidt and others, for Deelmann (Inaug. Diss., Amsterdam, 1918) has described INTRATHORACIC TUMORS 195 the destruction of cancer cells in the absence of thrombosis. Another group of investi­ gators invoke physico-chemical changes, such as anomalies of surface tension, increased viscosity in the pulmonary blood, or changes in hydrogen ion concentration, while the constant motion of the lungs has also been suggested as a reason for their comparative freedom from metastasis. This by no means exhausts the list of explanations, none of which, however, can be accepted as wholly satisfactory. The article is accompanied by two photomicrographs. WM. H. WOGLOM

Primary Sarcoma of the Pulmonary Arteries, A. GOEDEL. Zur Kenntnis des prirnaren Lungenschlagadersarkoms, Frankfurt. Ztschr, f. Path. 49: 1-9, 1935. Goedel reports the case of a forty-seven-year-old man who died with the clinical diagnosis of myocarditis, dilatation of the heart, and generalized edema. Autopsy disclosed a primary sarcoma originating in the first portion of the pulmonary artery and involving its various branches. There were also separate nodules of tumor in the right auricle and pericardium. Histologic study showed the tumor to be a typical spindle-cell sarcoma. Only four other cases of primary sarcoma of the pulmonary artery have been reported in the literature. A photograph of the gross specimen and three photomicrographs illustrate the article. BENJAMIN R. SHORE

Pleural Cyst Resembling a Pulmonary Metastasis, A. FEHR. Pleuracyste, eine Lungen­ metastase vortauschend, Deutsche Ztschr. f. Chir. 246: 244-247, 1936. The case is reported of a sixty-five-year-old man in whom the diagnosis of meta­ static carcinoma of the left lung was made from roentgenograms of the chest. At autopsy a large serous cyst lined with pleural epithelium was found attached to the left dome of the diaphragm beneath the pericardium. A roentgenogram, photograph, and photomicrograph illustrate the article. BENJAMIN R. SHORE

Diagnosis and Surgical Treatment of Anterior and Posterior Mediastinal Tumors, Report of a Case of Posterior Mediastinal Tumor, S. W. HARRINGTON. New York State J. Med. 35: 1073-1080, 1935. Stressing the advances made during recent years in the early detection of mediastinal tumors, the author emphasizes the contribution of roentgenography. Early recognition has made it possible to approach these tumors surgically before they have become in­ operable. Surgical removal has shown that many of them are benign. If allowed to progress unmolested, however, they may subsequently become malignant. Tumors of the anterior mediastinum usually cause more symptoms than others, because of the smaller space in which they grow. Pain is predominant especially in the presence of malignancy. It is usually progressive and associated with or augmented by inflammation of the respiratory apparatus. When located in the posterior media­ stinum, benign tumors may give no symptoms, sometimes almost filling one side of the thorax before they are clinically evident by symptoms other than dyspnea on exertion. Malignant tumors, on the other hand, produce severe pain and dyspnea, especially if located in the upper chest. Dysphagia is sometimes noted. Bronchoscopy sometimes reveals the presence of a mass. Thoracoscopic examina­ tion after artificial pneumothorax may show the tumor or even permit biopsy for diagnosis. Anteroposterior and lateral stereoroentgenograms are of aid in determining the location of the lesion and its relation to surrounding structures. X-rays after the introduction of barium into the esophagus or of iodized oil into the trachea are fre­ quently of value. Radiation therapy for diagnosis is also helpful. especially in ruling out the radiosensitive lymphoblastomas. In the surgical treatment of mediastinal tumors important considerations are early diagnosis, careful preoperative preparation, the selection of operative approach, and adequate means for supporting pulmonary pressure during operation. Artificial pneu­ mothorax helps the patient to become accustomed to unilateral alteration of arterial pressure, but should be done from three to five days before the major operation is attempted. The operative risk has been materially reduced by the use of intratracheal anesthesia. For this the author prefers cyclopropane or ethylene. 196 ABSTRACTS

A total of 47 cases have been operated upon by the author and his associates. Thirty-five of the tumors were located in the posterior mediastinum. Of these, 19 were fibroblastomas, 4 of which showed malignant change. There were 4 endotheliomas and 12 chondro-osteosarcomas. The anterior approach was used in 4 of these cases and the posterior in 31. Five patients of the entire series died following operation. Nine patients subsequently died from recurrence with an average postoperative duration of three years and seven months. Postoperative blood transfusions and an oxygen tent may be necessary if respiratory difficulties occur. One successfully treated case is reported in detail with four illustrations. For the surgical technic the reader is referred to the original article. THEODORE S. RAIFORD

Intrathoracic Tumor (Fibrosarcoma) of the Posterior Mediastinum Associated with Small Diaphragmatic Hernia. Lymphosarcoma of the Anterior Chest Wall, S. W. HARRINGTON, J- M. DORSEY AND E. L. STROHL. Surg. Clin. North America 15: 1119-1136,1935. A fifty-year-old man had an intrathoracic fibrosarcoma originating from the tenth intercostal nerve immediately after its exit from the spinal canal. In this region there was moderate erosion of bone around the foramen but no suggestion of any communica­ tion of the tumor and the spinal cord. The growth was very adherent to and had caused collapse of the lower lobe of the left lung. The excised tumor measured 9 by 8 by 5 centimeters and weighed 209 grams. The patient was given a course of postoperative radiotherapy and was well two months after operation. An incidental finding in this case was a small diaphragmatic hernia. A thirty-five-year-old woman had a lymphosarcoma originating in the soft tissues of the right anterior thoracic wall at the level of the second rib. The growth was hard, fibrous, and nodular, and extended into the chest through the second intercostal space. Histologic study of a piece of the growth removed showed it to be a " fibrous, infla rn­ matory lymphosarcoma of the Hodgkin's type." The results secured following radio­ therapy of the residual tumor are not stated. Roentgenograms, photographs, and a photomicrograph illustrate the reports. BENJAMIN R. SHORE

Coexistence of a Cardiopathy and a Mediastinal Tumor, E. STIENON. Coexistence d'une cardiopathie et d'une tumeur mediastinale longtemps meconnue, Scalpel 88: 1327-1335, 1935. The author reports a case which he observed for five years. The patient had a double mitral murmur and a completely irregular pulse. Electrocardiograms showed the irregularity and suggested auricular fibrillation. Roentgenograms showed cardiac enlargement and a mediastinal tumor. Since the patient lived five years with the tumor, the author tries to point out the adaptability of the heart to pathological conditions. Several illustrations are included. CHARLES A. WALTMAN

Primary Sarcoma of the Pericardium, L. G. STEUER AND C. S. HIGLEY. ]. A. M. A. 105: 1110-1111,1935. The authors report an unusual case of sarcoma in a forty-seven-year-old white man, which had involved the entire pericardium and encroached upon but not definitely invaded the myocardium. Death was apparently caused by cardiac embarrassment four months after the onset of the first symptoms of cough and dyspnea. The diagnosis was confirmed by post-mortem examination, but the type of sarcoma is not mentioned. There are three illustrations. THEODORE S. RAIFORD

Pulsating Tumors of the Stemum, Report of Four Cases, G. CRILE, JR. Ann. Surg, 103: 199-209, 1936. Five pulsating neoplasms of the sternum have been observed in a series of 16 tumors of the sternum treated at the Cleveland Clinic. The 16 growths included 5 primary sarcomas, 4 metastases from carcinomas of the breast, 4 metastases from malignant THE DIGESTIVE TRACT 197 adenomas of the thyroid, 1 cavernous hemangioma, 1 chondroma, and 1 metastatic hypernephroma. The pulsating tumors included 4 metastatic malignant adenomas of the thyroid gland and 1 metastatic hypernephroma. The histories of these five cases are included. No primary pulsating tumor of the sternum has been reported. There are no illustrations. A bibliography is appended. BENJAMIN R. SHORE

THE ABDOMINAL WALL

Difterential Diagnosis of Abdominal Wall Tumors, J. HALBAN. Zur Differential­ diagnose der Bauchdeckentumoren, Wien. med. Wchnschr. 8S: 790-791, 1935. This is a general article concerning the differential diagnosis of lipomas, dermoids, neuromas, and desmoids of the anterior abdominal wall and their separation from intra­ abdominal tumors. Such tumors are of especial importance in gynecological diagnosis, since they are more frequent in women than in men, in the proportion of 87 to 13; and also because they are most frequent in the right lower quadrant, the inclusion of des­ moids probably accounting for this. BENJAMIN R. SHORE

Lipoma of the Abdominal Wall, L. BERARD, M. E. MARTIN AND M. HENRY. Gros lipome profond de la paroi de I'hypochondre gauche, Lyon chir. 32: 479-480, 1935. A report of a lipoma, 20 X 10 cm., in the left hypochondrium. It is unillustrated. CHARLES A. WALTMAN

THE DIGESTIVE TRACT

The Question of the Radiation Treatment of Carcinoma of the Esophagus, K. WASSER­ BURGER. Zur Frage einer Strahlenbehandlung des Osophaguskarzinoms, Strahlen­ therapie 52: 611-616, 1935. Wasserburger reviews the results of his attempts to treat carcinoma of the esophagus with radium. The radium has been used in a stomach tube, from 40 to 53 mg. of the element being placed in the tube over a distance of from 66 to 88 mm. A total of from 2700 to 3700 milligram hours of treatment were given in each case. This dose was given in daily sittings of from four to six hours each over a period of three weeks. Filters of 1.5 mm, platinum and 0.2 mm. aluminum were used. The distance between the radium containers and the mucosa varied between 5 and 8 mm. This method of treatment was carried to completion in 9 patients. Two of these have been lost track of. Marked improvement in the general condition and the ability to take food resulted in 2 of the patients, lasting seven and eight months, respectively, after which symptoms recurred and death ensued. The author points out that, although it is possible to cause temporary regression of the primary tumor in the esophagus by means of this form of therapy, the treatment has no effect on the metastases in the tracheobronchial and gastrohepatic lymph nodes. Metastases to these nodes regularly occur with the disease, and until some method is found of influencing them not much can be hoped for. Eight reproductions of roentgen films are included. C. D. HAAGENSEN

Oesophagectomy for Carcinoma of the Thoracic Oesophagus, E. S. J. KING. British J. Surg. 23: 521-529, 1936. King reports the case of a fifty-six-year-old woman with a primary carcinoma of the esophagus situated at the level of the junction of the sixth and seventh thoracic vertebrae. The diagnosis was made by roentgenograms and histologic study of a biopsy specimen. The patient was informed of the diagnosis and accepted the risk of esophagectomy. As preliminary measures to this operation, gastrostomy and artificial pneumothorax on the left side were performed. Under avertin and intratracheal gas and oxygen anesthesia, the chest was opened, the esophagus and growth freed, the lower end divided at the diaphragm and the upper end drawn out through an incision in the neck. The portion of esophagus removed was 6 inches in length. The patient made a good recovery and is well several months after the operation. An esophagoplasty will be 198 ABSTRACTS undertaken later. The article is illustrated with photographs, roentgenograms, and photomicrographs. BENJAMIN R. SHORE

Gastrostomy for Carcinoma of the Esophagus, BERARD AND COLSON. Gastrostomie de Fontan pour neoplasme de l'oescphage datant d'un an, avec maintien d'un Hat general parfait et possibilite d'alimenation par les voies naturelles depuis dix mois, Lyon chir. 32: 64-65, 1935. A patient with carcinoma of the esophagus, proved by biopsy, was treated by gastros­ tomy, and one year later was in good health and able to take soft food by mouth. The gastrostomy functioned without regurgitation. No photographs are included. CHARLES A. WALTMAN

Carcinoma of the Gastro-Intestinal Tract, H. FINSTERER. Zur Klinik und Therapie des Karzinoms des Verdauungstraktes, Wien. med. Wchnschr. 85: 1273-1274, 1305-1308, 1335-1337, 1389-1391, 1420-1423, 1438-1440, 1935; 86: 39-42, 95-98, 182-186, 1936. This is a general review of the diagnosis and treatment of malignant tumors of the gastro-intestinal tract based upon 1122 carcinoma and 15sarcoma cases seen by Finsterer during the last twenty-five years. Early diagnosis and exploratory laparotomies in doubtful cases are urged in order to lessen the mortality from cancer of the stomach. The only absolute contraindication to radical resection is the demonstrable presence of distant metastases. Debility, age, enlarged supraclavicular lymph nodes, which mayor may not contain a carcinoma, jaundice, and anemia do not of themselves preclude the possibility of radical surgery. The operative mortality fol1owing gastric resection in patients under sixty was 6.3 per cent, while in those from sixty to eighty-two years of age it was only 10.3 per cent. In the final analysis the operability of a gastric tumor can be determined only by laparotomy. In a series of 693 cases operated upon for gastric carcinoma, 12 total gastrectomies were done, 448 resections, 122 gastro-enterostomies, and 111 exploratory laparotomies and jejunostomies. The operative mortality for the 289 resections limited to the stom­ ach was 8.3 per cent, while that of 159 cases in which the growth involved neighboring organs, as the pancreas, liver, and colon, was 43.4 per cent. The mortality following gastro-enterostomy for inoperable growths was 18.8 per cent. Although this latter operation is supposed to prolong life, the average survival following operation in this series was only 3.5 months. Five-year cures were obtained in 70, or 22.2 per cent of the 315 patients operated on prior to 1927. In the group of 192 cases in which the growth was limited to the stomach alone, five-year cures were obtained in 54, or 28.1 per cent, while in a second group of 123 cases in which neighboring organs were involved, five-year cures were obtained in 16, or 13 per cent. In the entire series of cases there were 8 sarcomas of the stomach, an incidence of 1.7 per cent. There were 6 lymphosarcomas, 1 round-cell sarcoma, and 1. myosarcoma. Cures were obtained by resection in three of the lymphosarcoma cases. In a series of 149 cases of carcinoma of the colon, resections were done on 118, entero-anaatomoees on 10, and colostomies alone on 21. Almost half of the 118 patients on whom radical resections were done were between the ages of sixty and eighty­ six years. One-stage resections were done in 56 cases, with 7 deaths, an operative mortality of 12.5 per cent. In the entire group of 118 cases there was an operative mortality of 21.1 per cent. The author discusses also carcinoma of the esophagus, pancreas, biliary tract, small intestine and rectum. BENJAMIN R. SHORE

Carcinoma of the Digestive Tract in Early Life, GERHART WOLFF. Das Carcinom des Verdauungsapparates im Jugendalter, Ztschr. f. Krebsforsch. 38: 409-449, 1933. On the basis of his own experience and the published observations of others, the author concludes that carcinoma of the digestive tract may develop at any age, even in earliest infancy. Males are slightly more susceptible throughout than females. The symptoms in early life are those ordinarily associated with this disease in the higher THE DIGESTIVE TRACT 199 age periods, but the course is more rapid, except in the case of the tongue and the rectum, where the prognosis is about the same as in later life. The paper closes with a theoretical discussion on etiology, which leads to the con­ clusion that in general Cohnheim's hypothesis has less cogency than Virchow's in the case of the gastro-intestinal canal. WM. H. WOGLOM

Modes of Onset of Symptoms of Carcinoma of the Stomach, D. L. WILBUR. Minnesota Med. 18: 586-590, 1935. Wilbur points out that the predominating symptoms of gastric cancer may be of several types. They may be typical or may be similar to those of ulcer of long or short duration. They may be those of pyloric obstruction, of anemia, of a general decline in health or nutritional disturbance, or, finally, they may be due to metastatic involvement. Suggestive of malignant disease in the presence of a previously known gastric lesion are: (1) disappearance of intermittency or exacerbation of symptoms with substitution of a continuous or remittent clinical course; (2) irregular diminution or disappearance of pain-food-ease sequence; (3) substitution of usual pain or distress by a dull ache, even­ tually aggravated rather than eased by alimentation; (4) loss of appetite and onset of nausea in spite of normal or elevated acids; (5) loss of weight and strength out of pro­ portion to reduced food intake; (6) advanced age and recent development of symptoms; (7) diminished secretion of acid; (8) disturbance of motor function of stomach; (9) onset of anemia in the absence of gross bleeding; (10) appearance, increase, or persistence of occult blood in gastric contents or feces on a meat-free diet; (11) residuum in the fasting stomach in the absence of barium retention after six hours. Five illustrative cases are mentioned briefly but there are no illustrations. THEODORE S. RAIFORD

Carcinoma of Linitis Plastica Type Involving the Intestine, C. F. DIXON AND G. A. STEVENS. Ann. Surg. 103: 263-272, 1936. The authors report 6 cases of linitis plastica with involvement of the intestinal tract. The duodenum was involved throughout its second part in one case; the small intestine, exclusive of the duodenum, was involved in 5 cases and the colon in 5 cases; there was a typical lesion of the rectum in one case. In four cases multiple metastatic growths of the linitis plastica type were demonstrable, exclusive of the involvement of the large and small bowel. These lesions were present in the diaphragm, pancreas, perirenal fat, esophagus, appendix, peritoneum, omentum, mesentery, fallopian tubes, uterus, and bladder. A review of the literature discloses 37 other cases in which a carcinoma of the linitis plastica type involved one or more portions of the intestinal tract. In only one of these, the primary coexistence of the gastric lesion apparently was not noted. Two photo­ graphs and one drawing illustrate the article. A bibliography is appended. BENJAMIN R. SHORE

