The Breast the Digestive Tract

Home , Hematosalpinx, Lactic acid fermentation, Splenic tumor

The abstracts which follow have been classifled for the convenience of the reader under the following headings : Experimental and Biochemical Studiee, Intrathoraeio Tumors Spontaneous Animal Tumors, Plant The Digestive Tract Tumors, Biological Effeota of Radia- The Liver and Biliary Tract tion The Pancreas Etiology, Clinical Observations, Blood Peritoneal and Retroperitoneal Tumors, Studies Mesenteria Cysts Diagnosis and Treatment The Spleen Tumors of the Skin The Suprarenal Glands The Eye The Female Genital Traot The Ear The Qenito-Urinary System The Oral Cavity, Nose and Paranasal The Nervous System Sinuses, Throat and Salivary Glands The Bones and Joints The Thyroid and Parathyroid Glands The Lymphatic System The Carotid Body Statbtias, Cancer Research, Education, The Breast Public Health As with any such scheme of classifloation, overlapping has been unavoidable.

Shall an article on '' Cutaneous Melanoma, an Histological Study JJ be grouped with the artioles on Histology or with the Skin Tumorsl Shall Traumatia Cerebral Tu- mors go under Trauma or The Nervous System? The reader's ohoice is likely to depend upon his personal interests; an editor may be governed by no such con- siderations. The attempt has been made, therefore, 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 expreesed 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 JOUBNAL will not only welcome conwpondence of this nature but hopes in the future to have a large number of author abstracts, so that the writer of a paper may preeent his subject in his own way. ABSTRACTS EXPERIMENTAL AND BIOCHEMICAL STUDIES, SPONTANEOUS ANIMAL TUMORS, PLANT TUMORS, BIOLOGICAL EFFECTS OF RADIATION Experimental Obmrvations on Tar Tumors, U. CASTBLFRANCO.Oeeervasioni aperimentali sui tumori da oatrame, Riv. di pat. sper. 8: 140-157, 1932. The author applied tar to the skin of 60 mice and 2 hem, giving sixty treatments each over a period of six month. The skin of one set of animals was soarified before the tar was used. In no OBBB did tumors develop. Using 16 rabbits, he injeoted tar dissolved in oil into the breast or sorotum, and in some oases pencilled the rabbits’ ears with oarbon used as one pole of an electria oircuit. Hyperkera- toah resulted, but no real neoplsetio process was found on hiatologio examination. Thia artiole contains photograph and a long bibliography. JEANNEITXIMUNRO Muonce of Breatbing Carbon Monoxide and Oxygen at High Percentages for Prolonged Period8 upon the Development of Tar Cancer in Mice, J. A. CAMP- BBLL. J. Path. & Bact. 36: 243-248,1933. In earlier work (ibid. 35: 379, 1932, abst. in Am. J. Cancer 16: abet. p. 1258, 1932) the author found that oarboa monoxide respiration had a retarding effeot on the growth rate of mow oaroinoma 63, while it had no apparent effeot on that of the Roue fowl swooma. It appeared interesting, in view of the reoent theoretio explanation that the apparent inorease in the inoidenoe of human lung oancer is eaeooiated with the inoreaeed presenoe of oarbon monoxide in the air of streets, garages, faotories, kitohem, etc., to experiment with tar oancer, which more closely ~wemblesspontaneous human oardnoma than do transplantable tumors. The author tarred mice, one series of whioh breathed carbon monoxide, the seoond ordinary air as controls, and the third a gas mixture oontaining about 60 per cent oxygen. The experiments were continued for nine months. The findings are set out in four tables and two graphs. The author’s oonolueions are that oarbon monoxide breathed by doe for prolonged periods (up to about one third of their span of life) retards but does not prevent the development of tar cancer, and th8t breathing oxygen at 60 per cent of an atmosphere has no effeot on suah development. F. CAVHRS Some Aspects of the Thymus in Mice Treated with Tar and in Mice with Tumors, A. LAMMA. Aspetti diversi del timo in topi inoatramati e in topi portatori di tUmOi, EV. di pat. 8p. 8: 50-67, 1932. The author applied tar at repeated intervals to the shaved skin of 16 miae. Eleven of the animals died in a oaohectio condition during the treatment. These mice all showed aonsiderable atrophy of the thymus. The other animals, whioh did not have cachexia, were killed after a longer aourse of treatment. These showed little atrophy of the thymus. The thymic struoture appeared the same in those animals in which oancer developed under the tar treatment as in those dying at a similar stage of the treatment without oancer. In two of the animals treated primary tumors of the thymus developed, miorosoopio drawings of which illustrate the article. In a seoond experiment the author injected 13 mioe with material from the adenocuucinoma of Ehrlioh. All developed tumors. Twelve of the animals 893 394 ABSTBACTS showed moderate atrophy of the thymus, apparently independent of the duration of the experiment, of the amount of tumor development, and of the general oondition of the animal. The artide contains a review of the literature on the relation of the ductless glands to tumor development. The author accepts the theory of Fiohera that tumor development depends on an imbalanoe of the internal aeoretions and believes that the thymus exerts an inhibitory aotion on tumor development. JEANNIITTIIMUNRO

Atypical Epithelial Growth Following the Intrabmnchirl Application of Cod Tar. L. M. SCHABAD.Experimentelle stypisohe Epithelwuoberungen nach intra- traoheobronohialer EinfUhrung dee Steinkohlenteem in die Lungen, Zteohr. f. Krebsforsoh. 38: 154-177, 1932. Two-tenths of a oubio oentimeter of warm ooal tar introduoed onoe into the lunge of 27 guinea-pige, from a syringe inserted into the traohea, did not produoe tumors, although 7 of the animale survived for aiX months or more, and one for fourteen months. Characterhtio inflammatory and regenerative ohanges were set up, somewhat resembling adenoma or even adenoaaroinoma,, and it waa such as these, no doubt, that led previous investigators to desoribe the produotion of oaroinoma. In no om, however, did the lesions grow invaaively or metastasize, and in animals that lived more than six months it waa evident that they were regressing. WY. H. WOQLOM Combined Action of Roentgen Rap and Tar on the SLln of the white Mmm, G. A. SBDOINID~.Die kombinierte Wirkung der Rhtgenetrahlen und des Steinkohlenteera auf die Haut der weissen Miturn, Ztaohr. f. ICrebeforach. 38: 21-34, 1932. Nineteen mioe were exposed to x-rays, 19 were rayed and later tarred, while 29 were tarred and then rayed. In all 3 series the dose waa 258s to 2840 r, administered onoe a month, for from two to five months, over an area of 1 sq. om. at the root of the tail, the rest of the body being proteoted meanwhile with 3 mm. sheet lead. The factors were 60 kilovolte, 2 milliamperes, dietanae 28 om., no filter. Suoh exposures produced a ohronio dermatitis and, in one of 11 survivors, a caroinoma, at least 14,200 r having been required in the latter instance. In the seoond group, rayed and then tarred for six months, only one mouse among the 19 surviving developed a aaroinoma. In the third, three months of tarring alone did not suffioe to elicit oaroinoma, though the skin was altered in suoh a way that 6 out of 9 sufvivors reoeiving 16,OOO r developed oanoer. Four mioe that were given 9OOOr all esoaped a malignant growth, but one among 4 that had 6000 r finally fell victim to carcinoma. With this single exception, 15,000 t seemed to be the minimal oardnogenio dose. Au the animals with neoplasms outlived the period ordindy permitted to mioe bearing tar tumors, for the hydine ohanges set up in the oonneotive tissue prevented invaaive growth. [Seven poor photomiorographs leave the reader in doubt, but on the whole the abstraotor is not oonvinced that the lesions were malignant.] WY. H. WOOLOM Mobilization of the Hiotoblastic Reaction in the Suppreedon of Cucinoxq F, VAN~Kuber die Mobilisierung von hietoplaetisoher Reaktion sur Ditmp- fung des Carcinoms, Ztsohr. f. Krebdoraoh. 38: 94-98, 1932. Believing that diminished funotion of the liver and the retiouloendothelial system underlies the development and growth of oancer, the author sought to stimulate these organa in a patient with extensive oanoer of the cheek by introduo- EXPERIMENTAL AND BIOUHlDMICAL STUDIES 395 ing radium emanation subcutaneously in the hepatic region. The result was encouraging, though the patient died. Five rabbits were accordingly injected at the same site with emanation, 4 doses, each of 1/50 millicurie in 0.2 C.C. of physiological saline solution, being given. A few days after the last treatment them animals and five untreated controls were started upon a course of tar painting. Keratosis and cachexia were more advanced in the controls than in the treated group at the end of four months, though no carcinomas developed in either. Attempts to arrest inoperable carcinoma of the stomach in man by setting up a lymphatic and hietiocyte reaction with radium emanation, injected into the leg, are briefly mentioned. WM. H. WOOLOM

Period During Which a Transplantable Mouse Sarcoma Can Be Transmitted by Mom of Blood and Tumor-Free Organs, LUDWIKGROSS. uber die Zeitgren- sen der Ubertragungsfehigkeit eines Impfsarkoms mittels des Blutes und der tumorfreien Organe der Maus, Ztschr. f. Krebsforsch. 38: 241-248, 1932. Recent descriptions of the transplantation of various tumors by means of blood or of organs free from metastases suggested to the author the presence of an in- tangible causative agent, though there still remains the difficulty of explaining why transfer should 80 rarely succeed. He therefore undertook to test the hypothesis that this agent is present in the blood only at certain times, employing for his experiments the Vienna mouse sarcoma, which takes in almost 100 per cent of inoculated animals, grows with fair rapidity, and metastasizes with relative frequency (about 10 per cent). It was found that twenty-four hours after subcutaneous inoculation of this neoplasm the blood, liver, spleen, and kidney would elicit tumors when subcutaneously introduced into normal mice. The resulting growths arose at the injection site, had the histological structure of the Vienna sarcoma, and proved ultimately fatal. Organs removed from two to six days after tumor implantation produced only transitory nodules; from the seventh to the fourteenth day progressively growing sarcomas were generally elicited, and later only temporary tumors again, as a rule. Brain gave only transient nodules, and urine none at all. WM.H. WOOLOM EffectUpon Tmsplautable Tumore of Previous Treatment by Homologous Serum and Blockade, G. A. CEIIURCOAND A. VOLPE. uber die Beeinflussung der Impftumoren durch Vorbehandlung mit arteignem Serum und Blockade, Ztschr. f. Krebsforsch. 38: 113-120, 1932. Rats were injected intraperitoneally with normal rat serum or India ink or with both together, and afterward inoculated subcutaneously or intraperitoneally with Jemn rat sarcoma. The tumors in the third group showed the greatest &Terence in comparison with the controls and with those of the other two groups; they reaahed an enormous size within a short time, and the abdominal growths had not only differentiated in the direction of fibroaarcoma but contained areas of myxowaoma, and relatively large amounts of India ink. This experiment is the first of a series planned to investigate the constitutional basis underlying tumor origin and tumor growth, in its relationship to anaphylaxis, allergy, and blockade. WM.H. WOOLOM Influence of the Sex Hormone from the Anterior Lobe of the Hypophyaie on Tumor Growth in Mice, LUDWIKGROSS. Zur Rage des Einflusses der Hypopbysen- vorderlappengeschlechtshormone auf das Tumorwachstum bei Meusen, Ztschr. f. Krebsforsch. 38: 289-290, 1933. A transplantable mouse sarcoma [unepecified] was not inhibited by anterior bppophyseal hormone (Praelobin, or Antepan), whether or not this had been ex- 396 ABSTBAOTS posed to red light before use. The doses employed (a total of 60 or 120 rat units) were much smaller, however, than the amount of Prolan which Zondek and his collaborators (Zondek, Zondek and Hartoch: Klin. Wohnschr. 11 : 1786,1932, abet. in Am. J. Cancer 18: 137,1933) said would retard the growth of the Ehrliah mouse caroinoma (a total of 4,400 rat units). WM. H. WOOLOM

Effect of Estrogenic Agents on Tmsplnntable Tumors, KLARAMOLNAR. uber die Beeinfluasbarkeit dee Angehens und Wachstums von Impftu,moren duroh 6strogene Substansen, Ztschr. f. Krebsforsch. 38: 188-193, 1932. Menformon from the blood of irradiated male dogs (see Silberstein, Fellner, and Engel: Ztschr. f. Krebsforech. 35: 420, 1932, abst. in Am. J. Cancer 16: abet. p. 1013, 1932) or in the form of a commercial preparation (Degewop) influenced neither the takes nor the growth of the Ehrlich carcinoma in male or female mice. Wx. H. WOOU>M Influence of Extracts of Endocrine Glands on the Development of Mouse Cuci- EMEFUCHFODOR, GEDEON ER~S, AND STBPHAN K~NOS.br den Einflues von Extrakten aus dem endokrinen Driisensystem auf die Entwiok- lung des Milusecarcinoms, Ztsohr. f. Krebsforsch. 38: 1-20, 1932. Extracts of various organs were injected daily into mice bearing the Ehrlich carcinoma at a distance from the tumor and beginning on the day of its inoculation. Preparations of liver, spleen, pancreas, and central nervous system, as well as insulin, inhibited the growth of the tumor and diminished the inoidence of metastases. Extracts of bone-marrow, parathyroid, ovary, and corpus luteum exerted a less distinct retardation, while those of the suprarenal, posterior lobe of the pituitary, pineal gland, and thymus exerted no inhibitory effect. Of various combinations, that of bone-marrow, spleen, liver, pancreas, and parathyroid proved most effective. [The " special method " by which the extracts were prepared ie not given.] WM.H. WOOLOM Influence of Ultraviolet Radiation on the Mnlignancy of Rabbit Carcinoma, W. A. COLLIERAND A. COHN. Einfluss der Ultraviolettbestrahlung auf die Malignitiltsdisposition des Kaninchenkrebses, Ztschr. f. Krebsforsch. 38: 208- 216, 1932. It haa been asserted on the one hand that ultraviolet light will produce cancer in mice and rats and, on the other, that it will caw the regression of mouse carcinoma. The authors find that it does not increase the malignanoy of the Brown- Pearce rabbit carcinoma and, transferring this result to man, declare that there is no danger of producing carcinoma with ultraviolet rays, assuming reasonable dosage. WM. H. WOOLOM Influence of Sodium Chloride or Calcium on the Malig~ncyof Rabbit Car- cinoma, W. A. COLLIEI~AND A. COHN. Der Einfluss von Kochsals und Kalk auf die Mdgnitiltadispodtion des Kaninchencarcinoms, Ztsohr. f. Krebs- forsch. 38: 291-295, 1933. Rabbits were injected intravenously with a suspension of the Brown-Pearce rabbit carcinoma. Half of each lot were reserved for controls, while the other half received 10 per aent sodium chloride suboutaneously or an [unspeoified] organic preparation of lime by mouth. Sodium chloride, even in the small doses given (0.2 to 0.3 gm. daily for from four to six weeks), diethotly accelerated growth, whereas lime exerted no appreciable effect. Forty treated animala and 30 controls appear in the final reckoning. WY. H. WOOLOY EXPERIMENTAL AND BIOClHEMIUAL STUDIES 397

Influence of Trypanosornee or Tubercle Bacilli on the Malignancy of Rabbit Carcinoma, A. COHNAND W. A. COLLIER. Der Einfluea der Trypanosomen- und Tuberkuloaeinfektion auf die Malignitiitsdisposition des Kaninchenkreb- ses, Ztschr. f. Krebsforsch. 38: 296-300, 1933. The growth of the Brown-Pearce rabbit carcinoma waa not influenced by in. testing the bearer with Trypanosoma brucei, though the inhibition of mouse carcinoma by another trypanosome haa been reported [see Am. J. Cancer 16: abt- p. 613, 19321. Infection with bovine tubercle bacilli, on the other hand, distinctly retarded the neoplasm. Eighteen trypanosome, 10 tuberculosis rabbits, and 32 controls were employed. WM. H. WOOLOM

Experimental Inveetigation of Immunity to Transplantable Tumors, A. I. WY- ~OSCHANIN. Zur experimentellen Erforsohung der Immunitiit gegen Impf- tumoren, Ztschr. f. Krebsforsch. 38: 99-112, 1932. Explants of the Ehrlich mouse carcinoma and the Jensen rat sarooma grew well in contact with fragments of spleen, kidney, liver, or muscle from resistant mice or rats respectively. Thus there seemed to be no factor present in these tissues able to exert a direct toxic action on the tumor cell. This result agrees with that of Lumsden (Lancet 2: 112, 1926) but contradicts Centanni’s experience (Ztschr. f. Krebsforsch. 28: 47, 1929). WM. H. WOOLOM

Observations on the Movement of Cells in Vitro with Reference to Tumour Im- munity, WARNFORDMOPPETT. M. J. Australia 2: 718-722, 1932. It has been shown (Roc. Roy. Soo., Series B 106: 176,1928) that lymphocytes migrating from a fragment of spleen in dro moved in response to a concentration gradient: to the higher concentration if the medium were isotonic and in the opposite direction if the concentration were sufficiently high to be harmful. The test waa exoeedingly delicate. The same diffusion vessel was used in the present experiments, but saline solution, a drop of normal mouse blood, one of blood from a tumor-bearing mouse, and a fragment of the tumor in question (sarcoma 37) were employed. It was assumed that with clotting and subsequent shrinkage the antibodies would d~useout to establish a gradient of conoentration, or titre. Under these oircumstances movement of cells toward the tumor blood was observed in most experiments. When this came from another tumor mouse, however, an unexpected movement away from the blood took place. Blood from mice that had been oured by radiation and which, from the disappearance of a coexist- ing untreated tumor, seemed to be immune, caused no selective movement. A few experiments were made to see if the reaction could be used aa a clinical teet, but so far ib value has not been established. WM. H. WOOLOM

The Chromosomes in Malignant Tumors, (CommunicationI.), B. ALEXENKOAND A. NATANSOHN.Karyologbche Untersuchung der btisartigen Geschw[ilete, (I. Mitteilung.), Ztschr. f. Krebsforsch. 38: 264-273, 1933. In the Flexner-Jobling carcinoma the authors found a departure from the number of chromosomes normal for the rat and secondly, numerioal differenoes even in the same tumor. Two types of discrepancy occurred. In one, the chromosome content varied by a whole haploid number, so that it was haploid, triploid, tetra- ploid, and so on; in the other, and apparently more common type, the abnormality was not so great, the count varying from that of the normal tieeuea by a gain or loae of but one, two, or three chromosomes. 398 ABBTRAUTS

As both types oould be found in the same growthi, the quantitative relationships were almost unbelievably oomplex, and the ignoranoe in whioh this whole question is ohrouded reduoes to mere speoulation any hypotheais that seeks to explain oanoer in term of ohromosome abnormality. In partioular do Boveri’s hypothesis and that of somatio mutation suffer, for both regard the ohromosome not only as a steadfast morphological struature, but aa the bearer of certain definite gene oomplexes. Yet in place of the specifio numerioal alteration demanded by Boveri’s hypothesis, or the uniform ahange in gene oomplex implied by the hypothesis of somatio mutation, there was found a whole series of fundamental variations within the same growth. Aooording to present belief it would be justifiable to infer that the oells of a tumor differ as much in charaoter from one another as their ahromosome numbers differ, were it not that the comparative permanence distinguishing the morphological and functional properties of a new growth precludes any auoh suppodtion. On the other hand, it oannot be aseumed that all oells of a neoplasm are identioal in spite,of large numerioal variations, for this oontroverts prevailing beliefs in the significanoe of the ohromosomes for heredity. In short, the facts oannot be fitted into ourrent theory. War. H. WOOLOM

Experimental Cucinoma of the Gallbladder and Liver, N. PETROVAND N. GOT- KINA. Experimentelles Gallenblasen- und Leberoarcinom, Ztsohr. f. Krebs- fomch. 38: 249-263, 1933. Small sealed ghatubes, 7 empty and 12 oontaining 0.4 to 1.8 miorograms of radium, were deposited in the gallbladders of 19 male guinea-pigs from three to four months old. The tubes were reoovered at autopsy in but 7 animals-a *X times in the gallbladder and once in a dilated bile-duct; in the others they had evidently been passed with the bowel contents. Four oaroinomas were found, two in oonneotion with empty tubes after sixteen and a half and thirty-one and a half months, and two in oonneotion with radium tubea after thirty-four and a half and thirty-nine and a half months. In the first 3 animals there were primary tumors in the liver and metastases in various organs; in the fourth, a small infiltrating but non-metastasising growth between gallbladder and duodenum. Thus radioaativity, thought by Larerue-Barlow to be an important factor, proved of no consequenoe. Gallstones also, therefore, oan elioit caroinoma even though not radioactive, and where oalculi and malignant disease ooexist, the former must be regarded as the primary lesion and the oaroinoma as secondary. Thb is not to say, however, that in a aaroinomatous gallbladder whioh is at first free from oalouli, gallstones may not appear as a seoondary oonsequenoe. As the epithelium of the gallbladder regularly exhibited proliferative lesions running from simple hyperplasia to ohanges that oould justly.be oalled precancerous, the malignant transformation must have been initiated here in most oases, though the intrahepatio bile-passages oannot be entirely dismissed from oonsidera- tion, for there, too, proliferative ohanges were to be found in not a few instances. [The illustrations and the autopsy reports appear to sustain the authors’ oontention.] Wur. H. WOOLOM

Reaction of Invertebrates to Cucinogenic Substmcer md to B. Tumefaciens Sm. md Town, J. ANDRlh THOMAS.Contribution B 1’Btude des daotions de quel- ‘quee invertebrds B l’inoculation de substances a proprietes oanoBrigbes et du Bacterium tumefdns Sm. et Town, Ann. Inst. Pasteur 49: 234-274, 1932. Inoculation of various aaroinogenio agents (menio, indol, ooal tar) in oombinr- tion with extracts of thuee (ohiok embryo, sea-urohin eggs, eta.) produced only I) EXPERIMENTAL AND BIOCHIBMICAL STUDIEB 399

mild inflammatory reaction in the tunic of Aecidia mentula and in Nereis diverei- co2.r. B. tumejaciene, on the contrary, set up intense inflammation in Aecidia mentula and, in Nereis diversicolor, when granulomas due to degenerating oocytes were present, large “ tumors ” of rapid invasive growth and atypical appearance. WM. H. WOOLOM

The Question of “Tomato Tumors,” E. HAMMERAND A. TBRBR~~OORIN.Zur Frage der ,,Tomatentumoren,” Ztschr. f. Krebsforsch. 38: 194-207, 1932. Rats were injected intraperitoneally with the juice of tomatoes from various countries, one series in the winter and another in the summer. Nodules were produced resembling in the gross those described by Bellows and Askanazy [see Am. J. Cancer 16: 1625, 19321, but of entirely different microscopic appearance. 8ince these lesions regressed slowly, showed not the slightest indication of invasive growth, did not metastasize, and were not transplantable, the authors believe them to have been foreign body granulomas. As in the investigations of others, similar nodules could be produced in the mow and the guinea-pig. WM. H. WOOLOM

Production of a Malignant Growth in a Guinea Pig, T. J. GLOVERAND J. L. ENOLB.Public Health Reports 48: 319-321, 1933. A micro6rganism was isolated from a case of human carcinoma and injected into the mammary region of an old guinea-pig on Nov. 5, 1932. Five days later a “ rather evenly distributed infiltration was noted in the region of inoculation. This slowly became localised into a well-defined, indurated mass about 2.3 em. in width and 3.4 cm. in length. It was noted on Dec. 22 that isolated nodular areas were developing in the region.” On Feb. 28 the animal was killed. The diagnosis of malignant adenoma with metastases in lymph nodes, omentum, and kidneys WM made. It is stated that the microbrganism injected was reoovered from the thue of the breast tumor. No photomicrographs of the tissues are offered in evidenca. [It is very doubtful that the tumor was produced by the bacterial injection; it was probably already present when the injection was made. Bullock and Curtis have shown that Cystioercus sarcoma requires a minimum of eight months for its development after infestation by the worm. Even the most potent tar rarely gives rise to a carcinoma in the mouse in less than three months. Rabbits often require six months’ to a year’s painting for the production of carcinoma, and it seems probable that guinea-pigs should require approximately the same period. Yet in the experiment reported the tumor apparently arose in a few weeks.]