Extension of Gastric Carcinoma into the Duodenum, B. CASTLEMAN. Ann. Surg. 103: 348-352, 1936. Twenty-one cases of carcinoma of the pyloric end of the stomach in which there was extension of the. tumor into the duodenum have been collected from the surgical and post-mortem records of the Massachusetts General Hospital. The extension varied from 4 to 23 mm. and in most of the surgical specimens carcinoma cells w.ere found at the distal cut edge, which implied that the remaining duodenal tissue contained tumor. The extension rarely involved the mucosa but spread along the submucosa, often in the lymphatics. It is suggested as a conclusion from this study that at least 3 em. of duodenum should be removed in all gastric resections for carcinoma of the pylorus. Four photomicrographs illustrate the article. BENJAMIN R. SHORE

Gastrostomy in the Management of Gastric and Esophageal Carcinoma, W. L. WATSON. Surg., Gynec. & Obst. 62: 729-734, 1936. The Janeway type of gastrostomy is preferred for cases of carcinoma of the esophagus and cardiac end of the stomach. It allows the instrumentation necessary for the 200 ABSTRACTS· accurate implantation of gold seeds in the lowermost portion of an esophageal cancer and permits the safe retrograde insertion of the radium element tandem in the esophageal lumen at the site of the tumor. At operation, or through the resulting stoma, it is possible to obtain a biopsy from a lesion located in the cardiac portion of the stomach and to insert gold seeds into it under direct vision. This type of gastrostomy is per­ formed under local anesthesia through a relatively small incision and should be done early in the course of the disease. The technic is described in detail. The esophageal radium element tandem is also described and illustrated by photographs. BENJAMIN R. SHORE

U Pulmonary CompUcations" after Gastrectomy, P. ROCHET. Deux cas de " soi di­ sant " complication pulmonaire apres gastrectomies pour cancer de l'estomac, Lyon chir. 32: 243-249, 1935. Two cases are reported in which partial gastrectomy was done for carcinoma of the stomach. Each patient showed clinical signs of pneumonia after operation, and death was attributed to that cause. Autopsy, however, showed that both had peritonitis and that pneumonia was either absent or insignificant. The author points out that in one case the peritonitis was localized and the patient might have benefited by drain­ age had not the diagnosis of pneumonia been so willingly accepted as a cause of fever and circulatory collapse. CHARLES A. WALTMAN

A New Palliative Operation for Inoperable Gastric Cancer, O. ORTH. Zu den Aus­ filhrungen des Herrn Westhues auf dem diesjahrigen Chirurgenkongress: Uber eine neue Palliativoperation bei inoperablem Magenkarzinom, Zentralbl. f. Chir. 63: 311, 1936. Orth believes that the occlusion operation for inoperable gastric cancer (see Westhues: Arch. f. klin. Chir, 183: 17, 1935. Abst. in Am. J. Cancer 27: 172, 1936) has its place in the paIliative treatment of these growths but in no way can it be considered as a substitute for radical resections on operable tumors. BENJAMIN R. SHORE

Myoma of the Stomach, F. SCHROEDER. Beitrag zur Klinik des Magenmyoms, Arch. f. klin. Chir. 184: 738-745, 1936. The case is reported of a thirty-four-year-old woman in whom the diagnosis of a benign myoma of the stomach was made from the clinical history and typical roent­ genograms. At operation multiple, edematous, submucous myomas of the stomach were found and resected by the Billroth I method. The patient made an uneventful recovery and has remained well two years. Two photographs and two roentgenograms illustrate the article. BENJAMIN R. SHORE

Roentgenologic Diagnosis of Malignant Tumors of the Duodenum, Z. v. HRABOVSZKY. Zur R6ntgendiagnostik der bosartigen Geschwulste des Zwolffingerdarms, Fortschr. a. d. Geb. d. Rontgenetrahlen 52: 580-594, 1935. The author reports four cases of primary malignant tumors of the duodenum in which the diagnosis was made roentgenographically before operation. One of the lesions was a carcinoma of the papilla of Vater, two were extrapapillary carcinomas, and one was a lymphosarcoma. Lymphosarcoma produces a narrowing of the duodenum throughout its entire length, while infiltrating carcinomas cause shorter constricted areas. As the neoplasms involve more of the mucosa, obliteration of the normal folds takes place. Roentgenograms and a photograph illustrate the article. BENJAMIN R. SHORE

Duodenal Sarcoma, K. HERMAN. Ober das Duodenalsarkom, Ztschr. f. klin. Med. 128: 649-655, 1935. On the basis of x-ray studies alone the author reports a case of duodenal sarcoma. Many authorities are quoted to support the diagnosis, but there is no report of a biopsy. Four x-ray photographs show the filling defect in the duodenum. CHARLES A. WALTMAN THE DIGESTIVE TRACT 201

Lymphosarcoma of the Intestine, C. W. MAYO AND C. R. ROBINS, JR. Surg. Clin. North America 15: 1163-1170, 1935. The authors report two cases of lymphosarcoma of the intestine. In the first case the tumor was localized in the cecum, while in the second case it arose in the ileum about seven feet from the ileocecal valve. The lesions were resected in each case with satis­ factory results. The patient with the cecal lesion received postoperative irradiation. No prolonged follow-up is given. Photographs and photomicrographs illustrate the article. BEN]AMIN R. SHORE

Primary Carcinoma of the Jejunum with R.eport of Two Cases, E. M. HODGKINS. New England J. Med. 214: 477-480, 1936. The author reports two cases of carcinoma of the jejunum which were successfully treated by surgical removal. Both patients are living at present, one five and the other eight years after operation. The clinical and pathological aspects of these lesions are discussed briefly and there is a short bibliography. There are no illustrations. THEODORE S. RAIFORD

Mucoid Carcinoma of the Caecum in a Boy of Thirteen Years, R. F. OGILVIE. British J. Surg. 23: 601-606, 1936. Ogilvie reports the case of a thirteen-year-old boy on whom the diagnosis of tuber­ culosis of the cecum was made at the time of a laparotomy and ileocolostomy. The patient showed marked cerebral symptoms and died four months later of what was regarded clinically as tuberculous meningitis. Autopsy disclosed a mucoid carcinoma arising in the cecum and metastatic tumors in the para-aortic, omental, and bronchial lymph nodes, lungs, and meninges. The primary growth and its metastases showed large amounts of mucus. The article is illustrated with photographs and photomic­ rographs. BENJAMIN R. SHORE

Carcinoma of the Colon, F. A. STRATTON. Wisconsin M. J. 34: 741-743, 1935. A brief description of the symptomatology, treatment, and pathology of carcinoma of the colon, without illustrations or bibliography. THEODORE S. RAIFORD

Secondary Carcinoma of the Large Bowel, E. L. YOUNG, JR. New England J. Med. 213: 1219-1221, 1935. Four cases are reported in which primary malignancy of the large bowel was followed by a second growth in a different location. The relationship of such lesions to papil­ lomata of the bowel is discussed and the opinion set forth that these secondary tumors are really new growths rather than metastases or recurrences. A roentgen examination every six months after operation and routine study of the stools and symptoms is advised in order to detect such secondary cancers. There are no illustrations or references. THEODORE S. RAIFORD

Amebiasis and Cancer of the Colon, A. C. REED AND H. H. ANDERSON. Am. J. M. Sc. 191: 237-250,1936. The authors report four cases in which cancer followed and accompanied amebiasis of the colon. The coincident sites of election and the overlapping of symptoms fre­ quently make differential diagnosis difficult. Most important among the diagnostic procedures are sigmoidoscopic examination, roentgenography, gross and microscopic fecal examination, biopsy of any suspicious lesion found on sigmoidoscopic examination. Two ways are suggested in which amebiasis may contribute to cancer, first by chronic irritation and second by the production of papillomata and polyps, in either of which cancer may develop. Treatment should consist of clearing up the amebic infection and resection, if possible, of the tumor. All four of the authors' patients developed recurrence after operation. Three died and the fourth was rapidly failing at the time of this report. There are eight illustrations and a short bibliography. THEODORE S. RAIFORD 202 ABSTRACTS

Adenosquamous Cell Carcinoma of the Intestine (Combined Adenocarcinoma and Squamous Cell Carcinoma). Report of a Case with a Review of the Literature, S. MILTON RABSON. Arch. Path. 21: 308-319, 1936. An adenosquamous-cell carcinoma of the ascending colon is reported in a forty-nine­ year-old woman. This type of neoplasm, uncommon elsewhere in the body, is even rarer in the gastro-intestinal tract apart from the esophagus and rectum; when it does occur, it is found at sites of stagnation, as the pylorus, ileocecal valve. cecum, ascending colon, etc. The squamous epithelium is ascribed to metaplasia. The paper is adequately illustrated and accompanied by a good bibliography. WM. H. WOGLOM Submental and BUateral Submaxillary Dissection; Colostomyas First Stage in Opera­ tion for Carcinoma of Upper Part of Sigmoid; Exteriorization Operation for Sig­ moidal Polyp, C. F. DIXON. Surg. Clin. North America IS: 1303-1307, 1935. The first case reported by Dixon is that of a seventy-two-year-old man on whom submental and bilateral submaxillary dissection was carried out under local anesthesia following local removal of a Grade II squamous epithelioma of the lower lip in another clinic. The second case is that of a forty-three-year-old woman on whom a colostomy was performed preliminary to resection of the sigmoid colon for carcinoma. The third case is that of a fifty-four-year-old woman with a benign polyp situated in the sigmoid colon. This was resected by the multiple stage technic. None of the cases is illustrated. BENJAMIN R. SHORE

Cancer of the Rectum and Sigmoid, E. P. HAYDEN. New England]. Med. 214: 401­ 410, 1936. The author reviews a series of 81 cases of cancer of the rectum and sigmoid which he has treated. Fifty-one radical excisions were done, 3 local excisions, and 10 palliative operations. In 3 no operation was done, and 14 patients were operated upon elsewhere. In the radically operated group the operative mortality was 15.4 per cent; 20 patients died from four months to five years and ten months after operation and the remaining 24 are living for periods up to five years and ten months after operation. [The number of five-year cures is not mentioned.] The surgical technic is briefly described, but nothing new is added. Hayden finds that those living or apparently cured were chiefly those without perirectal involvement, with tumors graded as malignant adenoma or adenocarcinoma, grade II. In the group of cases with death from recurrence the growths were more malignant in general and the percentage of regional metastases was higher. The reverse was true in a sufficient number of cases, however, to justify a liberal standard of operability. Six statistical tables and three illustrations are included. THEODORE S. RAIFORD

Lymphatic Spread in Cancer of the Rectum, W. B. GABRIEL, C. DUKES, AND H. ]. R. BUSSEY. Brit.]. Surg. 23: 395-413, 1935. At St. Mark's Hospital in London. five-year survivals were obtained in 91 per cent of 24 patients with Group A cancers of the rectum, in 64 per cent of 36 patients with Group B growths, and in 16 per cent of 34 patients with Group C tumors. In Group A are included those growths removed by perineal excision before there was gross extension to the perirectal tissues; in Group B are the growths which have extended by direct spread to the perirectal tissues but which have not caused metastases to the regional lymph nodes; and in Group C are those tumors associated with glandular metastases. . A dissection of the lymph nodes removed with 100 cancers of the rectum has been made. Seventy tumors were removed by the perineo-abdominal and 30 by the perineal route. The specimens were cut along the anterior aspect, pinned out, and fixed in formalin. In some of the perineo-abdominal excision specimens, as many as 60 lymph nodes were found; the average was 28. The exact position and size of each node was marked on a natural-size drawing, calipers being used to insure accuracy in measure­ ment. As far as possible each node was bisected and one-half taken for section, the other half being left in situ. In the total 100 cases, lymph node involvement was found THE PANCREAS 203 in 62. A single node was involved in 13 cases, 2 in 11 cases, 3 in 7 cases, and 4 or more in 31 cases. This lends fresh evidence to the well known fact that in the early stages, rectal cancer spreads slowly from node to node. The orderly and predictable course of lymphatic spread was impressing. The first nodes to receive metastases were those situated in the perirectal tissues on the same level or immediately above the primary growth. The next to be affected were the chain of nodes accompanying the superior hemorrhoidal vessels. As a rule, these were invaded from below upward. In an advanced case the metastases formed an unbroken chain from the regional lymph nodes to those situated at the point of ligation of the inferior mesenteric vessels. The possibility of determining grossly whether lymph nodes were involved by tumor or not was studied in a series of 1242 nodes removed from perineo-abdominal specimens. Of these, 905 were considered from gross characteristics to be free of metastases; sub­ sequent microscopic examination showed 18 to contain metastatic tumor, an error of 2 per cent. On the other hand, in 337 nodes which were thought, from their gross characteristics, to contain tumor, metastases were present actually in only 132. An error was therefore made in 205 cases or 61 per cent of the total. Since a surgeon is inclined to be so much influenced by the discovery of enlarged nodes, it is important that he should know that conjectures with respect to metastases in the rectal, hemorrhoidal, or paracolic nodes are more often wrong than right. The commonest source of error consists in presuming nodes to contain metastases which are enlarged as a result of inflammation. Drawings of specimens removed from twenty-four cases to illustrate the lymphatic spread are included. BENJAMIN R. SHORE

Diagnosis and Treatment of Carcinoma of the Rectum, A. E. WEINSTEIN. West Virginia M. J. 31: 461-465,1935. A brief discussion of the diagnosis and treatment of carcinoma of the rectum, with- out illustrations or bibliography. THEODORE S. RAIFORD

One Hundred Untreated Cancers of the Rectum, E. M. DALAND, C. E. WELCH AND I. NATHANSON. New England J. Med. 214: 451-458, 1936. The authors have collected data on 244 cases of rectal cancer, 100 of which were untreated. These 100 patients lived from one to forty-nine months after the onset of symptoms with an average duration of fourteen months. Colostomy was performed in 80 cases but this procedure did not appreciably lengthen the life span. It did, however, contribute materially to the comfort of the patient. Colostomy combined with x-ray treatment produced similar results. The operative mortality in the two latter groups was 12.5 per cent. Radical operation was performed in 42 cases with an operative mortality of 26.2 per cent. Five-year cures were obtained in 30 per cent of the radically treated cases, and in others life was prolonged and freedom from symptoms obtained. Five statistical tables are included. A bibliography is appended. THEODORE S. RAIFORD

Carcinoid Tumor of the Appendix: Report of a Case, W. W. ELLWOOD. Illinois M. J. 69: 171-174, 1936. The author reports a small carcinoid tumor of the appendix discovered in a routine examination of a specimen removed for acute suppurative appendicitis. The tumor per se had never given rise to symptoms. A short bibliography is included. There are no illustrations. ' THEODORE S. RAIFORD

THE PANCREAS Carcinoma of the Pancreas and Obstructive Jaundice.•.• Obstructive Jaundice Caused by Pancreatic Cyst, E. S. JUDD AND P. F. OLSON. Surg. Clin. North America 15: 1099-1107, 1935. The case is reported of a sixty-year-old man on whom a gastrojejunostomy was per­ formed in 1933 for an obstructing lesion of the second portion of the duodenum. Eight 204 ABSTRACTS months later jaundice occurred due to pressure on the common bile duct from a carci­ noma originating in the head of the pancreas. It is pointed out that if the correct diagnosis had been made at the time of the first operation and a cholecystgastrostomy done at that time, this stoma would probably have closed spontaneously in the absence of back pressure of bile to keep it open. The second case reported is that of a forty-seven-year-old man in whom a satisfactory result was obtained following marsupialization of a pancreatic cyst which was causing jaundice by pressure. There are no illustrations. BENJAMIN R. SHORE

Primary Carcinoma of the Pancreas in Children i Report of a Case in a Boy Fourteen and a Half Years of Ace, with Generalized Metastases, W. R. SMITH. Am. J. Dis. Children 50: 1482-1494, 1935. A fourteen-year-old boy complained of weakness, cough, loss of weight, and an abdominal mass. Post-mortem examination showed a primary tumor in the pancreas with metastases in the liver, stomach, adrenals and lungs, and in the peritracheal, peribronchial, peri-aortic and mesenteric lymph nodes. There are two illustrations and a comprehensive bibliography. THEODORE S. RAIFORD

Rare Type of Diftuse Carcinoma of the Pancreas with Unusual Metastases, RUPERT A. WILLIS. J. Path. & Bact. 42: 203-207, 1936. A case of widespread carcinoma of the pancreas with preservation of the lobular pattern of that organ is described, in a woman of sixty-three. Blood-borne metastases of peculiar distribution were present, namely in the liver, small intestine, thyroid, and heart. Four photomicrographs and a photograph of the gross specimen illustrate the article. WM. H. WOGf.OM