Alk8lods and Cancer. Communication I. The Infiuence of M Alkaline Diet on the Origin and Growth of Malignant Tumore, ANNAGOLDFBIDBR. Zur Alka- loeefrage in der Krebsforschung. I. Mitteilung. Wie ist die Wirkung der alknliachen Nahrung auf das Entstehen und Wachstum der bilsartigen Gesch- Wnlste, Ztschr. f. Krebsforsch. 38: 121-134, 1932. No spontaneous ‘tumors developed in a group of 40 mice kept for about nine months on an alkaline diet (bread and milk with 40 C.C. of 10 per cent potassium citrate ad libitum), though de Rasd (Ztschr. f. Krebsforsch. 32: 598, 1930) had reported their production by this means. The injection of a proprietary preparation (Polysan) said to raise blood- alkalinity, together with the administration of sodium citrate by mouth, increased the growth rate of mouse carcinoma 63. [The uninformed reader would gather from this article that its writer was the 6rst to determine the reaction of tumors and that her belief in their manifest alka- 400 ABSTBhoTS linity has met with uniform aoceptance. Aotually she was the seventh, and opinions have been about equally divided; some investigators have found tumors acid, some alkaline, and some within the range of normal tissues. Furthermore, of the four articles aited to sustain her contention that neoplasms are distinotly alkaline, two are misquoted; one of them oontains no reference to the reaotion of the growth itself, while some neoplasms described in the other were acid. The abstractor believes that a protest should be entered against such unwarrantably careless use of the literature. He has already disoussed the whole matter in another connection (Am. J. Cancer 16: abst. p. 750,1932), and need only add that Chambers and Ludford (Proc. Roy. Soc. London, Ser. B. 110: 120, 1932; abet. in Ztsohr. f. Krebsforsch. 38: Ref. 20,1932) have recently reported no color Werence among dyes injeated into the nucleus or oytoplasm of normal or malignant cells. In either 0886 the pH of the cytoplasm lay between 6.4 and 7.0, and that of the nuoleus above 7.2.1 WM. H. WOQLOM

Acid-base Balance in Tunom, N. OKWNBIFF.Uber das Sliure-Basengleiohgewicht bei den Proocessen des Tumorwachstums, Ztsahr. f. Krebsforsch. 38: 283-288, 1933. The lactic aoid produced in tumors by glycolysis exerts a profound influence on the acid-base balance, not only in the tumor itself but throughout the entire organism. Determinations with the quinhydrone eleotrode on 40 Ehrlioh mouse caroino- mm and 25 oancers of the human breast gave an average figure of pH 6.6, with extremes of 7.56 and 6.00. The variations were caused by 3 faotors: (1) Age of the tumor; the younger the growth the higher the acidity. (2) Part of tumor examined; the periphery was muah more aoid than the center. (3) Histological structure; the cellular Ehrlich tumor was considerably more mid than the less oellular carcinomas of the human breast, most of whioh were soirrhous. It is not surprising to find tumors acid; the astonishing thing is that they are not more so. This is evidently because of their capacity to buffer the lactic acid whioh they elaborate, a oiroumstance which enables them to esoape oowquences that otherwise would be inevitable. WM. H. WOOLOM

Buffer Capacity of Tumor Tiswe, N. OKUNEFFAND 0. TSCHIBTOWITSCH.br die Puffereigensohaft des Tumorgewebes, Ztsohr. f. Krebsforsoh. 38: 178-187, 1932. Although oonsiderable amounts of lactic acid are elaborated by tumors, their reaotion is 80 little affected thereby that the greater part would appear to be neutralised in situ, and determinations for cancer of the breast in women and for the Ehrlich mouse oaroinoma showed that their butrer oapacity aotually was high [see preoeding abstract]. The authors suggest that the following substances are conoerned: bicarbonate, potassium proteinate, and inorganio phosphate. Because of the variety and effioaoy of $hem buffers, any therapeutio measures employing acids would have to be carried out energetically. WM. H. WOOLOM Alkalodr and Cancer. Communication II. The Action of X-Rays on the Reac- tion of the Uving Orgllrism, ANNA GOLDFIPDIPR.Zur Alkelosefrage in der Krebaforsohung. 11. Mitteilung. uber die Wirkung der IUIntgenstrahlen auf die aktuelle Raaktion im lebenden Organismus, Ztsahr. f. Krebsforsoh. 38: 135-141, 1932. Intense radiation for half an hour lowered slightly the pH valuea of the Jensen rat sarcoma, the Flexner-Jobling rat oaroinoma, and the nodtissue employed BB control (musoles of the foot). WM. H. WOQLOM EXPERIMENTAL AND BIOOHEMIOAL STUDIES 401

Allulosis and Cancer. Communicntion III. The Action of Radium Emanation on the Regreedon of Tumors and on the pH Value in Malignant Time, ANNA GOLDFEDEFLZur Alkalosefrage in der Krebsforschung. 111. Mitteilung. Die Wirkung der Radiumemanation auf das Zuriickgehen bsw. Verschwinden des Tumors im Zusammenhang mit der Versohiebung der pH-Werte im Tum- orgewebe, Ztschr. f. Krebsforsch. 38: 142-146, 1932. Radium or its emanation displaced the pH value of the Flexner-Jobling rat carcinoma toward the acid side, and with this change the tumors began to regress. WM. H. WOGLOM

Alkaloelcl and Cancer. Communication IV. The Ammonia Content of Tumors in Comparison with that of NodTissue, ANNAGOLDFEDIB. Zur Alkalose- frage in der Krebsforschung. IV. Mitteilung. Ober den Ammoniakgehalt des Tumorgewebes im Vergleich Bum gesunden Gewebe, Ztschr. f. Krebsforsch. 38: 147-153, 1932. A determination of the ammonia oontent of mouse carcinoma 63 and the Flex- nerJobling rat aarcinoma was undertaken in the hope of explaining the alkaline reaction of tumors. It was found, however, that the values for slightly acid normal tissue (muscle) and for alkaline tumor were approximately the same, so that there appeared to be no relation between the reaction of a tissue and its ammonia content. WM. H. WOGLOM

Experimental Alteration of Tumor Metabolism in the Living Animal, MAXRam AND ADOLFHOCHWALD. Experimentelle Beeinflussung des Tumorstoff wech- eels am lebenden Tier, Med. Klin. 28: 1391-1395, 1432-1434, 1932. The administration of large amounts of sugar (1-4 0.0. of a 40 per cent glucose solution daily for from three to sir days) to rats bearing the Jensen sarcoma caused widespread necrosis in the tumors. Even five hours after the injection of still larger quantities (one dose of 15 0.0. to a 150 gm. rat) the tumor was almost entirely whitish-yellow in color, with hyperemic areas, and its metabolism was seriously aamaged. Control tumors showed no such extensive necrosis. Half an hour after glucose had been introduced the lactic acid content of the tumor had risen nearly 300 per cent, while its oxidative capacity was more or less impaired. In the next few hours these abnormalities increased and ana&robic glycolysie, at first uninfluenced, began to fall. Evidently such tumors were dying because their energy requirements were no longer being met. As a large single dose of sugar often proved fatal, fractional doses were given at short intervals when it was desired to have the animals live for a time. This procedure they withstood very well, and results comparable to those achieved in the earlier experiments could sometimes be brought about even with smaller amounts. Sex hormone from the anterior lobe of the hypophysis led to a disturbance in lactic acid synthesis .and eventually inhibited oxidation, when given in large amounts. When it was exhibited with sugar, the effects of the two were combined. A few successful results followed the attempt to cure tumors, but the material is still inadequate for presentation. WM. H. WOGLOM

Metabolism of Nodand Tumour Tissue. VII. The Anaerobic Conversion of Fructose into Lactic Acid by Tumour and Adult Nod Tissues, FRANK DICKENSAND GUYDBIJMMOND GRIVILW. Biochem. J. 26: 1546-1558,1932. Having previously shown that various embryonic tissues differ in their behavior toward fructose (Biochem. J. 26: 1251, 1932. Abst. in Am. J. Cancer 17: 982, 402 ABBTRAOTS

1933). the authors now turn their attention to the activities of a number of transplantable animal tumors and of adult normal rat tkues. The anaerobic attaok by retina, submaxillary gland, and spleen was negligible, while kidney and testis exerted a slight change. When these results are compared with those of others who have worked with brain, nerve, and liver, it appears that adult normal tissues which convert glucose into lactic acid show but little anaerobic action on fructose, while liver, which cannot utiliae glucose anaerobically, can readily form lactic acid from fructose under certain conditions. The Jensen rat sarcoma and the Mill Hill fowl fibrosarcoma 1 showed a steady anaerobic fructolysis equal to about a third of the glycolysis. The Rous chicken sarcoma also attacked fructose to some'degree, but the Brown-Pearce rabbit tumor, 2 mouse carcinomas (63 and 1131, and a mouse sarcoma (3187) had not the ability to convert fructose into lactic acid. Thus there exists among tumors a variability in behavior towards fructose which is quite as pronounced as that found among the embryonic tissues. The spontaneous increase in anaerobic fructolysis observed by Rosenthal [see Am. J. Cancer 16: abst. pp. 1277-1278, 19321 in the Jeneen rat sarcoma was not apparent in the Mill Hill tumor. Rosenthal's activator theory is discussed, as is ale0 the possibility that glucose and fructose are split into lactic acid by similar routes in the Jensen rat sarcoma. WM.H. WOQLOM

Activation of Fructose Fermentation by the Jensen Sucoma with Pyro-mcemic Add and Various Oxidizing Agenta, OTTO ROSIBNTHAL.Die Aktivierung der Fructosevergiirung beim Jensen-Sarkom durch Brenatraubensllure und ver- schiedene Oxydationsmittel, Ztschr. f. Krebsforsch. 38: 216-240, 1932. Sewah has been made for substances that will augment lactic acid fermentation by the tumor cell, the eplitting of fructose by the Jensen rat sarcoma having been used as an indicator beaause any aotivation occurring would be better appreciable than in the much more vigorous glucose fermentation. Beaides pyro-racemic acid, whose stimulating effect upon glucose fermentation was already known, methylene blue, thionin, Capri blue, potassium femcyanide, hydrocyanic acid, and amyl nitrite were found to activate the splitting of fructose. Thehave the oommon property of being reduced by the tissues and serving as hydrogen acceptors. The mechanism of this process with its significance in lactic acid fermentation are discussed, and the findings for tumor compared with those for normal tissue. WM.H. WOQLOM

studies on the Change in the Amount of Cholerterol and Phorphow Compounds of Cancerow Tluue at Varim Periods of its Growth, M. UMMOTO.J. Biochem. 16: 69-82, 1932. Determinations were made of water, nitrogen, cholesterol, and phosphorus in the FlexnerJobling rat carcinoma at different stages of growth. It was found that water, free and combined choleeterol, and inorganic pliosphorus increase with increasing tumor age; total nitrogen and total phosphorus remain constant; lipoid, protein, and acid+oluble organic phosphorus and phosphatase aotivity decrease with increasing tumor age. H. Q. WOODARD

Phoaphata in Tumom and Murcle, W. R. FRANKS.J. Physiol. 74: 196-206, 1932. The respiration and phosphorus metabolism of Crocker mouse tumor 180 were studied in uitro. A trace of oreatine phosphorus was found in the tumor. The EXPERIMENTAL AND BIOCHEMIOAL STUDIES 403 increase in free phosphate during incubation was greater when glucose was absent from the surrounding fluid than when it was present. When the tumor was in- cubated in the presence of glucose and glycolysis was marked, there was an ac- cumulation of acid-aoluble organic phosphate. No evidence waa obtained of a shift from hexosemonophosphate to hexosediphosphate during glycolysis in surviving tumor. H. Q. WOODARD

Invemtigations in Enzyme Action Directed towards the Study of the Biochemistry of Cancer: The Activation of Pancreatic Pro-lipa8e, D. L. WOODHOUSB.Bio- chem. J. 26: 15121527, 1932. A method has been elaborated for the separation of the inactive pro-lipase fraction of the pancreas in sufficient quantities so that the interaction of the pro- lipase with chemical compounds, serum co-enrymes, and other physiological fluide may be studied. A few lead sdta were found capable of activating the pro-lipase. A co-enryme capable of activating the pro-lipaae was found to be present in urine and ovarian fluid. Small amounts of human and animal sera were found to activate the pro- lipaae; cancer sera did not differ in activity from normal sera. H. Q. WOODARD

Influence of Oxygen Tension on the Rate of Autolyds of Certain Malignant Tumors and NodThues, MARYE. MAVPJR,J. M. JOHNSON,AND CARLVOPJQTLIN. Pub. Health Reports 48: 42-51, 1933. Reduced oxygen tension exerted a distinct influence on the autolysis rate of the WCer rat carcinoma 256, the Jensen rat sarcoma, and of skeletal muscle and liver from albino rats. Under greatly reduced tension the rate of proteolysis was in- ctebeed and the rate of oxidation of sulphydril groups was lowered, as compared with digeetion under atmospheric oxygen tension. The same relationships were found in the digestion of coagulated egg white by papain and the digestion of blood fibrin by papain in the presence of reduced glutathione. WM.H. WOQLOM

Surface Tension in Malignant Tumors, I. PH. HBNNEIMANN.Oppervlaktespan- ning bij kwaadaardige gerwellen, Geneesk. tijdschr. v. NederLIndil 72: 1278- 1285, 1932. Following a short theoretical discussion on surface tension, the writer mentions experiments performed by various investigators on the surface tension of tumor extracts as compared with normal tissues and shows they do not agree. Because of these discrepancies he made some determinations with Cysticercus sarcomata of the rat. Control experiments were made with muscle, liver, spleen, and lung. Immediately after the death of the animal the tissues were ground with sand and mixed with a physiological salt solution. The suspension then was shaken for one hour and centrifugalired. The determination of the surface tension was performed immediately afterwards with a “ viscostagonometer.” A stalagmometer could not be used because not enough liquid was available. It was found that the surface tension of the extract of a spontaneous sarcoma in the liver, caused by Cyuticercu8 fa8Ciolari8, waa as high as that of the liver itself, and that the surface tension of extracts of tumors obtained by transplanting the above mentioned sarcoma, was higher than that of liver, muscle, spleen, and lung of the animals in question and of normal rats. A short bibliography completes the article. JOHANNESP. M. VOQELAAR 404 ABSTBAOTB

Biochemistry of the Row Chicken Sarcoma. II. Bide-. 10. Changer in the Relative Concentration of Certain Vital Flcton, VLADIM~RMOR~IWK. Bioohemie des bus-Sarkoms der HUhner. 11. Bioohemie. 10. Vednderun- gen der relativen Konsentration einiger biogenen Elemente, Ztschr. f. Kreb5 forsoh. 38: 62-62, 1932. With this article the author terminates a series of biophysical investigations and analyses of ashed tumors. As a result of the experienoe thus gained, he con- cludea that the variations so far recorded by others, such as anomalous respiration, deviation in the activities of respiratory ferments, aacumulation and abnormal splitting of lower organio aoids, alterations brought about by lipolytio ensymes, disturbances in the globulin-albumin or oholesterol-leaithin ratio, ohanges in hydration, permeability, etc., are none of them oauses of malipant growth. All are seoondary. WM. H. WOQLOM

Potassium Content of Malignant Tumors, A. EPBTIOIN.Zur Rage des Kaliumge- haltes in Krebsgeschwlllsten, Ztsohr. f. Krebstorsoh. 38: 63-74, 1932. Fifty-two benign or malignant neoplasms of various typea were examined in respeot to their potassium oontent. In 11 oases this was determined before and after radiation, while in 6 the surrounding tissues also were investigated. Tumors were found to contain more potassium than the corresponding normal tissues, the amount being larger the greater the malignanay of the growth. For a day or two after radium treatment the potassium oontent inoreased, but began to fall on or about the fourth day. The reason for this rise is said to be inflammation and oell destruotion, while the deorease is explained by diminished vitality of the tumor cells. [The augmented potassium oontent of neoplasm desoribed by the author amply oonhs the work of his predeoessors, most of whom appear to be cited in his introduotion.] WM.H. WOQLOM

Relation Between the Rate of Growth of Tumors and Their Vitamin A Content, E. VOQT. Besiehungen swisohen der Waohetumpotens der Tumoren und ihrem Gehalt an Vitamin A, Med. Klin. 28: 1344-1345, 1932. The vitamin A content of 25 human tumors waa determined oolorimetrically. Little or no vitamin was found in 8 myomas; small but appreciable quantities were found in 5 ssroomas; vitamin A was found regularly in caroinomas, and the amount was greater the more rapidly the tumor was growing. H. Q. WOODARD

The Cells of Human Cancer. Chromosomes in the PrImUy and Metastatic Tumor, A. H. ANDms. Zebtudien an Mensohenkrebs. Der chromosomale Bestand im Primilrtumor und in der Metsetwe, Ztsohr. f. Zellforsoh. u. mikr. Anat. 16: 88-122, 1932. Andres' studies were made on a basal-cell epithelioma that metastasiced to a regional lymph node. In both the primary tumor and, the metastasis the cells showed asymmetrioal mitoses, and the abnormalities in the ahromosomes and variability in their numbers observed by others in cancer cella. The abnormalities in the metastatic tumor were of the same type as in the primary growth, but more numerous and variable. In both, some cells with entirely normal chromosomes were present. The abnormalities of the chromosomes, the author believes, are not to be regarded as an etiological faotor in the pathogenesis of oanoer. Rather there is a primary change of the physiaoohemiaal nature of the cell protoplasm. This is to be regarded as a genetic mutation oharaoterietic of oancer. A number of photomicrographs are reproduced EXPEBIMENTAL AND BIOOHEMIOAL STUDIES 405

Action of Erytbrodn on the Vitality of Cells, A. H. ROFFO. Action de 1'Brythrosine sur la vitalit6 des oellules, NBoplasmes 11: 104, 1932. This is a brief abstract of a paper read before the Argentine Society for the Study of Cancer. The fluorescent substances eosin or erythroein inhibit growth in cell cultures, and completely so if the influence of ultraviolet rays be superadded. The effect is greater upon neoplastic tissues than upon normal ones. These agents, themselves inert, are activated by light, as is a third fluorescent material, methylene blue, though this exerts other and important effects upon oxydo-reduction. WM. H. WOQLOM

Action of Chlorophyl on HodErythrocytes and Those from Cmceroue'hdivid- uals, A. H. ROFFO. Die Wirkung des Chlorophylls auf normale und krebsige BlutkBrperchen, Ztschr. f. Krebsforsch. 38: 312-325, 1933. Also in Bol. Inst. de med. exper. para el estud. y trat. del ctincer 9: 100-120, 1932. Chlorophyl is hemolytic under the influence of ultraviolet and light rays with a wavelength above 2300 Angstrom units, and more actively so for erythrocytes from cancer patients or sarcoma-bearing rats than for those from patients with other lesions or from normal rats. Thus it exhibits a property already demonstrated for other fluorescent Substances. [See Am. J. Cancer 16: abst. pp. 780,1012, 1014, 1293,1932; 17: 480,971, 972, 1933.1 WM. H. WOQLOM

The Setting Free of Carcinoma Lipids by Blood Serum and Its Possible De- pendence upon the Reticdoendothelid System, R. WILH~IM.LipoidauslBs- ung aus Krebesellen durch Blutserum und ihre allfUge Abhgngigkeit vom Reticuloendothel, Wien. med. Wchnechr. 82: 979-980, 1932. The author brings together and discusses some recent findings. Using for the most part metastatic human tumors obtained at autopsy, he finds that the serum of both healthy persons and cancer patients is capable of dieaolving out lipoids contained in malignant tumors. The amount of lipoid substance obtained from cancer tissue by the action of normal serum depends to a much greater extent upon the amount of serum used than is the oase with the serum of cancer patients; that is, with the latter serum the lipoid yield reaches the maximum sooner, and this maximum is smaller, than when the serum of healthy persona or of patients suffering from non-malignant disease is used. The author next refera to animal experiments which seem to show that when substances are injected into the body which cause blockage of the reticulo- endothelial tissue system, this difference between normal and cancer serum disap- pears. Stern found that when emulsions of mouse carcinoma were treated with serum from cancer-bearing mice and implanted in normal mice the resultant tumors grew more rapidly than in a control series. Wilheim attributes this increased virulence to the action of the serum in setting free lipoids when added to carcinoma tissue. He correlates his findings with those reported by Freund and Kaminer, according to whom a similar Werence exists between normal and cancer serum in the proceea of cytolysis of cancer cells. He believes that this carcinolysis is related to hemolysis, and that it is not a proteolytic proaess but one bound up with the lipoid metabolism of the cancer cell. The enzyme lipase, whether obtained from plants or animals, when freed from proteasee, is capable of lysing both normal and cancer cells. The glucoside saponin has a similar action, but it emulsifies and does not split fats, and its action is feebler than that of serum. F. CAVBIRS 406 ABSTRAOTS

Quantitative Study of Lymphocyte Production, J. M. YOFF~Y.J. Anat. 67: 260- 262, 1933. From experiments on lymphooyte produotion in dogs, the author adduoes evidenoe that the lymphooytes of the blood are replaoed on an average two and a half times daily; that since the blood lymphooytes normally remain eonstant, the same number of lymphooytes must leave the blood daily as enter it; that the lymphocytes leaving the blood probably peee into the bone marrow, where they develop into erythrooytes and granulooytes. He dieaueaes the view, still prevalent among olinioiane and pathologieta, that, because the lymphatio tiesues are often the seat of seoondary inflammation or of malignant deposits, these tieeues exist for the purpose of aoting as a barrier whioh holds up, at least for a time, the spread of injurious matter. It is equally true that the lymphatio system faoilitaten rapid dimemimation of suoh produots. The author argues that if the barrier theory is onrreot it involves the assumption that in the majority of people, who live the greater part of their lives without either aoute inflammation or malignant disease, the lymphoid tissue is funotionless, merely marking time until it is needed. “ In the normal body the only funotion that oan be definitely assigned to the lymphoid tissues is the produotion of lymphooytee.” F. C~vlaae

Examinntion of Neoplpeme of the Breast and Skin by the Method of Miero- incineration, I. Y. O~ca. Proo. Boo. Exper. Biol. & Med. 30: 511-513, 1933. Oloh reports a study of the inorganio salt oontent of neoplasms of the breaat and skin in oomparison with that of the normal tissues, by the method of mioro- inoineration. The ash of a section of normal breast tissue is flat white. In caroinoma of the breast the ash of the malignant epithelial oeb waa decidedly bluish; that of the stroma varied from white to bluish white. Where there WMI epithelial degeneration the blue oolor deareased or was entirely absent. In ohronio mastitis with oystio enlargement of the duota but no proliferation of the duct epithelium, the ash was white. When epithelial proliferation ooourred, the ash showed a definitely blush tinge. In the cellular areas of sarooma the ash was bluish-white and not as aoncentrated as in oaroinoma; in areas of cellular degeneration there was no blue ash. In the skin, the ash of the epidermis is deoidedly bluish; this ie probably the only normal tiseue with ash of thie oolor. The ash of the oorium and underlying struotures is white. In warts and hyperkeratoses resulting from x-ray burns, the hyperplastio epithelial oells showed an intensifioation of the blue oolor, but the desquamating, oornified epithelium and the epithelial pearls yielded a white ash. In nevi, pigmented or not, the nevus oeb gave a white ash; but when malignant ohange ooourred, there was some ash of a bluieh tinge^ in addition to a large amount of flat white ash. Caroinoma of the akin, whether bsesl-oell or squamous-cell, showed a greater oonaentration of blue ash in the malignant epithelial oells; in the squamous-cell growths the ash of the epithelial pearla and areas of oellular degeneration was predominantly white; the amount of ash was greater in the latter. White ash in inoinerated times indioatee the presenoe of aaldum or magnesium. The ohemioal signifioanoe of the bluish ash has not been determined; Poliaard believes it indioates sodium or potassium. At any rate, the findings by miaro- inoineration demonetrate a fundamental ohemiaal diflerenoe in the mineral 8alt oontent of normal tkues and benign and malignant neoplasms. Thie Merentis- tion is evident in early proliferative ohanges whioh are oonsidered to be “ pre- oumora of malignanoy.” EXPEBIMENTAL AND BIOCHEMIOILL STUDIES 407

Note on the Technique of Microincineration :Its Advantages an an Application for a Eistochedcal Study of Nod and Malignant Tissues, E. S. HORNINQ. J. Cancer Research Com., Univ. Sydney 4: 118-121, 1932. A simple technic for the incineration of tissue sectiom ia described. In favorable cases the different ash constituents may be recognised qualitatively. H. Q. WOODARD Findings Apparently Favoring the View of a Cancer Virus in Some Spontaneous lnimrl Tumors, C. CXAMPY.Quelques faits favorables B l’idb d’un virus cancbeux dane quelquea canoers animaux (cancers des Gallinac&, cancers des Tritons), Bull. Aced. de ma, Paris 108: 1631-1634, 1932. The author states that he has observed what he calls endemic malignancy in a strain of fowls raised by him, the tumors including carcinomas of the intestine, ovarian tumors (rare), and embryomas, in addition to sarcomas. Several birds other than the domestic fowl were placed in cages with the fowls and two of these also developed tumors; one out of six Barbary ducks had bilateral embryomas of the ear, and one out of six guinea-hens an intestinal carcinoma. The author thinks these observations favor the theory of a contagious cancer virus. In the ensuing discueaion, Hallion stressed the need for considering the possibility of purely coincidental occurrence of spontaneous tumors before attributing theae growths to an infective virus. F. CAVBRS

Sarcoma and Carcinoma in a Guinea-pig, C. C. TWOBTAND J. M. TWOBT.J. Path. 6: Bact. 35: 976, 1932. A four-year-old male guinea-pig had an intra-abdominal tumor involving the right kidney and a Boft tumor involving the right breast. The renal tumor was an oeteogenic sarcoma; the breast tumor was a columnar-cell adenocarcinoma, probably from the ducts. The lymph nodes were not involved. Carcinoma is one of the most frequent tumors found in guinea-pigs, but usually occurs in the breast of the female.

Contribution to the Chemistry of Plant Tumors, G. KUIN AND E. KEYSSNEIR. Beitrllge zum Chemismus pflanslicher Tumoren, Biochem. Ztschr. 254: 251- 285, 1932. I. Nitrogen Balance: Determinations were made, by standard methods, of the albumin nitrogen, soluble nitrogen, ammonia nitrogen, amide nitrogen, and amino nitrogen of normal and tumor tissues from the balsam, geranium, tomato, beet, and turnip. The tumors were produced by B. tumefmiene. All the plant tumors examined contained more albumin than adjacent normal tissue. Soluble nitrogenous substances were higher in the tumors of the balsam, geranium, and tomato than in the normal tissues, but were lower in the tumors of beets than in the normal tissue. II. Hydrogen-ion Concentration. Determinations were made of the pH, the ethergoluble acids, and the ash acidity of tumor and normal tissue from balsam, geranium, tomato, sunflower, cucumber, beet, and turnip. By all methods the tumors were found to be more alkaline than adjacent normal tissue. III. Catalase Content of Plant Tumors. The catalase content of normal and tumor tissue ,was determined by a modification of the oxygen method, details of which are given. The authors conclude that the catalase activity of the tumors of three different types of beets is much greater than that of the adjacent normal tissue. The activity is due to an ensyme originating in the tumor tissue. It is not due to bacteria nor bacterial products, and is independent of the strain of B. turn-faciens used to produce the tumor. H. Q. WOODARD 22 408 ABBTBILOTS

Biological Action of Homoqibneour and Eeterogeneour X-rays, C. M. SCOTT. Roo. Roy. 8m., Seriea B. 112: 366-3@, 1933. In 1929 Moppett reported the dteof experimente in the roentgen irradiation of the allantois of the fowl through a window formed by removing a pieoe of the egg ehell after six daya’ inoubation, that is, when the allantois has almoat oompletely grown round the egg. He oonoluded from his findinga that a homogeneous beam of roentgen raye is enormously more aative than is a heterogeneous beam, and that there is an antagonism between roentgen ray8 of different wavelengths in their biologioal effeots [see Abet. in Am. J. Canoer 17: 182, 19331. The author has repeated these experimente, following Moppett’s teahnio. He emphasisee the faot that the allantoie is not very suitable material for irradiation; for one thing, it is injured by exposure to the air, and it is, M he pute it, a dying fiseue. Hie main oonoluaion, however, is that equal weak dosage of homogeneous and heterogeneoue roentgen reaye produces identioal effeate on the dantois hence there om be no antagonism between the componente of the heterogeneous beam, He oonfirme Moppett’s finding that a doee of two or three r unite adminietered over a period of two to three howproduaee the eame effeot as a dose of 800 r adminietered in one hour. The detailed findings are set out in a series of tablee, and there are illuatrations of the apparatus used. F. CAVIO~~S Comparative Action of X-Rays and Gunnu Rap in Sterilization of the Fderof the Fruit Fly Drorophilr Melanognator, S. SIMON.Aotion oomparh dee .rayons X et des rayons gamma eur la et&ilhtion dee femelles de Drosophils Melanogseter, Canoer 7: 229-248, 1930. In a short survey of the literature of the eubjeot Simon pointa out that the majority of etudente of the problem regard the biologio aotion of x-raye aa independent of the wavelength. In the earlier inveetigatione, however, the measurement of the quantity of the radiation was not aoourate, and the importance of the rate at whioh the dose waa given waa not realired. Aoaordingly Simon undertook to inveetigate the effeot of the radiatione of both x-raye and gamma raye, taking into aoneideration the time faotor. It is, however, to be understood that the gamma raya were not measured in r unite. In order to avoid diffiaultiea in interpretation of reeults and reduce errore to a minimum, it is neoBBBBIy to um a8 a test objeot eomething as homogeneous and as simple as poesible, 80 that the only variable is the quality of the radiations and the rate of their applioation. Suoh requirement8 eliminate aomplex thuee euoh ae nkin, teetiole, lymphoid etruoturee, ovariea, and engrafted tumors. Individual variations in the oeh, the poseible infiuenae of nervous and veeoular conneotione, intensity of the metabolism of the tissue, mitotio aotivity, and varioue other extrinaio fedora play an important r31e in the degrea of radioeeneitivity. Such problems as the direct or indireot aotion of the radiation, the differenae in radioeeneitivity between the mitotio and resting aell, and the influenoe of the metabolic activity of the oell after irradiation, are etill being studied and are far from settled. The radiation of germinating aeede euffere from the same oomplexity. Physioo- ahemioal testa, suah aa the floooulation of oolloide, the blaakening of photographio plates, and the dholoration of ohemioal substances have the advantage of aim- pliaity, but are too far removed from living tiesuee to permit of generalisation. Thie leaves as eatisfaotory biologiaal material only tieaue aulturea and ova euoh M those from Asoaria, from ineeote, and Batreohia. Siae tieeue bulturee and egge in the ooum of development oontain a variable number of mitoms, and ae it is well-known that the radiosensitivity of the oell differs at different &ages of mitosis, the author has preferred to eliminate aelh and tiesuee in aative mitoeis and to ohooee as a biologioal teat the egga of Drosophilo near the end of maturation, but not yet fertilised. EXPHRIMENTAL AHD BIWHBMICIAL STUDIES 409

The female Drosophila will deposit unfertilired eggs eight days after the lnrval stage. The best results me obtained by radiating virgin fernales five to six days old and then having the females fertilized by males of the same strain immediately after irradiation. It is neoemary to see that copulation takes place, otherwise unfertilired eggs would be deposited spontaneously, whioh artifioially inoreases the peroentage of non-hatohing eggs. Curves have been made by counting the eggs from 10 to 20 females. The eggs as soon as they are laid are examined at intervals and the peroentage of non-hatohing is established. This remains below 5 per oent in the controls and varies in the irradiated inseots acaording to dosage. Eaah series contains an average of 3,000 to 4,000 eggs. The x-rays were given at 170 kv. 4 ma. with filter of % mm. of oopper and 1 mm. of aluminum. The flies were placed in a namow oelluloid cylinder and this put inaide a box of Columbia wax with walls 1 am. in thiakness. This is to assure the utiliration of diffuse radiation. The gamma rays were produced in an apparatus oonsisting of a wooden cylinder with an internal diameter of 14 mm. Its external surface was covered with wax, to whioh the radium tubes adhered. The thioknese of the wall was suah that the radium tubes were 1 om. from the internal surfaoe. The radium was contained in Dominioi tubes with a wall of 1 mm. of platinum. They contained 13.33 mg. or 0.00 mg. distributed over a length of 16 mm., also 3.33 mg. The second lot of needles, filtered with mm. of platinum, contained 1.33 mg. or 0.06 mg. distributed for a length of 6.16 mm. Suoh distribution is praotioally homogeneous for a length of 4 om., provided 4 series of tubes are plaoed dong the oylinder. The time faotor was eliminated by giving the x-radiation and gamma radiation for the same length of time, which was four to five hours. The oomplete sterilisation of the females was diffioult, requiring a dose of from 10,OOO to 15,000 t. A mortality of 50 per oent was obtained by a dose of 600 r of x-ray or 100,000 ergs of gamma rays. A dose of 1800 t or 300,000 ergs caused a mortality of about 95 per oent. A atudy of the results ehowed that no difierenoe in the effeote of the two types of radiation oould be observed when the exposures were of equal duration. When the gamma rays were given for four hours and the x-rays for nine minutes, the x-rays were biologioally more aotive. The oonalusion is that when the same number of ergs absorbed by a o. a. of irradiated tiesue are given in the same time the effeot is equal. The method of measurement in ergs is that developed by Stahel and published in Le Canoer 5: 1, 1929.