THE BILIARY TRACT

Pellqrous Syndrome and Primary Cancer of the Liver, J. MARGAROT, P. RIMBAUD AND GUIBERT. Syndrome pellagreux et cancer primitif du foie, Bull. Soc. franc, de derrnat. et syph. 42: 1486-1494, 1935. The authors present a case of primary liver-cell carcinoma in a man fifty-nine yean old who entered the hospital with many classical symptoms of pellagra. He had become ill about six months before admission, complaining of post-prandial distention, nausea, and extreme weakness. Three months later cutaneous lesions of violet color, slightly swollen and edematous, appeared on the backs of the hands and forearms, on the legs and anterior thighs, and the buttocks, and finally two weeks before admission on the face. Those on the exposed areas of the body were the most severe. Shortly after hospital admission, severe vomiting set in and a barium meal showed distention of the stomach and narrowing of the duodenum. Death occurred about six weeks after admission. At autopsy there was found a carcinoma apparently arising in the hilar region and invading the left lobe but principally extrahepatic and involving the head of the pancreas and the duodenum. No metastases were found. Histologically, the diagnosis of primary liver carcinoma seems justified. The question arises whether in the absence of known alcoholism or avitaminosis, the symptoms observed here may be called pellagra, and secondly what part, if any, was played by the liver tumor, which did not reduce either liver function or bile output to any appreciable degree. It is for this reason that the authors speak simply of a pellagrous syndrome occurring along with a primary liver-cell carcinoma. There are no illustrations and no bibliography. THEODORE P. EBERHARD

Case of Fibroma of the Liver, O. KAPEL. Ein operierter Fall von Leberfibrom, Zentralbl. f. Chir. 63: 212-214, 1936. From a thirty-three-year-old woman a finely lobular tumor about 10 ern. in diameter, on the upper surface of the right lobe of the liver, was removed. Histologic study showed PERITONEAL, RETROPERITONEAL, AND MESENTERIC TUMORS 20S it to be a fibroma. Recovery was uneventful. One photomicrograph illustrates the report. BENJAM1N R. SHORE

Coogenital Cyst of the Liver Re.embUq an Ovarian Cyst, N. ATAUM. "Hepar cysti­ cum congenitum " als grosses Eierstockcystom erkannt, Zentralbl. f. Chir. 63: 204­ 208, 1936. The case is reported of a nine-year-old girl with lower abdominal enlargement of two years' duration. The preoperative diagnosis was ovarian cyst. At operation a cystic tumor containing 500 c.c. of thin fluid and weighing 1950 grams was removed from the undersurface of the left lobe of the liver. The diagnosis of a congenital cyst of the liver was made after histologic study. Photographs of the patient before and after operation and a photograph of the gross specimen illustrate the report. BENJAMIN R. SHORE

Adenoma and Adenomyoma of the Gallbladder, E. S. JUDD AND M. T. HOERNER. Surg. Clin. North America 15: 1091-1097, 1935. Although papillomas are found in about 8.5 per cent of all gallbladders removed surgically, adenomas are not common. Sixty-nine of the latter tumors were found in a series of 9550 gallbladders extirpated for cholecystic disease. The adenomas vary in size from 0.5 to 4.0 em. in diameter, the majority averaging 1.5 em. Many are semi­ solid and oval, some are large and cystic, and others are papillary. The tumor may occupy any part or all of the wall between the mucosa and serosa. These adenomas are apparently silent growths and cause only symptoms which can be associated with the co-existing cholecystitis. Two cases of adenoma of the gallbladder are reported. One was in a fifty-five-year­ old woman and was associated with stones, while the other was in a fifty-year-old man and was unassociated with stonee. Photographs and two photomicrographs illustrate the article. BENJ AMIN R. SHORE

PERITONEAL, RETROPERITONEAL, AND MESENTERIC TUMORS

Pseudomyxoma Peritonel, F. L. MELENEY. Ann. Surg, 103: 457-461, 1936. Meleney reports the case of a forty-five-year-old man in whom a series of operations including an amputation of the cecum, an ileocolostomy with a tape ligation of the ileum below the tumor, and a permanent left inguinal colostomy, was performed for a mucus­ producing tumor situated in the right side of the false pelvis. Histologic study of tissue from this mass showed a large amount of mucin and epithelial cells. This led to the supposition at one time that the growth was a colloid carcinoma, but the outcome has subsequently shown that it was a pseudomyxoma of the peritoneum. An origin in the appendix could not be proved. Five drawings illustrate the report. . BENJAMIN R. SHORE

PapUlomatolia Peritonel, A. H. WELLS. Am. J. Path. 11: 1011-1014, 1935. The author reports a case of benign villous papillomatosis of the peritoneum in a seventy-year-old man who died following a prostatectomy. It was considered a primary growth of the peritoneal cells, evidence of infection being absent. There are no illustrations. THEODORE S. RAIFORD

SJDlpathoblutoma, W. WENDEL. Uber das Sympathoblastom, Zentralbl. f. Chir, 63: 8-11, 1936. Wendel reports the case of a six-year-old girl with a large retroperitoneal' tumor situated in the left flank. An emergency operation for intestinal obstruction was performed, at which time a portion of the growth was taken for histologic study. The diagnosis of sympathoblastoma was made from the characteristic rosettes. The child died four months later with the symptoms of a transverse myelitis. No autopsy was obtained. One photomicrograph illustrates)he:article. BENJAMIN R. SHORE 206 ABSTRACTS

Rare Case of Cystic Chylangioma of the Mesentery, E. VERTAN. Ober einen seltenen Fall von Chylangioma cysticum mesenterii, Zentralbl. f. Chir. 63: 86-87, 1936. A five-year-old girl had a cystic tumor situated between the leaves of the mesentery of the small intestine. A satisfactory recovery followed removal of this growth and resection of 10 ern. of small intestine. One photograph of the gross specimen is included. BENJAMIN R. SHORE

THE SPLEEN

Reticula-endothelial Sarcoma of the Spleen, K. H. LANGENSTRASS AND M. NEUMANN. Arch. Path. 20: 752-759,1935. A case is reported of reticulo-endothelial sarcoma of the spleen-the only primary sarcoma of that organ discovered in 6400 autopsies, though about 120 cases have been reported in the literature. The patient was a man of forty-two admitted to the hospital for dementia paralytica. Three years after his admission the abdominal lymph nodes began to enlarge, a hard nodular mass appeared at the crest of the left ilium, and examination revealed various metastatic growths. Material from the inguinal nodes and the bone tumor was diag­ nosed as metastatic carcinoma. Within a period of six weeks the hemoglobin percentage fell from 74 to 44 and the red cell count from 4,010,000 to 2,310,000. The white cell count was normal throughout. Death occurred four months after the appearance of the first signs of neoplastic disease. At autopsy numerous metastatic tumor nodules were found. The spleen weighed 695 gm, and was dark, firm, and nodular. Some of the nodules showed pale central areas due to the absence of blood and scarcity of blood spaces. There was a fairly definite fibrous capsule separating the neoplasm from the adjacent splenic pulp. In another section the splenic pulp was found to be entirely replaced, except for the capsule, by undifferentiated neoplastic cells. Some of the cells were spindle-shaped with a long narrow nucleus; others were round, oval or polyhedral. Giant cells were fairly numerous. Mitotic figures were frequently seen. The Perdrau stain revealed an extremely dense diffuse anastomosing stroma of argyrophilic fibers. The growth is classified as a primary sarcoma of the spleen arising in the reticulo-endothelial cells. The tumor cells were similar in all the metastases. Three photomicrographs are included and there is a short bibliography.

THE FEMALE GENITAL TRACT

Diagnosis of Latent Carcinoma of the Cervical Portio, H. HINSELMANN. Um die Diagnose des latenten Portiocarcinoms, Gynlik. Rundschau, 1936. New developments in the early diagnosis of uterine carcinoma affect chiefly carci­ noma in the external os or in the lower segment of the cervical canal. Corpus carcinoma is concerned to a lesser degree; it develops in a later age group and produces symptoms relatively earlier. With the colposcope one can see in the depths of the cervical canal a brownish exudate even in women who have not yet noticed a bloody discharge. This finding suggests an early diagnostic curettage and improves the prognosis. Hinselmann now prefers splitting of the cervix to the use of the various dilating sounds formerly employed to obtain a view of the lower canal. In the visible portio the colposcope has widened the field of biopsy by magnifying the vision and illumination ten-fold, and permitting the detection of carcinomatous tumors of less than a millimeter in diameter. The colposcope has also taught that the mucosa is altered in a certain fashion for a considerable extent, and that carcinoma arises multi­ centrically in this altered tissue. This finding is most important, particularly in view of Stoeckel's demand that in the future carcinoma be diagnosed before it has ulcerated and hence before it has given any symptoms. The colposcope detects only alteration in the mucosa. Malignancy must be proved by the microscope. Hinselmann has seen 1699 cases which showed either carcinomatous THE FEMALE GENITAL TRACT 207 aggregations or precancerous changes. All of these he includes in his group IV, synony­ mous with the" incipient carcinoma" of other authors. From 1932 to 1935, 2881 am­ bulant and 3800 hospital cases were examined; mucosal alteration was discovered in 732, or 10.9 per cent of the total. There were 348 cervix amputations with typical Group IV changes in 75, or 21.5 per cent of the operative cases. The author believes he is not justified in allowing these cases to go untreated up to the stage of manifest carcinoma in order to disprove the claims of those who deny that they are precancerous. In all doubtful cases after colposcopy the author substitutes amputation of the cervix for simple biopsy. Often the specimen reveals far more changes than had been detected with the colposcope. Ten per cent formalin fixation and hematoxylin, eosin and van Gieson stains bring out the hornification and other changes best. Hinselmann avoids the use of the terms II precancerous" or " beginning carcinoma." He classifies his tissue into four groups. He estimates that of his 169 cases in Group IV about 10 per cent are borderline, leaving 150 cases designated as " latent carcinoma," which does not, however, prevent the entire group from having definite value in rela­ tion to carcinoma. In other words, some of these cancers have not yet broken their shell. The most important change found in Group IV cases is leukoplakia; and this hornification is already pathologic in mucous membranes where the horny layer is normally absent. The mucosal alterations are alike microscopically in that they consist of epithelium with a tendency to hornification. Within these groups are the most variable forms whose extreme development is a cell of very rapid growth. From the stage of purely super­ ficial epithelium, designated Group III, the transition occurs in many ways to Group IV and thence to the conglomeration of growth products into microscopic nodules falling into the class of definite carcinoma. NELSON B. SACKETT

Value of Colposcopic Diagnosis in Carcinoma, H. HINSELMANN. Die Wirksamkeit der kolposkopischen Karzinom-Diagnose, Schweiz. med, Wchnschr. 66: 200, 1936. Hinselmann reports his 165th case of early carcinoma of the cervix diagnosed by colposcopic examination. Two photomicrographs accompany the article. WM. H. WOGLOM

Colposcopic as the Preferred Method of Early Diagnosis of Cervical Cancer, A. BUCHER. Die Kolposkopie als Methode der Wahl zur Fruhdiagnose des Portiokarzinoms, Schweiz. med. Wchnschr. 17: 3G-32, 1936. This is a general article concerning the value of colposcopic examination in the early diagnosis of cancer of the uterine cervix. There are no illustrations. BENJAMIN R. SHORE

Prognosis of Cancer of the Cervix Treated by Irradiation, N. B. SACKETT. New York State]. Med. 35: 1153-1158, 1935. At the Woman's Hospital in New York 493 cases of cancer of the cervix were ob­ served from Feb. 15, 1919, to Apr. 15, 1930. Of these, 474 were treated by irradiation. The absolute five-year survival rates were as follows: Grade I, 70 per cent; II, 52.8 per cent; III, 21.1 per cent; IV and V, 0; total, 25.8 per cent. Ten-year cures were ob­ tained in 254 cases, of which 247 were irradiated, as follows: Grade I, 66.6 per cent; II, 39.3 per cent; III, 9.3 per cent; IV, 0; total, 16.5 per cent. From these results the author concludes that irradiation prolongs life for five years in from a fourth to a third of the cases and for ten years in from a sixth to a fifth of the cases. He believes, however, that these figures can be doubled if the lesion is detected earlier. Among the complications of irradiation therapy were acute and chronic inflamma­ tion, .hemorrhage, lymphedema and phlebitis, intestinal obstruction, rectal disorders such as proctitis and diarrhea, fistulae, urinary tract disorders, and pain from involve­ ment of the nervous system. Except for hemorrhage no one of these complications occurred in more than 10 per cent of the cases. Most complications were less frequent in patients destined to survive, and many complications in the survivors were transient 208 ABSTRACTS and easy to relieve. Complications were more frequent in the hopeless, untreated cases and often appeared a few weeks or months before death from extension of the disease. Most of them are due to progression of the disease and indicate a grave prognosis. Carcinoma of the stump after supravaginal hysterectomy occurred in 7 per cent of cases. There are six statistical tables but no illustrations. THEODORE S. RAIFORD

Cancer of the Cervical Stump after Subtotal Hyaterectomy, CLAUDE BECLERE. A propos du cancer developpe sur moignon de col apres hysterectomle subtotale, Bull. Soc. d'obst. et de gynec. 24: 372-378, 1935. The author, commenting on a paper by Sejournet (Abst. in Am. J. Cancer 27: 807, 1936), states his conviction that many cases of cervical stump cancer are not new primary lesions but were actualIy present in the cervix at the time ofhysterectomy for some other lesion. A plea is made for more accurate classification. JOHN S. LOCKWOOD

Carcinoma after Subtotal Hyaterectomy, S. LABORDE. Cancers du col restant apres hysterectomie subtotale, Bull. Soc. d'obst. et de gynec, 24: 446-451, 1935. In a group of 1508 cases of cancer of the cervix the author found that 57, or 4.9 per cent, occurred in portions of the uterus left behind after subtotal hysterectomy, though most reports from individuals performing the hysterectomies indicate an incidence of less than 1 per cent in subsequent development of stump cancer. In the writer's series only, 39, or 3.6 per cent could definitely be classified as primary cancers of the stump, the others representing lesions overlooked by the operator at the time of hysterectomy. Fifty-two of the patients were treated with radiation, and of these only 7 now survive, the shortest interval being one year, the longest eleven years. The author does not believe that there is sufficient evidence to warrant the conclu­ sion that cancer is more likely to develop in a cervical stump than in any other cervix. Those who choose to perform the conservative operation for treatment particularly of fibroids must take upon themselves the special responsibility of making certain that the cervix left behind does not harbor cancer or a precancerous lesion. JOHN S. LOCKWOOD

Sarcoma of the Cervix Following Supravaginal Hyaterectomy for a Myoma, R. RECK­ MANN. Sarkomwachstum im Portiostumpf nach supravaginaler Amputation des Uterus wegen Myom, Arch. f. Gynak, 159: 478-484, 1935. , A supravaginal hysterectomy was performed on a fifty-year-old woman presumably for a benign uterine myoma. Seven months later there was a recurrent necrotic tumor in the retained cervix. Histologic study of this growth showed it to be a myoma. Six weeks following this a large recurrent tumor was again present in the cervix. Histo­ logic study showed the growth to be a spindle-celIsarcoma. It was treated by roentgen and radium irradiation, but the end-result is not stated. The author thinks it most likely that in this case the original uterine tumor probably contained sarcomatous ele­ ments. There are no illustrations. BENJAMIN R. SHORE

Adenomatous Polyp and Hypertrophy of the Cervix, BINET, TIEGER AND CARAC. Polype adenomateux et allongement hypertrophique du col uterin, Bull. Soc. d'obst. et de gynec. 24: 338-339, 1935. An unillustrated case report of a woman of fifty-two years, in whom an adenomatous polyp of the cervix had apparently caused marked elongation and hypertrophy of the cervix. She was treated by cervical amputation. JOHN S. LOCKWOOD

Cholecystectomy Following Total Abdominal Hyaterectomy and BUateral Salpingo­ Oophorectomy for Carcinoma of the Fundus; Cholecyatectomy in the Presence of Large Ovarian Cyst; Endometriosis, Ovarian Cyatl and InterUgamentoua Fibroid Tumor, V. S. COUNSELLER. Surg. Clin. North America IS: 1309-1316, 1935. The first case reported by Counseller is that of a fifty-eight-year-old woman whose gallbladder was removed'for stones three weeks following total abdominal hysterectomy and bilateral salpingo-oophorectomy for an extensive carcinoma of the uterine fundus. THE FEMALE GENITAL TRACT 209