DMerential Action of Gamma Rays, S. Rues AND G. M. Scow. Brit. J. Rsdiol. S: 814-823, 1932. The radium used in the experiments here reported was soreened by varying thiokneeses of platinum. In order to aompensate for the varying distanoes from the tissues of the radium salt with the dBerent filtrations, the thinner tubes were waled into very thin sheathe of silver or platinum of the same outside dimension M the 3.0 mm. tube. Ionization measurements were made by an electrosoope with very thin walls of aluminum, so that it measured not only the gamma rays but also the beta radiation. The only variation then was in the type of radiation, the time factor being kept oonstant aad the differenoes in ioniretion value adjusted by the aoncentration of the radium. Rabbits were anesthetiaed and tubes stitohed on either aide of an ovary. The greatest damage was done by the more lightly soreened tube. With a dose of 45 mg. hours with a lightly screened tube, the ovary was shrunken and opaque, showed no small ova, and only a few shadows of small Graafian follioles. With the same dose, using 2 mm. of platinum, the ovum was elightly shrunken and mioro- scopioally had the appearanee of a normal ovary exoept for the reduction in the 410 ABSTRACTS number of ova and Graafian follicles. ‘With the longer exposure, while the effects were more severe, the damage done was greater with lower filtration. The writers argue that in human beings a dose of 1100 mg. hours should cause only slight transient damage to the ovary. [This statement is not in accord with the general clinical experience that 1400 mg. hours caws a permanent amenorrhea even in young women.] Needles were also inserted into rats’ livers, and in photomicrographs the diameter of the damage shown decreased as the screening increased. The authors aonclude that in using two varieties of tissue, the ovary of the rabbit and the liver of the rat, there is a proportionately greater biological effect when radiation of the longer wavelength is used, the ionisation values being constant. In the dieaussion, Dr. N. 8. Find said that he had always maintained that the purely physical view of absorption of radiation by cells could not be held completely to account for the effects observed, and he hoped that the facts would find their way abroad because high voltage work was being held beak in many places by the belief that only the physical absorption of radiation mattered. Dr. Peterson rather shrewdly wondered whether the effects described might not be due in part to the different distribution of energy from the applicators, some giving off a large proportion of beta rays, others much less. Dr. Douglaa Webster said that it was not perfectly clear what Professor RUM was trying to prove by these experiments, nor indeed what he had proved. He had dealt with several subjects, including the biological effects on different types of cells. He waa not EU~that in either problem Prof, Rum had come to a conclusion. Dr. Webster correctly ahallenged Dr. Finsi on the aseumption that 900 k.v. would be more effective clinically than 200 k.v. {certainly an excellent point]. Dr. Finri reported that nothing was known about voltages above 200 [and this in November 1932!], but an inference could be drawn from the fact that up to 200 k.v. improved results had always followed increased voltages and increased filtration. To these happy remarks Dr. Stebbing added the weight of hie authority, that he was sure that the shorter the wavelength the larger the percentage of recovery. Professor Hopwood said that he waa glad that Dr. Webster had brought up the question of what Professor Rues was trying to prove, because he did not think that Professor Russ set out to prove anything. Miae G. M. Scott explained that it was not possible to compare the ovary of one rabbit with the ovary of another rabbit; therefore, it had always been neceeaary to compare the radiated ovary against the controlled ovary in the same rabbit. Professor Rues in closing said that in his opinion biological effects were not proportional to physical effects.

ETIOLOGY, CLINICAL OBSERVATIONS, BLOOD STUDIES Refl~~ti~~on the Etiology and the Prophylaxis of Cancer, M. CHATON. RBflex- ions relatives B 1’6tiologie et B la prophylaxie du cancer, Rev. gdn. de clin. et de th6rap. 46: 273-279, 1932. The author maintains that the clinical. course of cancer, its spread by the lymphatics and then by the blood, follows that of other diseases caused by a living organism. The histological characteristics also support thin hypothesis. While the causative organism has not been definitely isolated, much experimental work indicates that cancer can be transmitted by contact with or by grafting of aan- cerous tissue. The study of houses, towns, and other smaller and larger areas where cancer is especially prevalent also suggests that cancer may be contagious; at least, it cannot be proved that it is not. ETIOUMY, CLINICAL OBBBRVA!lTONS, BLOOD STUDIES 411

Cancer and Heredity, J. DUCUINQ.Cancer et hBrBdit6, Toulouse mBd. 33: 557- 561, 1932. The author comments on the difficulty of obtaining satisfactory family histories for determining heredity in man, and on the difference of opinion in regard to the heredity of oancer among those who have investigated this subject on the basis of clinical and family histories. He refers to the studies of heredity of cancer in mice made by Maud Slye, which he regards as very exact. But as breeding cannot be controlIed in man as in laboratory animals, it is impossible to trace hereditary factors in the same way, especially as the cancer factor is regarded as a recessive character. If cancer ia really hereditary, the cancer tendency is not the same in all who poseem it, for there is not “ a cancer,” but “ a whole series of cancers.” If two persons with the cancer tendency mate, they may transmit to their offspring two different cancer tendencies which are, so to speak, “not comple- mentary,” and both may remain latent, without producing cancer. Therefore, if cancer hereditary in man, it is not always transmitted; the offspring of a person with cancer is not necessarily doomed to have cancer; and cancer may develop where there is no history of this condition in preceding generations. In- disputable facts prove the reality of acquired cancer of the industrial type. Relation Between SypW and Cancer, J. SCAPIER. Syphilis et cancer, NBo- plasmes 11: 277-290, 1932. The author believes that syphilis forms the usual or even universal basis upon which malignant growths develop. Cancer shows a predilection for those organs which have been attacked by syphilis, first because of the chronic irritation exerted on these organs by the spirochete and, secondly, because of the humoral condition of the syphilitic subject after treatment by antiluetic drugs, these remedies being potent carcinogenic agents. Most, if not all, cancer patients have previously been infected by syphilis; if they have been treated by antisyphilitic drugs, 80 much the greater is the risk of their becoming victims of cancer. When an author begins with statements like these, the reader may expect that the argument will be supported by convincing evidence. In this case he will be disappointed, for this paper is as misleading, biased, and bigoted a piece of special pleading aa hundreds of other effusions on cancer etiology that are allowed to appear in all except the really reputable medical journals. There is no need to summarire the statements cited from equally imaginative writers or torn from their context in more reliable sources and misunderstood by the author in com- piling this paper. He seems to lay great stress upon his own research work. He says that he has obtained with ease first hyperkeratosis and later epithelioma by rubbing the ears of guinea-pigs with a mixture of arsenic and vaseline; nothing is said as to the number of animals used, time of appearance of the lesions, eto. The chief triumph, however, was obtained 4th two rabbits. One was inoculated with syphilis and its blood Wassermann became positive; it was then given 1 C.C. of novarsenobenrol intravenously once a week, and its ears were rubbed with amenicated vaseline; after a month there was hyperkeratosis and soon afterwards (interval not stated) the horny area showed malignant warts, and the animal died with metastases in the lungs. The second rabbit was similarly treated but not infected with syphilis; it also produced a skin epithelioma but no metastases. This experiment is regarded a8 proof of the author’s thesis as stated at the beginning of this abstractf F. CAVERS Local Circulation and Cancer, G. JEANNENEY.Circulation locale et cancer, Gas. mBd. de France (supp. rediol.), pp. 164-161, Jan. 15, 1932. A special study of the local circulation of the face in relation to the incidence of cancer has been made by the author at the Cancer Institute of Bordeaux. The 412 ABSTRACTS oapillarosoope was used in the living to some extent; but the study is based ohiefly on histologio examination of the outaneous blood vessels made at autopsy after oareful injeotion with oolored gelatine. The sites of more than 300 oanoers of the faoe in relation to the looal oiroulation have been reoorded by a simple graphic scheme; and this has dearly demonstrated that the sites of predileotion for cancer are the are88 that are most poorly vseoularized. Two other points are espeoially oonsidered-the vasaular ohanges in two types of preoanoerous lesion, mars and syphilis. The frequent ooourrence of oanoer in oertain types of soars is well known; these scars result from healing by second intention of burns, uloers, fistulas, lupus, and x-ray dermatoses. In all the essential lesion is a solerosis of the blood vessels. In preoanoeroue syphilitio lesione- leukoplakia and soars of ulcerated gummas-vascular ahangee suoh as endarteiitis and soleroab are marked. In surgioal wounds, heeling by seoond intention should be prevented; and in other wounds that show " vicious " soars, as burns, it is often best to exoise the scar, with akin grafting it the loss of substance is large; the latter is espeoially advantageous as it supplies new blood vessels. All these findings indioate that outaneous epitheliomas show a tendenoy to localire in tissues poorly vascularired and poorly supplied with blood. It is for thia reason that the author has suggested sympatheotomy in the treatment of certain oanoers, to improve the looal circulation. The loiroulatory insuffioiency acts to some extent by preparing the soil for oanoer, as it oauses degenerative ohanges in the tissues. But it probably plays a more important rde, aoting in two ways. (1) The lowered blood supply diminishes the nutrition of the oells and hastens their destruotion, with the liberation of speoial cellular elements-tre- phones of Carrel, oytosts of Turok-that stimulate mitosis in the surrounding living oells. (2) The defioient cirouletion results in the retention in the tissues of organio metabolio waste matter, the r8le of which in oancer is recognized: cholesterol (Roffo) and indol (Carrel). In this way the looal defenses are destroyed and the meohanism regulating the oellular equilibrium is disturbed. Bactedologicrl Study of Chronic Ulceration in Relation to Cudnonu, EDWARD WATTBSAUNDBRS. Ann. Surg. 9s: 327-335, 1932. The author reports a study of 41 identioal strains of streptooocci isolated by anaerobic tissue cultures from 24 reseoted gsstrio uloers, of which 6 were carcinoma; 2 cases of ulcerative oolitis with large adenomatoid hyperplastio polyps; 2 rectal oarainomata; 8 infeoted oervioea; 3 mammary oarainomata. All of these organisms were proved identical by agglutination, cross agglutination, and agglutinin absorption, and were also proved identioal morphologically and oulturally with the Streptooocoua lactiaus of oows' milk.

Cmcere with Fever, NOF~DMAN.A ptopos des oanaers B forme fdbrile, Loire m6d. 46: 102, 1932. Not only seoondary cancer of the liver, but primary cancer may oauae prolonged fever. The author's patient had fever for 120 days, with a temperature varying from 38" C. in the morning to 40" in the afternoon. Clinical examination and therapeutio tests eliminated abecess, syphilis, and hydatid cyst of the liver. The diagnosis of oanoer was oonfirmed by exploratory operation. Contribution to the Study of Multiple Neoplume. Carcinoma of the Larynx and Ikophrqw, Both Appuemtly primuy, in the Same Individual, V. FEBRUCCIO. Contributo all0 studio dells plurioith neoplaefioa, Oto-rino-larin. ital. 2: 311- 313, 1932. A man aged sixty had carcinoma of the larynx. Laryngeotomy was done. Examination of the specimen showed a well limited squamoua oarcinoma whioh ETIOLOGY, CLINICAL OBWIBVATIONS, BLOOD STUDIES 413

had not involved cartilage. The adjacent nodes were free. A few months after operation dysphagia developed. Esophagoscopy then revealed a constricting growth at the level.of the aorta. Biopsy showed epidermoid carcinoma. Fer- ruccio concludes that both tumors were primary. C. D. HAAQENSEIN Coexistence of Basal- and Prickle-Cell Epitheliomafi, A. MARIN. Coexistence d’6pith6liomas baso- et spino-cellulaire ches un m@mesujet, Union m6d. du Canada 61 : 770-772, 1932. The patient had an ulcerating growth pn the lower lip, and a nodular and partially ulcerated lesion on the right temple near the external canthus of the eye. The lip lesion was a typical prickle-cell epithelioma and the lesion on the temple a typical basal-cell epithelioma. Case of Multiple Radium Carcinomata, HANSDROSCHL. Ein Fall von mehr- fachen Radiumkrebsen, Ztschr. f. Krebdorsch. 38: 274-282, 1933. A physician, born in 1878, had worked frequently during the period 1905-1907 with feebly radioactive material (uranium ore deposit), though without apparent harm. Since 1911 he had employed concentrated sealed preparations of radium, interrupting his activities only during the war years 1916-1918 and, up to 1931, by occasional vacations amounting to about eight months in all. He had never used x-rays. Radium was employed in the form of plaques, tubes holding 30-73 mg. of radium element, and an apparatus for external applications containing 60-112 mg. of the element. The total amount of active material with which this physician came daily into contact ran from 200 to 850 mg. The hands were most exposed to the filtered primary radiation from these appliances, though the rest of the body waa not spared; secondary rays were of smaller import, for these were weakened or entirely absorbed by the containers. Actud exposure often lasted but a few eeconds, for the danger was well understood, and the greatest care possible under the aircumstances was exercised; yet between 1911 and 1930 the patient gave or superintended about 41,000 treatments. There had been no acute radium burns or telangiectasia. In 1913 unusual sensitiveness of the hands to higher temperature (warm water) was noticed, and then a diminution of tactile sensation in both index fingers; at the same time their papillary markings became indistinct, the skin was dry, inelastic, and pigmented, and prickling sensations appeared in the finger tips. By 1921 these had become atrophic, small hyperkeratoses with painful fiaeures began to appear on various fingers, and sweat secretion ceased over both hands. The situation became progreaeively worse until, in 1930, an ulcerative lesion removed from the ring finger of the right hand was found to be an epithelioma. In spite of thin warning the patient continued with his usual work, and in 1932 an ulcer had to be excised from the right index finger and the right thumb amputated; in both cases the microscopic diagnosis was carcinoma, Death occurred a few months later from aplastic anemia. [The author found one similar instance in the literature, but mimed the case of MacNeal and Willis (J. A. M. A. 80: 466, 1923).] WM.H. WOQLOM Complex Symptomatology Caused by Two Epitheliomas of Different Origin in a Syphilitic, P. GOVAERTSAND J. DAQNELIE.Symptomatologie complexe pro- duite par deux 6pith6liomas d’origine d86rente ches une syphilitique, Scalpel 85: 106&1063, 1932. A woman seventy-one years of age was admitted to the hospital in a state of mental confusion. Examination showed a paresis of the right facial nerve without hemiplegia; a mass along the sternum which appeared to be a carcinomatous 414 ABSTBAOTB metastasis; a cancer of the uterine cervix. The diagnosis of a thoracic metastasis and possible cerebral metastases of the cervical cancer was made. Further examination showed the Wassermann reaction in both the blood and spinal fluid to be positive. The nervous symptom were attributed to ahhilitic involvement of the central nervous system. At autopsy it was found that the latter diagnosis wae correct. The thoracic tumor warn a prickle-cell epithelioma of exactly the same type as the cervical tumor. A study of a lesion on the tongue showed a syphilitic leukoplakia with a highly Merentiated prickle-aell epithelioma at the base of the lesion. There were, therefore, in this case two epitheliomas, entirely independent of each other, and a syphilitic infection which still further complicated the diagnosis.

Tumorr, of Muscle Type: Report of a Group of Caaes, with 8peci.l Reference to Metantamis of Leiomyourconu to the Brain, J. STANLBIYCOHBN. Arch. Path. 13: 857-887, 1932. The incidence of muscle tumors varies with the type. Leiomyoma is of frequent occurrence, especially in the uterus. Leiomyosarcoma is rare, occurring much less frequently than is commonly believed. It is seen usually after the menopause. Rhabdomyoma, found as a rule in early life, is rare; the kidney, heart, vagina, cervix, and testicle are the most common sites. Rhabdomyo- sarcoma is seldom seen. The author discusses the theories of origin of muscle tumors, of which the cell inclusion theory of Cohnheim ie the most commonly mentioned. Two other possible theories are suggested for the origin of rhabdomyoma: development of the striated muscle cell from the fibroblast through metapleais, and d8erentiation from the smooth muscle cell. The histologic findings in the various types of muscle tumor are described, and photomicrographs illustrate the text. Diagnosis depends on the finding of spindle- shaped cells arranged in whorl formation or of cross striations in large, irregular cells. Mallory’s and van Gieaon’s differential stains are of diagnostic aid. A number of cases are reported, including what the author believes is the first case of leiomyosarcoma metastasising to the brain. The patient was a man of sixty-five with primary leiomyosarcoma of the left kidney.

Studies in Biology and Pathology, E. K. WOLFF. Neuere Forschungaergebnim in Biologie und Pathologie, Jahresk. f. iirLrstl. Fortbild. 24: 16-33, 1933. In this review of recent contributions in biology and pathology, Wolff includen a discussion of certain tumors of the adrenal cortex and of the ovary that cause an abnormal change in the sexual secondary characteristics. The tumors of the adrenal cortex that cause such changes-precocious puberty or virilism in the female-have long been recognised. Most of such tumors are benign, but a case recently reported by Paul (Virchow’s Arch. f. path. Anat. 282: 308, 1931) shows that carcinoma of the adrenal cortex may have a similar effect on the internal secretions. In his cme the patient wan a woman who showed marked virilism, with onset of symptoms five years before her death. Tumors of the ovary that produce virilism in women are of less frequent occurrence than those of the adrenal cortex. G. A. Wagner has recently presented a review of the clinical findings in such cases, and Robert Meyer of the pathological characteristics of these tumors (Ztschr. f. Geburtsh. u. Gynlk. 98: 134, 149, 1930. Abet in Am. J. Cancer IS: 477,478, 1931). Young women between the ages of twenty-one and thirty-two are most often affected; the changes in the secondary sex characteristics begin with a complete cessation of menstruation. If the Bfiected ovary is removed, the remaining overy resumes normal function, most of the symptoms disappear and ETIOLOQY, OLJNICAL 03BEIEVATION8, BLOOD BTUDIEB 416 menstruation becomes normal. These tumors are not malignant, although the cellular structure is largely undifferentiated, and does not show typical testicular elements. Other ovarian tumors having the opposite effect are the granulosa-cell tumors, which cause either premature menstrual bleeding, excessive bleeding, or a recurrence of menstrual bleeding after the menopause. A recent report by Arnold, Poerner and Msthias (Virchow’s Arch. f. path. Anat. 277: 48-68, 1930) indicates that similar symptoms may be caused by carcinoma of the ovary; in their patient, a woman, sixty-three years of age, in whom there was decidua formation of the uterine mucous membrane, the tumor recurred with extensive metastases.

Tumors of the Buttock, P. GOINARD. Sur les tumeurs de la fesse, Bull mdd., Paris, 46: 473-474, 1932. Tumor is here used to include the various lesions which may appear in the buttock. A discussion of the differential diagnosis is given.

Malignant Glands of Groin Treated with Radium, WINIFREDF. BUCHLEY.Lancet 1: 884, 1932. A woman of sixty-five, seen in 1930, had enlarged nodes in both groins and a mms below Poupart’s ligament on the right side near the femoral vessels. The node in the left groin was removed, and pathologic examination revealed squamous carcinoma. Radium needles were introduced below the wound and into and below the growth in the right groin. Radium plaques were applied to the right thigh and radium needles were later inserted below the growth. The tumors all disappeared, and the patient, who had been emaciated and frail, gained in weight and two years later was active and well. No primary growth wm discovered.

Cam of Abdominal Tumor, F. MLJLLEx~. Fall av buktum(lr, Svenska Ltiktidning 29: 146-146, Sept. 30, 1932. This paper is a discussion of the differential diagnosis in the case of a man suffering from syphilis and arthritis, with severe trauma to the back and an abdominal tumor. No conclusion is reached.

HeopIastSc Diatheds, F. BELLELLI. La diatesi neoplastica, Riforme med. 48: 64, 1932. The author reports the history of a famous writer, not named, who died at eighty-four, following tracheotomy for a secondary epithelioma of the larynx. Among the patient’s writings was a description of several operations for recurring mooma of the mouth, which he had suffered thirty-four years previously. The present report is of more interest from a biographical than from a medical point of , view. JP~ANNEITTEMUNRO

Blood Picture in Cancer Patients, L. A. ADLIWANKINA. Das Blutbild der Krebs-’ kranken, Ztschr. f. Krebsforach. 38: 326-333, 1933. Examination of the blood of 700 patients with cancer of various organs (uterus, gastro-intestinal tract, skin, and female breast principally) showed the following: All cancer, except that of the skin, was accompanied by a hypochromatic anemia (e.g. average hemoglobin 66 per cent, average erythrocyte count 4,510,000, average color index 0.72, in cancer of the uterus), which set in after ulceration with its oonaequent hemorrhage and secondary infection. It was more severe in young than in elderly patients. WM. H. WOQLOM 416 ABSTRAOTS

Lactic Acid of the Blood in Corer of Malignant Tumors, U. FOQLIANI.L’acido lattico del Bangue nei tumori maligni, Riv. di pat. sper. 6: 33-45, 1932. The author reviews the literature on experiments dealing with glycolysis in the presence of malignant tumors. Some experimenters have ooncluded that an increase of the blood laotio said it3 to be found in oaohexia due to malignancies, others have found it in oases with liver meteetasea, others in the presenoe of tumors rich in cellular elements. Fogliani, using the Mendel-Goldsoheider method, determined the lactic soid of the blood in 46 oases of malignanay. Twenty-two cases showed inoreased lactia aoid, twenty-four were normal. In nine cases with liver metastases the blood lactio soid was inoreased. In two such cases it was normal. No constant relation was found between the lactic aoid of the blood and the cellularity or sise of the tumor or the degree of cachexia present. In some owe8 it was normal early in the disease and increased later. Using a small group of tumor omea with controls suffering from other diseases the author tried Margreth’s method of feeding la& soid and testing the blood at intervals (see Boll. d. SOC. ital. di biol. 3: 523, 1928). He conoludea that at present the determination of the blood laotio acid in malignancy is of no olinioal value; that the factors increasing blood laotio aoid in tumor cams are probably multiple, including liver damage both by the neoplasm and by other factors, pulmonary changes, oaohexia, and the siae of the tumor. He believes that the laotic aoid torersnoe teat will be of more value than the mere‘ fasting laotio aoid determination. JIDANN~TTBMUNRO

Behavior of Reducing Subskncer in Blood Plamna of Cancer Patienb in Relation to Prognosir, E. G. MINOPOULOB.Gtudea et reoherches Bur le potentiel Bvolutif et le oontr6le des thhrapeutiquea de la oandrose, Bull. de ~’ASSOC. franp. p. 1’6tude du oancer 21: 654-665, 1932. The author believea that there must be some ahemioal difference in the blood of those oanoer patients who do well after operative or radiation treatment and that of those who show reourrenoes or metastases. His argument is based partly upon the faat that olinioal findings often afford unsafe ground for prognosis (explained by the author as being attributable to differences in oonetitution, or terrain, or what he calls the developmental potential of the tumor in a given patient), and partly on analogy with suoh abnormal blood oonditions as the presence of sugar or.urea, whioh may oompliaate malignant disease and its surgioal treatment. For several years the author has tested the blood of oanoer patients, numbering about 300, for reduoing substances, before and after treatment. He says these are hitherto unknown components of the proteins, and that his method of determining their presence and amount is, so far as he knows, an original one. He hydrolyaes the plasma (method not indioated), ad& Millon’s reagent, then an exoem of sodium hydroxide. No further details of the method are given, except for a remark that in the oold the mixture, when made in a test tube with fresh plasma, gives a coloration passing from yellow to bleakish green. The reduoing substance is recorded in grams per 100 0.0. in B series of tables. It inoreases in amount with inoreasing malignanoy of the tumor as shown clinically and histologically. After treatment-aurgioal, radiologioal, or both oombined-the peroentage increases in cases whioh deteriorate and are found later to show reourrence or metastasis, diminiehes in those whioh show apparent cure, and remains stationary in oases [only one mentioned, and that after an interval of only two months] showing neither progress nor deterioration. The percentage found before treatment varies from 1 to 4; in two exoeptional oases, not desoribed, it was aa high as ETIOLOGY, OLINICAL OB&BBVATXONB, BLOOD STUDIEB 417