In the second patient. a fifty-eight-year-old woman, an ovarian cyst was found at the time of cholecystectomy. This cyst was to be removed two weeks later if the patient's convalescence from the cholecystectomy were uneventful. The third case is that of a forty-one-year-old woman with diffuse endometriosis of the pelvic organs. A subtotal hysterectomy, bilateral salpingo-oophorectomy, and appendectomy was performed. BENJAMIN R. SHORE Increased Blood Pressure Associated with Uterine Myomas, E. STRASSMANN AND R. PHILIPP. Die Blutdruckerbohung, ein Hinweis auf die innersekretorische Storung bei Myom, Arch. f. Gynak, IS9: 537-547, 1935. Blood pressure studies on 500 patients with uterine myomas and 500 control patients in a similar age group showed pressures under 120 mm. of mercury in 15.4 per cent of the myoma patients and in 28.6 per cent of the control cases. Blood pressures over 140 mm. of mercury occurred in 43.6 per cent of the myoma patients and in 33 per cent of the controls. In a group of 460 patients with myomas who were menstruating regularly, blood pressures over 140 mm. of mercury occurred in 42.16 per cent while only 25 per cent of 387 control patients who were menstruating regularly showed figures above 140. It is concluded that an increase in the blood pressure is not a direct result of a uterine myoma but that it represents a disturbance in the organs of internal secretion. especially the ovaries, thyroid gland, and adrenals. BEN]AMIN R. SHORE Phlebitis in the Presence of Uterine Fibroids, VILLARD. La phlebite spcntanee au cours de l'evolution des fibromes uterine non op~r/!s, Lyon chir. 32: 89-93, 1935. The author describes four cases of unilateral or bilateral phlebitis developing in the presence of uterine fibroids. The patients were relieved by hysterectomy. In the presence of a phlebitis in a woman, without known cause, a latent fibroid should be suspected. CHARLES A. WALTMAN Uterine Fibroids with Phlebitis, G. COTTE. A propos des myomes uterins avec phlebite au cours de leur /!volution, Lyon chir, 32: 95-96, 1935. A case of bilateral phlebitis associated with a uterine fibroid is presented. Hysterec­ tomy was performed with relief of the symptoms. CHARLES A. WALTMAN Two Rare ComplicatioDs of Fibroids, BARTHfLEMY. Deux complications rares des fibromes, Bull. Soc. d'obst. et de gynk 24: 350-352, 1935. The author calls attention to two cases which he considers unusual, one being pelvic tuberculosis associated with a large myomatous uterus, the other associated intramural fibroids and an adenocarcinoma of the fundus. There are no illustrations. lOHN S. LOCKWOOD Fibroid and Cancer of the Fundus, E. DELANNOY, HIOCO AND H. BfDRINE. Fibrome et cancer du corps, Bull. Soc. d'obst, et de gynec 24: 390-392, 1935. A case report. lOHN S. LOCKWOOD

Diapostic DUBculty in Prepancy Complicated by Fibroids, REEB AND ACKERMANN. Difficultes de diagnostic dans un cas de grossesse compliquee d'un fibrome ramoIli, Bull. Soc. d'obst. et de gynk 24: 308-309, 1935. Also in Gynecologie 34: 291-297, 1935. Gravid Fibromatous Uterus Weighing S400 gm.; Extraction of Infant Weighing 2700 1Dl. by Cesarean Section Followed by Hysterectomy, with Survival of Mother and Child, P. BRAULT AND A. MOISAN. Uterus fibromateux gravide de 5 kilos 400; extraction par cesarienne d'un enfant de 2 kilos 700; bysterectomie, mere et enfant vivants, Bull. Soc. d'obst. et de gynec, 24: 440-442, 1935. Necrotic Fibroid Complicating Pregnancy at Term, R. KELLER. Fibrome en Hat de necrobiose compliquant la grossesse conduit a terme, Ibid. 24: 486-487, 1935. Spontaneous Labor in a Patient with a Fibroma Weighing 7 Kilos, J. HOEFFEL AND BERNARD. Accouchement spontane chez une femme atteinte d'un fibrome volumi­ neux de plus de 7 kilos, Ibid. 24: 483-486, 1935. A group of rather unimportant case reports, the titles being self-explanatory. lOHN S. LOCKWOOD 210 ABSTRACTS

Hormonal Determinations in Cases of Chorionepithelioma, A. MANDELSTAMM. Beitrag zur Frage des Chorionepithelioms und seiner hormonalen Untersuchung, Arch. f. Gynak, 160: 239-262, 1935. The histories of three patients with chorionepitheliomas in whom the Aschheim­ Zondek test on the urine was of distinct aid in diagnosis and prognosis are reported. A fourth case is reported of a chorionepithelioma in a forty-two-year-old patient in whom the symptoms were of such an acute nature as to suggest an extra-uterine pregnancy. The patient died two days fol1owing enterostomy for an obstruction due to compression of the colon by the pelvic tumor. The peritoneal cavity at the time of operation con­ tained a large amount of blood and the liver was the seat of metastatic tumor. Photo­ graphs of gross specimens and photomicrographs illustrate the article. BENJAMIN R. SHORE

Quantitative Horm,one Determinations in Cases of Chorionepitheliomas and Hydatid Moles, J. RUZICSKA. Chorionepitheliom und Mola hydatidosa aus dem Gesichts­ punkte der quantitativen Hormonbestimmung, Arch. f. Gynak, 160: 76-96, 1935. Quantitative studies of the gonadotropic hormones in the urine of patients with chorionepithelioma and hydatid moles failed to show such high determinations as have previously been reported; the average figures were from 30,000 to 50,000 mouse units. It is concluded, however, that the Aschheim-Zondek test is of extreme value in diagnosis and prognosis in these cases. A photograph of a gross specimen and two photomicro­ graphs illustrate the article. BENJAMIN R. SHORE

A Case of Chorionepithelioma, HOCHE AND BOHEME. Un cas de chorioepitheliome, Bull. Soc. d'obst. et de gynec. 24: 408-409, 1935. A case report. ] OHN S. LOCKWOOD

Endometriosis with Particular Reference to Conservative Treatment, R. B. CATTELL AND N. W. SWINTON. New England]. Med. 214: 341-346,1936. Forty-three cases of endometriosis have been observed at the Lahey Clinic. The youngest patient was twenty-two and the oldest sixty-two years of age, the average being 37.1 years. This closely paral1els the age incidence of menstruation. The ovary was the site of the growth in 26 cases, the uterus in 9, the rectovaginal septum in 4, and the round ligaments, intestinal wall, fallopian tube, abdominal scar, appendix, and peritoneum in the other cases. The duration of symptoms varied from thirty-six hours to ten years. Three cases were diagnosed as endometriosis before operation and in several others this was the tentative diagnosis. The treatment of endometriosis depends on the location and extent of the lesion and the age and general physical condition of the patient. Complete involvement of the ovaries and the necessity for castration were rare; three of the patients had children following the removal of one ovary. The average age of 17 patients treated radically was 41.5 years while that of those treated conservatively was 29.2 years. All of the patients treated by bilateral oophorectomy were cured; all but 2 of those treated con­ servatively were cured and the latter 2 were improved. The authors emphasize the importance of the conservative treatment of endometriosis during the child-bearing age. BENJAMIN R. SHORE

Carcinoma Arising from Extensive Endometriosis, ROBERT HANSER. Carcinom auf der Basis ausgedehnter Endometriose, Ztschr. f. Krebsforsch. 43: 306-322, 1936. The patient was a thirty-two-year-old woman who sought relief for an almost constant and uncontrol1able menstrual bleeding of some seventeen years' duration. She had never had a surgical operation of any sort. On admission she was extremely anemic. the uterus was considerably enlarged, and displaced by a tumor more than twice the size of a man's fist, that sprang from its left posterior surface. Curettage yielded a small amount of a more or less atrophic endometrium. As the bleeding con­ tinued unabated, nothing remained to be done save hysterectomy. At operation a large, soft, white, apparently malignant tumor was found adherent THE FEMALE GENITAL TRACT 211 to the omentum and intestines, and was extirpated as completely as possible together with the uterus and the adnexa of one side. Microscopic examination showed a well preserved endometrium except at the site of a polypoid growth on the posterior uterine wall. The number of glands was greatly augmented in some areas, diminished in others, and the glands themselves varied extremely in size and shape. Here and there in otherwise gland-free myometrium there were found islands of unmistakable endometrium which had no connection with the endometrial lining. The outer half of the myometrium was entirely without glands, consisting only of normal uterine muscle. Nowhere was there any suggestion of malig­ nancy; the epithelium was universally arranged in a single layer, sharply separated from the stroma, and its cells were of uniform shape and size. The polyp had the characteristics of an endometrioma. The process in the posterior uterine wall, separated from the endometrium by a broad zone of gland-free myometrium, was definitely carcinomatous. Here, on the external surface of the uterus, interspersed with the carcinoma, there were found areas of typical endometrioma, and endometriomas were found, also, in polypoid. form, in the uterine ends of the fallopian tubes; only, unlike that in the cavity of the uterus, these showed the beginnings of malignant change. Thus in the uterine cavity, the proximal ends of both tubes, and the posterior wall of the uterus there were found lesions which can be described only as endometrioid growths, or endometriomas, or, in view of their wide distribution, endometriosis. The unusual thing about them is that they underwent a malignant transformation, an event which examination of the literature showed to be most unusual, if not unprecedented. The patient was living and apparently well several months after her operation. The author raises the question of a connection between the endometriomas and the metrorrhagia, but comes to no definite conclusions. It is suggested that the endo­ metriomas may have represented developmental defects. The paper is illustrated by 3 photomicrographs WM. H. WOGLOM

An Endometrioma Situated in the Mid-Portion of the Thigh, Z. W. MANKIN. Beitrage zur Histogenese der Endometriome, mit Hinweis auf eine besonders selten vorkom­ mende Lokalization im mittleren Oberschenkeldrittel, Arch. f. Gynak, 159: 671-688. 1935. The case is reported of a thirty-three-year-old woman with a slightly movable, nodular growth 6 x 3 x 1.5 em. situated on the anterior aspect of the middle third of the left thigh. The tumor had originated two years previously following local trauma. It had been excised once and had promptly recurred. The growth was relatively pain­ less until the menstrual periods, when it became enlarged and tender. Histologic study of the excised specimen showed numerous cystic areas lined by epithelium re­ sembling uterine mucosa and containing dark blood. The diagnosis of endometrioma was made on the clinical history and histologic characteristics of the growth. After reviewing the histogenesis of endometriomas it is concluded that they represent ectopic, growing portions of normal uterine mucosa and not degenerated elements incident to menstruation. Implantation can take place by: (1) the retrograde route through the fallopian tubes; .(2) by direct implantation at the time of an operation; (3) by the lymphatic system. The latter mode of dissemination was considered to be the most likely in the case here reported. One photograph and one photomicrograph illustrate the article. BENJAMIN R. SHORE

Adenomyomas in Abdominal Wounds, J. C. MASSON AND W. P. MARBLE. Surg. Clin. North America IS: 1109-1113,1935. A thirty-three-year-old woman had been operated on previously for right tubo­ ovarian abscess. Following this operation, the wound drained for eighteen months. It then remained healed for two and one-half years. Then, after a prolonged period of vaginal bleeding, which was considered to have resulted from an early spontaneous abortion, serosanguineous fluid escaped from the site of the old drainage tube that had been placed in the abdominal incision. This was repeated, with each menstrual period. A small nodule which gradually increased in size was first noted in the scar six years 212 ABSTRACTS previously. At operation a circumscribed adenomyoma 3 em. in diameter was found and removed. There are no illustrations. BENJAMIN R. SHORE

CaBe of Umbilical Endometrioma, E. DELANNOY AND H. BEDRINE. Sur un cas d'endo­ metriome ombilical, Bull. Soc. d'obst. et de gynec, 24: 206-207, 1935. A case report. JOHN S. LOCKWOOD

Primary Carcinoma of the Fallopian Tubes, Report of Two Case., H. CHARACHE. Ann. Surg. 103: 290-296, 1936. Two cases of primary carcinoma of the fallopian tube are reported. One patient is living and well one month after operation; the other died of a pulmonary embolus following the freeing of abdominal adhesions and an ileostomy for acute intestinal obstruction two years and eight months after salpingectomy for carcinoma. This latter case is only the second on record in a virgin. Three hundred and twenty-three cases of primary carcinoma of the fallopian tubes have been reported in the literature. A serosanguineous vaginal discharge, various menstrual disturbances, abdominal pain associated with a palpable adnexal tumor, and a negative uterine curettage are the important aids to the diagnosis. Radical surgical removal of both tubes and ovaries and panhysterectomy followed by roentgen ray therapy is the treatment of choice. The prognosis is poor; only seven patients having survived longer than three years. Two photomicrographs illustrate the article. BEN]AMIN R. SHORE

Adenomas, Cysts, and Carcinoma of Gartner's Duct, H. ROCKSTROH. Adenome, Zysten und Karzinomdes Gartnerschen Ganges, Ztschr. f. Geburtsh. u. Gynak, 112: 95-108, 1935. Four case reports are given: two of adenomas, one of a benign cyst, and one of carcinoma of Gartner's duct. The adenomas were found incidentally and were without special significance. The patient with a carcinoma was forty-two years of age and sought treatment for menorrhagia. Two biopsy specimens taken. from an erosion on the cervix were considered benign, and the diagnosis of carcinoma of Gartner's duct was made only after amputation of the cervix for non-healing of the erosion. Radium therapy [dosage not stated] was given and the patient has remained well for ten months. The article is illustrated with photomicrographs. BENJAMIN R. SHORE

Histogenesis of Certain Ovarian Tumors and Their Biolopc Effects, S. H. GEIST. Am. J. Obst, & Gynec. 30: 650-664, 1935. Investigation of the tumors of the ovary producing definite physiological changes in the host has afforded better understanding of normal gonad physiology and has made possible a classification of ovarian neoplasms based on physiological as well as embry­ ological grounds. The author presents a comprehensive summary of what has been accomplished in classifying the tumors of the ovary derived from hormone-producing cells. The granulosa-cell tumor arises from the granulosa-cell forerunners in the ovary which have not been used in forming graafian follicles, and produce estrogenic hormone, resulting in an exaggeration of certain aspects of female physiology, particularly an increase in uterine bleeding and general over-feminization. The theca-cell tumors arise from the forerunners of the theca interna cells and are consequently similar in biologic effect to the first group. The arrhenoblastoma arises from the male-conditioned elements which have remained quiescent in the ovary, and presumably elaborates a male sex hormone, as evidenced by defeminization of the individual both in appearance and function. The dysgerminoma arises from dysgerminal elements of the epithelium, has no physiologic effects on the host, but occurs chiefly in individuals with defective gonads and atypical somatic development. The author includes good photomicrographs and photographs of each of these four types of tumor and describes in some detail the pathological and clinical features by which they may be recognized. The bibliography appears only in the author's reprints. JOHN S. LOCKWOOD THE FEMALE GENITAL TRACT 213

Statistical Study of Tumors of the Ovary, LOUIS GERY AND JOSEPH ADRIAN. Etude statistique des tumeurs de I'ovaire, Bull. Soc. d'obst. et de gynec. 24: 310--313, 1935. In this paper the authors apply the classification of ovarian tumors as suggested by Masson to a group of 506 specimens in the Institute of Anatomy at Strasbourg. The main divisions in this classification are: tumors of the ovary proper (42.6 per cent), wolffian tumors (27 per cent), mesenchymal tumors (8.2 per cent) dysgenetic tumors (14 per cent), metastatic tumors (2.4 per cent) and indeterminate tumors (5.8 per cent). Malignancy characterized 195 or 38.5 per cent of the tumors, and 260 or 51.4 per cent were benign. In the remaining 51, or 10.1 per cent, the authors were unable to reach a definite conclusion as to whether the tissue was benign or malignant. JOHN S. LOCKWOOD

Pregnancy Following Surgical Treatment of Ovarian Cancers, Z. VON SZATHMARy. Schwangerschaften nach operiertem Ovarialcarcinom, Arch. f. Gynak. 159: 563­ 573, 1935. During the past sixteen years 177 patients have been operated upon for malignant ovarian tumors in the Second University Woman's Clinic in Budapest. In 26, or 14.7 per cent, one normal ovary and the uterus were left at the time of removal of a malignant ovary; pregnancy occurred in 3 of these cases, an incidence of 1.5 per cent in the entire series of 177. However, only 14 of the 26 patients have survived more than five years, and of these only 8 were in the child-bearing age. One-third of the patients, therefore, in whom a normal ovary was left and who were still in the child-bearing age sub­ sequently became pregnant following the removal of one carcinomatous ovary. It is concluded from this study that bilateral oophorectomy for malignant disease should be reserved for women past the child-bearing age or for those cases in which gross bilateral involvement of the ovaries is evident at the time of operation. The one exception to this rule is papillary ovarian carcinoma, which is known to metastasize widely; in these cases both ovaries and the uterus should be removed without regard to the age of the patient. BEN]AMIN R. SHORE

Clinical Significance of Dermoid Carcinomas, Z. v. SZATHM.by. Uber die klinische Bedeutung der Dermoidcarcinome, Arch. f. Gynak. 159: 689-700, 1935. One hundred and fifty-eight cystic teratomas were observed among 1005 prolif­ erating ovarian tu mors studied during the 'past seventeen years in the Second University Woman's Clinic in Budapest. In this series of 158 cases of dermoid cysts, associated carcinomas were found in 6 cases; 3 were primary, that is, originating in the dermoid itself, and 3 were secondary to tumors arising in other parts of the ovary. In the first group of 3 cases there were a typical squamous-cell epithelioma, a less differentiated squamous-cell epithelioma, and a carcinoma of thyroid tissue. In the second group of three cases, there were a granulosa-cell tumor and 2 papillary carcinomas. The histories of these 6 patients are given in detail. The article is well illustrated with photomicrographs. BEN]AMIN R. SHORE

Malignant Degeneration of Ovarian Dermoid Cysts, VILLARD AND CAILLOT. Trois cas de deglmerescence maligne de kystes derrnotdes de l'ovaire, Lyon chir, 32: 453­ 457, 1935. Two cases of carcinoma developing in dermoid cysts of the ovary are reported. In a third case a malignant ovarian tumor was present, but the exact histology was not determined. CHARLES A. WALTMAN