8 and 10 per cent [i.e., juat about the percentage of total proteins found by various writers to occur in normal blood plasma]. Every patient showed, immediately after treatment (up to one month, according to the tables), a diminution in the percentage, but every untoward feature or complication occurring after this [the author mentions shock and excedve reaction only] wee duly reflected by a rise. Only three oases are cited ee having been followed for two years. In one showing apparent cure the pre-treatment percentage wee 2.28, falling after treatment to 1 and then remaining steady at 0.8 to 0.9. In two cases showing metaatasjs the first percentages were 2.1 and 2.35, and the last 2.65 and 1.95; in these two cases the figures immediately after treatment were 0.9 and 0.95. The author states that he has also observed (1) a lowering of the calcium and phosphorus of the plasma pari paesu with increase of reducing substance; (2) an increase, by 0.25 to 0.75 per cent, of reducing substance in the blood of a vein proceeding from the tumor ee compared with that of a peripheral vein; (3) an increased amount of reducing substance in the plasma of the relatives of cancer patients, even when the former were apparently healthy persons. [Skeptical comment on these findings seems hardly necessary. The author disarms criticism by admitting that he knows nothing about the chemistry of the blood proteins and the products of their hydrolysis, by giving no sign that he is aware of recent research on the subject, and by offering no details of his method of arriving at the figures he mentions aa quantitative determinetions. In these respects his work stands in sharp contrast with, for instance, that of Guthmann and Plota (Arch. f. Gyniik. 141: 557, 1930, abet. in Am. J. Cancer IS: 345, 1931) on the possible prognostic value of determinations of the blood proteins in cancer. In one respect, however, his work is comparable with theirs; both are in need of repetition in view of their claims to provide a biochemical guide and check on prognosis.] F. CAVERS

Changes Produced in the Oridation-Reduction Potential of the,Senun by X-rays, N. WATERMAN.Uber Anderungen des Red.sx.-Potentials im Serum durch Rdntgenbestrahlung, Ztschr. f. Krebsforsch. 38: 301-311, 1938. Though there were individual Werences to be observed, the oxidation-reduction potential of serum from cancer patients was higher, and mow readily influenced by x-rays, than that of normal persons. The “ unbalanoed ” potential thus brought to light would exert a profound influence on the several vital processes running their course at the surface of the cell, a view which is supported by recent observations on enayme activity, permeability, surface tension, and so on. All these would necessarily become more labile, and the conditions necessary for the inception of cancer might thus be offered. WM.H. WOOLOM

New Findings in Regard to Cancer and their Practical Signifiwce, N. WATERMAN. Lee nouvelles donn6es de la canc6rologie et leur int6r@tpratique, Scalpel 85: 862853, 1932. This is a brief review of the author’s work on certain physico-chemical factors in cancer. He has studied the oxidation potential of the blood serum and found that it is higher in cancer patients than in normal persons, although it varies widely in the same individual. He believes that this may prove to be of importance in the study of cancer. He has also studied lysis of cancer cells in suspension, and aa a corollary the phenomenon of agglutination. By extraction with ether he has obtained lytic and agglutinating substances from the cells of the reticulo-endothelial system, which he has also used in animal experiments in an attempt to establish a method of organotherapy in cancer. 418 ABSTRAOTS

Study of the pE of the Urine in Cancer, DTJPONT AND DALLONQIUVILLIU.Con- tribution B 1’6tude du pH de l’urine ohea les canoBreux, Bull. de l’hc. frang. p. l’dtude du canoer 21: 574-678, 1932. The authors made 201 determinations of the pH of the fasting urine of 22 patienta, 20 of whom had canoer. Both oolorimetric and eleotrometrio methods were used; the values obtained by the two methods agreed to 0.1 pH or better, In patients with cancer of the digestive tract the urine WBB more alkaline than normal; in those with oancer of the uterus, nasopharynx, and breast the pH was normal. €I.Q. WOODARD

Magnesium and Cancer in Indo-China, J. BABLDTAND H. BADEB. Magndaium et dancer en Indoahine, Bull., d. l’tlseoc. franc. p, 1’6tude du cancer 21 : 57CM73, 1932. Cancer is very oommon among the Annamites of the alluvial regions of Indo- China. Preliminary study shows that the soil and surfaoe water in these regions are poor in magneaium. [Bee also Bablet, J.:‘Sur la fr6quence et les modalit& du cancer chez lee Annamites,’Ann. de 1’Inst. Pasteur 48: 594403,1932. Abst. in Am. J. Cancer 17: 1076, 1933.1 H. Q. WOODARD \ What I Think about Cancer, K. W. DOIUQD.Wisconsin M. J. 31: 24-28, 1932. The author states that what he has to say ia not the result of personal researah but a mlective r6sume of what others have thought and done.

DIAGNOSIS AND TREATMENT

Biopry in Tumors, C. ALDXANDERHDLLWIQ. Arch. Path. 13: 607-653, 1932. Because it covers such a range of literature on the subject of biopsy Hellwig’s review is much better read in the original than in abstract. After a short history of the praotice, in whioh its introduction as a routine method of diagnosis is attributed to Ruge (1879), the author disousses the dangers of biopsy, quoting the experimental work of Wood and of Knox and Tysser, whereby it was shown that inoieion of the Flexner rat oarcinoma.did not increase the tendenoy to metastasis but that massage of the tumors greatly inoreaaed the number of meteetatio growths. The dangers of biopsy in tumors of various types and localisation are then oonsidered and numerous authorities are quoted. This seotion oonoludes with a reference to Nather, who has expressed the opinion that all dangers of biopsy oan almost certainly be avoided if this procedure ia not regarded BB a minor operation for offioe praotim but is performed in the operating room with preparations to proceed immediately with treatment should sections reveal a malignant growth. The teohnio of examining biopsy tissue is then taken up, and the advantages of mioroscopio diagnosis during operation are disoussed. The author states his position as in agreement with Wood, that any general acceptanae or condemnation cannot be made, and that everything depends on the intelligenoe of the pathologist and the breadth of his experienae. In a series of 250 biopsies Wilson’s frosen section method led to a oorreot miorosaopio ditagnoeis in 244 cases. In 368 biopsies Terry’s method permitted a oorreot diagnosis in 94 per oent. In 98 per oent both mioroscopic diagnoses were identioal in regard to malignanoy and benignanoy. Thie section of hie paper the author oonoludes aa follows: “ To do justioe to the patient, no examination of tiesue can be regarded oomplete if all three diagnostia methodgthe inspeotion and palpation of the gross materiel, the mioroacopio examination of supravital preparations, and finally the leisurely study of paraffin or celloidin motions-are not employed. The knowledge DIAGNOBIB AND TREATMENT 419 of tumors has run Considerably ahead of the general training in pathology, so that, even with the upof all three methods, errors in diagnosis will still be too frequent.” About twenty pages are devoted to the clinical value of biopsy, and the figures and opinions of a large number of muthorities are,quoted both on cancer in general and cancer in various locations. The concluding section of this paper deals with the future of biopsy. The author believes that it can be safely asserted that with the present microscopic methods, mortality from cancer could be effectively reduced if the benefits of expert biopsy were available to every patient with cancer. He concludes: “ In the attempt to improve the present situation, the first and most important step must be, in my opinion, to take measures to attrmct to the field of surgical pathology young physicians of the highest caliber. A career in tumor pathology must be made as interesting and amtiefactory from every point of view as a career in any other phase of medicine. Surgical pmthology-called by R. Meyer the step child in the family of medical specialties-will then perhmps grow up to a brighter future.”

Some Unusurl Pelvic Conditions, H. THOBBBYAND P. E. WALTONSMITE. M. J. Australim 1: 364-366, 1932. Four cases mre reported to illustrate the likelihood of errors in clinical diagnosis and the neceeaity of biopsy: (1) a retroperitoneal fibroma originally diagnosed as a myoma of the uterus undergoing rapid malignant chmnge; (2) a malignant epithelial tumor of the ovmry, diagnosed clinically as a twisted ovarian cyst; (3) a cmse of uterine endometriosis, believed to be a fibromyoma; (4) a bleeding polypus, first believed to be benign, but showing, on operation, an area of small spindle-cell myosarcoma with diffuse peritoneal and intestinal metastases.

Quantitative ModJfiution of the Bendien Reaction h SerodiagnoSis of Maligaancy, E. C. LOWE. Brit. M. J. 1: 407-411, 1933. In correspondence in the pages of the Britieh Medical Journal (1: 1008, 1932) Lowe previously reported that in 200 tests on various sera with a modification of Bendien’s technic he obtained findings similar to those claimed by that writer. [For details of Bendien’s method see review in Am. J. Cancer 15: 2829, 1931.1 He now publishes details of his method, with findings in a larger series of cases. He divides each serum into three portions, marked A, B, and C. A is used un- heated; B is inactivated by being heated to 58”;C is treated with ether, which separates out the lipoid-protein complex. Bendien himself proceeded to determine the ultra-violet absorption spectrum of an alkaline solution of the vanadic acid protein precipitate. The author examines solutions in NaOH of the A, B and C preoipitmtes separately with the Zeise interferometer, and, by a calculmtion based upon the interferometer readings for the three fractions, claims to hmve obtained a more accurate final result for each serum examined. “ The tube of the A series in any case which gives the first reaction having been determined, the unit measure thue obtained is taken as the basal figure for the computation of that serum, and the corresponding B and C deposits are similarly estimated, with the result that from these values in interferometer units a fraction may be worked out in which the numerator is calculated from C mnd the denominator by subtracting B from AsJJ For instance, in one case of normal serum the amount of precipitation in tube 6 gave the readings 40, 20, 45, giving the fraction 45-40/40-20 = 5/20; whereas in an early owe of carcinoma of the cervix the readings were 59, 57 and 109, giving the fraction 100-59/6k57 = 5012. The author examined 238 clinically non-malignant oases (including 92 normal persone) and 362 cases of varioue degrees of rnsligaanay, the latter ranging from 420 ABSTBAUTS the most advanoed and obvious to the earliest, olinioally unoertain types. Of the 302 malignant sera, 349 gave positive and only 13 negative reeults;.of the 238 non- malignant sera, 220 were negative and only 12 positive. [The author has examined a larger number of oases than haa any previous worker with the Bendien reaotion, and his findin@ are auoh aa to d for repetition on larger series of oases, with muoh larger and more varied oontrol series. It may be noted, however, that other writera who have repeated the firet part of Bendien's test have oonoluded that this is quite unepeoifio (see abetracts in Am. J. Canaer 16: 314, 786, 1048, and 1299, 1932); while the seoond or speotrographio part may be disregarded entirely. As stated, Lowe haa replaaed it by interferometry.] F. CAVER~ Early Dtrqnodr of Malignant Genital Tumoft by the Citolli-Phza Reaction, R. BOLAFFLSulla diagnosi preooae dei tumori genitali maligni mediante la resarione Cite&-Piassa, Riv. ital. di gineo. 13: 172-186, 1932. The Citelli-Piassa oonaiats in injeating suboutaneously in the fasting patient one oubio oentimeter of an extraot of a malignant tumor and studying the effect on the white blood oount thirty minutes after injeotion. The proponents of the reaction claim that in oanaer sderera there is a hemoclaatio shook with lowering of the white oount. The 70 0-8 used by the author oomprieed 20 malignant neoplasms mostly of the uterus, 15 aseorted gyneoologioal 0-6, 20 pregnancies, and 16 puerperal oases. Considering a drop of lo00 in the white oount aa a positive reeation, Bola5 found that 75 per oent of the malignanaies gave a positive reaction; aho, 20 per oent of the ~ariousgyneoologioal cases, 45 per cent of the prepnoies, including all the pathologioal pregnanoies in the eerie6 and some of the normal onerr, and 40 per cent of the puerperal 08888. The paper diecuesee the relationship between embryonal oella and oanoer oeh. The author ooncludes that the test is of little value in the diagnoeis of genital malignancies. JEANNETTEMTJNRO A New Contribution regarding the Specificity of the Citelli-F%zn Reaction In Human Malignant Tumom, S. BARBERA.Nuovo oontributo alla specificitti della reasione Citelli-Piassa nei tumori maligni umani, Oto-rino-laring. ital. 2 : 132-145, 1932. Barbera oarried out the Citelli-Piassa test (hemoolasis produoed by an extract of oaroinoma or mooma, as the ommay be) in 34 patients with malignant turnom. In thirty the test waa positive and in four negative. When extraots from other proteins, inoluding milk, toneil, spleen and thymus thsue, and time from a uterine myoma, were used, the test WBB oonstantly negative. The author condudes that the test is of praotioal value in diagnoeis. In this paper he fails to desoribe his teohnia. C. D. HAA~RINEB~N Clinical Value of Blood M&gnedumDetermination for the DiagnMie of Cancer, E. GIOVANNONI.I1 valore Woodella magnesiemia per la diagnosi di cancro, Rseeegna clin. therap. e. 80. &. 31: 167-180, 1932. Giovannoni did blood magnesium determinetione on a series of patients to determine the diagnostia value of this tent. Ae oompared with the values obtained in 10 normal patients used controls, a seriea of 16 patients with aanoer who had reoeived no treatment showed definite.diminution of the blood magnesium. Ra- dium treatment had the effeot of reiring the blood magnesium slightly in several of these oases, while surgioal treatment had no appreaiable influence. Determinations made on a eerie6 of 7 patients with pulmonary tuberouloais who were reoeiving oaloium therapeutioally, and on a series of 7 cases of tertiary lues being treated with arsenio, abo showed a'diminhhed blood magnesium oontent. A bibliography is included. C. D. HAAOBNSEN DUONOBIB AND TBEATMENT 421

Lead Treatment for Inoperable Carcinoma, A. E. OSTERBERQET AL. Roc. Std. Meet. Mayo Clin. 7: 231-237, 1932. This is an abstract of the experience of the Mayo Clinic during the past two years in the treatment of malignant lesions by lead compounds. The preparation ueed was lead phosphate in colloidal suspension protected by a colloid such as gelatin or acacia. Lead selenide was also used to some extent. Ninety-five patients were studied with varying degrees of success and of completeness. Only 48 of these received what may be termed adequate treatment, i.e. either received 400 mg. of lead or had clinical signs of lead intoxication. The following genera observations were made: Although the tumor does not have absolute specificity in the removal of the lead from the circulation, because considerable amounts of the material are found in such tissues as the liver and kidney, the lead does accumulate in the tumor to a much greater extent than in the skeletal muscle or in a muscle such as that of the heart. The concentration of lead in the tumor is increased over that in normal tiseue four or five fold. Like- wise, lead is present, for example, in metastatic lesions to the liver in much greater concentration than in the adjacent normal hepatic tissue, though the latter concentration may exceed that present in tumor elsewhere. The necessary lethal quantity within a tissue is very small. The elimination of lead is a very slow process, the daily output of lead following a course of treatment of approximately 600 mg. being only in the neighborhood of 0.1 to 0.2 mg. The most encouraging results are obtained when a plumbism has been produaed. This condition is evidenced by anemia, abdominal colic and general disability, but not by peripheral manifestations or lead line. Of the 48 " adequately treated " patients 26 are dead and 22 alive. Of the 26, 16 received, also, radium or roentgen therapy. The average amount of lead given the average patient in this group of 26 was 284 mg.; the average amount given the 22 patients now living was 371 mg. In the group of 26 the duration of life after aompletion of the treatment was from five to four hundred days. Immediate reactions to the injections were observed in 14 patients. Nine had delayed symptoms of chronic lead intoxication. In 16 there was marked symptomatic improvement for a time following the administration of the lead. This was evidenced by relief of pain, increase in appetite, and gain in weight and strength. Of the 22 patients living at the time of the reportsix months to two years and a half after treatmentall but 2 manifested toxic symptoms. Nine of this group were clinically free of carcinoma at the time of the report, from eight months to two years and a half after treatment;.13 had some carcinoma remaining, but of these 9 were free from pain and leading a comfortable existence. For the studies described only inoperable cases were selected. The authors have gained the impression that in cases of superficial carcinoma, such as of the breast, sarcoma of the extremities, epitheliomas of the neck, etc., treatment was perhaps more satisfactory than if the lesions were in hollow viscera. Of the living petients who are believed to be free from recurrence, four had carcinoma of the breast. There was no irradiation in these cases, but the breasts had been extirpated surgically and recurrence was treated by the intravenous injection ?f lead phosphate.

Surgical Treatment of Pain, Especially by Chordotomy in Inoperable Carcinoma, F. SCHUCK. Die chirurgische Schmersbekilmpfung, insbesondere die Chordo- tomie beim inoperablen Karsinom, Deutsche med. Wchnsahr. 59: 8-10, 1933. Section of the afferent nerve fibers situated on the anterior and lateral sides of the spinal cord is recommended for relief of pain in inoperable carcinoma of the reotum, prostate, and genital organa. This operation is teohniaally not diffiault, 422 ABSTRACTS and complications are rare. The author reports twelve cases in which he has performed this operation without an operative death. The relief of pain is complete, instantaneous, and lasting, according to the author. [Others have not been so sucmsaful.] BBNJAMINR. SHO~

Calcium Treatment of Pain in Cancer, R. J. BBHAN. Am. J. Burg. 17: 242-246, 1932. The author has observed reduction and even complete alleviation of pain following the administration of calcium to cancer patients. He believes, also, that it may exert a retarding influence on cancer growth. Eleven illustrative case reports are presented.

Treatment of Certain Recurrent Cancem, E. DUBOUX.Comment traiter mrtaines Acidives Btendues de cancers, Bull. m6d. Paris 46: 487-488, 1932. The author notes that in some reourrent cancers, especially of the breast, radiotherapy is of no value and in fact makes the aondition worse, while adequate surgical removal of the tumor leaves so large a wound that satisfactory closure and healing are not obtained, even with plastic methods. The wound ie often infected. In such cases removal of the tumor by the electric knife is recommended; hemorrhage is thus avoided, and also dissemination of the canoer cells, by sealing of the blood vessels and lymphatios. The wound is dressed at firsttor ten days-with hydrogen peroxide. Later, dressings of magnesium ahloride and a lead solution are alternated daily.

Cancer and Hydrochloric Acid. A Preliminuy Report, C. R. HARKBN.J. Iowa M. Soo. 22: 215-216, 1932. The frequent finding of hypochlorhydria in patients with malignant lesions other than gastric led the writer to institute treatment of cancer with large quantities of hydrochloric acid, liver extract, ventriculin, cod-liver oil, and ultra-violet radiation, together with foods rich in calories and vitamins.

Lipocyfic Coefacient and Diet in Cancer, H. P~~BICAUD.Coefficient lipocytique et alimentation du cancBreux, NBoplasmes 11 : 291-296, 1932. The lipocytic coefficient, liDoid Dhosphorus, which falls considerably in cancer, may give the clue to a prokr &et fir patients with malignant disease. Cho- lesterol combines with poisons elaborated by the cancer cell to form toxocholesterol -non-toxic and inactive. The lipoid phosphorus unites with these poisons to yield toxolecithin, a hemolytic agent that oauses the anemia and caohexia. By furnishing oholesterol, the toxicity of toxolecithin can be destroyed. WM.H. WOQLOM Radiation Therapy of Cancer, Basic Principler, Their Application and Reaults, W. L. MATTICK.Radiology 18: 107Ck1089, 1932. This is a review of the accepted principles of the biologic action of radiotherapy, dosimetry, and the methods and results in various malignant neoplasms treated at the State Institute for the Study of Malignant Disease, Buffalo, New York. The five-year clinical results and the methods used are espeoially interesting. Of 340 bd-cell epitheliomata of the akin, 82 per cent were oliniody arrested, the treatment consisting mainly of two to three erythema doses of unfiltered x-rays. The same treatment is used in papillary squamoutioell oiuoinomae, though radium DIAGNOSIS AND TEEATMENT 423

-"150 millicurie houreor more ',--is al~oemployed. In the infiltrating variety, radon aeeds, two millicuries to every one and one-half centimeters of tissue are inserted interstitially. Regidnal nodes are treated by block diesection, roentgen therapy or radium packs. Of 60 carcinomas of the penis thus treated, 7 were clinically arrested. Of 44 cases of carcinoma of the lower lip, without palpable cervical nodes, 68 per cent were clinically arrested; in 23 cases with palpable nodes the proportion fell to 13 per cent. The importance of the anatomical extent of the cancer at the time of treatment is emphasised by statistias in cancer of the breast and cervix. In 489 cases of cancer of the breast claesified according to Steinthal, there were 65.per cent five- year arrests in Group I, 23 per cent in Group 11, and only palliative results in Group 111. The treatment coneists of preoperative and postoperative roentgen therapy and radical mastectomy; 120 per cent of an erythema dose in five days or 130 per cent in eight days is given over a large field, which includes the supraclavicular region, breast, and axilla, with x-rays at 200 k.v. In 374 carcinomas of the cervix, the five-year results were as follows: for Group I, 64.2 per cent; Group 11, 28.5 per cent; Group 111, 14.4 per cent; Group IV, 1.4 per cent. Of 48 operable adeno- Carcinomas of the fundus of the uterus, 50 per cent were arrested by irradiation. The treatment of cancer of the rectum is chiefly surgical, but in 23 cases only 17 per cent of five-year arrests are reported. The corresponding results in lymphosarcoma are 10 successes in 77. Of 52 fibrosarcomas, 10 were arrested at the end of five years, and of 16 melanomas without clinical evidence of metastases, 8 were thus arre?ted. In melanomas with metastases, oeteogenic bone sarcomas, carcinomas of the lung, and embryomas of the kidney only palliation was obtained. MAURICELENZ Dircuerion on Some Phplrical md Medical Aspects of X-Ray Dosage in Malignant MMue. The Measurement of Penetrating Radiations in Therapy, W. V. MAYNEORDm AL. Roc. Roy. SOC.Med. 25: 771-782 (Section of Radiology), 1932. Mayneord, in opening this discussion, stated that the dose of radiation at any point may be defined as the energy absorbed during the irradiation per unit volume in a very small volume surrounding the point considered. It by no means follows that the same dose of different radiations will produce the same effect either quan- titatively or even qualitatively. The unit dose depends on the ioniaation produced in one cubic centimeter of air under normal conditions. Such a unit relates to the ionisation and probably to the energy absorbed in the volume of air experimented upon, and so is not the incident radiation but the absorbed radiation. There is good evidence that over a wide range of wavelengths the absorptions of air and tiaeues run approximately parallel, that is, tissues are to the physicist merely-a particularly interesting type of compressed air. Much evidence of a biological character supports the view that the s8me dose in r of different Wavelengths does produce the same biological effects. Whether thh ia true also in therapy is a subject for discussion. From a physical point of view it might be thought that for gamma rays and hard x-rays the effect should be independent of the wavelength, but that the effects of softer rays might be greater than the dose in r would suggest. The reason for this is the change in fundamental mechankm of absorption from recoil effects to photo-electric effects, the recoil effects being nearly independent of the atomic number of the atoms affected, whereas the photo-electric effects vary greatly with the atomic number and therefore may be different in substances of different chemical composition. [Packard and Exner (Am. J. Cancer 16: 1257 and 1275,1932) have shown that the same number of T unite, even with the softest Grens raye, have the same lethal effeoteaa hard x-rays.] 424 ABSTMUTS

The time faotor or time spaoing of the radiations, however, is all important, and complicates the problem of dosage so muoh as to make a statement of dose almost useless unless aooompanied by a preoise statement of the time qmoing of the radiation. While the ionisation unit hi generally aocepted for x-rays, the present impoe- sibility of measuring gamma rays with the same apparatus has prevented very accurate comparison of the biologioal action of the two groups of radiation. An admirable beginning has been made by Murdooh and Stahel, who have determined the distribution of radiation around radium tuband attempted to arrange as uniform as possible an irradiation throughout the volume to be treated. Their unit of dose is ergs per o.c., but it ia advantageous to attempt to make the measurements in r units so as to have the results comparable with those of x-rays. The author’s measurement8 suggest that 1 mg. hr. at 1 om. for radium [filtration not given] is equivalent to approximately 9 r. F. Hernaman-Johnaon discueeed new theories with regard to x-ray dosage and cancer. He suggeeted that there is olinioal and experimental evidence in favor of indireot rather than hotaction of radiation on the 08118, and quotes with ap proval experimental studies whereby it has been shown that a tumor whioh has been given a dose that in duo would normally oaw its disappearance, will, if removed within a day or two, grow vigorously in another animal; and alEO that if the bed of a tumor be previously irradiated the tumor is unlikely to take. [The first statement hse been refuted by Wood (J. A. M. A. 86; 1039,1926), who showed that the lethal doee for animal tumora, in Vitro and in uiuo, WM the aame, and every radiologist knows that the radiation of a skin area does not preGent the spntsd of metaataaes. Also abundant experimental work has shown that the moderate radiation of the skin of an animal doe8 not prevent the take of a tumor unless the radiation has been so prolonged and intense that the vdand the auboutaneoua tissue are oompletely blooked. 0bviously.a tumor grafted in them oiroumstanoea gets no blood supply and will not grow. The writer’s conclusion that “ radiation oures prinoipally by stimulating looal and general thue resistanoe ” is therefore somewhat questionable.] N. S. Finsi alEO disouwed the dosage of x-ray in malignant dieease. He stressed the difference in the biologioal effeot of the prolongation of the time faotor and stated that the optimum time is not yet known. He inaiats that the radiation must be homogeneous, and that better results are obtained by high voltage. Gamma rays are more effeotive than x-rays. He quotes workere at the Memorial Hospital stating that a combination of x-rays and radium M better than either alone [which has also been refuted], and en& with a dimuseion of the faotora affeoting doage, whioh are: locral sep&, whioh interferes with giving full doses of radiation; the patient’s general oondition; the stage of the dieem when the tumor beoomes practioally inaenaitive to radiation; previous treatment. He does not believe in the immuniring theory whioh aaaumea that one dose of radiation im- mUNSe8 a growth against future treatment. He inabts upon the neoessity of investigation of the use of higher voltages than are at present employed, and upon the use of full doses in our present treatment. F. L. Bopwood agreed with Mr. Mayneord that the ionisation method of mew uring x-rays primarily measured the energy absorbed in the ionisation chamber, but thought that there were difference8 in the effeot of radium implanted in the tieeues and the eame amount of radiation used externally. Dr. Claude Gouldesborough spoke in favor of using a 2 per oent solution of sodium fluorescein whieh, when painted on the skin over a tumor, seemed to give remarkable results. He hmd failed to obtah any astisfeation, however, with the poeum fluorescein ealt. He felt that the fluoreeOein was eotiveted by the DIAGNOBIB AND TBEATMENT 425

x-rays, giving rise to secondary rays which have a " photwhemical action on the malignant cells." Dr. Douglas Webster spoke of the great variations in different clinics in the time and intensity factors. He detailed several clinical cases which he had treated from several points of view. In one case of extensive invasion he had tried five minute daily doses, each of 15 per cent skin erythema. There was considerable improvement in some localities, but the disease, aa a whole, advanced. He had tried frequent small divided doses in rapidly growing tumors following a suggestion on the results of irradiated tissue cultures with very short exposures at frequent intervals, and had interesting results. While he, personally, waa inclined to the use of lower intensities, he held that it waa important that future investigations should be done with 30 ma. tubes to shorten the exposure lengths even if the doses. were divided.

Note on the SignMcaace of Do~gein the Irradiation of Inter-related Ti8rue11, WM. H. Lon. M. J. Australia 1: 796-798, 1932. The success. of the technio of radiation depends upon the fact that the radiosensitivity of the malignant cells is, in general, greater than that of the surrounding healthy cells. The ideal method is the one in which the diflerence in radiosensi- tivities-the radiosensitive interval-is employed to the greatest advantage. At least one value of dosage can be found for which the difference between the biological effects in the two tissues is maximum. Before it is possible to determine thb dosage, however, it is necessary to know the sensitivities of the tissues in question. Very little preoiee information of this nature is available at present for human tissues.

Radiotherapy with Small Qurntitier of Radium, PAUL0. SNOKIL Radiology 18. 3534360, 1932. "hie is a description of the author's use of small quantitiee of radium for treatment, by the usual interstitial, surface, and intracavity methods. The total dosage given is moderate, In carcinoma of the cervix, for instance, 3200 milligram hours in the cervix and 800 milligram hours in the vagina are given. The filtration for surface applicators is frequently 1 mm. brass. On account of the small quantities of radium available, the target skin distances in surface applicators do not exceed 23 cm. The author gives no clinical statistics in support of his methods. MAURICRILENZ Radon ver~wRadium. A Pr- Report, H. A. McCoy. M. J. Australia 2: 232-234, 1932. The author presents data on the result8 of using radon needles with a filter of 0.5 mm. nickel, the needles having an outside diameter of 2 mm. A comparison of these results with those obtained with radium needles filtered by 0.5 mm. platinum shows the great superiority of the latter. After irradiation with the radon-nickel needle healing was delayed, there was considerable necrosis, and the scm were large and indurated. These sequelae were not observed after radium treatment with 0.5 mm. of platinum filtration. CHABLEBPACURD

Obrervationr on the Filtrations employed in Radon Therapy, R. KAYESCOTT. M. J. Australia 2: 231-232, 1932. The amount of filtration which should be employed is determined largely by the blood supply of the part to be treated. When the supply ie good, aa in the lip, tam, and breast, 0.4 mm. of platinum is suitable, but care must be exercised to 426 ABSTRAOTS avoid thrombosis of the veseele and subsequent infection. Eighty-eight millicurie hours is a reasonable dose. When the vascular supply is poor, the filtration must be increased to 0.5 or even 0.8 mm. platinum; but 0.5 mm. is not advised for irradiation of the suprascapular region, since its use often lead8 to severe neuritis. The heavier filtration is necessary when the site of exposure is dose to bone, The author advises a dose of 200 to 240 millicurie hours. CMBLBS PACKARD

On the Treatment of New Growthe by Fluorescein and X-Rays, H. A. COLWILL. Brit. M. J. 1: 457-458, 1933. Concise report on 45 cases of carcinoma, of which 30 were recurrence6 of breast cancer, treated by oral administration of sodium fluorescein, about one gram ' being given four hours before roentgen treatment. In some cases of ulcerated growth a 5 per cent solution of tbis substance was applied locally, but only at the time of roentgen treatment. No special effect was observed in 6 cases of rectal cancer or in 15 non-ulcerated mammary cancers. In only 9 08888, all of ulcerated recurrent breast cancer, did the fiuorescein seem to be of some benefit as an adjuvant to the roentgen therapy. In experiments with bacterial cultures, the author found that sodium fluorescein exerted a mild antimptio aotion, a 5 per cent solution taking about seven hours to lriu ordinary organisms, including Staphylo- coccus aureua and BdUua coli. He suggests that the adjuvant action of thiR substance when used with roentgen rays may be due to its antibacterial propertiea. F. CA~RS Case Illustrating the Effect6 of Prolonged Action of Radium, JOAN M. Ross. J. Path. & Bact. 35: 899-912, 1932. A woman of forty-four with an inoperable carcinoma of the breast was treated with radium. At the end of aix dam 26 needles were removed; the twenty-sixth, containing 2 milligrams of radium, could not be found. An x-ray examination showed that the needle was in the pencardium. Two years after the needle was lost the patient had a recurrence of the breast canoer in the supraclaviaular region and was treated with surface application of radium. Three years after the needle was lost the patient died. There was clinical evidence of a cardiac muscular leaibn, mitea, and jaundice. At autopsy atrophic changes were found in the cardiac muscle and there was thickening of vessel walls. The needle was found in the inter- ventrioular septum, and the heart muscle for a distance of one inch about it was completely destroyed. The liver contained a large hemorrhagic tumor some four inches in diameter. The distance between the upper surface of the tumor maas and the radium needle was about two inches. The bone marrow was hyperplastic; the lymph nodes showed replacement of lymphooytes by plasma cells. The lungs and bone marrow contained tumor emboli. The author believes that the hemangio-endothelioma of the liver was derived from the endothelial lining of branches of the portal vein, due to prolonged radiation by the gamma rays of the radium. There is a very complete bibliography, and the paper is illustrated by three macrophotographs and 23 microphotographs.

Two Ca~esof Epithelioma Treated with Radium, J. P. LOCKHART-MUYYB~RY. Proc. Roy. SOC.Med. 26: 522-523, 1933. The author treated two squamoue-cell tumormne of the anu8, the other of the left buttock-with radium. The first had been treated nine months and the second lese than a month at the time of reporting; the dosages given were 1200 and lo00 mg. hours [filtration not, ~tated]. Two illustrations ere shown. F. CAVIORS BEIN 427

THE SKIN

Radiotherapy of Cancer of the Skin, L. W. VAN DEB BURG. De stralenbehandeling van den huidkanker, Geneesk. tijdschr. v. Neder1.-Indil! 72: 1317-1321, 1932. Van der Burg is of the opinion that from the point of view of treatment the histologic structure of a cutaneous tumor is lesa important than the clinical symp toms. The site of the tumor, the area of skin involved, and especially the degree of penetration into the underlying structures are very important. The cases of cancer of the foot treated by the author were all 80 far advanoed that the neighboring bones were involved and the skin ulcerated. Amputation was always necessary. No satisfactory results could be obtained with either radium or x-ray treatment. In such cases either removal of the involved bone or amputation is imperative. Swollen lymphatic nodes in the inguinal region may be merely inflamed. X-ray treatment should be done and the glands eventually removed. Cancer of the forehead and nose should be treated with radium applied on a wax moulage. Small tumors can be treated by insertion of needles. These ale0 give excellent results in cancer of the lip. If after six weeb there is still a hard part left, aoagulation or excision should be done. Carcinoma of the auricle should be treated by excision or by a moulage, since interstitial radiation causes necrosis of the underlying cartilaginous tissue. In extensive cancer, amputation of the auricle is necessary. Photographs show six cases of skin canoer before and after treatment. JOHANNP~SP. M. VOGELAAR

Cancer of the Skin among the Natives of Dutch East India, J. J. TH. Vos. Over huidkanker onder de Inlandsche bevolking, Geneesk. tijdschr. v. NederLIndil! 72: 1303-1309, 1932. The Cancer Institute in Bandoeng received during a period of about four and a half years 306 patients with cancer of the skin, 45 of whom were Europeans and Chinese and the remaining 261 natives of Dutch East India. The number of cases of skin cancer observed is increasing rapidly. The writer compares his Statistics with those of the pathological institute in Gbttingen for 1921-1927 (Egenolf: Ztschr. f. Krebsforsch. 31: 396, 1930). The frequency of skin cancer is given as 15.3 per cent for the Gbttingen Institute (2639 cases of cancer), and 37.6 per cent for the Institute in Bandoeng (677 cases). Even when the cases of carcinoma of the penis and of the scrotum &reexcluded, the percentage in Bandoeng is 33.7 per cent. A table showing the localization of skin cancers reveals that carcinoma of the heis frequent in the material of both institutes, but that in the Dutch colonies there are many more cancers for the rest of the body. The feet and legs are involved even oftener than the head region. About 21 per cent of all the cancers re melanocarcinomes;74 per cent of the latter involved the foot. This is probably due to the high frequency of wounds and chronic ulcers (frambesia, lues) in that region of the body. Only 5 out of 54 cases of melanocarcinoma involved the eye. Five tables illustrate the text. JOHANNESP. M. VOGELAAR

Psoriasis and Multiple Superficial Epitheliomr, CARROLLS. WRIGHTAND REUBEN J. FRIEDMAN.Arch. Derm. & Syph. 27: 70-77, 1933. The authors here contribute an exoellent review of our knowledge concerning the relationship of multiple superficial epitheliomata of the skin with long standing psoriasis, together with reports of five ceee~. The association of the two conditions hee long been recognized, and there is considerable evidence to support the view 428 ABSTRAOTS that the appearance of epitheliomata in psoriatic patches, often preceded by the appearance of wart-like keratoses, bears a distinct etiological relationship to the previous ingestion of arsenic over long periods of time. The 0888s here reported are multiple epitheliomata arising from previously healthy skin in patients suffering from psorisaie. None of the patients had arsenical keratoses or pigmentation and in eections from one of the oases no arsenic could be demonstrated. This type of epithelioma is often confused with and should be distinguished from other forms of atypical epithelial proliferation such M Bowen’s disease, extra-mammary Paget’s disease, and arsenical epitheliomas and keratodermae. When aesooiated with psoriasis, it may be overlooked or regarded M part of the psoriatic eruption. W. BAYABDLONQ

Melanotic Sarcomata, F. A. E. SILCOCK.Roc. Roy. 800. Med. 26: 493-496,1933. A man of fifty-four said that following a knock on the front of the left shin a fiat, dark mole had appeared, and that about eighteen months later several similar lesions, varying in color from purple to black, had arisen on the leg and on the left upper arm. All bled freely on slight injury; some had gradually disappeared, while fresh ones developed. About two years before coming to the hospital the patient had notioed a lump in the left groin. Histologic examination of some of the lesions, of which there were about one hundred in all, showed definite neoplaatia structure, consisting in large, branching, pigmented oeh embedded in a fibrous tissue matrix, eroding the malpighian layer of the skin and covered by B thin layer of epidermis. One illustration shows the lesions on the leg and arm. F. CAVEX~

LupSucomr: A Fatal Case, W. J. O’DONOVAN.Brit. J. Dermat. 44: 638-541, 1932. A woman of forty-nine yeam first oame under observation in 1912, presenting extensive lesions of lupus vulgaris on the left forearm and a smaller lemon at the bend of the right elbow. The disease had first appeared when the patient was eighteen years old. Beginning in 1908 she received x-ray treatments three times a week for a period of three years and three months. Further x-ray treatments were given in February 1917, January 1918, and March 1919. In March 1920 a biopsy was done which revealed dt dewfibrosis of the dermis and subcutb of the left forearm and moderate chronic inflammatory infiltration of the dermis not characteristic of lupus. No sign of malignanoy.” In April and September 1920 radium plaques were applied on five oooaaions. In Ootober diathermy treatment was given. In April 1921 the back of the lower forearm showed an ulcer with an everted rolled edge and a granular moist dace, above which, half-way to the elbow, was a red, firm, irregularly shaped tumor. This tumor was removed surgically, and the microscopic report WM spindle-cell sarcoma. After removal of two recurrenoes, amputation through the elbow joint was done in Ootober 1921. In January 1922 amputation WM performed through the shoulder joint for recur- renoe in the Btump. The patient died September 10, 1922. No autopsy was performed. Just prior to death metastatic deposits were demonstrated in both lunge. W. BAYAUDLONQ

Xerodenar Pigmentoeum and Cancer of the Sldn, W. J. Roo8 VAN DBINBBIXQ. Xeroderma pigmentosum en huidkanker, Geneesk. tijdeohr. v. Neder1.-Indil! 72: 1311-1316, 1932. ’ This is a report of two cases of skin carcinoma in patients with typical xeroderma pigmentosum. One of these, a twenty-nine-year-old Sundanese man, THBl 8KIN 429

showed on the skin of the face, breast, and abdomen many small tumors resembling pigmented nevi and warts. Two large ulcerating tumors on the forehead and a cancerous papilloma under the right eye were removed, and radium treatment was given afterwards. The patient left the hospital after two months, despite indica- tiom that other turnore were developing. The other patient was a fourteen-year-old Chinese girl with xeroderma of the face, forearms, and hands. Biopsy of an ulcerating tumor in the glabellar region showed it to be a carcinoma. It was removed by electrocoagulation. A tumor on the nose showed an irregular, bleeding surface. In xeroderma pigmentosum the skin is in H precanoerous condition. Malig- nant degeneration generally appears early, and death from cancer may occur under ten years of age. The first of the two patients did not seem to have a special sensitivity towards light and the urine did not contain hematoporphyrin. Two pictures of the patients show the various new growths described in the text. JOHANNESP. M. VOQELAAR

Xerodermia Pigmentom, H. MACCORMAC.Proc. Roy. Soc. Med. 26: 495-496, 1933. A man of thirty-four showed in the skin areas exposed to light a variety of lesio~freckles,telangiectases, warts, and ulcers with the blackish crusts characteristic of xeroderma pigmentosum. A small tumor of the right eyeball which was excised for hbtologic examination showed, however, inflammatory and not neoplastic characters. There wm no family history of a similar condition. The first skin lesions had appeared fourteen years previously. F. CAVE~S

CUS of x.nthoma, M. G. FRIABT.Un cas de xanthome, Scalpel 85: 541-542, 1982. A girl seventeen years of age had multiple yellow cutaneous tumors on the eyelids, neck, and extremities; they were painless and not accompanied by either pruritus or inflammation. There were also nodules on the tendons of the fingers and on the Achilles tendon. These nodules had been present since the patient was three or four years of age, but the cutaneous tumors had developed only in the last seven years. Biopsy of one of these tumors showed typical xanthoma cells containing cholesterol; the blood cholesterol wm about 6 gm. The patient showed no sugar in the urine and normal blood sugar.

Mycosis Fungoides iTumeurs d’emblbe, H. MACCORMAC.Roc. Roy. SOC.Med. 26: 495, 1933. The patient was a man of fifty-two. The initial favorable response to roentgen therapy oon6rmed the clinical diagnosis [no mention of histologic examination], but three months later the lesions again developed rapidly and ceased to respond to x-ray. At this stage, when a fatal termination in a relatively short time appeared probable, an attack of erysipelas developed. Following this the lesions flattened and again became responsive to radiotherapy. This is the second case of rapidly progressive mycosis fungoides coming under the author’s notice in which an attack of erysipelas completely altered the course of the disease. In the ensuing discussion the author was asked about the possibility of treating this disease by infection with malaria and other pyrogenic agents. He replied that in his opinion erysipelm, which caused a skin reaction, was more likely to be of benefit than something which raised the general body temperature, as malaria or typhoid. F. CAVERS 430 ABBTBAOTB

Relation of Cancers of the Skin and Skin Appendage6 to Focal Ledon6 in Other Ectodermal Structurer, MONTROSET. BURBOWS.Southern M. J. 25: 125-133, 1932. This article is a continuation of previous studies made by the author (Proc. SOC.Ekper. Biol. & Med. 20: 574, 1929; Rediology 17: 775, 1931; Dental Cosmos 73: 1102, 1931), which seem to him to indicate that cancer may be secondary to other forms of degeneration in the body.

THE EYE

Didhroe Papilloma of the Limbus, M. F. WEYMANN.Am. J. Ophth. 15: 310-312, 1932. The author points out that the corneal limbus is a transitional sone between the cylindrical and cuboid epithelium of the conjunctiva and the stratified equamous epithelium of the cornea, and ia therefore a Bite of eleotion for neoplasms. He describes a oaae of diffuse papilloma oocurring in a man of seventy-eight, in which the oonjunbtival portion of the tumor showed histologic eppearances of malignancy although there was no evidence of rupture of the basement membrane or invasion of the fibrous stroma by cells or cell groups. He recalls a second case observed by him which approached the malignant type more closely, on account of recurrence. The author prefers to treat these tumors with Shahan’s thermophore rather than by cautery dissection. Tumors treated by the latter method frequently recur, but it is claimed for the thermophore that no damage is done to normal tissue and that, if there is recurrence, it may be used repeatedly. Should these tumors become frankly malignant, there is no tendency to metastatin until the orbit is invaded. Even when invasion of the cornea has begun, an attempt should be made to eradicate the tumor with the thermophore. Should this fail and orbital invasion occur, exenteration is the operation of choice. The author particularly stre- the fact that papillomata of the limbus are potentially malignant and that patients who have had such growthe removed should be kept under observation periodically for several years because of the frequency with which these growths recur, aa well as the risk of malignant change. There are four illustrations. F. CAVBRB

Sucoma of the Iris: Report of a Case Complicated by a Cpt, R. E. MBINK. Arch. Ophth. 8: 864-870, 1932. “ Sarcoma of the iris is rare.’ A primary cyst of the iris is also rare, but to find these two conditions together is extremely rare.” The author reports the coin- cidence of these lesions in the right eye of a woman of thirty-six. The blood Wsesermsnn reaction was negative, and the diagnosis suggested by examination of the eye was tuberculosis or sarcoma, most likely melanosarcoms of the ciliary body causing splitting of the tissue of the iris. The latter diagnosis was confirmed histologically after enualeation. The iris showed sleo a number of sqdl melano- matous nevi, and there was a cyst of the ciliary body. The author reports the individual and somewhat varying opinions of various pathologist6 to whom he submitted his slides, but on the whole the diagnoeie of early melanosarcoma was supported. Four good illustrations sre given. [If the author’s commonsense procedure of submitting sections of doubtful tumors to, expert pathologists were widely followed, we should see fewer examples of otherwise good reports spoiled by suspicioua and unsatisfactory histologic diagnoses.] F. Cavlpas THB 431

Metastatic Cueinoma of the Optic Disk, with Report of a Case, W. T. DAVIS. Arch. Ophth. 8: 226-237, 1932. Involvement of the intra-ocular end of the optic nerve by metastatic carcinoma is of rare occurrence. The author could find only three cases in the literature, one an extension of a glioma of the optic chiasma, the others metastases from distant carcinomas. The wedescribed is that of a woman of thirtysne, who had been operated upon for scirrhous cancer of the right breast in June 1929 and who, on seeing the author exactly a year later, complained of severe headaohes which had begun six months previously. The fundus of the left eye showed raising of the disk and retina, an appearance which the author was inclined to ascribe to involvement of the choroid by metastatic carcinoma. The patient died three months later; autopsy could not be obtained. In the ensuing discussion, Dr. G. F. Suker estimated that up to 1909 there had hen reported 04 authenticated cases of metastatic ocular carcinoma, and in 1920 an additional 54, msking a total from 1872 to 1920 of 118 cases. In more than one third both eyes were involved, rarely simultaneously, although the second eye is apt to be involved shortly after the first. The probable reason why cancer metastasis to the orbit or optic nerve is so rare is that the ophthalmic artery leaves the internal carotid at a right angle, allowing carcinoma cells to pass the narrow ostium of this artery and be carried on to the brain or meninges. In most cases metastasis occurs to the choroid. Evidently in the case described by Davis it had spread from the choroid into the disk and then along the optic nerve. Dr. W. L. Benedict described two personal cases of metastatic carcinoma of the choroid near the optic disk. The author gives seven excellent illustrations. F. CAVERS

Aquired Cyst of the Optic Disk, J. LEVINE].Arch. Ophth. 8: 209-217, 1932. The author reporta the case of a girl of fourteen years, a deaf mute, with retinitis pigmentosa, whom he has had under observation for three years. Late in 1931 there was seen in the left eye a gray cystic mass protruding from the optic diek at its nasal margin. This had appeared since the last examination made four months previously, has since grown longer, and now projects farther into the vitreous; it is thin-walled, and no blood vessels are apparent in it. The cyst ia evidently acquired; there are no other congenital anomalies, no amblyopia or strabismus. In determining its pathogenesis the possibility of tuberous sclerosis, or gliosis of the superficial portion of the brain, is to be considered. The author discusses the association of this condition with ocular and other (especially cutaneous) lesions, with references to the literature. In his patient there were, at the time of reporting, no neurological signs of tuberous sclerosis; meanwhile he assumes that cysts of the optic disk may occur in cases of retinitis pigmentosa, due to cystic changes occurring in areas of gliosis. There are eight good illustiations. F. CAVERS

Venow hgioma of the Retina, Optic Nerve, Chiurn and Brmin: Case Report with Portmortem Observations, E. F. KRUQAND B. SAMUXILS.Arch. Ophth. 8: 871-879, 1932. A man of twenty-one complained of defective speech, unsteady gait, right ear noises for seven years, restlessness, and depression. There was a history of instrumental birth, and his mother stated that at the time of birth the cornea of the right eye was “ imperfect.” A few days after his birth she noted ,a peculiar mot- tling of the skin of the right side of his face. As a child the patient had had severe and prolonged bleeding from the gums ,when a dentist lanced them to hasten the eruption of the right molar teeth; again, following tonsillectomy, he 432 ABSTBAOTS had severe hemorrhage due to involvement of the right soft palate and tonsillar foees by an angiomatous lesion. There was now a raised soft angioma of the right aide of the face and temple. The right ear puleeted aynchronouGy with marked throbbing of the right temporal and carotid arteries. X-ray film of the skull showed two unusually large vascular channels in the right frontal bone coursing in a vertical direction. The right eyeball was proptosed, the lids thickened, and the conjunctival vessels congested. In the fundus the veins were so engorged and tortuous that the disk was almost completely obscured; the vessels were greatly thickened, suggesting a prolonged and progressive process. About six months after examination the patient committed suicide. At autopsy an angiomatous lesion was found extending from the right retina along the optic nerve, ohiasm, and tract to the right of the midbrain and, via the right superior cerebellar peduncle, to the dentate nucleus. These findings explained the entire symptomatology of the oase, which was one of oongenital angiomatous msl- formation. Evidently this was entirely venous, as opposed to the two remaining groups of vascular malformation: (1) telangiectaaes, capillary malformations, or cavernomas, (2) arterial or arteriovenous angiomaa. The venous angiomas show three anatomical types: (1) the simple varix, (2) the serpentine type arising from a single much enlarged vascular channel, at times associated with (3) a small racemom variety forming a maw of interwoven and sometimes pulsating vessels. In the case deaaribed the presence of the enlarged throbbing carotid and temporal arteries, with the systolio bruit, indicates an arterial component entering into the vasaular complex, while the preeence of choked disk shows that the venom element was predominant. The authors’ admirable account of this interesting case is accompanied by aeven excellent illustrations. The pathologic findings in the brain are to be described separately by Brock and Dyke. F. CAVERS

Retinoblaetoma with Metukees in Cranial and Leg Bonei, MONTHUSAND FAVOBY.Tumeur de la &tine avec mdtastaaes multiples, Bull. SOC.de pddiat. de Paris 30: 237-239, 1932. At autopsy on a girl of two years it was found that a retinal tumor had metas- tasised to the periosteum of the cranial bones and of the bones of the lower ex- tremity. No other metastases were found. F. CAVI~IRS

Gliom Exophptum, RODOLPHM. CUTINOAND RALPHLLOYD. Am. J. Ophth. 15: 426-428, 1932. Glioma exophytum or tuberosum is a form of glioma originating on the outer surface of the retina. Several small nodules appear and spread out between the retina and chqroid in the subretinal space, oausing early retinal detachment. By confluence they form a tuberous deposit on the outer surface of the retina. The oase reported occurred in a child of six. Enucleation was performed, and a year later there had been no recurrence. The condition was first thought to be Coat’s disease. The error in diagnosis is attributed in part, to the ege of the child, since glioma is seldom seen in children over four; and in part to the fact that the tumor instead of growing into the vitreous was flattened out between the retina and choroid, causing early retinal detachment.

Adenocuciaom of the Lacrimal Glaad, RJCRABDH. FBIUYBIUBG.Am. J. Ophth. 15: 417-422, 1932. A case is reported in which a neoplasm of the right orbit was known to have exieted twenty-five years before death of the patient. Nine yeare after the clinical onset of the tumor the displaced eyeball was removed. Soon after this TmBYE 433 there was noticed in the right orbit a tumor mass, which increased in size slowly for seven years, when suddenly it began to grow rapidly. Sixteen years after the original onset, an exenteration of the right orbit and involved nasal sinuses was done. Recurrence followed this, and a second exenteration was done, twenty-five years after the tumor was first known to be present. Two days later the patient died of meningitis. At autopsy it was found that there was complete destruction of the right orbit, the roof being absent and the brain exposed in an area measuring 34 by 4 om. There was traumatic hemorrhagic softening in the frontal lobe in apposition to the right orbit, and an acute purulent exacerbation of a subaoute leptomeningitis. Neoplastic tissue was found extending along the right optic nerve and the pituitary gland was displaced to the left by a mass of the neoplastic tissue, pyramidal in shape, occupying the position of the right cavernous sinus. The capsule of the pituitary was invaded on the right by the neoplasm. No distant metastases were found. Microscopic examination of the tissue removed both at autopsy and at exenteration showed adenocarcinoma of the lacrimal gland. The author reviews the literature on tumora of the lacrimal gland. An analysis of the reported cases shows that the great majority of these were mixed tumors of the salivary gland type. The protracted history of the author’s oase suggests that the adenocarcinoms here may have originated in suah a mixed tumor, the epithelial elements overgrowing the supporting tissue components. Photomicrographs are shown, and a bibliography is appended.

Epitheliom of the Lacrimal Caruncle, H. DESPRITS.A propos d’un BpithBlioma oaronculaire, J. d. sci. m6d. de Lille 50: 433-435, 1932. The laorimal caruncle has practically the same histological characteristics as the border of the eyelid, and it is not surprising that it is the site of the same type of neoplasms, benign or malignant, as the latter. The author reports a case in a man who a year previously had noted a small nodule in the internal angle of the right eye. At the time of examination, a tumor mass, which was freely movable, WBB found in the region of the lacrimal canal, replacing the caruncle; the surface showed alight alteration but no infection. Palpation revealed a downward prolongation of the growth for about 2 om., but without invasion of the deeper structures of the eyeball or the bony orbit. A wide resection was done, which, however, preserved the eyeball; the internal third of each eyelid was resected. Histologic examination showed a typical basal-cell epithelioma.