Ovarian Teratomas, Z. v. SZATHMARY. Cher die klinische Bedeutung und zur Path­ ologie der Ovarialteratome, Arch. f. Gynak. 159: 653-670, 1935. Among 1005 proliferating ovarian tumors studied in the Second University Woman's Clinic in Budapest, there were 167 teratomas, 158 of which were cystic. One hundred and thirty-eight, or 87.5 per cent, of the 158 benign tumors were unilateral, while 20, or 12.7 per cent, were bilateral. The dermoid cysts were unilocular in 141 cases and multi­ locular in 17 cases. Hair was present in 90 per cent of the cysts, bone in 31 per cent, and 214 ABSTRACTS teeth in 18.3 per cent. Thyroid tissue was present in 10 cases, nervous tissue in 6, carti­ lage in 4, smooth muscle in 3, striated muscle in 1, and gastric mucosa in 1 case. Other neoplastic conditions were found in 10 cases. There were 2 deaths among the 167 patients, following surgical removal of the growths, a primary mortality of 1.2 per cent. The article is illustrated with photomicrographs. BENJAMIN R. SHORE

Brenner Tumors, E. FAUVET. Zur Klinik und Genese der Brenner-Tumoren, Arch. r. Gynak, 159: 585-611, 1935. The author reports 4 cases of typical solid ovarian tumors of the Brenner type. No cystic growths of this type were observed. Analysis of the clinical symptoms associated with these growths leads to the conclusion that the hormonal disturbances are not entirely of ovarian origin and may possibly be attributable to the adrenal cortex. Definite proof of this assertion, however, is lacking. Several photomicro­ graphs illustrate the article. BENJAMIN R. SHORE

Pavement Epithelium in an Ovarian Tumor of the Brenner Type, W. P. PLATE. Pflas­ terepithel in einem Ovarialtumor vom Typus Brenner, Arch. f. Gynak, 160: 309-316, 1935. An ovarian tumor measuring 18 x 14 x 10 em. and weighing 750 grams was removed with the uterus and the other normal ovary from a fifty-five-year-old patient. Histologic study of the growth showed it to contain epithelium of the Brenner type and also areas of pavement epithelium. A photograph of the gross specimen and photo­ micrographs illustrate the article. BENJAMIN R. SHORE

Speci1lcity of Masculinizing Ovarian Tumors, W. SCHILLER. Zur Frage der Spezifitat vermannlichender Ovarialtumoren, Arch. f. 'Gynak, 160: 344-430, 1935. This is a rather long and detailed discussion of the various types of masculinizing ovarian tumors and their modes of action. There are three main groups of such tumors: (1) all ovarian neoplasms in which there is a tubular arrangement which more or less resembles testicular tissue or testicular adenomas; (2) lutein ovarian growths; (3) adrenal tumors which also involve the ovaries. The chief symptoms of masculinization are hypertrophy of the clitoris, hirsutism, and deepening of the voice. The chief symptoms of defeminization are decrease in' the size of the breasts, amenorrhea, and psychic disturbances. The only real proof that a given ovarian tumor is actually the cause of masculinization is return of the patient to normal following the removal of the growth. The article is illustrated with photographs of a patient before and after operation and numerous photomicrographs. Several case histories are also reported. BENJAMIN R. SHORE

Ovarian Pseudomyxoma Peritonei and a Mucocele of the Appendix, H. ABBELOOS. Maladie g~latineuse de peritoine kystes de I'ovaire et mucoceles appendiculaires, Scalpel 88: 1283-1289, 1935. Two cases are reported. One patient was a woman of forty-five whose abdomen was filled with masses of gelatinous material. An ovarian cyst was adherent to the pelvic peritoneum. Autopsy disclosed numerous peritoneal implants of an epithelial nature which formed small multilocular cysts. These cysts were filled with mucous secretion. The wall of the ovarian cyst had completely desquamated and was infiltrated with lymphocytes. The second case was one of mucocele of the appendix in a man, fifty years old. A review of the literature accompanied these reports. CHARLES A. WALTMAN

Bilateral Ovarian Tumors, H. PAUCOT AND E. HOUCKE. Tumeur ovarienne bilaterale, Bull. Soc. d'obst, et de gynec, 24: 205-206, 1"935. A case report. JOHN S. LOCKWOOD THE GENITO-URINARY TRACT 215

Hormonal Content of Corpus Luteum Cysts, A. v. PROBSTNER. Hormonuntersuchun­ gen in Corpus-Iuteum-Zysten, Endokrinologie 16: 174-179, 1935. Bilateral corpus luteum cysts were removed from a twenty-two-year-old patient four weeks following curettage of the uterus for a benign hydatid mole. Studies of the ovarian cystic fluid showed moderate amounts of prolan B and a smaller amount of follicle hormone. Persistence of prolan in the urine following the termination of pregnancy should suggest a reservoir, such as an ovarian cyst, which is feeding this hormone into the circulatory system. There is nothing to suggest that it is formed locally in a corpus luteum cyst. A typical corpus luteum cyst removed from a twenty-three-year-old patient showed large amounts of follicle hormone but none of the corpus luteum type. BENJAMIN R. SHORE

Luteinoma of the Ovary, DECOULX, BEDRINE AND BASTIEN. Luteinorne de I'ovaire, Bull. Soc. d'obst. et de gynec, 24: 458-459, 1935. A case report. JOHN S. LOCKWOOD

Pedunculated Parovarian Cyat and Dermoid Cyst of the Ovary in a Young Girl, J. VAN VERTS. Kyste pedicule du parovaire et kyste dermotde de I'ovaire chez une fillette, Bull. Soc. d'obst. et de gynec, 24: 203-204, 1935. A case report. JOHN S. LOCKWOOD

Ovarian Cyst and Pregnancy, FAVREAU. Kyste de I'ovaire et grossesse; difficulte du diagnostic, Bull. Soc. d'obst. et de gynec. 24: 40{}-401, 1935. A case report. JoaN S. LOCKWOOD

Cyst of the Vagina and Prolapse, G. DESBONNETS. Kyste du vagin et prolapsus, Bull. Soc. d'obst. ,et de gynec. 24: 460-461, 1935. A case report. JOHN S. LOCKWOOD

Cystic Lymphangioma of the Recto-vaginal Septum, HAMANT AND ROTHAN. Lym­ phangiome kystique de la c1oison recto-vaginate, Bull. Soc. d'obst. et de gynec, 24: 339-340, 1935. A brief case report without illustrations or unusual features. JoaN S. LOCKWOOD

Lipoma of the Vulva, E. DELANNOY. Liporne de la grande levre, Bull. Soc. d'obst, et de gynec. 24: 452-453, 1935. A case report. JOHN S. LOCKWOOD

THE GENITo-URINARY TRACT

Prognosis in Renal Carcinoma and the CUnical and Pathologic Data AffectingIt, W. F. BRAASCH AND M. GRIFFIN. J. A. M. A. 106: 1343-1346, 1936. As an index to prognosis and in the interest of simplified terminology, it would seem best to regard all malignant tumors of the renal cortex as carcinomas and to grade them according to the degree of cellular differentiation. From a clinical point of view, these tumors may be divided further into two groups which have distinct clinical character­ istics: (1) adenocarcinomas (hypernephromas); (2) alveolar carcinomas. While the size of the tumor alone has no bearing on the postoperative results, nevertheless, a large firm tumor with a short history and evidence of marked toxemia would indicate an unfavorable prognosis and would accordingly render the advisability of operation questionable. BENJAWN R. SHORE 216 ABSTRACTS

Primary Adenocarcinoma of the Xidney, L. ATHERTON. Kentucky M. J. 33: 440-444, 1935. Two case reports of primary adenocarcinoma of the kidney. In each instance, after pyelography, surgical removal of the involved kidney was done, followed by roentgen irradiation. In the first patient pulmonary metastases occurred one month after operation. W. S. MACCOMB

Cancer of the Xidney, GAYET. Cancer du rein. Importance de la radiographie pour le diagnostic, Lyon chir. 32: 447-448, 1935. Intravenous pyelography failed to reveal a hypernephroma of the kidney which was demonstrated by a retrograde pyelogram. CHARLES A. WALTMAN

Traumatic Rupture of a Carcinoma of the Kidney in a Child, O. ORTH. Traurnatische Ruptur eines kindlichen Nierenkarzinoms, Zentralbl. f. Chir. 63: 382-384, 1936. The case is reported of a four-year-old child who was seen in shock from hemorrhage shortly after slipping and falling on the ice. The diagnosis of a ruptured spleen was made and laparotomy performed. The spleen was intact but there was a large rent in the left kidney and a large retroperitoneal hematoma. The clotted blood was evacuated and the kidney was removed. Examination-of this organ revealed a large carcinoma. The child made a good recovery from the operation but died three months later of widespread metastases. A photograph of the gross specimen and a photomicro­ graph illustrate the article. BENJAMIN R. SHORE

UnuauallyLarge Renal Tumors, W. WALTERS AND N. W. THIESSEN. Surg, Clin. North America 15: 1155-1157, 1935. The authors report two cases of unusually large renal tumors. One was an adeno­ carcinoma of the hypernephroma type which measured 20 em. long and weighed 290 gm. The other was a case of bilateral polycystic kidneys. There are no illustrations. BENJAMIN R. SHORE

Squamous-Cen Carcinoma of the Renal Pelvis: Report of Case, M. SILVERSTONE. Brit. J. Surg. 23: 332-336, 1935. The case is reported of a fifty-four-year-old man on whom a right nephrectomy was performed for a squamous-cell carcinoma originating in the renal pelvis. At the time of operation, a number of firm, smooth lymph nodes were found extending from the renal pedicle upward to the region of the liver. The patient died two months after operation. A photograph and three photomicrographs illustrate the article. BENJ AMIN R. SHORE

Transurethral Resection of the Malignant Prostate with a Review of Fifteen Cases, A. JACOBS. Brit. J. Urol. 7: 321-329, 1935. When a digital examination of the prostate by rectum reveals a gland which is obviously malignant, the disease must in general be regarded as fatal. If a permanent suprapubic drainage apparatus can be obviated and the patient enabled to pass urine without discomfort, the remainder of his life will be less burdensome to himself and his household. For this the author advocates transurethral resection. During the past year he has performed such resections on 15 of 19 patients proved to have carcinoma of the prostate gland. There was one operative death. Twelve of the remaining 14 patients were relieved of obstructive symptoms. One of the two others required suprapubic drainage in spite of the resection, while the other continued to have supra­ pubic leakage from a previous cystostomy wound even after two resections. BENJAMIN R. SHORE

Tumors of the. Spermatic Cord, Bpididymis, and Testicular Tunics, G. J. THOMPSON. Surg., Gynec. & Obst. 62: 712-728, 1936. The author reviews the literature and reports a series of 41 additional cases of tumors of the spermatic cord, epididymis, and testicular tunics seen at the Mayo Clinic prior THE GENITO-URINARY TRACT 217 to Jan. 1, 1935. Of the 66 spermatic cord tumors, 21 were lipomas, 1 a fibroma, 1 a hemangioma, 1 a cystadenoma, 1 a fibrosarcoma, and 1 a myosarcoma. The 13 tumors of the epididymis included 1 dermoid cyst, a hitherto unreported type of epididymal enlargement, 1 cystadenoma, 4 angiomas, and 7 carcinomas. There were 2 tumors arising in the tunica vaginalis, a fibroma and a cystadenoma. The following conclusions were drawn from this study. Approximately 70 per cent of al1 tumors of the spermatic cord, 40 per cent of the tumors of the epididymis, and 60 per cent of tumors of the testicular tunics are benign. The prognosis is more favorable in cases of tumor of the spermatic cord, epididymis, and testicular tunics than in cases in which tumor originates in the testis; tumors of the testis are, almost without exception, highly malignant. The 41 cases are reported in detail together with photographs and photomicrographs. BENJAMIN R. SHORE

Inguinal Gland Metastases in Carcinoma of the Penis, B. S. B'ARRINGER. J. A. M. A. 106: 21-24, 1936. Sixty-three of 100 patients with carcinoma of the penis treated at the Memorial Hospital apparently and probably had no extension beyond the primary growth. Fifty-five of these 63 patients have been symptom-free for periods ranging between one month and ten years fol1owing treatment. Eight patients died of the disease be­ tween one and five years, and 19 have been well for over five years. Thirty-seven, or a little more than one-third of the patients had metastases to the inguinal lymph nodes; a positive diagnosis of carcinoma was made by histologic study in 14 of these cases. Nine, or 24 per cent, of these 37 patients were controlled for periods between one and ten years. In none of the nine was radical dissection of the groin done at the Memorial Hospital. One patient had had a groin dissection at another hospital with recurrence of the cancer in the groin. Four were treated by external irradiation alone and 4 by external irradiation and radon seed implantation. One patient received 110 treatment. The 28 remaining patients all died of carcinoma, although four lived between two and three years and one lived more than three years. BENJAMIN R. SHORE

Prognosis in Malignant Growths of the Testicle, K. M. WALKER. Lancet 2: 1424, 1935. All malignant tumors of the testicle have a high degree of malignancy, though the outlook is slightly better in seminomas than in teratomas, Aside from the nature of the tumor, prognosis depends upon the time at which the lesion is discovered, the presence or absence of metastases, and the completeness of the treatment. Simple orchidectomy is seldom curative, and orchidectomy with surgical extirpation of the lymphatic field is a severe operation with a mortality of about 10 per cent and a con­ siderable number of recurrences. The majority of surgeons favor orchidectomy supple­ mented by x-ray therapy. Following such therapy the author has patients living free from recurrence for eight, seven, six, three, and two years, though his total number of cases is small [number not stated].

Two Cases of Chorionepithelioma of the Testicle, with a Positive Aschheim-Zondek Testin One Case, A. LEVI-VALENSI, J. MONTPELLIER, M. DEBRIE AND M. BARTHOLI. Deux cas de chorio-epitheliome du testicule (avec reaction de la grossesse positive dans un cas), Semaine d. h6p. de Paris 11: 179-184, 1935. In one of the cases reported the diagnosis of trophoblastoma or chorionepithelioma of the testicle was made from biopsy of a subclavicular node. This patient gave a posi­ tive Aschheim-Zondek test. A second case was diagnosed as chorionepithelioma of the testicle from a tumor removed with the left testicle. The Aschheim-Zondek test in this case was negative. No autopsy findings or photomicrographs are included. CHARLES A. WALTMAN 218 ABSTRACTS

Carcinomatous Change in a Condyloma Acuminatum or Precancerous Condylomatoid Tumor? H. MUHLPFORDT. Uebergang von spitzem Kondylom in Karzinom oder kondylomatoide Prakanzerose? Centralbl. f. allg. Path. u. path. Anat. 64: 38-40, 1935. The author discusses Schirner's article (Centralbl. f. al1g. Path. u. path. Anat. 61: 305, 1934. Abst. in Am. J. Cancer 24: 431, 1935) on unusual1y early malignant changes in a condyloma, and comes to the conclusion that the lesion was actually a " condyloma­ toid precancer" such as he [Muhlpfordt] has described, and included in one category with Paget's and Bowen's diseases. Thus there are precancerous lesions of the genital organs as there are of the breast and the skin. Al1 are cancers from their very inception, but cancers that are held in restraint by the defensive forces of the body. The following classification is proposed for tumors in the genital area: 1. Condyloma acuminatum (a fibroepithelial growth). 2. Condylomatoid precancer (an apparently benign tumor with malignant potentialities). 3. Carcinoma. In an addendum Schirner reiterates his original diagnosis. WM. H. WOGLOM

THE NERVOUS SYSTEM

Tumors of the Brain, J. G. LOVE. Surg, Clin. North America 15: 1379-1385, 1935. This is a general article concerning the diagnosis and treatment of brain tumors, illustrated with several case reports and drawings. BENJAMIN R. SHORE

Roentgen Diagnosis and Treatment of Brain Tumors, H. OLIVECRONA. Bedeutung des Rontgenbildes fur die Anzeigestellung und Behandlung der Gehirntumoren, Fortschr. a.d. Geb.id. Rontgenstrahlen 52: 355-368, 1935. This is a general discussion of the roentgenologic diagnosis and localization of inflammatory and neoplastic lesions of the brain. It is profusely illustrated with drawings, photographs, and roentgenograms. BENJAMIN R. SHORE

Indications and Limitations of Encephalography, F. E. FLUGEL. Grenzen und Anzeige der Enzephalographie, Fortschr. a. d. Geb. d. Rontgenstrahlen 52: 349-355, 1935. Encephalography will demonstrate changes in the size, form, and position of the ventricles of the brain and is indicated in al1 cases in which there is a suspicion of an intracranial lesion. It is especially useful in the early diagnosis of brain tumors and will lead to correct diagnosis in 10 per cent of the cases in which neurologic signs are lacking. Roentgenograms and photographs illustrate the article. BENJAMIN R. SHORE