Cue of Orbital Plaemocytoma, E. HOLM.Acta ophth. 10: 334-342, 1932. The author attributes the first description of plasmocytoma to Wright, of Boston, in 1900; his references to the literature consist in names and date%only. These tumors consist of rounded or polygonal cells in a delicate fibrous matrix. The oell has a non-granular, strongly basophil cytoplasm; its nucleucl is small, eccentrically placed, and surrounded by a clear zone, Hence the cell corresponds morphologically with the typical plasmocyte found in inflammatory conditions, particularly those of the subacute type. In some plasmocytomas, especially those of highly malignant character, the cells have multilobate nuclei and large acid+ phile nucleoli. Most of these tumors arise in the bone marrow and, like multiple myeloma, occur chiefly in the vertebral column and ribs; but they have also been found in other bones, lymph nodes, intestine, pleura, nose, paranasal sinuses, naaopharynx, conjunctiva, cornea, etc. The author describes a case in some detail. A woman of seventy-three had a swelling below the left eyeball, pressing the latter upwards but causing no pain. 434 ABSTIWYT8

At operation, besides the main tumor which was the mse of a haselnut and wes attached to the posterior bony wall of the orbit, two smaller tumors were found; all three tumors were removed. X-ray treatment was given after operation. Ten months later the patient was readmitted on acoount of a tumor of the right orbit. This responded well to x-ray treatment, showing early regression; there was no sign of recurrence of tumor in the left orbit. Unfortunately the disease proved to be of an extremely malignant type, and the rest of the patient’s history may be summarised by stating that from this time until her death, in a state of extreme cachexia, a year later, successive tumors appeared in various parts of the body-forehead, wriet, left femur, etc. Every one of these tumors WM radiosensitive, but M one tumor regressed another appeared, while those in the orbits and the neighboring regions recurred. At autopsy it was found that the tumor mass in the right orbit had penetrated the orbital roof but had been apparently arrested on coming into contact with the right frontal lobe of the OerebrUm; the left orbit was filled with tumor tissue which had eroded the roof to paper-like thinness and had grown into the nsaopharynx. There had been no invasion of lymph nodes or the internal organs. The author thinks that this case is one of independent multiple tumors, mnce there WM no evidence of metastatio transference. He suggests that plaemoaytoma, like chloroma, arises from the periosteum or from the subcutaneous tissue; ale0 that it resembles multiple myeloma in shqwing apparent primary multiplicity without gross signs of a metastatic proceae. There are two good photomiorographs. F. CAVBRB

THE EAR

Bilateral Auditory Nerve Tumour in Care of Multiple Rewofibromatods, F. C. OIUNBROD. Proc. Roy. 800. Med. 26: 566-567, 1933. A girl of fourteen years had multiple subcutaneous tumors, diagnosed by biopsy M neurofibromas. She was dull of hearing and showed symptoms suggestive of cerebellopontine angle tumor, but, although tumors in this region are frequently associated with neurofibromatosie, none WM found at operation. Autopsy, however, revealed a large tumor in the right oerebellopontine angle, also a smaller one on the left auditory nerve, which, though M large as a haselnut, had produced no symptoms. F. CAVlnRB

Two Cases of Rodent Ulcer of Pinna Treated by Radium, J. F. O’MALLFIY. Proo. Roy. SOC.Med. 26: 563, 1933. Both patients were women, aged sixty-seven and seventy-nine. In the first the carcinoma of the outer ear was of ten years’ duration, in the seoond it had been noticed only six months before treatment. In both cases the treatment was considered effective. F. CAVERS

Lymphangio-endothelioma of a Cylindromatour Type in the Mastoid Region, G. Rnaeo-Fa~~~~81.Linfangioendotelioma a tip0 cilindromatoso della regione mastoidea, Oto-rino-laring. ital. 2: 248-259,1932. A man aged iifty-eight had a large, non-ulcerated tumor of the skin in the mestoid region. It was removed locally, and WM olded by the author as a “ cylindromatous lymphangiosndotheliome.” The six photomicrographs of the specimen suggest that he was dealing with a beaal-oell carcinoma of the adenoid oystic type. The histogenesis of the tumor is discuesed at length, but no follow-up is included. There is a short bibliography. C. D. HAAQFINSEN THE OBAL CAVITY 435

Fibroma of External Auditory Meatus in a Boy Aged Ten Years, C. P. WILSON. Proc. Roy. Soc. Med. 26: 568, 1933. Brief report, the title of which seems a sufficient abstract. F. CAVERS Fibronutous Tumor Developed in a Mastoid Scar, MOUNIER-KUHN.Tumeur fibromateuse d6veloppt4e sur une cicatrice mastoidienne, Lyon m6d. 150: 26-27, 1932. A report of R fibroma developing in the lower two-thirds of a mastoidectomy scar more than a year after operation. The tumor did not involve the skin and clinically did not resemble a keloid. The mass was the size of a hazelnut and was diffusely fixed to the deep tissues. Following its excision, microscopic examination revealed a true fibroma. WILLUMJ. HOFFMAN Osteoma of the Mastoid Process; I. FRAEINKEIL.Osteom des Processus Mas- toideus, Gtschr. f. Hrrla-, Nasen- u. Ohrenh. 30: 623-626, 1932. Osteoma of the mastoid process has been reported but rarely. The author reviews fully the cases in the literature and reports a case of his own. A man fiftyeight years of age had a bony swelling on the right mastoid process. Roent- gen-ray examination showed that it consisted of compact bone with its base partly on the mastoid process and partly on the squamous portion of the temporal bone.

THE ORAL CAVITY, NOSE AND PARANASAL SINUSES, THROAT, AND SALIVARY GLANDS Malignancy and Growths of the Mouth and Jaws, C. W. WALDRON.J. Am. Dent. A. 19: 2125-2139, 1932. Four thousand deaths annually in America occur from cancer of the mouth, jam, and lip. Bemuse many cases of oral cancer are attributable to chronic irritation, oral hygiene is a preventive measure of real value. Waldron sounds a warning to dentists not to extract teeth from areas involved by lesions which may be malignant. Preliminary dental treatment should be limited to elimination of sources of irritation, such as sharp or jagged enamel margins and restoration faults. Cancer affects the lower lip nineteen times as often as it does the upper, and is fourteen times as frequent in men as in women. Prognosis depends upon the extent of involvement, whether there are regional .metastases or not, the histologic grading of the malignancy, and the skill and judgment exercised in treatment. Surgical excision of the primary growth with block dissection of cervical nodes is a long-estabtished and reasonably successful procedure, resulting in a five-year survival rate of from 60 to 80 per cent, depending on the duration and extent of the lesions. Radiotherapy can claim a three-year survival rate of 76 per cent for all stages of the disease (90 per cent of recurrences develop within three years). Leukoplakia is probably the commonest precancerous lesion within the mouth. Its eradication is difficult; its presence is a potential danger. Treatment should be aimed at removal of the irritant factors which produced it, such a8 syphilis, trauma, oral sepsis, and abuse of tobacco. Administration of magnesium sulphate in 15 grain doses three times a day for two months may result in marked reduction of the lesions. Any persistent are@ may be removed by electrocoagulation with a flat electrode. The mortality of carcinoma of the tongue is very high; only 25 per cent of patients are alive three years after treatment. The increased mortality is explained in part by the greater likelihood of metastases developing by the time the patient 436 ARSTBAOTS presents himself for treatment. * The local tumor oan be destroyed by radium, cautery, or electroooagulation, or it may be excised by soalpel, endotherm, or oautery. Treatment may be by interstitial irradiation by radium needles or emanation seeds, followed by surgioal exobion. The gravest problem is treatment of cerviaal metsstases. Neok disaeotion and interstitial irradiation have produced some oures, but the peroentage of failure is large. Waldron briefly disausses oanoer of the floor of the mouth, cheek, jam, maxilla, antrum, and mandible, and the serious oomplioation whioh arises when oanoer invades the jaw bone. The various leeions of the mouth and lip are illustrated by twenty-tour exoellent alinioal photographs. WILLIAMJ. HOFFMAN

Summug of Etiologic Racton and Resultant Ledom in Cancer of the Oral Cavity, Eapechlly in Relation to Prevention of MaUgnant MMaw and Rowmation of the Teeth, JOSIIPHCOLT BLOODCIOOD. J. Am. Dent. A. 19: 1738-1744,1932. In a brief disouseion, Bloodgood emphdses the relationship between oancer of the mouth and irritation from tobaooo, teeth, and ill-fitting dental plates. He oontraets the oonditiona of forty yeare ago, when 90 per oent of the lesions of the mouth whioh oame under the observation of the surgeon were oanoerous, with the present day, when 90 per oent are not oanoerous. Emphasising the praotioal and sooial value of newspaper publioity, he states that the peroentage of early oams of oanoer or preoanoerous lesions seen by the physioian depends upon the spaoe given to the subjeot in the publio preea. If an equal amount of publicity oould be gained for the early symptoms of oanoer of the oervix and stomach, he believes a larger peroentage of early oms would be presented. to the olinioians and the percentage of oures thereby greatly inoreamd. In the making of an oral survey, Bloodgood includes aareful inspeation and palpation of the entire muoous membrane of the oral oavity, transillumination, radiography, biopsy, Wssaermann test, blood oounts, and smears for the preaehoe of organisme. WILLIAMJ. HOFFMAN Treatment of Malignant Growth6 of the Oral Cavity, WILLIAML. CLARK. Aroh. Phys. Therapy 13: 771-775, 1932. Methods whioh have proved valuable in the treatment of oanoer of the oral oavity are surgery, x-rays, radium, and eleotrothermio prooedures (deeicoation, oold high-frequenoy knife, and ooagulation). Deeiooation and coagulation not only remove the tumor growth, but also destroy the neoplsstio oelle for a short distance from the aotual tissue involved. The soar following the urn of eleotro- desicoation and ooagulation is soft, and not as extensive as that resulting from other methods. Malignant diseam of the oral oavity ie always a serious diseeee but it is not neoeeaarily hopeless, einoe many brilliant results are obtained by the judicious employment of the methods mentioned. Of these, eleotrothermio treatment of the local lesion holds first plaoe, in the author's opinion, WILLIAM J. HOFFMAN

Vadoue Tumon of the Buccal Cavity, T~DBNAT.Diverse6 tumeura de la oavitd buooale, Bull. etm6m. Boo. net. d. ohir. 58: 1,l34-1138, 1932. This is a short desoription of three malignant tumors of the oral oavity. The first was a round- and spindle-oell wooma of the uvula in a man of thirty-two yeare. In six months this tumor reaohed the sise of a large egg. Fourteen months after exobion, pulsating nodules appeared, one after the other, in the scalp, olaviale, ohest wall, sternum, posterior iliao region, and region of the greater troohanter. These grew to large sise and caused the patient's death two years after hie original examination and treatment. The primary tumor never exhibited any evidenoe of pulsation and did not reour. THH OWOAVITY 437

The seoond patient was a boy eight years of age, oomplaining of dysphagia, dyspnea, and hoaraenees. Examination disclosed a tumor the size of a butternut involving the soft palate. This was smooth, shiny, firm, and non-tender. On the day after admission respiratory embarrassment was so severe that a traoheotomy had to be performed, after which the tumor was exoised. Within eighteen days a recurrence was evident, and death ensued five months later from gradual asphyxia despite the traaheal cannula. The histologio diagnosis was lymphosarooma of the soft palate. The third oaae was a hemangioma of the tongue in a young man of eighteen years, first observed at the age of two. It had grown slowly during the intervening sixteen years, but aix months before being wen by the author, had rapidly enlarged until it produoed a meee whioh protruded through the open mouth down over the lower lip and ohin, and extended baokward to involve the anterior third of the tongue. This WBB treated by a wedge-shaped exoision. The edges were closed with suture and primary union ocourred. Histologic examination revealed a oavernous hemangioma involving the whole thickness of the anterior third of the tongue, but with no evidenoe of malignancy. [In justice to the author it should be noted that the two oases of sarcoma were treated in 1888 and 1894 respectively, before the advent of radiation therapy.] WILLIAMJ. HOFFMAN

Fibromaa of the Buccal Cavity, H. TERWELP. Fibrome der MundhBhle, Arch. f. Derm. u. Syph. 167: 1-14, 1932. Terwelp reports two oases of benign fibromas of the buooal oavity and one of symmetrical fibromse of the maxillae. These growths were d situated along the alveolar borders and were easily removed. They showed the typioal histological pioture of oompaot, hard fibromas. The prognosis for this type of tumor is good, 8nd malignant degeneration is observed only rarely. The article is well illustrated with photographs and photomiorographs. BIDNJAWR. SHORB

Rue Fonns of Leukoplnkia Mucosre Oris, K. ULLMANN.Uber seltene Formen von Leukoplacia mucosae oris, Ztschr. f. Stomatol. 30: 80!2-811; 868-877, 1932. Among the less usual aauses'of leukoplakia is a stomatitis resulting from thera- peutic use of or industrial contaot with metals-arsenio, biemuth, gold, nickel. The author reports a case in which treatment of lupus with a gold preparation oaused stomatitis and the formation of plaques of leukoplakia. Another type of leukoplakia not previously desoribed is what the author oaUs hkoplakia ekctrogd- uanica, due to the presence of gold and amalgam fillings and vulcanite prostheses in the mouth. These foreign substances acted upon by the saliva form a sort of galvanio battery, and the electric currents so generated, though of alight intensity, act oonetantly to bring about changes in the mucow membrane that result in leukoplakia. Within two years the author has observed 11 oases of leukoplakia of this type and 2 eases of abnormal pigmentation.

Aduaratinoma of the Lower Jaw, A. E. VAN HUTTBN. Een adamantinoom aan de onderkaak. Geneesk. tijdsohr. v. Nederl.-Indill72 : 1309-1310, 1932. The Netherlands East Indian Canoer Institute reoeived in the past five years not lees than 13 cases of adamantinoma, all of whioh were benign. A short report is given of a twenty-six-year-old native who for two yearn had had a large tumor of the left lower jaw. The mucous membrane of the mouth was extensively ulcerated and the skin of the cheek showed a small ulcer. The affected bone was re- 438 ABSTBACTS moved by a radical operation. Four pictures showing the patient before and after the treatment and two of the removed tissue are added to the text. No x-ray pictures are given. JOHANNBPSP. M. VOQELAAB

Are There M-t Ad.mmtino111a8? I(. SPRING. Gibt es maligne Adaman- tinome? Ztschr. f. Stomatol. 30: 466-466; 608-621, 1932. The author is of the opinion that only those epithelial tumors of the jaw that show reticular epitheliiim resembling normal enamel pulp or the formation of enamel pulp cysts in the inner part of the tumor should be regarded as true adamantinoma, although in certain atypical growths the basal-cell epithelium usually forming the outer layers of the tumor may greatly predominate. Clinically the roentgen-ray picture of a true adamantinoma is that of a multilooular opt, even though the tumor shows no cyst formation. A bseal-oell epithelioma does not show this picture even though it invades the bone of the jaw. The author reports a oaae in which a tumor of the lower jaw had grown slowly and recurred after one removal. After the second radical removal, metsetatia nodules developed in various bones in the skull. Histologic examination of the tumor of the jaw removed at the radical operation showed an adamantinoma, partly solid and partly cystic, with the typical epithelium resembling enamel pulp. No abnormal mitoses or atypical cell nuclei were demonstrated. One of the metastatic nodules showed similar characteristics, but in this growth there were numerous atypical nuclei, as in carcinoma simplex. In this case the clinical history and the roentgen-ray picture of the lower jaw were typical of adamantinoma. Since recurrences are frequent in adamantinomas that are entirely benign, the recurrence in this case does not indiaate malignancy. The tumor in the lower jaw showed no definite malignant characteristics histologically, but it did metas- tasise; this is comparable with malignant adenomas of the thyroid and ovary. Adamantinomas have been known to develop carcinomatous characteristics histologically. In these there is a history of unusually rapid growth after a period of slow growth; there may either be metastases or invasion of the local soft tissues. In other cases the conneotive-tissue stroma of the adamantinoma may undergo sarcomatous degeneration, with rapid destruotive growth and metastases.

Adamantinom, Case of Fifty-one Yem’ Duntion, V~RQINIAKNB~BLAND FBANTZ AND LOUISSTIX. Arch. Surg. 25: 890-897, 1932. The case reported here is one of the most persistent examples of adamantinoma in the literature. The patient, a woman of thirty-two, first applied for treatment in 1878, complaining of a lump in the right side of the lower jaw, which had developed after the extraction of a carious tooth. Four and a half years later the mass was so large it hung down 80 as to touoh the shoulder. It was surgically removed, followed by infection, sequestration of dead bone fragments and prompt reourrence of the tumor. Seven years after its onset a huge tumor had involved one-half of the mandible and a jaw resection was performed. During the next forty-four years the tumor grew slowly and steadily until 1929, when the patient died. About six or eight years before her death an attempt was made to treat it by radium implantation without definite benefit. The specimen removed at autopsy measured 14 x 13 x 11 om. and weighed 960 grams. Cut section revealed a massive tumor oontaining many cystio areas. Excellent gross photographs and microphotographs iUustrate the pathologiod features of this tumor, whose history extended over a period of fiftssne years. WILLIAMJ. HOFFMAN THE OBAL CAVITY 439

Operative Treatment of Fractures and Cysts of the Jaws, ROBEIRTH. IVY.J. Am. Dent. A. 19: 1516-1527, 1932. Three types of jaw cysts are described: the dentigerous cyst, dentoperiosteal (radicular) cyst and ameloblastoma (adamantinoma). The firat is treated by removal of the cyst with its capsule and the extraction of the unerupted tooth if it cannot be brought into proper alignment. Dentoperiosteal cysts usually require the extraction of the offending tooth and any adjoining devitalized teeth whose roots are exposed in the cyst cavity. The technical steps of treating the cyst itself by the " open (marsupialisation) and " closed," (mucoperiosteal flap) methods are described. Ameloblastoma probably should be treated by complete resection of the involved portion of the mandible, since it is the author's experience that conservative enucleation, curettement, and radiation are usually followed by recurrence. Two of his cases were treated by complete resection followed several months later by bone graft to restore continuity of the mandible. WILLIAMJ. HOFFMAN Benign Giant Cell Tumor of the Jaw in Childhood. Report of Case, GEORG~A. HEICTOR.J. Am. Dent. A. 19: 2105-2108, 1932. Benign giant-cell tumors of the jaws (exclusive of epulides) are not common. The youngest patients reported in the literature were two children six years of age. Hector adds one more to this young group. A six-year-old girl complained of a lump in the left side of the lower jaw which had developed a month before she came to the clinic. There was a firm, fixed mass in the area between the lower left permanent lateral incisor and the left second deciduous molar tooth. The surface of the tumor was smooth and was not tender to palpation. The overlying mucous membrane was normal. Radiographs revealed lose of bone in the affected area. Biopsy showed benign giant-cell tumor. The tumor was treated by curettage, packing with iodoform gauze, and suture of the overlying mucosa. WILLIAMJ. HOFFMAN

Burt Cell Cancer in a Large Dental Cyst of the Upper Jaw, H. PICHLER.Basal- rellenkrebs in einer grossen Zahnzyste des Oberkiefers, Ztschr. f. Stomatol. 30: 843-847, 1932. At operation, by the nasal route, on a dental cyst of the upper jaw a mass of neoplastic tissue was found in the anterior and least accessible portion of the cyst. Histologic examination of the specimen established the diagnosis of basal-cell Baroinoma. There was a certain resemblance between the malignant tiesue and the epithelium of the nasal mucosa. The growth apparently originated in the neeel epithelium and invaded the cyst wall. There was apparently no etiological relation between the cyst and the epithelioma. Except for the presence of the cyst, however, operation would not have been done when the malignant growth wm in so early a stage.

Diagnoris of Carcinoma of the Lip, N. M. WHITEIHILL.J. Iowa State M. 800.22: 533-534, 1932. Cancer of the lip, because of its location, is amenable to early discovery, diagnosis, and treatment. It is to be differentiated from pyogenic infections, tuberculous lesions, syphilis, and leukoplakia. Because of its tendency to ulceration, it is often infected and for this reason nearly half of the moderate-sized glandular enlarge- ments found in association with it are inflammatory. The pathological diagnosis of the lip lesion rests finally on a biopsy, but the author condemns this practice on the ground that a small bit of tiesue often is insufficient for a diagnosis. He believes that a proper biopsy epecimen taken 23 440 ABBTRAUTB from the periphery of the lesion constitutes a mutilation nearly equal to that of a total removal and, in addition, subjects the patient to the danger of diesemination of the disease. [Many will disagree with the author. Most oaroinomaa of the lip are uloerated when seen by the olinioian; the removal of a small fragment of tissue from such an ulcerated tumor involves negligible risk of dissemination. The diagnosis from these small sections is usually easy, shoe squamous caroinoma is a clear-cut pathological entity. In small and moderately advanced malignant lesions of the lip destined to be treated by radium, a biopsy is essential for planning proper dosage, formulating a prognosis, and providing a proper record suitable for statistical evaluation of the treatment employed.] WILLIAMJ. HOFFMAN Recurring Epithelioma of the Lower Lip aad Chin; Diathermy and Cautery Ex- cision; Reconstruction of Lower Lip, F. A. FIQI. Surg. Clin. North America 12: 951-954, 1932. A man aged twenty-one years presented a recurring epithelioma of the lip and chin. Two and a half years previously a fiesure had developed on the lower lip which did not heal. Radium waa applied on three ocoaaions over a period of several months, followed by seven or eight roentgen-ray treatments to the lip and four to the neck during the next eight months. Despite this treatment, the lesion grew, and about a year after its first appearance a V-shaped excision waa made and the submental lymphatic struotures were removed. Eight months later a reourrence 3 om. in diameter developed in fhe poetoperative scar of the lip, and another, 2 cm. in diameter, over the right mental protuberance. There were no palpable nodes. Biopsy disclosed squamous carcinoma, grade 3, and a wide cautery excision waa carried out, the wound being left entirely open. Small recurrenoes again appeared on the lip and were removed by the cutting cautery. Six months later a tube flap was formed on the thorax and the lower end lined with a full-thicknees graft taken from the left arm. After four months the flap waa raised and sutured in place to repair the defect of lip and chin. A narrow flap of mucous membrane from each side of the postoperative opening into the mouth waa brought aorotm the free border of the flap to furnish a vermilion margin on the reconstructed lip. Four weeks later the pedicle was cut across and a portion of it utilised in reconstructing the chin, the remainder being returned to the thorax to replace the wide thinned-out scar. The original condition following low of the lip and part of chin, as well as the excellent final result, are well shown by photographs. WILLIAMJ. HOFFMAN Carcinoma of Oral Cavity and Base of Tongue, A. ROBBINFBLD.Carcinoma cavi oria et baseos linguae, Acts ohir. Scandinav. 70: 123-131, 1932. About 10 per cent of all caroinomas affect the mouth, and of these, about 70 per oent occur in the lips, 20 per cent in the tongue, and 10 per cent in oral mucosa. Men are dected four times more frequently than women. About 99 per cent of oral oancers are squamous-cell; adenocarcinomaa arise from the sublingual glands and sometimes from the gum. Primary carcinoma of the floor of the mouth is rare, but secondary extension from cancer of the tongue to the floor is aommon. The author mentions most of the etiological factors that have been suggested by different writers; states that in differential diagnosis the chief lesions to be distinguished are tuberoulosis, gumma and aotinomycosis; stresses the need in doubtful oases for biopsy, followed by immediate radioal operation if carcinoma is diagnosed; and oonsiders that surgery is the treatment of ohoice, and that radium and electrocoagulation should be reserved for inoperable cases. He estimates the primary postoperative mortality at 10 to 15 per cent, and three-year freedom from recurrence and metastasis at 16 to 20 per cent. THE OML UAVI!CY 441

A caae is reported in a man of fifty-four, who attended hospital in 1925 because of a small ulcer on the right side of the buccal floor near the submaxillary gland; all the teeth were carious; there were no enlarged lymph nodes. The author first removed the right cervical nodes and right submaxillary gland, verified the diagnosis of carcinoma by biopsy, and then operated radically, resecting the geniohyoid and genioglossal muscles and the left cervical nodes and submaxillary gland along with the tumor. When the patient was seen seven years later there was no sign of recurrence or metastasis. F. CAVERS Carcinoma of the Tongue with Special Reference to Treatment by Irradiation, JOBBPHC. BECKAND M. REESEGUTTMAN. Ann. Otol., Rhin., & Laryng. 41 : 924-932, 1932. Histologic studies of the relative degree of cellular differentiation of neoplasms of the tongue have a practical value in explaining the success or lack of success with surgery or irradiation in the various types so treated. These histologic criteria indicate whether the tumor is best treated by surgery or irradiation and make it possible to calculate the intensity of the irradiation dosage. A biopsy should determine the details of treatment. Surgical failures in cancer of the base of the tongue are due to the preponderance in this region of highly anaplastic tumors, which fact similarly explains the spectacular [but often temporary] regressions following their treatment by irradiation. Surface applications of radium to the tongue are not used by the writers; instead, interstitial irradiation by removable radon seeds or radium element needles is advocated, and the method of inserting and anchoring these is described. Treatment of the neck in the presence of carcinoma of the tongue is as important as the treatment of the primary growth. Palpable nodes are not necessarily malignant; many are inflammatory as a result of the infected, ulcerated primary tumor. If no glandular involvement can be made out grossly, the neck is sub- jected to intense irradiation by radium or x-rays or by the subcutaneous introduction along the lymphatic drainage area of needles containing from 1.3 to 2 mg. of radium element. The needles are left in situ for five to seven days. If palpable nodes are present and histologic examination of the primary lesion reveals an adult type of tumor, radical neck dissection on the involved side is done, with resection of the jugular vein or common carotid artery if necessary. The neck dissection is later followed by irradiation. If the primary growth is of the anaplastic, transitional-cell, or lymphoepithelioma type, no surgery is performed, the entire treatment being by irradiation. WILLIAMJ. HOFFMAN Case of Primuy Fibrowcoma of the Tongue, G. NICOLOBI.Un caso di fibrosarcoma primitivo della lingua, Riforma med. 48: 53-55, 1932. A fifteen-year-old boy entered the hospital with a history of a painless, slow- growing tumor of the tongue of one month’s duration, which had begun to ulcerate two weeks previously. The tumor was resected widely. Microscopically it was a well defined nodule composed of atypical connective-tissue cells, large, round, oval and polygonal, with many mitotic figures. About the tumor was an infiltration of lymphocytes and polymorphonuclears. The article is illustrated by a photograph and photomicrographs. No follow-up is given. JEANNETTEMUNRO

Malignnnt Tumors of the Vallecula (Glosao-Epiglottic Pouch), J. DUCUINGAND L. DUCUING. Les tumeurs malignes de la vall6cule, Toulouse m6d. 33: 303- 313, 1932. Tumors of the glosso-epiglottic pouch are given little attention by either laryn- gologhta or surgeons. They are not included by the former with the so-called 442 ABSTBAOTB

“ extrinsic cancers ” of the larynx or oancer of the lingual tonsils, nor by surgeons with oancem of the base of the tongue. In his studies of b large number of human larynges, the author has found that there rarely are lateral epiglottio folds; so thatr in nine cases out of ten the gloeso-epiglottic pouch is continuous with the gloeeo- tonsillar groove, without definite demarcation. The glosso-epiglottio pouohes are lined with a stratified pavement epithelium and contain two type6 of glands- follicular and mucous. Tumors of this pouch are fairly frequent, and would be more frequently recorded if they were diagnosed at an earlier stage. Many of these tumors are diagnosed as cmcer of the base of the tongue. Cancer of the gloeso-epiglottic pouch, like cancer of the base of the tongue, occurs most frequently in males. At the Cancer Center of Toulouse there were 30 oases of oanmr of the base of the tongue, of which 13 were strictly speaking cancers of the vallecula. These cancers are rarely glandular; as a rule, they are epidermoid epithelioma, sometimes of a mixed or transitional type; in one of the authod cases the pathological findings indicated a sarcomatoid epithelioma, but clinically, and in its radiosensitive- neas, the tumor was sarcomatous, Symptoms arise earlier in tumors of the vallecula than in tumors of the base of the tongue strictly speaking. They consist in the sensation of a foreign body and tingling or burning in the throat. On examination the tumor has the same appearance as tumors of the base of the tongue, but the cervical nodee are rarely involved. The nodes in the region of the jugular vein are often enlarged. Biopsy should be done to establish diagnosie. The authors advise implantation of radium in strietly localired tumors; external application of radium in diffusetumore, or electrocoagulation; surgical removal of nodes if not fixed, otherwise treatment by radium or the x-ray. Results of treatment by any method are unsatisfactory, recurrences or generabed metastases being the rule.

Carcinoma of the Nose, GORDONB. NEWAND F. Z. HAVBNS.Surg. Clin. North America 12: 941-943, 1932. Carcinoma presenting in the nasal fossa may arise in the nasal sinuses or in the upper part of the nose. Tumors of low-grade malignancy may attain huge size and still be destroyed. Except for the actively malignant types them growths rarely metastamre. Those of high-grade malignancy may be entirely cleared up by external irradiation, although it is in this type that metastases occur early and prognosis is poor. The case reported by the writers is unusual in that it occurred in an eighteen- yearsld woman, who complained of complete obstruction of the left side of her now for the past month. A tumor filled the left nostril, bulging out the lateral wall, pushing the septum to the right, and extending posteriorly 80 far that it was visible by posterior rhinoscopy. Under intratraoheal gas anesthesia the growth was exposed by lateral rhinotomy and destroyed by surgical diathermy. It was found to arise by a pedicle from the middle third of the nasal septum. Histologic examination revealed aquamous carcinoma, grade 2. Thirty-three months later there was no evidence of recurrence. WILLIAMJ. HOFFMAN

Melano-epithelioma of the Nose, GORDONB. NEWAND FRED2. HAVENS.Surg. Clin. North America 12: 943-945, 1932. Melano-epithelioma of the mucous membrane of the nose, throat, and mouth occurs rarely. Only six such cases have been observed at the Mayo Clinio, three of the nose, one of the palate, one of the tonsils, and one of the hypopharynx. The case reported in this instance occurred in a male aged sixty-four years, who had THE OEAL OAVITY 443

had slight bleeding from the right nostril for two months and obstruction to breathing for two weeks. A blue-black tumor, 2.5 om. in diameter, was found on the right side of the cartilaginous septum. By means of a lateral rhinotomy the tumor was exposed and destroyed by surgical diathermy. A year later a new lesion developed at the site of a small area of pigmented mucosa previously observed at the base of the inferior turbinate. This was definitely a new growth and not a recurrence or metastasis. This area also was destroyed by surgical diathermy. Microscopic examination revealed the same type of melano-epithelioma as that previously removed from the septum. WILLIAMJ. HOFFMAN

Case of Giant Cell Tumor of the Septum Hasi, H. S. WIEDER. Laryngoscope 42: 786-787, 1932. Wieder reports an exceedingly rare condition, a typical benign gianbcell tumor -proved histologically-developing from the cartilaginous portion of the nasal septum a few weeks after local trauma to that area. The tumor was a sessile mass about one centimeter in diameter and was easily removed with a snare. Post- operatively the patient received x-ray therapy. Thirteen years later there was no evidence of recurrence. WILLIAMJ. HOFFMAN

Blockade Theory of Polyp Formation, JOHNL. JENKINS.Laryngoscope 42: 703-704, 1932. According to the theory advanced by Jenkins, the sequence of events leading to the development of a polyp is as follows. Chronic inflammation causes the mobilisation of large numbers of lymphocytes, which infiltrate the intercellular spaces of the infected area; the crowding in of these lymphocytes produces a mechanical " blockade " of the tissue spaces so that a local lymphedema develops. If this lymphedema persists, a polyp is formed. If the lymphocytes are destroyed by irradiation, the polyp fluid will be absorbed, but if the chronic inflammation per- aists, the same cycle will be repeated and a new polyp will result. WILLIAMJ. HOFFMAN Malignant Disease of the Larynx and Pharynx, R. STEWART-HARRISON.J. Laryngol. & Otol. 47: 725-755, 1932. Also (in German) in Schweiz. med. Wchnschr. 63: 41-44, 1933. The material upon which this paper is based comprises 144 cases of cancer of the larynx and pharynx treated by protracted fractional irradiation, by Schins at Zurich, from the spring of 1929 to the end of 1931. Of these 144 patients, treatment was completed by 116 (80 per cent). The usual reason for discontinuing treatment was the bad general condition of the patient. Since in the oldest cases only three and onshalf years have elapsed since treatment, the author cannot report five-year cures. He reports his " percentage of looal success " and defines this figure as the number of patients who have become free of signs and symptoms of disease as the result of the treatment and who, up to the present time, have not developed a local or regional recurrence. The opti- mal percentage of local success is the ratio of this figure to the number of patients who completed treatment. The results are further analyzed on a basis of situation, nature, and extent of the lesion. The percentage of local succem has been 55.1. This group numbers sixty-four patients. Ten of them are locally free of disease but have distant (not regional) metastases; 14 died of intercurrent disease but were symptom-free at the time; the remaining 40 are without any evidence of disease from nine months to three and onehalf years after treatment. [The results reported, while still too recent for definite conclusions as to ultimate cure, corroborate the experience of Coutard and others. They justify the 444 ABSTRAOTS opinion of many roentgenologists that the Coutard technic holds out much hope for the successful treatment of a group of cases for which surgery has little to offer.] WILLIAMJ. HOFFMAN Discussion on the Treatment of Malignant Diseare of the Eppopharpru, Roc. Roy. Soo. Med. 25: 431-450, 1932. This discussion on hypopharyngeal tumors was opened by Trotter, with a paper on treatment by excision, which has appeared elsewhere (Abst. in Am. J. Cancer 16: abst. p. 1346, 1932). von Eicken of Berlin described the application of radium in hypopharyngeal tumors and the Coutard method of radiotherapy, with which he has had no immediate experience. Hunter discussed treatment under two head-direct surgical intervention and surgical intervention with radium. Exposure and examination of the primary growth are necessary to determine which method shall be employed. If the growth proves operable, the operator proceeds with opening the pharynx and removing the area involved. If the growth is inoperable, the pharynx is not opened but radon seeds are inserted either at on- or after a week's delay. Colledge, St. Clair Thomson, Harmer (see abst. in Am. J. Cancer 16: abst. p. 1082, 1932), Cede, Mollison, and Negus also contributed to the discussion. A number of illustrative case reports are appended.

Carcinoma of the Naso-pharynx in a Twenty-six You Old MM, GBO.W. MAC- KLPNZIB. Eye, Ear, Nose and Throat Mo. 11: 448-451, 1932. In a white male, aged twenty-six years, enlarged cervical nodes were observed following an acute cold with sore throat. The swellings were painless, but pro- gressed despite repeated treatment by x-rays. Examination revealed bilateral, hard, fixed masses in both sides of the neck and a granulating tumor mass in the posterior portion of the right nostril, extending into the neeopharynx. Biopsy showed oarcinoma. Bilateral neck dissection was done with difficulty, and the specimens removed were reported not to contain evidence of carcinoma. Because of severe pain in the region of the ethmoid and maxillary sinus, a part of the tumor mass in these areas was removed. Examination of this tissue showed it to be rapidly growing squamous carcinoma. Treatment by irradiation was planned. WILLIAMJ. HOFFMAN

Ununul Cure of Endothelioma of the Nuopharynx, THOMASGmm~ AND W. H. EVANS. J. Laryng. & Otol. 47: 406-409, 1932. A woman, sixty-four years of age, had had a hard, spherical growth removed from the right side of the nasopharynx. Eleven years later the left choana was completely blocked by a smooth, nodular mass growing from the left side and posterior wall of the nasopharynx. The growth was smooth, firm, and fixed. It was removed and pronounced an endothelioma. Eleven years after this, obstruction of the right nasal passage developed, with loss of hearing on the right side. The right choana waB blocked and the left airway restricted. A mass wee easily shelled out at operation. Microscopic study revealed a structure made up mostly of tubular spaces and hyaline material suggestive of an endothelial origin, although the diagnosis of mixed tumor of the salivary gland type oould not be excluded. WILLIAMJ. HOFFMAN

Fibroma of the Nose and Rasopharynx, GORDONB. Nsw AND FRBD2. HAVBNB.' Burg. Clin. North America 12: 939-941, 1932. Fibromata of the nose and neeopharynx are relatively rare in female subjects. Most of them cause symptoms about the time of puberty. Of 62 cases observed THH ORAL CYAVITY 446

at the Mayo Clinic, 61 were in males and 11 females. New prefers destruction of the major portion of the tumor by diathermy and insertion of radium points into the base. The case reported occurred in a girl aged fourteen yeare, who complained of difficulty in breathing for the past four years. Soon after symptoms were observed, tonsils and adenoids were removed without benefit. Later a growth was found in the left nostril, and four attempts were made to remove it during the following year. When first seen by the authors, the maas had obstructed both nostrils, and filled the nasopharynx, extending below the soft palate. Under intratracheal anesthesia the soft palate was retracted by catheters through both nostrib and the tumor was destroyed by electrocoagulation, the electrode being applied through the nostril and the nasopharynx. No irradiation was used. Recovery was normal, and the patient returned three months later much improved in health, having gained thirty-five pounds. No trace of the tumor was found in nose or nasopharynx. WILLIAMJ. HOFFMAN

Nad Fibroma Growing from Body of Sphenoid Successfully Removed with Introduction of Radium Needha, Case Report, R. H. FISHER.Laryngoscope 42: 701-703, 1932. A fibroma of the postnasal space, arising from the body of the sphenoid bone, caused nasal obstruction and repeated severe nasal hemorrhages. It was successfully treated by the insertion of radium element needles. WILLIAMJ. HOFFMAN

Naeophar@ged Fibroma; Report of Two Cases, W. SPIILBEIRQ.Laryngoscope 42: 872-876, 1932. Nampharyngeal fibromata are not common. They usually occur in the young, predominating in males between the ages of ten and twenty-five years. They are single, as a rule, and arise most often in the nasopharyngeal recess, though they may occur elsewhere. The tumor is usually some form of fibroma, a polypoid fibroma or fibromatous polyp, Microscopically it is composed of fibrous tissue with large cavernous blood spaces. It may extend to the orbit, accessory sinuses, pterygoid or temporal fossa, or even to the cranial cavity. Treatment may be by surgery or by radiation. Radiotherapy may consist in surfaoe application of a tube of radium within the naris, implantation of radium needles or gold seeds of radon, or external irradiation with x-rays or radium. Since the tumor is often radiosensitive, many excellent results have been attained by this means. The author reports two cases successfully treated by surgery. WILLIAMJ. HOFFMAN

Orbito-ethmoidal Osteoma, G. MALFATTI. Osteoma orbito-etmoidale, Oto-rino- lhg.ital. 2: 305-306, 1932. A man aged twenty-seven had a large, hard tumor which bulged into the left orbit, pushing the bulb outward and downward, and also bulged into the left nasal cavity, which it blocked. Roentgenograms showed it to be an osteoma. Before operation could be done a fatal meningitis developed. Autopsy showed the osteoma to arise as a sessile growth from the labyrinth of the ethmoid. C. D. HMQENSIN

Cysts of the Antrum, T. E. FULLBE.J. Arkansas M. SOC.29: 127-130, 1932. Two types of cysts of the antrum are recognised: dentigerous or follicular cysts and periosteal or radicular cysts. The dentigerous cyst arises from some part of the follicle of a non-erupted tooth. At operation the whole or part of a tooth-like 446 ABSTBAUTB object whioh resemble! the crown may be found. These oysts usually are die- covered in adolescence or early adult life. Dental aysts are muoh more common than dentigerous cysts and are found muah oftener in the upper than in the lower jaw. They arise as the result of inflammatory changes produaing a mass of granulation tissue firmly attached to the root of the tooth. Central necrosis ooours, leaving a cavity which is the starting point of a cyst. Such cysts may grow to enormous size and may extend into the antrum, nose, or mouth; the walls may he thinned out so that a parahment- like crackle is elicited on palpation. Exploratory punoture reveals yellowish fluid. Empyema of the antrum and a suppurating cyst which has perforated into the antrum are to be differentiated by radiography. Treatment of both types of cyst is by surgical removal. WILLIAM J. HOFFMAN Cancer of the Uvula and Phyoiotherapy, G. MORAMARCO.I1 oanoro del velopen- dolo e la terapia fisioa, Stomatologia 30: 20-22, 1932. The author disoueaes the olinical picture and therapy of oanoer of the uvula from the point of view of the stomatologist, giving no original material. He favors radium therapy in oonjunotion with x-ray or diathermy. JEANNB~TTEMUNRO Mixed Tumow: of the Soft Palate Resembling the Mixed Tumoura of the Parotid Gland, DOUQLABG. CARRUTHERS.M. J. Australia 2: 692, 1932. A woman of forty-eight had a large tumor of the soft palate. The biopey diagnosis was “ a mixed growth arising from muoous glands resembling a mixed tumor of the parotid and of relatively low-grade malignanoy.” As the tumor was movable and encapsulated, its removal was attempted in spite of its size. Six months later there were no evidences of reourrenoe. Radium Therapy of Tumon of the Soft Palate, J. SBIV~RBIANO.Die Radium- therapie bei den Neoplasmen des Gaumensegels, Strahlentherapie 45 : 177- 180, 1932. A report of the result of interstitial radium therapy in 37 malignant neoplasms of the soft palate treated at the Radium Institute of Buoharest. In 9 the primary lesion was oontrolled, but there was extension to the regional lymph glands. Sixteen oases were arrested for one year, 8 for two, and 4 for five years. Twenty- one oases were basal-oell epitheliomata situated mainly near the margin of the soft palate; 16 cases were of the squamoua-cell type, usually arising from the more forward part of the soft palate. There was also one lymphosarooma. Standard 0.6 mm. platinum needles with a radiating surface of 1 to 1.5 cm. and a radium content of 0.66 to 1.3 mg. radium element were inserted into and 3 mm. beyond the palpable neoplastio zone and allowed to remain for three to five days. Radium dermatitis of the tongue was diminished by soreening the latter by means of dental modelling compound impregnated with barium sulphate. One case of osteo-radium-neorosiaof the hard palate is reported as being due to over-irradiation; 1152 mg. hours were given in this oase. An interesting statement is that in Buoharest neoplasms of the soft palate ooour four times aa frequently as those of the tongue and twenty-five times as frequently aa those of the tonsil. MAURICELENZ Pack for Use in Applying R~diumto the Soft Palate, J. S. WILBON. Radiology 18: 640-641, 1932. The author describes a radium paok for the soft palate, whioh is maintained in position by two strings going through the nares, similarly to a postnasal plug, and which embodies some of the prinoiples of the radium-bearing oork employed at the THBloBIuI aAm 447

Curie Institute of Paris. The applicator consists of a small copper pan containing the radium tubes and covered by dental modeling compound. The author has employed it in one case of carcinoma of the soft palate. MAURICELENZ

Cancer of the Larynx, VANDEN WILDENBERG.Le cancer du larynx, Bruxelles m6d. 12: 1234-1247, 1932. Van den Wildenberg believes that intrinsic cancer of the larynx is being diagnosed today in an earlier stage than was the c88e before the war. As a rule the patients are heavy smokers, but exceptions occur. The average age of incidence lies between fifty and sixty years. Few cases are seen before the twentieth year, but nearly 5 per cent occur between twenty and thirty yearn of age. Intrinsic cancer of the larynx below the age of thirty-five is usually featured by rapid growth and frequent reourrence, but such cases are not always hopeleaa if the original operation is sufficiently radical. Lymph node involvement occurs late in intrinsic carcinoma of the larynx but early in extrinsic cancer. Cancer of the cord, because of the poverty of lymph veasels, metastasizes only rarely; cancers of the vestibule, false cord, or ventricles, because of the richer lymphatic supply, metastasize more frequently and fairly early. The earliest evidence of the disease is a persistent hoarseness. Pain is usually not a part of the picture. Cough does not develop until there is ulceration. Any thickening of the vocal cord, especially after middle age, must be viewed with suspicion. Badiography offers nothing toward the early diagnosis of cancer of the larynx. The best method is inspection of the larynx of every patient presenting any symptom which could be related to the larynx. All diagnoses should be verified by biopsy. Van den Wildenberg has always advocated radical total laryngectomy in cases of intrinsic carcinoma of the larynx, and most of the Belgian school have followed this rule. He believes that the trend of foreign surgioal opinion is also toward the adoption of this principle. Radium and roentgen therapy he regards of little value in such cases and quotes rather depressing statistics of the results of such treatment. Partial laryngectomy, economic laryngeotomy, and laryngofiasure with sub- perichondral resection are all more or less the same operation. There are cases of early intrinsic cancer of the larynx so limited in extent that one is justified in treating them by laryngofissure or hemilaryngectomy, but they form only a small proportion of the total number. Hence, more than half of Van den Wildenberg’s patients were treated by total laryngectomy. The author’s results offer strong support to his preference for radical operation. He has performed 16 total laryngectomies, 5 of which were complicated by pharyngeal involvement. There was no operative mortality. This is contrasted with Sebileau’s mortality of 35 per cent in 22 cases in which economic laryngectomy was done. Twenty-five per cent of Van den Wildenberg’s 16 cases recurred, and 12 (75 per cent) remained cured. Thirteen patients were treated by laryngofissure. The operative mortality was 16 per cent; there were 2 recurrences and 75 per cent of cures. Two patients treated by hemilaryngectomy remain free of disease. Four patients were treated by Sebileau’s method ’ of economic laryngectomy. Three died of recurrences; one is free of disease after seven years. WILLIAMJ. HOFFMAN Diagnosis and Treatment of Intrinsic Cancer of the Larynx, G. E. HODGB. Can- adian M. A. J. 27: 623-628, 1932. There is perhaps no field in medicine in which the gradual improvement of technic has yielded such brilliant and satisfactory results as the treatment of 448 ABSTRACTS cancer of the larynx. One of the chief reasons for this is the better understanding of the distribution of the lymphatics of this region. The vooal oords, which have practically a closed system and contain few lymphatics,' divide the cavity of the larynx into an upper and a lower network. These two networks empty into glands on either side and do not anastornose with the neighboring lymphatics. Intrinsic cancer of the larynx is ten times as frequent in men as in women and seldom is seen before the age of forty years. It arises usually in the anterior or middle third of the vocal cord, rarely in the ventricle or upon the ventricular bands. Ninety-eight per cent of cancers of the larynx are carcinoma; two per cent are sarcoma. Ninety-six per cent of the former are squamous-cell, two per cent basal- cell, one per cent papillary, and one per cent adenocarcinoma. The likelihood of a recurrence following operation is directly proportional to the malignanoy of the tumor, high-grade tumors being.followed by recurrence in 72 per cent of the cases, low-grade tumors in only 6.6 per cent. Intrinsic carcinoma causes early symptom, usually persistent and progressive hoarseness, which in an adult should be regarded as possibly cancerous until proved otherwise. Biopsy should be resorted to in all doubtful cases, and operation should not be long delayed. The surgical treatment should be suited to the extent of the disease and the histology of the tumor. Laryngofissure in early cases affords almost 80 per cent of cures. Hemilaryngectomy should be employed in more advanced lesions; total laryngectomy must be resorted to if the tumor is at all extensive. Inoperable cases may receive valuable palliation and occasionally be cured by radium and x-rays. WILLIAMJ. HOFFMAN

Treatment of Carcinoma of the Larynx, HARRINQTONB. GBAHAM.Ann. Otol., Rhin., and Laryng. 41: 898-902, 1932. Intrinsic cancer of the larynx arises in a box comparatively isolated from the surrounding tieaue by a strong, oartilaginous wall, the invasion of which is relatively slow. The tumor gives early warning of its presence by the production of persistent hoarseness. Alert diagnosis will afford a fairly large percentage of early, favorable cases. Cancer of the larynx occurs over a wide range of ages, though most of it is seen between the ages of forty and sixty-five. It may develop in the young on the bash of persistent or recurrent laryngeal papilloma. Surgical operations for oancer of the larynx should vary according to the extent of the diaeaea. An early oancer of the middle third of one vocal cord may be removed in toto and a good, clean, functioning larynx remain, with a clear, loud voice. This may be done by direct or indireot methods; however it ki performed, the base should be fulgurated and radium applied. The most convenient approach is by laryngofieeure. More extensive growths will require hemilaryngectomy. Graham has a poor opinion of window reseotion for the purpose of exposure to x-rays or radium. He believes the treatment inadequate in early lesions and futile in more advanced cases. In the latter a laryngectomy offersmore likelihood of success. WILLIAMJ. HOFFMAN

Plea for Window Resection Method in Dealing with Certain Topes of Laryngeal Carcinoma, with a Clinical History of Seven Cases, NORMANPATTERSON. J. L-g. k Otol. 47: 81-91, 1932. Patterson reports seven cases of laryngeal cancer treated by " window reeection '' of a part of the thyroid cartilage. All of these cases were unsuitable for laryngohsure and, had window resection not been available, all would have required total laryngectomy. Patterson believes that in a definite, well chosen group of cases such as he describes (when the disease is limited to the anterior portion of the larynx but has crossed the midline and involved both cords), THEQ OEAL OAVSTY 449

window resection should be the operation of choice. He also believes that the results as regards freedom from recurrence, if the patients are carefully selected, are perhaps as good as in tutal extirpation. He employs Lack’s technic with a few modifications. One of his seven patients was well after more than nine years; one after more than five years; one three years and five months. One was well three years and eight months and then died from cerebral hemorrhage; one was well eighteen months and died of heart failure. One died of postoperative pneumonia and one of recurrence of disease five months after operation. WILLIAMJ. HOFFMAN

Circumscribed Leukokeratoeis of the Larynx and the Pre-Cancerogenic State, P. CALICETI. Leucocheratosi circoscritta del laringe e stato pre-cancerigeno, Oto-rino-laring. ital. 2: 230-239, 1932. Caliceti’s patient was a man aged thirty-nine who had a single circumscribed area of leukoplakia on one ventricular fold. It was excised. Two photomicrographs of the specimen are presented. The author fails to include a follow-up of hia case, but indulges in an extended theoretical discussion of whether or not such leukoplakia is precancerous. A bibliography is included. C. D. HAAGENSEN

Epidermoid Cucinoma of Larynx in a Woman. Partial Lmyngectomy after Roentgen Therapy. Result after Three Years, M. JACOD.Epith6lioma epidermdde du larynx ches une femme. Laryngectomie partielle aprb roentgenth6rapie. R6sultat aprPs trois ans, Lyon m6d. 150: 22-26, 1932. A woman of forty-five years presented a raised tumor of the whole right half of the larynx, extending from the right vocal cord, which it completely surrounded, to the right aryepiglottio fold. This mass extended forward to the anterior oommissure and infiltrated the left ventricular band. Internally it had grown owr beyond the midline and obstructed the glottis. At the time of examination the tumor had not become ulcerated. Biopsy, made later, revealed an epidermoid ominoma arising from laryngeal mucosa. There were no cervical metastases. Such was the preoperative settinean obviously advanced case of intrinsic carcinoma of the larynx, requiring, if surgery alone were to be relied upon, a total laryngectomy. The patient was given a preoperative course of roentgen therapy of 4000 Solomon units of radiation to the tumor and 2000 units to each side of the neck, directed along the carotid sheath. Following this treatment the laryngeal tumor underwent regression, so that a partial laryngectomy was considered adequate for removal of all involved tissue. This plan was accordingly carried out. Con- valescence was uneventful, and healing, though slow, was complete. The patient was exhibited three years later to demonstrate the following features: the possibility of utilising less radical surgery later if the laryngeal tumor be firat treated by heavy doses of irradiation; the fact that postoperative healing of suah irradiated tissues, while much slower than otherwise, nevertheless does take place satisfactorily ; the preservation of laryngeal respiration and vocal function in a case where both would have had to be sacrificed if radiation had not been utilised. WILLIAMJ. HOFFMAN

Congenital Cyst of the Larynx, A. J. LORIEAND P. Lox. Laryngoscope 42: 957- 960, 1932. Congenital cyst of the larynx is one of the rareties of laryngology. The literature contains six cases. The authors’ patient, a child of four and one-half years, had never cried audibly. At three weeks he suffered from attacks of 450 ABBTBAaT8 dyspnea followed by regurgitation of feedings. These attacks became more frequent during the two and a half months previous to examination. The child was emaciated, eyenotic, and dyspndic. The anterior chest presented a marked anterior bulging, while the lateral chest wall and infra- and supra- sternal areas were strongly retracted during efforts at inspiration, The larynx was edematous and obstructed by a swelling which could not be identified. Low tracheotomy was performed under local anesthesia. Five daya later bronchos- aopy revealed a large cyst almost completely obstructing the larynx. Incision of the cyst wall releesed a quantity of mucoid secretion. Eleven days later a broad-baaed oyst was removed by excision of the mucous membrane of the upper left half of the larynx and left half of the epiglottis. Recovery was normal. The ohild developed a voice of rather husky quality. WILLIAMJ. HOFFMAN

Cwe of Multiple Papillomata of the Larynx with Aerial Metantnoes to the L-, H~PNBYB. HITZAND ERNSTOIPSTBIRLIN. Am. J. Path. 8: 333-338, 1932. A two-year-old white child had di5culty in breathing and was unable to speak aloud. A year previously a dry, irritative cough had developed, followed by gradual lose of voice. Examination disclosed numerous papillomatous masses covering both vocal cords and much of the ventricular bands. They were excised. The pathological diagnosie was benign papilloma. Five months later the child was readmitted with similar symptom caused by recurrence of the papillolhata. Six months later she again required treatment and at that time removal was supplemented by 2.5 mg. hours of radium therapy. Within three months this treatment had to be repeated, and two months later stenosie was so marked that a tracheotomy was performed. Subsequently large masses of papillomatous material were several times removed from the larynx. The child finally died, and at autopsy the entire larynx and upper trachea were found filled with cauliflower-like masses of distinct papillary structure, varying from 3 to 8 mm. in diameter. A few attained the size of peas. The lower half of the trachea and large bronchi were normal, but in the lungs were many small cavities connected with the smaller bronchioles. These were of various size and their walls were covered with fine granules about the siae of millet seeds. The nodules in the lungs consisted of strands of squamous epithelial cells resembling those found in the larynx. Columnar cells were frequent and formed not only the basal layers, as in the primary growth, but were also found everywhere between the polyhedral cells. Mitotic figures were more plentiful than in the tissue taken from the larynx. These latter findings were interpreted to mean that the tumors in the lung had a common origin, namely from tumor masses in the larynx which were detached and carried into the bronchi by aspiration. They were able to pass through the larger bronchi but were arrested in the bronchioles, obstructing their lumina. In this way they became implantation metastases and began to grow into the alveoli. Four photomicrographs show the histology of the growths. [This is apparently an authentic case of aerial metastases such as has been occasionally reported in the French literature as occurring from aspirated particles from a cancer of the esophagus. Another report of aerial metastasis follows.] WILLIAMJ. HOFFMAN

Papilloma of the Bronchus, H. B. ORTON. Ann. Otol., Rhin. & Laryng. 41: 933- 938, 1932. Orton reports two cases of papillomata of the larynx followed by the develop ment of papillomata of the trachea. He regards the tracheal growths as secondary implants from the laryngeal papillomata. WILLIAMJ. HOFFMAN THB OBAL UAVITY 461