IDtimate Results of Operations for Intracranial Tumors, H. CAIRNS. Yale J. BioI. & Med. 8: 421-492, 1936. A report dealing with the late results of a series of intracranial tumors operated upon during the twelve-month period, September 1926 to September 1927, in the clinic of Dr. Harvey Cushing at the Peter Bent Brigham Hospital, Boston. During that period Dr. Cairns acted as Assistant Resident Surgeon in Dr. Cushing's clinic. A report of the year's work was first published by the British Medical Research Council (Special Report Series No. 125, London, His Majesty's Stationery Office, 1929). That report was concerned with a discussion of the 369 patients admitted to the clinic for symptoms more or less unmistakably suggesting intracranial tumor." In 157 of these cases the tumor was histologically verified and classified after operation. Of these patients, 22 died in the hospital j the remaining 135 left the hospital alive. The present report is concerned with the ultimate fate of the latter group. 0( the 135 patients discharged from the hospital, 63 were alive when last heard from, seven to nine years later. The time and manner of death of the 72 patients who have succumbed in the interval is in most instances known and in some cases post-mortem examinations were secured. Survival tables [of which several are included] support in a general way the impression that about half the intracranial tumors coming to THE NERVOUS SYSTEM 219 operation are benign, one-half malignant. Such survival tables do not, however, ordinarily give any clue to the period of useful life following operation. To assess the value of surgical treatment for intracranial tumors it is necessary to consider separately each pathological type. The life history of a glioma can be predicted with reasonable accuracy after it has been thoroughly studied histologically. Glioblastoma multiforme is typically a rapidly growing tumor of the white matter of the cerebral hemispheres of adults. The illness runs a rapid course and even very radical extirpation of the growth is usually followed by recurrence. There were 8 cases of this type of tumor in the series studied. In 6 an apparently complete removal of the lesion was accomplished at operation, in 2 only partial removal. In all, the tumor recurred after a brief interval and all the patients soon died. The shortest survival period from operation was two and a half months, the longest fourteen months, the average six and a half months. Cerebe1lar medulloblastoma is another highly unfavorable type of glioma. Usually arising in the vermis of a child or young adult, it grows rapidly and quickly produces hydrocephalus. Even though the tumor can sometimes be shelled out, apparently completely, it recurs usually within a year. Metastases may occur in the cerebral and spinal subarachnoid spaces as well as in the ventricles. X-ray or radium therapy produces a prompt amelioration of symptoms for the tumor is, at least at first, the most sensitive to x-rays of any of the intracranial neoplasms. Of 5 patients with cerebellar medulloblastomas, all died in from two to nineteen months after operation. The average survival period was thirteen months. Cerebral medulloblastoma occasionally occurs but is much less common than the cerebellar type. The cerebral lesion does not appear to have the same life history as the cerebellar medulloblastoma nor, as a rule, the same degree of radiosensitivity. There were two examples of cerebral medulloblastomas in the author's series. One patient died five months after operation while the other survived nearly five years. These tumors are occasionally mistaken histologically for oligodendrogliomas. Cerebellar astrocytoma is one of the most satisfactory intracranial tumors to deal with surgically. Composed of fully differentiated astrocytes, it occurs chiefly in young adults and children, in the vermis and lateral lobes of the cerebellum. It generally appears quite circumscribed and benign. If all the tumor visible to the naked eye is surgically removed, the tumor, as a rule, does not recur. In this connection, however, it must be noted that symptoms of recurrence after incomplete removal may be delayed for as long as eleven years. There were 4 cases of cerebellar astrocytoma in this series. In one case extirpation was incomplete and death occurred after a second attempt at operation fourteen months later. In the other 3 cases the tumor was completely re­ moved, and all three patients were well when last heard from seven to nine years after operation. The longest survival in Dr. Cushing's entire group of cerebellar astro­ cytomas is twenty-six years. Cerebral astrocytomas are often not as homogenous tumors histologically and in general are more invasive and less readily extirpated. Recurrence after an apparently complete removal is common. There were 15 cerebral astrocytomas, 11 of which caused death within three years. Eight patients had a second operation for recurrence of the tumor. The average survival period was thirty-seven months. There is considerable variation in the rate of growth of individual astrocytomas. Oligodendrogliomas also show more variability in their rate of growth than was formerly appreciated. There were 2 cases in the series. In one death occurred suddenly one year and nine months after operation. The second patient survived nearly nine years, during which time four operations had been carried out. Astroblastoma, too, shows considerable variation in its rate of growth. Of the 4 patients in this series from whom tumors of this type were removed, one lived three months, another thirteen months, a third survived over four years, while the fourth patient is entirely free from symptoms nine years after operation. There were 29 patients with pituitary adenomas operated upon during the year, the majority by the transsphenoidal route. Of these tumors, 5 were chromophilic adenomas, 24 chromophobic adenomas. One patient died in the hospital, 9 died some years later, and 19 are living seven to nine years after operation. The working ability of these 19 220 ABSTRACTS individuals is as follows: insufficient information 3, full work 11, part work 1, no work possible 4. The writer favors the transfrontal operation for the majority of such cases, but believes the transsphenoidal approach is still to be used to advantage in elderly patients and in those whose vision has been badly damaged for a long time. The meningioma, or dural endothelioma, is a tumor that is usually attached to the dura. The evolution of the growth is generally so slow that the tumor frequently attains a large size before it produces serious symptoms. Such tumors are often very vascular and consequently difficult to remove. They are usually quite circumscribed and complete removal is generally followed by gratifying results. Meningiomas were found in 28 patients. Five of these died after operation. To the 23 patients who left the hospital alive 3 others have since been added. All of these 26 patients have been traced for seven to nine years from the time of operation. The location of the tumors was as follows: sagittal and parasagittal 5; convexity 5; pterional 4; sphenoid ridge 2: olfactory groove 4; suprasellar 2; cerebellar 4. Because of the fact that endothermy was introduced into the clinic in the year under consideration, several old patients had been sent for, which accounts for the apparently high incidence of meningiomas in the series. Likewise the effect on immediate mortality for the year was unfavorable, as many of the early attempts to use endothermy were inexpert. Of the 26 patients, 8 died at varying intervals, from recurrence of the tumor. In 2 of these removal had apparently been entirely complete. Prior to this time the importance of removing all suspicious overlying dura and bone was less fully realized. The two patients above mentioned had first been operated upon some years before. There were 18 patients alive seven to nine years after operation. Eight of these were completely well and 6 others were able to work. Certain cases in this series therefore provide excellent late results, but a study of the series as a whole provokes the question whether the results are ever likely to be as uniformly good as the late results of removal of cerebellar astrocytomas and hemangioblastomas. It must be realized, however, that the operative technic for removal has probably improved more for the meningiomas since then, than for any other intracranial tumor. Ten acoustic neurinomas were operated upon by the method of intracapsular extir­ pation, the greater part of the capsule with a shell of tumor tissue being left in place. Of the 10 patients, one died in the hospital soon after operation, another died three years later from bronchiectasis due to chronic dysphagia. Eight patients were living when last heard from seven to nine years after operation, but of these 3 were completely or seriously incapacitated. Little has been written about the condition of patients after this operation, but it is probable that prolonged disability is not unusual. Six patients in this series were left with severe disturbances of balance, lasting through a period of years after operation. At the present time the majority of neurosurgeons favor the intracapsular operation. A few advocate attempts at complete removal. If the latter operation is carried out indiscriminately, the mortality is likely to be very high. The problem is worthy of the most earnest and sustained attention because the tumor is quite benign. . There were 2 patients with intracranial cholesteatoma: one with a tumor of the anterior and middle fossae, not in any way connected with middle ear disease, the other with a tumor in the cerebellopontine angle. Although in neither case had the removal of the tumor been absolutely complete, both patients were alive and well seven years after operation. One of the most favorable intracranial tumors is the hemangioblastoma of the cerebellum, but that fact is not shown by the present series. One patient died after a complete removal, while in another the tumor was found to be irremovable. There were 2 cases of arteriovenous angioma of the cerebral hemispheres. Both patients were alive eight years after operation. One was treated by decompression and x-ray therapy; the other probably similarly. One patient with what was probably a left frontal parasaggital granuloma died two and three-quarter years after operation. One patient with a cerebellar tuberculoma died four months after operation; another is alive at the time of this report. Of the patients with metastatic tumors, one died in the hospital and 7 were discharged alive. Five of these died within five months after operation. In a much larger series of metastatic tumors from Dr. Cushing's clinic (Meagher and Eisenhardt: Ann. Surg. THE NERVOUS SYSTEM 221

93: 132, 1931. Abst. in Am. J. Cancer IS: 1845, 1931) the average postoperative sur­ vival was only six weeks. A regional classification of tumors is nowadays becoming less important than formerly, owing to the advances in neurosurgery. A few years ago it could be said that so far as deep-seated tumors were concerned the site of the tumor influenced the expectation almost as much as did its pathological nature. The recent results obtained with benign tumors of the midbrain, third and lateral ventricles make it obvious that this is no longer true. At present, in general, the site of a tumor is of paramount im­ portance in prognosis only when the tumor lies within the corpus calIosum, basal ganglia, midbrain, pons, or medulla oblongata. The writer gives analyses of the year's series of cases by location of tumor and then by age of the patient. Finally he discusses the effects of treatment on individual signs and symptoms. After complete removal of a tumor headache appeared to be relieved invariably. Vomiting also ceased. The degree of improvement of visual disturbance depends mainly on the amount of damage to the optic nerves that has occurred before operation. The writer hesitates to come to any conclusion as to the effects of operation upon epilepsy, as the series is too small. Postoperative epilepsy in the series was milder than before operation. Mental symptoms are generally permanently relieved folIowing tumor removal. Aphasia likewise responds very favorably, as do sensory and motor functions. There are 37 useful survivors front among the 157 patients. seven to nine years after operation. Of the whole series of 157 patients, 14 per cent died within a few weeks of operation, 12.7 per cent died in the first year, 12.1 per cent in the second year, 5.0 per cent in the third year. Forty per cent were alive at the end of seven to nine years, and 23.5 per cent were living a useful life. These good results are not modified by the number of benign tumors in the series, as the operative mortality of some types of benign tumors is higher than is that of malignant tumors. Selection of cases played practically no r6le in the results, as only 6 patients during the year died from brain tumor without a major operation having been performed. There was only one patient discharged from the hospital alive as having an inoperable tumor. When these intracranial tumor cases are compared with tumors affecting other parts of the body, the results do not appear so good. The latter groups however permit of quite strict selection of cases suitable for radical surgery, which is not true of brain tumors. The late results in malignant types of gliomas were almost uniformly bad. The best results were obtained in cases of cerebelIar astrocytomas, cholesteatomas, meningiomas, hemangioblastomas, pituitary adenomas, and in a smaII proportion of acoustic neurinomas. Numerous case reports are included and a bibliography is appended. EDWIN M. DEERY

Occurrence of Di1ferent Types of Brain Tumors in One Patient, E. SACHS. Surg., Gynec. & Obst. 62: 757-759, 1936. Sachs reports four cases of multiple brain tumors. The first patient was a man with bilateral eighth nerve tumors, an osteoma, and 2 meningiomas. The second had an acoustic neuroma and an enormous asymptomatic frontal meningioma. The third had a recurrence of a spinal meningioma fourteen and one-half years after the removal of the original growth. The' fourth patient had numerous cutaneous tumors of von Recklinghausen's disease, a large nevus on his back and another on his foot, and a large astrocytoma of the right frontal lobe. This last case raises the question of the relation­ ship between von Recklinghausen's disease and astrocytomas. The article is illustrated with photographs and roentgenograms. BENJ AM IN R. SHORE

Traumatism and Cerebral Tumor, L. RIM BAUD, H. L. GUIBERT, G. ANSELME-MARTIN AND R. LAFON. Traumatisme et tumeur cerebrale, Arch. Soc. d. Be. med, et biol, de Montpellier 16: 360-367, 1935. The patient was thrown from a cart and struck the occipital region but was able to get up and move about after the accident. He developed neurological signs and epilep­ tic seizures afterward and died two years and four months later. Autopsy disclosed a 222 ABSTRACTS glioblastoma of the frontoparietal portion of the right hemisphere. The authors sug­ gest that organization of a hematoma resulting from the trauma may have given origin to the tumor. There are no illustrations and no bibliography is included. CHARLES A. WALTMAN

Cerebral Angioma with Arteriovenous Fistula Treated Surgically with Electrocoagula­ tion, Report of Case, W. L. BUTSCH ANn A. W. AnSON. Surg, Clin. North America 15: 1317-1326. 1935. A twenty-six-year-old woman had an angioma and arteriovenous fistula involving the right parietal region of the brain. The arterial blood came from the middle cerebral artery which communicated with a large vascular ramification, including branches and sinuses from the lateral veins of the longitudinal sinus. A number of the afferent arteries were ligated and the remainder of the angiomatous mass was destroyed by electrocoagulation. A decompression was made at the base of the flap. A letter, written several months after operation. stated that the patient was much improved and had not had any more convulsions with loss of consciousness. Her left leg was of normal strength and she was able to do housework. She still had attacks of numbness in the left arm coming two or three times a month and lasting two or three minutes. There was some weakness of the left arm but not enough to impair its usefulness. Two drawings illustrate the article. BENJAMIN R. SHORE

Tumors of the Sellar Region, D. MANOLESCO AND G. SCHMITZER. Contribution a l'etude des tumeurs de la region sellaire, Rev. d'oto-neuro-opht. 12: 661-671, 1934. Remarks concerning tumors arising in the region of the sella turcica, and reports of 6 cases seen by the writers. (1) A woman of forty-two years had a pituitary adenoma which was treated satis­ factorily by x-ray therapy. Some six months after treatments began, the visual fields were normal. (2) A girl of sixteen showed the adipose-genital syndrome, bitemporal hemianopsia, and optic atrophy. X-rays of the sella were normal. Roentgen therapy was followed by disappearance of headaches and some improvement in vision. [Rather unusual that a craniopharyngeal pouch cyst should be favorably influenced by x-ray therapy.] (3) A man of forty-four showed bitemporal hemianopsia, paresis of the oculomotor nerves, and an enlarged sella turcica. The diagnosis was intrasellar tumor [presumably pituitary adenoma]. X-ray therapy resulted in disappearance of headaches and visual improvement. (4) A woman of forty years showed optic atrophy, bitemporal hemianopsia, and an enlarged sella turcica. The clinical diagnosis was intrasellar tumor [presumably pitui­ taryadenoma]. Roentgen therapy resulted in marked improvement in both headaches and visual acuity. (5) A woman of twenty-eight showed atrophy of the left optic nerve head and a temporal hemianopic visual field defect on the same side. A clinical diagnosis of left sphenoid ridge meningioma was made and x-ray therapy was followed by some im­ provement [another unusual result if it be true that meningiomas are not radiosensitive]. (6) The last case was that of a man of forty-four years who showed bilateral optic atrophy, bitemporal hemianopsia. and other signs leading to a clinical diagnosis of malignant pituitary tumor. X-ray therapy was not followed by clinical improvement. The writers stress the great importance of taking color fields of vision as well as white, in testing for visual field defects, since hemichromatopsia precedes hemianopsia. In cases where visual acuity is so low that the usual tests cannot be carried out it is well worth while testing light perception in the various sectors of the visual fields. In cases of oculomotor palsies the visual fields are very important and may yield valuable data. Radiotherapy is indicated in all tumors of the sellar region regardless of their nature. surgery being indicated only when x-ray fails. [Many will disagree with this statement as it does not seem logical to risk the remaining visual acuity of an individual while giving x-ray therapy in cases where the clinical syndrome makes it almost certain that the tumor is of a radioresistant type, such as the meningioma or the craniopharyngeal THE NERVOUS SYSTEM 223 pouch cyst.) Finally, the writers have found that the restoration of the fields of vision after x-ray therapy occurs separately for each color. EDWIN M. DEERY

Optic Atrophy in Cases of Hypophyseal Tumor, F. FISCHER. Klinische Stu die zur Op­ tikusatrophie bei den Hypophysentumoren, Ztschr. r. Augenh, 87: 184-199, 1935. In early cases of hypophyseal tumors the fundi of the eyes may be entirely normal, although the patients may by this time have decreased vision and bitemporal hemianopsia. The number of patients with hypophyseal tumors having normal eye grounds is quite large. The characteristic change when it does occur is temporal pallor of the discs, which in some cases may extend toward the nasal side. In a series of 58 proved cases of hypophyseal tumors, normal papillae were present in 6, temporal pallor in 32, and bilateral complete pallor of the discs in 20 cases. Fol­ lowing operation vision is improved but the pallor of the optic discs is not improved and may progress. The article is not illustrated. BENJAMIN R. SHORE

A Review, Clinical and Pathological, of Parahypophyseal Lesions, C. H. FRAZIER. Surg., Gynec. & Obst. 62: 1-33; 158-166, 1936. Frazier discusses in detail and illustrates with case reports, numerous photographs, drawings, charts, and photomicrographs the eight lesions of the parasellar region. These are intracranial aneurysms; tumors of the optic nerve and chiasm; tumors of the lesser wing of the sphenoid; pseudo-tumors, which include meningitis circumscripta and arachnoiditis; tumors of Rathke's cleft; hypophyseal stalk tumors; the suprasellar fibroblastomas, and the suprasellar adenomas. The diagnosis. prognosis, and treatment of all these lesions are discussed. BENJAMIN R. SHORE

Tumors of the Spinal Cord, W. M. CRAIG. Surg. Clin. North America 15: 1371-1377, 1935. Tumors of the spinal cord are predominantly benign and, if removed before perma­ nent injury has occurred, they respond satisfactorily, as a group, to surgical treatment. The extramedullary tumors, which arise outside the spinal cord itself, are most frequent and carry a favorable prognosis. In metastatic extramedullary and primary intra­ medullary tumors the prognosis is naturally unfavorable. However, neoplasms of this latter group occur rarely enough to make the prognosis for all tumors of the spinal cord hopeful until proved otherwise at operation. BENJAMIN R. SHORE

Neurofibromatosis. The Effect of Pregnancy on the Skin Manifestations, ]. C. SHARPE AND R. H. YOUNG. j, A. M. A. 106: 682-683, 1936. Four cases of von Recklinghausen's neurofibromatosis are reported in which definite detrimental effects were observed following pregnancy. Three of the patients had noted cafe au fait pigmentation of the skin since early childhood, while the fourth had had a clear skin until her first pregnancy. In only one case had a solitary subcutaneous nodule developed before pregnancy. In all of the patients with the occurrence of the first pregnancy numerous skin and subcutaneous tumors appeared. Histologic study showed them to be neurofibromas. In addition, areas of brownish pigmentation oc­ curred that were confined chiefly to the trunk. In all instances, delivery seemed to cause an arrest in the growth and multiplicity of the skin nodules. However, with each subsequent pregnancy the same phenomenon occurred. Delivery was normal in each case. The advisability of the prevention of pregnancy in those women with either the incomplete or complete form of neurofibromatosis is concluded from this study. BENJAMIN R. SHORE

Multiple Neurofibromatosis, R. KIENBOCK AND E. G. MAYER. Uber multiple Neuro­ fibromatose, Fortschr. a. d. Geb. d. Rontgenstrahlen 51: 387-391, 1935. An eighteen-year-old boy had suffered for many years with a painful spine, fever, and general debility. The diagnosis of tuberculous spondylitis had been adhered to until a large lobulated tumor mass in the posterior mediastinum was discovered by roentgen examination. It is now believed thatthis patient is suffering from neurofibromatosis 224 ABSTRACTS with secondary changes in the vertebral column. Photographs of the patient and roentgenograms illustrate the article. BENJAMIN R. SHORE Neurofibromatosis with Reference to Skeletal Chances, Compre88ion Myelitis and Malignant Degeneration, A. MILLER. Arch. Surg. 32: 109-122, 1936. A twenty-one-year-old man had a marked kyphoscoliosis, compression myelitis, nerve tumors, and cutaneous pigmentation typical of neurofibromatosis. Roentgen study of the vertebral column showed a sharply kinked kyphosis with the apex at the first lumbar vertebra. The vertebral bodies were porotic and collapsed and, owing to the destruction of the intervertebral discs, they could not be differentiated from each other at the apex of the curve. The patient died a few hours after the surgical removal of a superficial tumor near the right hip. Examination of the growths showed them to be neurofibromas which had undergone malignant change. The article is illustrated with photographs of the patient and photomicrographs. BENJAMIN R. SHORE

Facial Expresaion in von RecklinghaUien's Disease, RILLE. Der Gesichtsausdruck, ein neues Kennzeichen des Fibroma molluscum (Morbus Recklinghausen), Dermat, Wchnschr. 101: 1432-1437, 1935. The author describes a peculiar apathetic, sad, tired, sleepy, melancholy, resigned facial expression of patients with multiple neurofibromatosis. The one positive and characteristic sign is a slowing of the blinking of the eyes and lessening of the frequency of this movement. The characteristic facial expression may be present in persons with relatively few skin tumors and is apparently unrelated to the extent of the external skin deformities. Several photographs illustrate the article. BENJAMIN R. SHORE Neurofibromatosis Associated with Proptosis and Defect of the Orbital Wall, A. E. MOORE. Australian & New Zealand J. Surg. 5: 314-318, 1936. Moore reports the histories of two patients with neurofibromatosis, proptosis, and congenital absence of the orbital wall. One was seven weeks and the other four years of age. Photographs and roentgenograms illustrate the article. BENJAMIN R. SHORE

A Malignant Tumor (Sympathicoblastoma) of the Superior Cervical Ganglion, F. T. LAND. Brit. J. Surg. 23: 474-477, 1935. A four-year-old boy had edema over the left mastoid and enlarged cervical lymph nodes. During the course of a mastoid operation, an extensive tumor was found re­ placing the mastoid cells and extending into the auditory meatus, the digastric groove, and the posterior cranial fossa. Histologic study showed this to be a highly malignant undifferentiated tumor of the sympathetic nervous system. The patient died of meningitis six weeks later, or ten weeks after the onset of the illness. Autopsy showed an extensive sympathicoblastoma probably arising from the superior cervical ganglion. There were no metastases or other growths in the body. One photomicrograph illus­ trates the article. BENJAMIN R. SHORE

THE BONES AND JOINTS

Chronic Osteomyelitis As.oclated with Malipancy, M. S. HENDERSON AND H. A. SWART. J. Bone & Joint Surg. 18: 56-60, 1936. Of 2396 cases of chronic osteomyelitis seen at the Mayo Clinic up to July 1, 1934, only 5, or 0.208 per cent were associated with malignant changes. These occurred in one woman and four men, from forty-five to sixty-one years of age. Draining sinuses had been present from twenty-seven to forty-eight years in these patients, the average period being thirty-seven years. In four cases the disease had followed acute osteo­ myelitis, while in one case it was preceded by a compound fracture. In all these cases there was a history of sinuses which had closed and then opened again at a later date, sequestration of bone, and other symptoms characteristic of chronic osteomyelitis. In 4 of the 5 cases the regional lymph nodes were.found to be enlarged and firm. The THE BONES AND JOINTS 225 lesion was situated in the lower third of.the leg in 4 cases and in the upper third in 1 case. Amputation was performed in 4 cases and local excision followed by cauterization and irradiation with radium and x-rays was used in the fifth case, in which the neoplastic lesion was near the hip joint. Histologic study of the tumor showed Grade I epithelioma in 2 cases, Grade I I epithelioma in 2 cases, and fibrosarcoma Grade III associated with a Grade III squamous­ cell epithelioma in 1 case. The two patients who underwent amputation in 1925 and in 1929 respectively were well and had good functioning stumps in June 1934. The patient who underwent amputation in 1924 died of chronic nephritis without recurrent tumor in March 1935. In the case in which local excision of the tumor was performed in 1921. the patient died at a later date, but the cause of death could not be determined. The patient whose leg was amputated {or a mixed fibrosarcoma and epithelioma in 1933 is now in good health. The article is illustrated with two photomicrographs. BENJAMIN R. SHORE

An Analysis of Living Patients with Primary Malignant Bone Tumors, W. C. CAMPBELL. J. A. M. A. lOS: 1496-1502, 1935. This report is based upon a study of 100 living patients with primary malignant disease of bone. Of these, 14 were personally observed by the author while 86 were taken from the files of the Sarcoma Registry of the American College of Surgeons. Of the latter group, 85 are recorded as accepted five-year cures; 74 were osteogenic sarcoma, 10 Ewing's sarcoma, and 1 a myeloma. The author's 14 cases are chosen from a group of 125. Ten were osteogenic in type and 4 non-osteogenic. All patients were treated by radical surgery and are living without sign of recurring disease from four to twelve years after treatment. Brief reports of the author's cases are given, and there are 14 illustrations. There is little discussion of the Registry material. THEODORE S. RAIFORD

Skeletal Metastases from Malignant Tumors, H. HELLNER. Knochenmetastasen bosartiger Geschwulste, Ergeb. d. Chir. u. Orth. 28: 72-196, 1935. This is an excellent review of the theoretical and practical aspects of skeletal metas­ tases from malignant tumors. Such metastases may occur following the invasion of the blood or lymph channels by any malignant tumor and are apparently independent of treatment. Although many tumors apparently metastasize by way of the blood stream, evidence is cited to support the contention that certain types of tumors, especially those of the prostate gland and female generative organs, spread to the neighboring pelvic bones by retrograde involvement of the lymphatic system. The second half of this paper is devoted to a discussion of the skeletal metastases from special tumors. Carcinomas of the breast give clinical evidence of skeletal metas­ tases in from 4 to 5 per cent of the cases, although they have been reported by radiolo­ gists to involve the skeletal system in 30 per cent. Skeletal metastases are associated with 25 per cent of prostatic cancers, 35 to 60 per cent of hypernephromas, 1 to 2 per cent of gastro-intestinal cancers, and with a large proportion of thyroid and lung can­ cers. Numerous case reports with excellent photographs, roentgenograms, and photo­ micrographs illustrate the article. An extensive bibliography is appended. BENJAMIN R. SHORE

Pathological Fractures Due to Malignant Disease, C. E. WELCH. Surg., Gynec. & Obst, 62: 735-744, 1936. This study comprises all the pathological fractures which have been observed in the Pondville Hospital from its opening in 1927 through December 1934. Only those cases are included in which a fracture line was distinguished by x-ray and found to be associated with bone destruction characteristic of a metastatic tumor. There were 66 fractures occurring in 53 of 4739 cases of malignant disease seen during this time. In 26 of the 53 cases the primary site was the breast, in 11 the mouth and lip, in 6 the prostate, in 5 an osteogenic sarcoma, in 2 the cervix, and in 1 case each the thyroid, liver, and kidney. 226 ABSTRACTS

Of the 66 fractures, 29 involved the femur, 11 the humerus, 10 the mandible, 6 the pubis, 4 the clavicle, 2 a rib, 2 a vertebra and 1 each the tibia and ulna. Twenty-five per cent of the patients died less than one month after the fracture; approximately 25 per cent died in the next two months, and another 25 per cent before the expiration of a year. Eight patients are still living, the longest three years after the occurrence of fracture. The average duration of life after all fractures, including pa­ tients that are still living, is slightly over six months. If the carcinomas and sarcomas are separated, the prognosis with respect to length of life is seen to be nearly twice as long in the latter group. Five per cent of the fractures healed with firm union, 9 per cent showed moderate healing, and 6 per cent healed slightly; no evidence of healing was obtained in 80 per cent. Of the 9 fractures that healed, either fully or moderately, 6 received x-ray therapy to the bone after the fracture. The article is illustrated with roentgenograms. BENJAMIN R. SHORE

Spontaneous Regression of Carcinomatous Skeletal Metastases, E. WEBER AND M. BRANDT. Uber spontane Ruckbildung karzinomatoser Knochenmetastasen, Fort­ schr. a. d. Geb. d. Rontgenstrahlen 52: 511-515, 1935. The authors report the case of a thirty-six-year-old woman in whom metastases to the ribs from a primary breast carcinoma regressed spontaneously over a period of several months. This regression was demonstrated radiographically by increased calcification of the involved areas. Histologic study of the bones at autopsy, however, showed residual carcinoma in the areas under discussion. The article is illustrated with roentgenograms and photomicrographs. BENJAMIN R. SHORE

Interesting Malignant Bone Tumors, O. C. HUDSON, N. H. ROBIN AND P. A. ROBIN. J. Bone & Joint Surg. 18: 215-228, 1936. The following six cases of malignant bone tumors are reported: (1) metastatic carci­ noma of the breast resembling hyperparathyroidism; (2) endothelioma of the pubis; (3) Hodgkin's disease with osseous metastases; (4) metastatic adenocarcinoma resembling primary osteogenic sarcoma; (5) metastatic carcinoma from the cervix uteri; (6) telangi­ ectatic sarcoma of the humerus. The article is well illustrated with roentgenograms. BENJAMIN R. SHORE

Bone Tumours, Somewhat Unusual in Character, A. T. NISBET. J. Cancer Research Com., Univ. Sydney 7: 40-43, 1935. Four bone tumors are reported because of uncommon features either in their radio­ graphic appearance or in their response to radiation. Two of these were osteogenic sarcomata in which x-ray therapy had been apparently effective in controlling growth and metastasis over periods of ten and twenty months at the time of the report. One was a fibrosarcoma of the right tibia, completely resistant to roentgen therapy. The remain­ ing case was variously diagnosed from the roentgenograms as osteogenic sarcoma, osteo­ chondroma, osteomyelitis and osteitis fibrosa cystica. X-ray therapy brought about some improvement but the diagnosis was still in doubt. The paper is illustrated by roentgenograms. Giant Cell Tumor of Femur with Pathologic Fracture. Giant Cell Tumor of Tibia of a Child, with Cure by Excision and Bone Graft. Tumor Diagnosed as Sarcoma Proved by Biopsyto be Benign Giant Cell Tumor, with Seventeen-Year Cure•... Sciatic Pain Produced by Desmoid Tumor of Left Trochanteric Region. A Five­ Year Cure in a Case of Endothelial Myeloma of the Left Femur, H. W. MEYERDING. Surg. Clin. North America 15: 1207-1222, 1935. The first case reported is that of a thirty-four-year-old man in whom the diagnosis of a benign giant-cell tumor of the lower end of the left femur was made by roentgeno­ grams and histologic study of a biopsy specimen in June 1925. Nine years later the leg was amputated for a fibrosarcoma originating in the same region. Either the tumor which had been benign became malignant or a new tumor developed. THE BONES AND JOINTS 227

The second case is that of a twelve-year-old boy who was operated on in March 1931 for a giant-cell tumor involving the mesial side of the diaphysis of the right tibia. At that time excision and curettage of the growth were done and a sliding bone graft was inserted. The patient has remained well to January 1935. Roentgenograms show an almost normal appearance of the previously involved site. The third case is that of a twenty-two-year-old woman who was treated in 1917 for a benign giant-cell tumor arising in the medial condyle of the left femur. This lesion was treated by curettement, cauterization, radium irradiation, and Coley's toxins. This patient has remained well for seventeen years. It is pointed out that the original roent­ gen diagnosis was malignant sarcoma and that amputation had been recommended. The benign character of the growth was demonstrated only after histologic study of a biopsy specimen. The fourth patient was a forty-two-year-old woman with sciatica, in whom complete relief followed the removal of a desmoid tumor situated beneath the sciatic nerve. The fifth case is that of an eleven-year-old girl who has remained well five years and seven months following the taking of a biopsy and a series of roentgen treatments to an endothelial myeloma originating in the left femur. Several series of Coley's toxins were also given. Photographs, roentgenograms, and photomicrographs illustrate the cases reported. BENJAMIN R. SHORE

Giant-cell Tumor of the Maxilla and Femur, PATEL. Tumeur a myeloplaxes con­ comitantes (maxillaire superieur et femur), Lyon chir. 32: 209-212,1935. A case report of giant-cell tumor of the superior maxilla and the femur, without illustrations. CHARLES A. WALTMAN Multiple Myelomas with Tumor-like Amyloidosis. A Clinical and Pathologic Study, A. H. ROSENBLUM AND J. D. KIRSHBAUM. J. A. M. A. 106: 988-991, 1936. A thirty-nine-year-old woman had atypical lesions of multiple myeloma in the skull and both iliac bones. A biopsy taken from a mass in the sternum showed this to be a tumor-like amyloidosis of the bone marrow. There were large collections of homo­ geneous material which stained with eosin, and fine deposits of a similar material in the walls of the small arteries. Histologic study of material taken from a rib showed the typical structure of a lymphocytic myeloma. Roentgenograms and photomicrographs illustrate the article. BENJAMIN R. SHORE Pathologic Fracture Through Myeloma of Shaft of Femur, W. F. MACFEE. Ann. Surg. 103: 464--469, 1936. MacFee reports the case of a forty-five-year-old man with a pathological fracture of the left femur just below the level of the lesser trochanter. The underlying tumor in this case was a multiple myeloma of the plasma-cell type which also involved the vertebral column. Immobilization of the fractured leg and a series of deep roentgen-ray treat­ ments resulted in firm union of the fracture at the end of four months. The report is illustrated with roentgenograms and one photomicrograph. BENJAMIN R. SHORE Tumors Simulating Carcinoma-Schiiller-Christian's Disease or Xanthomatosis, W. A. HANSON AND 1. H. FOWLER. Minnesota Med. 18: 627-628, 1935. A case of Schuller-Christian's disease or xanthomatosis of the skull in a fifty-year-old woman had progressed but little over a period of nine years, despite failure to follow x-ray treatments as advised. The disease presented a bizarre picture-typical skull findings without diabetes or exophthalmos but with lymph node involvement from which the diagnosis was made. It is pointed out that the prognosis is much better than that of carcinoma. The treatment is radiotherapy. THEODORE S. RAIFORD On the Diiferent Forms of Non-Generalized Fibrous Osteodystrophy, E. FREUND AND C. B. MEFFERT. Surg., Gynec. & Obst. 62: 541-561, 1936. The authors have divided their 25 cases of osteitis fibrosa into the following four groups: (1) 18 cases of cystic and solid localized lesions: (2) 2 cases of multiple localized 228 ABSTRACTS lesions; (3) 2 cases of diffuse monostotic lesions; (4) 3 cases of unilateral osteodystrophia fibrosa. These cases are reported in detail with accompanying roentgenograms. The localized solid or cystic lesions of osteitis fibrosa are usually situated in the upper metaphysis of the humerus, femur, and tibia: less frequently diaphyseal, but never epiphyseal, localization is observed. More extensive cases are also occasionally seen with involvement of the greater part of the diaphyses. Multiple localized lesions are rare but may occur without any apparent rule in the distribution of the lesions. There is a strictly unilateral form of fibrous osteodystrophia with involvement of the entire or great portions of the diaphysis of bones arranged in longitudinal ray-like anatomical distribution. On the basis of such observations, it is believed that the localized form of osteitis fibrosa represents an abortive type of the extensive monosseous form. Dis­ turbances of calcium metabolism and tumor formation in parathyroid glands are demonstrable in almost every case of von Recklinghausen's disease, but never in the various localized forms of fibrous osteodystrophia. BENJ AMIN R. SHORE

Patholopc and Biochemical Chances in Skeletal Dystrophies. Analysis of Results of Treatment of Parathyroid Osteo8i., E. L. COMPERE. Arch. Surg. 32: 232-272, 1936. Parathyroid osteosis may be differentiated from other skeletal dystrophies which are clinically similar. This condition is characterized by weakness, pain in the long bones, generalized osteoporosis, a high calcium content of the serum, a low phosphate content of the plasma, increased excretion of calcium in the urine, and a negative calcium bal­ ance; an adenomatous tumor of one or more parathyroid glands has always been ob­ served at post-mortem examination and nearly always at operation, while the remaining glands are of normal size and structure. One hundred and twenty-four cases in which the diagnosis was verified at operation or autopsy have been collected from the literature and are reviewed. There is no good evidence that Paget's disease is caused by hyperparathyroidism. In this condition the calcium and inorganic phosphate contents of the blood are normal; the calcium balance in the chronic phase of the disease is markedly positive; the output of calcium in the urine is decreased and the parathyroid glands are usually observed to be of normal size and microscopic structure. Parathyroidectomy in cases of Paget's disease is not justifiable unless there is more evidence of pathologic change or dysfunc- tion of the parathyroid glands than is usually observed. . While removal of tumors of the parathyroid glands has not resulted in complete recovery in reported cases of osteitis fibrosa, the symptomatic improvement, the chemical evidence of increased retention of calcium, and the roentgen evidence of increased density of the bones in the cases in which observation has been made for a sufficient period after operation warrant surgical interventlonespecially as the operative risk is slight. Earlier diagnosis may lead to more favorable results, especially in the pre­ vention of renal damage. The article is illustrated with photographs, roentgenograms, and photomicrographs. An extensive bibliography is appended. . BENJAMIN R. SHORE

A Cblnp, Picture of Osteitis Fibrol& of the Femur, A. FILBRY. Die wechselvolle Geschichte einer Ostitis fibrosa des Femurs, Brun's Beitr, z, klin, Chir. 163: 117-119, 1936. In a twenty-four-year-old man a diagnosis of sarcoma of the right femur had been made seven y~rs earlier from supposedly typical roentgenograms. No biopsy was taken. The patient was treated with radiation therapy, sustained a pathological frac­ ture, which subsequently healed, and is entirely well at the present time. Roentgeno­ grams show increased calcification in the area of the femur previously involved but no evidence of a neoplasm. The diagnosis now is osteitis fibrosa. There are no illustra­ tions. BENJ AMIN R. SHORE LEUKEMIAS, HODGKIN'S DISEASE, LYMPHOSARCOMA 229

Serum Calcium, Inorganic Phosphorus and Phosphatase Activity in Hyperparathy­ roidism, Paget's Disease, Multiple Myeloma and Neoplastic Disease of the Bones, A. B. GUTMAN, T. L. TYSON AND E. B. GUTMAN. Arch. Int. Med. 57: 379-413, 1936. The calcium and inorganic phosphorus content of the serum and the serum phos­ phatase activity were determined in 4 cases of hyperparathyroidism, 76 of Paget's disease, 6 of multiple myeloma, and 45 of bone tumor. The relevant data from the literature are summarized. The usefulness and limitations of these determinations in the differential diagnosis of the diseases of bone under consideration are discussed. 1. Of the cases of hyperparathyroidism in which determinations are recorded in the literature, about four-fifths showed consistent hypercalcemia, with a calcium content of more than 12 mg. per hundred cubic centimeters, and about one-half, consistent hy­ pophosphatemia, with an inorganic phosphorus content of less than 2.5 mg. Increase in blood .phosphatase activity was found in every case of classic hyperparathyroidism with definite changes in the bones in which determinations were made (28 cases). Complicating factors affecting these values and their significance in differential diagno­ sis are discussed. The question of .. secondary" hyperparathyroidism is considered. 2. The calcium and inorganic phosphorus contents of the serum are within normal limits in cases of uncomplicated Paget's disease. The serum phosphatase activity is almost invariably increased in cases of advanced disease reaching values forty or more times the mean normal value. The level for serum phosphatase is roughly proportional to the extent of involvement of the bones and is probably affected also by the activity of the osseous lesions. In this sense, the determination may be of value in prognosis. Increased blood phosphatase activity is not specific for Paget's disease. The increase in instances of early, localized Paget's disease is often equivocal, so that the determination is of little value in such cases. Nor is it usually of assistance in differentiating cases of osteoplastic metastases in the bone, in which serum phosphatase activity is also increased. 3. Definite hypercalcemia has been observed in a number of cases of multiple myeloma. The inorganic phosphorus content of the serum is normal or somewhat elevated. The serum phosphatase activity is usually normal or slightly elevated. 4. Hypercalcemia is present in occasional cases of carcinoma with extensive, pre­ dominantly osteolytic metastases to the bones. The amount of inorganic phosphorus in the serum is usually within normal limits, but it may be depressed in cases of ad­ vanced cachexia or increased when renal insufficiency is present. The serum phos­ phatase activity is usually moderately increased or essentially normal. In cases of carcinoma with extensive, predominantly osteoplastic metastases, the serum phosphatase activity may be as high as that in advanced Paget's disease. The content of calcium and that of inorganic phosphorus in the serum are normal, except when renal insufficiency is present. In cases of carcinoma with metastases to the liver, with or without jaundice, variable increases in serum phosphatase activity are observed. 5. The physiologic significance of increased serum phosphatase activity in cases of disease of the bone is discussed. WM. H. WOGLOM

THE LYMPHATIC SYSTEM: THE LEUKEMIAS, HODGKIN'S DISEASE, LYMPHOSARCOMA

The Lymphomatoid Diseases (The So-Called Lymphoblastomas), E. B. KRUMBHAAR. J. A. M, A. 106: 286-291, 1936. This is a general discussion of the lymphomatoid diseases based on a study of 150 cases taken from the autopsy records of the University .and Philadelphia General Hospitals. Included in this group are leukemias, lymphosarcomas, leukosarcomas, pseudoleukemia, reticulosis, and Hodgkin's disease. Although this group of diseases includes several of different or unknown etiology, and though the pathologic histology is recognizably different in most, the great similarity or overlapping of many of the clinical pictures makes it convenient and advisable to include them under a group designation 230 ABSTRACTS of" lymphomatoid diseases." They are all similar in having a fatal prognosis and, with few exceptions, of being particularly susceptible to improvement by irradiation. BENJAMIN R. SHORE

Nature of the Anemia in Acute Leukemia, R. H. JAFFE. Arch. Path. 20: 725-741, 1935. The author has previously set forth his view that the anemia of acute leukemia is due not to replacement of erythropoietic tissue by leukemic tissue, as is generally held, but is the result of excessive destruction of the red cells as shown by the hemosiderosis of the blood-forming organs (Folia haemat. 49: 51, 1933. Abst. in Am. ]. Cancer 19: 992, 1933). This conception is supported by the fact that in some cases of acute leu­ kemia the patient dies of severe anemia before the leukemia has developed fully. Even though the blood picture may be typical of leukemia, microscopic examination of the organs shows only slight leukemic changes and a considerable amount of normal myelo­ poietic tissue. Five cases bearing out this theory are presented in detail. All were of short duration, and in all the essential macroscopic observations were those of severe anemia and of an excessive destruction of blood, as indicated by the rusty discoloration of the liver, spleen, and lymph nodes. Excessive destruction of erythrocytes was one of the most striking features. In 4 cases the reticulohistiocytic cells of the blood-forming organs were 'packed with erythrocytes, and in all 5 cases there was marked hemosiderosis of the organs of the reticulohistiocytic system. The excessive destruction of blood was as­ sociated with an increased reactive myelopoiesis which occurred chiefly outside the bone marrow. This extramedullary myelopoiesis was orderly and showed a distinct tendency to produce mature blood cells, not being different from the extramedullary formation of blood cells often observed in cases of severe anemia. The bone marrow was engorged with erythrocytes and revealed very little evidence of activity. In none of the 5 cases did the myelopoietic tissue occupy more than 20 per cent of the marrow spaces. In addition to the typical reactive myelopoiesis, in all 5 cases a proliferation of very immature blood cells was observed. In 3 of the cases hemocytoblasts or stem cells were found in the blood. Comparing the different foci of myelopoiesis, the author has gained the impression that under the continuous stimulation of the destruction of the blood cells an increasing number of immature precursors of blood cells are called into existence until the hemo­ cytoblastic stage is reached. Here and there the hemocytoblasts may reveal attempts at maturation, but rapid multiplication seems to prevent their differentiation. Four photomicrographs are included and there is a bibliography of forty references.

Treatment of Blood Dyscrasias by X-Radiation, A. T. NISBET. ]. Cancer Research Com., Univ. Sydney 6: 201-210, 1935. It has lately been found that in cases of leukemia, irradiation applied to the thorax causes a slower and more even diminution in the number of white blood cells; the spleen is reduced in size at the same time, although no direct application of x-ray is made to this organ. The mode of action of the irradiation when the thorax is the port of entry has not been satisfactorily explained. The theory that reaction takes place in the small amount of bone marrow in the ribs hardly explains the decrease in size of the spleen. The possibility of disintegration of neutrophils and lymphocytes causing an antitoxin would justify further investigation. The most likely explanation seems to be that the large quantity of blood at anyone time contained in the pulmonary tissue may take up some form of emanation similar to that collected from radium and used as radon. This charged blood stream traveling around the body would then act on the spleen, bone marrow, liver, and lymph nodes. [Such elaborate explanations are scarcely necessary. It is easy to demonstrate the bones of one's hand in a fluoroscope at some 10 or 12 feet from a patient undergoing treatment, a fact which indicates that sufficient radiation to affect the sensitive splenic myeloblasts is being scattered from the primary bearn.] In treating the thorax of patients with leukemia, two portals are used: (1) the whole LEUKEMIAS, HODGKIN'S DISEASE, LYMPHOSARCOMA 231 anterior surface; (2) the posterior thoracic wall. Two millimeters of copper is the standard filtration and the kilovoltage is from 200 to 250. A dose of 100 r is given at each sitting and only 300 r in all are given to each of the two portals. After two weeks, a reduction of the white cell count of from 20 to 25 per cent is to be expected. After a further period of fourteen days. a drop of 50 per cent usually takes place. At this time an additional dose of from 150-200 r to each portal may be given if desired. At no time is a rapid fall in the leukocyte count expected, nor is it desirable that it should be reduced below 20,OOp to 30,000 per cubic millimeter. During the past fifteen months, 10 patients with myelogenous leukemia have been treated by this method; 8 of these are still alive and completely well. BENJAMIN R. SHORE

Leukemia with Thrombocytosis, C. B. DRAKE. J. A. M. A. 106: 1005-1006, 1936. Drake reports the case of a sixty-five-year-old woman with myelogenous leukemia and a blood platelet count which ranged between 1,000,000 and 2,580,000. The case is reported because of this unusually high platelet count. BENJAMIN R. SHORE

Chronic Monocytic Leukemia with Cutaneous Manifestations, R. J. WEISSENBACH. Leucemie chronique a monocytes, avec manifestations cutanees, Bull. et memo Soc. med. d. hap. de Paris 49: 1658-1662, 1934. For two years a fifty-two-year-old man had had purpuric urticaria and circumscribed edema of the skin. A monocytic leukemia was discovered, there being 198,000 leuko­ cytes, 72 per cent of which were monocytes. The spleen and liver were not palpable and there was no lymphadenopathy. Bleeding time was normal, but the coagulation time was eleven minutes. Clot retraction was normal. The tourniquet test was nega­ tive. The platelet count was 190,000. Radiotherapy to the spleen improved the leukemia but did not affect. the skin lesions. Radiotherapy to the skin was necessary to control the urticaria and edema. The patient developed typhoid fever, during which time there were no skin complications, and after six weeks the leukocytes numbered 13,000, with 42 per cent monocytes. Death occurred from pulmonary tuberculosis the same year. Only two references are given and there are no photographs. CHARLES A. WALTMAN

Erythrodermia as the Initial Clinical Manifestation of a Subacute Lymphatic Leukemia, J. MARGAROT, P. RIMBAUD AND J. ROCHE. Erythrodermie constituant la mani­ festation clinique initiale et pendant quelque temps, exclusive d'une leucernie a elements primordiaux et d'evolution subaigue, Bull. Soc. franc, de dermat. et syph. 42: 1503-1510, 1935. This is a very detailed report of the clinical course and autopsy findings of a case of subacute lymphatic leukemia in a boy twelve years old. The first manifestation of illness was the appearance of bullous abscesses on the legs followed by cachexia and fever. Some three months later a generalized erythema appeared, sparing only the hands, not indurated, and covered with very dry, branny desquamation. Intense pruritus accompanied it. Examination at this time showed a moderate enlargement of the lymph nodes and a palpable spleen; a blood smear revealed a leukocytosis of 34,500 with 91 per cent large lymphocytes. The usual course of remissions and exacerbations followed until death, eight months later, from massive intestinal hemorrhages and ascites. No roentgen therapy seems to have been given, treatment being confined to two transfusions, injections of " septicemine " and" pyoformine," and calcium chloride by mouth. The report is without illustrations or bibliography. THEODORE P. EBERHARD

Aleukemic Leukemia, C. HENSCHEN AND A. ]EZLER. Aleukamische Myelose unter dem Bilde der Panmyelophthise, Ztschr. f. klin. Med. 128: 343-357, 1935. A report of the clinical and autopsy findings in a case of aleukemic leukemia which simulated the panmyelophthisis of Frank. The author points out that in panmyelo­ phthisis the liver and spleen are not palpable; if they are, one should suspect an abnormal form of leukemia. Several graphs and tables of blood counts before and after splenec­ tomy are included. There is a long bibliography. CHARLES A. WALTMAN 232 ABSTRACTS

Chromc Aleukemic Myelolls with Skin Tumon ResembUnc DuhrinI's Herpetiform Dermatitis, H. OPFER. Ein Fan von chroniach-aleukamischer Myelose mit Hauter­ scheinungen einer Dermatitis herpetiformis Duhring, Derrnat. Wchnschr. 101: 1479-1485, 1935. A sixty-three-year-old man with an enlarged spleen and liver and a relatively normal blood count had multiple pigmented skin nodules which resembled Duhring's herpeti­ form dermatitis. Histologic study of a biopsy specimen removed from one of these nodules showed polymorphonuclear leukocytes, eosinophils, and celIs resembling myelocytes and myeloblasts. The oxydase reaction was strongly positive. The diagnosis of chronic aleukemic myelosis was made. The herpetic and urticarial zones around the skin lesions were considered to. be the result of toxic by-products from the leukemic areas. Two photographs and two photomicrographs illustrate the article. BEN]AMIN R. SHORE

Acute Myelogenous Aleukemic Leukemia Which Simulated Agranulocytosis: Report of a Case, J. J. WELLS. U. S. Naval M. Bull. 33: 527-530, 1935. The title is descriptive of the condition which was found at autopsy in a thirty-nine- year-old individual. There are no illustrations. THEODORE S. RAlFORD

Gordon Test for Hodgkin's Disease, D. H. ROSENBERG AND L. BLOCH. J. A. M. A. 106: 1156-1158, 1936. In 1932 Gordon (Rose Research on Lymphadenoma, Bristol, John Wright and Sons, Ltd. 1932) reported the observation of a meningo-encephalitic syndrome following the intracerebral inoculation of rabbits and guinea-pigs with a sterile suspension prepared from lymph nodes of typical Hodgkin's diseases and in the ensuing year suggested this procedure as a valuable diagnostic aid. There are reports in the literature of some 77 cases of Hodgkin's disease in which the test has been applied; it has been found positive in 56, or 77.9 per cent, of these. Among 101 control cases, including normal lymph nodes and nodes showing carcinoma, sarcoma, lymphosarcoma, pseudoleukemia, leukemia, tuberculosis, lymphoid hyperplasia, and adenitis, the test was negative in 98, or 97 per cent. In the authors' own series of 3 cases of Hodgkin's disease, the Gordon test was positive in 2 seen early in the course of the disease and negative in 1 chronic case. Three abnormal lymph nodes used as controls gave negative tests. A more extensive trial by different investigators of this test is advocated. The technic of the test is described in detail. BEN]AMIN R. SHORE

Treatment of Lymphocranulomatoais with Large Doses of Roentgen Rays, F. MEL­ CHART. Die Behandlung der Lymphogranulornatose mit hohen Rontgendosen, Strahlentherapie 52: 460--463, 1935. During the past three years Melchart has treated 15 cases of Hodgkin's disease with large doses of roentgen rays. His plan is to treat the neck, the mediastinum, the axillae, and the groins through 8 x 10 or 20 x 20 em. fields, and at a distance of 40 to 60 em, Doses of 200 to 240 r are given to each of three fields per day, until a total surface dose of 2000 to 4000 r has been administered. In addition to this regional treatment, the whole body is irradiated at a distance of 2 meters. From SO to 100 r per day of this diffuse irradiation is given, until a total of about 1000 r has been administered. The author reports that 10 of the 15 patients 80 treated have been symptom-free for from six months to two and one-half years. C. D. HAAGENSEN