Unusual Papilloma of the Larynx, RAYMONDT. SMITH. Laryngoscope 42: 390- 392, 1932. Smith's case of papilloma of the larynx is of interest. The patient, a man aged forty-nine, gave a history of eight years of hoarseness and di5culty in breathing, Unable to work, walk, or sleep, he had lost 20 pounds during the previous two years. A sudden attack of extreme respiratory obstruction brought him to the author, who discovered a papillomatous mass between the vocal cords, immobilis- ing them and obstructing the glottis. Biopsy revealed benign papilloma. When an attempt was made to remove the tumor under sodium amytal anesthesia, complete respiratory block occurred and an emergency tracheotomy was required. Two days later the pedunculated tumor was removed through a laryngofissure and the base of the pedicle was fulgurated. During the following year two recurrences developed and were removed. The pathological report on the third specimen stated that there was now evidence that this tumor had become malignant. Total laryngectomy was then performed. The specimen revealed papillary squamous carcinoma. Smith concludes that fixation of the vocal cords can be caused by the mechanical obstruction sfIorded by a benign tumor; that recurrences are frequent after removal of benign papillomas of the vocal cord; that these recurrent tumors have been proved to become malignant, and that, therefore, all such patients should be regularly checked by examination, total laryngectomy being performed at the first' definite proof of malignancy. WILLIAMJ. HOFFMAN

Mixed Tumors of the Salivary Gland, A. GOSSET,I. BERTRAND,AND P. FUNCK- BRPNTANO.Les tumeurs mixtes de la gland sous-maxillaire, J. d. chir. 40: 161-181, 1932. The authors present an excellent study of mixed tumors of the submaxillary selivary gland based upon four cases and illustrated by fifteen photomicrographs. Theae turnore are relatively rare, the treatment is surgical, and their removal easy if they have not undergone malignant change. Many of them, because of their enoapsulation, can be shelled out; others, because of fixation to the gland, must entail its sacrifice. This, however, is not an important consideration, since no funational changes are noted, following the removal of a single submaxillary salivary gland. The authors, for that reason, prefer to remove the entire gland so as to diminish the likelihood of recurrence. WILLIAMJ. HOFFMAN

Histogenesis of the So-called Mixed Tumom of the Salivary Glands, 0. BRINCH. Kasuistische Beitrilge sur Histogenese der sogenannten Mischgeschwiilste der Kopfspeicheldrtisen, Ztschr. f. Stomatol. 30: 401-407, 1932. In two patients mixed tumors of the salivary gland type were removed from the poeterior part of the hard palate. Mixed Tumors of the Parotid Gland. A Study of Fifteen Cases, ARNOLD5. JACKSON. Wisconsin M. J. 31: 696-701, 1932. Mixed tumors of the parotid gland form only a small proportion of malignant tumors. Their early recognition is important in order that the tumor may be removed before invasive characters have developed. Otherwise removal is fraught with danger of injury to the facial nerve and consequent disfigurement. The histologic picture is usually a complex of cartilage, fibrous tissue, and epithelial elements. The same tumor may present many different types of tissue. The clinical prognosis cannot be determined by the histologio appearance. Diagnosis is not difficult;. location, consistence, appearance, and long history are typical. When the tumor is highly malignant, a short history and rapid 452 ABSTBaOTB growth are found. Mixed tumors occur at any age and in both sexes equally. Because of the slow growth and the fear that surgical removal may injure the facial nerve, many patients delay operation. Meanwhile the tumor may gradually enlarge, rupture its capsule, and invade neighboring structures. It is then that the faoial nerve becomes involved and must be sacrificed in an attempt to remove all the involved gland structure. There is, on the other hand, but alight risk of injuring the nerve if the tumor is excised before rupture of the capsule or before it has attained such size as to make its removal technically difficult. Jackson reports 15 cases; 10 were operated on without mortality, 2 patients have since died, and 8 are living with no evidence of recurrence. In the 10 cases operated upon, the capsule was intact in only 6. Two of the 4 patients in whom the capsule was ruptured have since died of the disease, a fact which emphasizes the importance of early diagnosis and treatment. WILLIAMJ. HOFFMAN

Observations on Seventy-one Mixed Tumors of the Parotid Gland, WILLIAM NEILL, JR. M. J. & Rec. 136: 187-189, 1932. The commonest growths of the salivary glands are the mixed tumors, 90 per cent of which are located in the parotid gland. They occur at any age, having been reported as early as seven months. The period of greatest incidence is between forty and sixty years of age. Etiology is obscure; trauma probably has no significance. Treatment usually is by surgery, and recurrence is the rule, occurring in some series in as many as 75 per cent. Injury to the facial nerve occurs in nearly 30 per cent of attempted surgical removals. Neill has an excellent group of material for study: 71 patients with mixed parotid tumors coming under his personal observation. Forty-nine were treated by surgery and radiation; 22 by radiation alone. Among the 71 patients were 40 males and 31 females. The average age was forty-five and one-half years; the oldest patient was seventy-nine and the youngest seven years of age. Various degrees of immediate facial palsy occurred in 17 cases treated by operative removal; in 32 there was no nerve injury; in 3 paralysis occurred without any operation. In the 19 remaining cases, treated by radiation alone, there was no instance of facial paralysis. Forty-one cases in which operation had been performed elsewhere, without immediate postoperative radiation, all showed recurrence. These 41 cases were treated by radiation and the growth was controlled, diminished, or made to disappear completely in 17, for periods ranging from six months to eleven years. On the basis of his experienoe Neill believes that these tumors are extremely di5cult to cure by surgery alone; that they usually are resistant to radiation; that recurrences are frequent, and that no single method of treatment.is completely satisfactory. In his opinion surgical excision followed by radiation in the smaller tumors, and radiation alone in the larger mmes, offer the greatest chance of successful eradication. WILLIAMJ. HOFFMAN

A Solid Tumor of the Submdllary Gland, H. Z. SALIE. Ein solider Tumor der Unterkieferdrtise, Zentralbl. f. Chir. 59: 2983-2984, 1932. Salih reports the case of a woman fifty years of age with a large, 6rm, nodular tumor of the left submaxillary gland which extended into the supraclavicular region. It had been present for two years but had reached its enormous sise after only four months of rapid growth. The tumor was removed under local anesthesia and weighed 1500 grams. Histologic examination showed an intra- capsular, malignant mixed tumor without cartilage formation. The article is illustrated with photographs of the tumor. BENJAMINR. SHORFI THE THYROID AND PABATHYBOID QLANDB 453

THE THYROID AND PARATHYROID GLANDS

EWeCell Tumor, A. A. EISENBERGAND HARRYWALLERBTEIN. Arch. Path. 13: 716-724, 1932. The HIirthle cell was originally described in 1894 by Hilrthle (Arch. f. d. ges. Physiol. 56: 1,1894) as a normal constituent of the thyroid gland, occurring on the outer surfaces of the walls of the follicles, in the growth of which he believed that it was concerned. Other investigators failed to find these cells uniformly present in the thyroid gland and subsequent studies would indicate that they are identical with the oxyphilic cell of Welsh, which is one of the two types of cells making up the parenchyma of the parathyroid gland. So-called Hilrthle-cell tumor of the thyroid gland, then, would appear not to originate from thyroid tissue but from parathyroid rests within the thyroid gland. It is an example of para- struma as described by Langhans (Virchows Arch. f. path. Anat. 189: 69, 1907) and by Getaowa (ibid. 205: 208, 1911), and corresponds to renal hypernephroma. Hilrthle-cell tumor is very rare. Except for a reference by Ewing (Neoplastic Diaeaees, p. 953) and a mention of 2 cases by Hsagensen (Am. J. Cancer 15: 2063, 1931), the authors have found no reported cases. Their patient was a woman of fifty-four. She had a small goiter which had recently increased in size and had had several attacks of unconsciousness accompanied by diffuse muscular twitching. Three quarters of the right lobe of the thyroid was removed. Ten months later there was marked enlargement of the gland from the left lobe past the midline, and the patient complained of a sense of constriction about the head. As before, there were no subjective symptoms or physical signs of Graves disease. The left lobe of the thyroid gland was removed and a diagnosis was made of toxic non- exophthalmic goiter and Hlirthle-cell adenoma of the thyroid. The authors point out that the convulsive seizure and constriction are suggestive of increased parathyroid secretion. Photomicrographs are shown and a bibliography is appended.

Cancer of the Thyroid Adherent to Trachea and Esophagus, L. BBRARDAND P. MALLET-GUY.Cancer thyroxdien adherant A la trachee et B l’oesophage, Lyon chir. 29: 371-374, 1932. A woman of sixty-six had had a swelling of the neck the size of a pigeon’s egg for the past thirty-five years. During the last two months it had grown to the size of an orange and caused difficulty in respiration and deglutition. Exami- nation revealed a general enlargement of the thyroid gland more marked on the right side. That portion of the gland was harder than normal and was fixed to the tissues behind the sternum, as well as to the carotid sheath, along which was a chain of nodes suspected of cancerous involvement. There was evidence of moderate thyrotoxicosis. The clinical diagnosis was carcinoma of the thyroid gland. Extirpation was difficult. The gland was adherent to the trachea and esophagus. The nodes were dissected out, including a section of the jugular vein to which they were adherent. Because of persistent ooeing, the cavity was packed with gauze. Two days later the odor of wine was noted on the dressing. Investiga- tion disclosed an esophageal fistula. An indwelling gastric feeding tube was then passed, and the patient was fed by that means. Two weeks later the fistula had closed and the wound was completely healed. Histologic study disclosed an atypical carcinoma of the thyroid gland. WILLIAMJ. HOFFMAN Goiter in the District of Kediri, L. D. EERLAND.Het kopvraagstuk in der resi- dentie Kediri, Geneesk. tijdschr. v. Neder1.-Indig 72: 129S1302, 1932. In 200 strumectomies performed in 1928-32, seven malignant goiters were ob- 454 ABSTBAOTS served. Two patients showed metastases in the skull. Adenomas were found in more than 30 per cent of the goiters. Thirteen photographs show patients with thyroid enlargement. JOHANN~BP. M. VOQBWB Parathyroid Adenonma with Mobilization of Calcium, J. A. LI~VBB.Lee ad6 nomes parathyrofdiens avec mobilisation calcique, Gaa. m6d. de France pp. 456458, 1932. Since the parathyroid hormone liberates calcium from the bones, its presence in excess causes decalcificationof the bones. This occurs in parathyroid sdenomas, the cellular elements of which are analogous to the cells of the parathyroid. As these cells proliferate they cause an excessive production of the parathyroid hormone. Hence the first symptom of parathyroid adenoma is the decalcification of the bones, with resulting deformities and fractures; aecondary to this is the deposition of calcium in the soft tissues. The bony lesions of parathyroid adenoma may simulate certain bone tumors. If the diagnosis cannot be made definitely from clinical and radiological findings, an osteotomy is justifled to determine the exact nature of the lemons. If histologic examination shows osteoporosis or fibrous osteitis, or a tumor consisting chiefly of myeloplaxes, an operation for removal of the parathyroid tumor if present must be considered.

THE CAROTID BODY

Probable Bilateral Tumor of the Carotid Body, GBORQEDE TARNOWSKY.Am. J. Surg. IS: 261-286, 1932. Tumors of the carotid body are not common, only 198 cases having been collected up to 1931. Bilateral tumors of this type are extremely rare. These tumors probably arise from the column of cells which ultimately develop into the sympathetic ganglia. Two varieties are recognized: (a) simple, highly vascular, slowly growing peritheliomata; (b) very malignant growths (potato tumor of Hutchinson). The author lists the following as essential points in the diagnosis of carotid body tumor: a solid tumor of long standing, situated in the anterior triangle of the neck, at or near the apex of the submaxillary triangle; siae varying from that of a hsselnut to a hen’s egg; tumor movable laterally but fixed vertically; non-expande pulsation; no fixatibn to overlying skin except in the very malignant type. Oc- casional signs and symptoms are: bruit and thrill on auscultation and palpation; bulging of the pharyngeal wall if the growth is large; dilatation or constriction of the pupil on the side of the growth, depending on the degree of sympathetic irritation; tenderness on deep palpation; attacks of syncope from vagus compression; late paresis of one vocal cord; tingling sensation in the neck. The treatment is careful surgical removal of the tumor. Irradiation has not been used in a sufficiently large number of cases to warrant a judgment of its value. Bevan considers his reported caae as a cure, but only thirteen months had elapsed at the time of hie report. De Tarnowsky’s patient was a forty-four-year-old Italian, who stated that twenty-six years before (1904) he had had a similar solid tumor removed from the left side of his neck. No recurrence developed. The present tumor arose in the right neck before he left the hospital and had grown very slowly for twenty-six years. It was a tense, smooth mass about 4 om. in diameter, movable laterally but not vertically. The tentative diagnoses were: lymph node tuberculosis or metastatic carcinoma; branchial cyst; small hygroma. The true nature of the tumor was not suspected. At operation a hard tumor maea WBB found within THE BBEAST 455

the carotid sheath and was dissected free, without damage to the carotid vessels. Microscopic examination revealed alveoli of delicate polyhedral cells and single very large cells with hyperchromatic nuclei. Bundles of nerve tissue were found throughout the stroma. The diagnosis was carotid gland tumor. It was impossible to obtain the patient's old hospital record, but the author believes the tumor removed twenty-six years before to have been of a similar nature and considers this to have been an instance of bilateral carotid body tumor. WILLIAMJ. HOFFMAN

Irritation d the Vague by a Tumour of the Carotid Body, MAURICECOKE AND H. A. DUNLOP. Lancet 2: 1050-1051, 1932. Stimulation of the vagus by the pressure of neoplasms is recognized, although paralysis is more commonly observed. Carotid body tumors may be associated with pain due to pressure on the cervical plexus. Attacks of dyspnea and syncope have also been reported. The authors' suggestion is that these symptoms and many others may be due to irritation of the vagus. A man of thirty-six complained of abdominal pain, vomiting, breathlessness, giddiness, and constipation. His pulse rate varied between fifty and eighty. Examination disclosed a tumor mass in the carotid area, apparently fixed to the deeper structures but not adherent to the skin. Following its surgical excision, histological examination revealed typical tumor of the carotid body. The symp toms of marked vagotonia (pain, vomiting, variable pulse rate, dizziness, and constipation) immediately cleared up after removal of the tumor and had not recurred when the patient was heard from eighteen months later. WILLIAMJ. HOFFMAN Voluminow Connective Tissue Tumor of the Neck. (Lipoma or Connective- Tissue Tumor of the Carotid Sheath), G. JIANNENEY.Volumineuse tumeur aonjonctive du cou. (Lipome ou conjonctivome de la gaine carotidienne), Gas. hebd. sci. m6d. de Bordeaux 53: 33&341,1932. Jeanneney's patient was a white woman of forty-five years. At the age of seventeen she had had a slowly growing tumor in the subhyoid region, which was extirpated when it reached the size of an orange. Recurrent tumors were removed at intervals of eleven years, four years, and four years respectively. Histologic examination always revealed.a simple lipoma. Two years after the fourth surgical extirpation, another recurrence developed and grew slowly for seven years. When examined by Jeanneney the tumor had attained the size of a football and hung down over the chest by a broad pedicle attached along the whole width of the upper neck. The under surface of the tumor, where it came in contact with the chest wall, showed pressure nearosis and ulceration, This huge tumor was encapsulated and lobulated, and wu easily removed at operation. Cut section revealed what appeared to be a simple lipoma except for one area suggesting myxomatous material. Microscopic examination revealed areas of liposarcoma, as well as other areas which were obviously myxosarcoma. WILLIAMJ. HOFFMAN

THE BREAST Cancer of the Breast, EDWARDJ. ILL. Ann. Surg. 95: 401-409, 1932. This report is based on thirty-two years of experience in which the author performed the Halsted operation for cancer of the breast 266 times. Many details of the operative technic are discussed, together with clinical facts concerning the individual patients. The author believes that the ultimate recoveries exceeded 30 per cent. 456 ABSTRAOT8

What Every Member of the Medid Profession Should Know About Protecting Women from Death from Cancer of the Breast, JOSP~PHCOLT BLOODQOOD. New York 8tate J. Med. 32: 259-264, 1932. A reemphasis on the value of routine annual examinations as a protection against cancer; the importance of immediate examination on the appearance of any abnormality; the eduoation of the general praotitioner in the diagnosis of breast lesions; the training of the surgeon both to meet the demand of earlier diagnosis and to maintain an adequate technic; and the training of pathologists in froren section differentiation between benign and malignant lesions.

Carcinoma of the Breast Removed by Actual Cautery, J. T. MASONAND H. W. Roam. Western J. Surg. 39: 821-827, 1931. The authors use the aotual cautery for the removal of breast oaroinoma. The skin incision is made with the cautery at white heat, approximately 2800' F., while the skin ia held on the stretch. The cautery is used at cherry-red heat, approximately 1800' F., for dissection of the muscles and the tumor; at dull red heat, 1400' F., for stripping the blood vessels. There is little postoperative pain; the incision heals in ten days to two weeks. A full oourse in deep x-ray therapy is given, beginning about the third week. In 1925 and 1926 the oautery was alternated with the oold knife in operations for cancer of the breast, but since that time it has been used exolusively. Of 33 patients operated upon with the oautery, 6 oould not be traced, 3 showed local reourrences, 5 died from metastases, one from other oauses, and 18, or 06.0 per cent, are living and well. Of 25 patients in whom the knife was used, 3 showed local recurrences, and 12 died of metastases, while 5 are living and well. The five-year end-results are not comparable, owing to the more reoent exclusive use of the cautery. Interstitial Irradiation of Mammary Cancer with Special Reference to Measured Tissue Dosage. A Supplementary Report, BURTONJ. LEE. Am. J. Roent- genol. 27: 547-556, 1932. This report supplements an earlier report by the author and his associates (Aroh. Surg. 24: 339, 1932. Abst in Am. J. Cancer 16: abst. p. 1371, 1932). Praotioally all the material is included in an article bearing the same title in Acts Radiologica 12: 410, 1932 (Abst. in Am. J. Cancer 17: 841, 1933). Carcinoma of a Supernumerary Breast Developing during Pregnancy, PATEL. Tumeur maligne d'une glande mammaire accessoire, d6velopp4e pendant la groaseme, Lyon ohir. 29: 390-392,1932. The tumor described by Pate1 appeared in a woman of thirty-two during the third month of pregnancy as a swelling in the right axilla, the mass being hard and adherent to the skin but movable on the greater pectoral musole. It is said to have developed in a true supernumerary breast, separated from the normal right breast by a groove; no enlarged lymph nodes were palpable. [The author does not say whether this extra breast had its own nipple and areola, but his photograph suggests that this was the case.] Radioal removal was done, with diasection of the axilla. The author, though giving no references to the literature, says that many cases reported as being of this nature have been in reality examples of oarcinoma arising in an axillary prolongation of a normal breast. In the ensuing discussion Albertin attached great importanoe to the faot that this tumor had beaome apparent during pregnancy and stated that the prognosis in such oases was extremely unfavorable. Tixier mentioned a case of wooma ocourring in what was apparently a supernumerary breast; at any rate normal INTBATHOBACIC TUMORS 457 skin existed between the normal breast and the axillary tumor. His experience had led him to the conclusion that the growth of malignant tumors in any part of the body was accelerated during pregnancy. He thought it would have been wiser, both in the case under discussion and in his own case, to have removed the normal breast as well as the affected supernumerary breast or axillary tail, since these were linked up in respect of their lymphatic vascular drainage. F. CAVBRB

Fibromyoma of $he Breast, P. J. MELNICK. Arch. Path. 14: 794-798, 1932. In a recent discussion of benign tumors of the breast Kleinschmidt (Chirurg 3: 297, 1931. Abet. in Am. J. Cancer 15: 2934, 1931) drew a sharp distinction between those of the skin and nipple and those of the breast proper; he enumerated in the former group hemangioma, fibroma, lipoma, and rarely myoma; in the latter group adenoma, fibro-adenoma, and fibroma, but not myoma. The author briefly cites the statements of several other writers and concludes that Klein- Schmidt was probably correct in excluding myoma from the benign tumors of the breast. Strong (Am. J. Obst. & Gynec. 68: 53, 1913), however, reported a case of true myoma of the breast proper, and Melnick now describes a dmilar case. A tumor of the right breast of a woman of forty-five gave the clinical impression of a carcinoma, without adenopathy, Simple mastectomy was performed and the specimen sent to the laboratory for frozen section examination, This revealed a benign fibromyoma and no further operation was done. The breast tissue was almost entirely replaced by the tumor, which was firm, well encapsulated, and quite free from the nipple; the cut surface was trabeculated, and near the center there was an irregular cystic area containing blood-tinged fluid. Histologically the tumor consisted of smooth muscle cells arranged in interwoven bundles separated by a moderate amount of connective tissue; very few mitoses were seen. The author thinks the tumor most probably arose from the muscular layer of the blood veasels. Perivascular foci of proliferation were seen, and also fusion of the muscular layer of the vessels with the tumor tissue. Two good photomicrographs are given. F. CAVERB

X-Ray Treatment in Gynecoma8tial JOHN G. MENVILLB.Radiology 18: 295-301, 1932. The author reports four cases of gynecomastia in one of which-an early case -x-ray treatment brought about an excellent result. Photographs and photomicrographs illustrate this report.

INTRATHORACIC TUMORS Euly Diagnosis of Malignant Dieease of the Mediastinurn, Lung, and Pleura, L. S. T. BURRELL.Praotitioner 130: 157-182, 1933. The author points out that an intrathoracic tumor may reach a considerable size before causing any symptoms, and that when such a tumor is suspected it is necessary to confirm the diagnosis of neoplasm, ascertain its site, determine its nature, and decide whether or not it can be removed by operation. Mediastinat Tumora: The earliest signs of mediastinal tumors are the results of pressure on some adjacent structure. Pressure on the superior vena cava or one of its branches causes engorgement of superficial veins in the neck, arms, chest, or abdomen. Enlargement of the veins of the neck noticed by a patient’s wife when he was stooping to don his shoes was the first sign in one of the author’s cases. A characteristic hollow cough due to pressure on the trachea is sometimes the first 468 ABSTBAOTS symptom notioed. Attaoka of stridor may ooour, and in one owbegan before any other symptoms, signs, or x-ray evidence of neoplasm developed. The earliest symptom may be from pressure on a nerve-paroxysmal oough from vagus irritation, abductor paralysis of a vooal cord if the reourrent laryngeal is affeoted, or inequality in siae of the pupils from involvement of the sympathetic. With these symptoms the x-ray will often show a rounded shadow in the mediaatinum; aortia aneurysm was in two cases mistaken for tumor despite soreening in the lateral and antero-posterior positions. When the nature of a mediastinal tumor is in doubt, or when it does not respond readily to roentgen therapy, the author advises operation, because if it ie a dermoid cyst or a fibroma, the patient’s life will be saved. Lung Tumora: These are much more oommon in men than in women and generally ocour about the age of fifty. Lung tumor should be euspeoted, therefore, when a middle-aged man shows signs of pulmonary disease, espeoially if the signs are unusual. When pleural effusion is diagnosed but no fluid is found and the needle passes through thick matter whioh feels like cork, a tumor is nearly always present. In bronchial oaroixioma the x-ray will show a shadow due to growth or collapsed lung or both, and with lipiodol injeotion may show a blooked bronohus. When it is doubtful whether the x-ray shadow is due to a mass in or outside of the lung, the latter should be collapsed by pneumothorax and x-ray examination repeated. In four of the author’s cases lung oollapse was found by x-ray and bronahosoopy to be due to obstruotion of a bronohus by a fibroma, whioh was suooeaefully removed. Pleural tumors, usually endotheliomae, should be suspeated in oases of pleural effusion whioh reours rapidly after each aspiration. In one of the author’s oases 5 gallons of fluid were aspirated within three months. Pleural tumors may ocour in patients of twenty years or younger and are generally first diagnosed as tubercu- lo&. In some oases the growth could be seen on examining the pleura through a thoracosoope. Four roentgenograms are given. F. CAVERB primrrp Malignnut Intrathoracic Growths, P. H.-5. HARTLEI-.St. Barth. Hosp. J. 40: 58-63, 1933. A woman of twenty-seven years had pains in the arms, shoulders, and baok, and was treated for a month for rheumatism. She then became breathleae and cya- nosed on stooping, and, as her symptoms grew worse, oame under the author’a care. The Wassermann and sigma reaotions were negative. X-ray examination showed a large tumor in the upper thorax above the heart,. Deep x-ray therapy was begun and oontinued almost daily for three weeks. Exploratory puncture yielded yellow, serous fluid containing 80 per cent neutrophils. Gas replacement was then done, about 1.5 liter of the fluid being withdrawn and 350 0.0. of air introduced. Within two weeks thereafter the tumor shadow had become smaller and soon afterwards it disappeared. Four months later the patient was readmitted, this time with a tumor over the seventh right rib, in the midaxillary line, and several palpable liver nodules, though x-ray showed nothing abnormal within the thorax. On biopsy the axillary tumor showed small round-cell sarcoma, infiltrating the adjacent interoostal mue- ale tissue. The patient died soon after this, and at autopsy there was found in the superior and anterior mediastinum a hard, white, fibrotio growth not involving the bronchi and showing the same histologic oharactere as the axillary tumor. In briefly reviewing the literature of intrathoracio tumors, the author estimates that the great bulk of primary malignant intrathoraoic growths, probably about 90 per cent, must be considered as oarcinomatous in nature. A few-perhaps 8 per oent-arising in the mediastinal nodes are, however, saroomatous. INTEATROIUOIO TUMOBB 459

In dealing with the clinical signs of intrathoracic tumors the author emphasizes those due to preaaure on vessels and nerves. Differential diagnosis and treatment are concisely outlined. F. CAVERS

Tracheal Neoplasm. Case for Diagnosis, CLAVELAND MOUNIER-KUHN.Neo- plasme trach6al. .Gas pour diagnostic, Lyon m6d. 150: 65-68, 1932. The authors presented the following case for diagnosis. A white male, seventy- five years of age, was admitted to the hospital because of s&ocation caused by a deep-seated goiter. On admission he presented typical laryngeal dyspnea, which had first developed three weeks earlier and had slowly increased in severity. This apparently was caused by compression of the trachea by a tumor of the left lobe of the thyroid gland. Radioscopy showed the trachea deviated to the right and a retrosternal shadow extending laterally beyond the borders of the sternum, resembling an annular substernal thyroid. A subtotal thyroidectomy was performed and a large colloid goiter extirpated from beneath the sternum. Five months later the patient developed sudden, violent attacks of suffocation which would persist for several minutes and as suddenly cease. Locally there was no evidence of a recurrence of the thyroid tumor, nor of any metastasis. Direct laryngoscopy revealed normally functioning vocal cords, but lower down the tracheal wall appeared to be almost completely covered by fungating masses of tumor tissue which reduced the lumen to a small space on the right anterior aspect. A biopsy was taken and this precipitated a respiratory crisis during which the patient nearly suffocated before the bronchoscope could be reintroduced to establish an airway. As soon as he had partially recovered, a tracheotomy was performed. Histologic examination revealed a typical squamous Carcinoma. Since this histology is incompatible with a thyroid or tracheal origin, the conclusion was reached that, despite the absence of esophageal symptoms, the tumor arose in the anterior wall of the esophagus and caused symptoms secondarily by invasion of the trachea. WILLIAMJ. HOFFMAN

Cyrtic Carcinoma of Trachea, V. E. NEQUS. Proc. Roy. SOC.Med. 26: 238-239, 1933. In a woman of forty-seven with eighteen months’ history of hoarseness and dyspnea a small, round, cystic tumor was found nearly filling the trachea. It arose from the lateral and posterior tracheal wall, extended up to but did not involve the cricoid, and occupied the length of more than two tracheal rings and their interspaces. The mucosa was incised longitudinally and stripped off , the cyst removed in pieces, and a cannula left in. The cyst wall was adenocarcino- matous, evidently derived from the mucous glands. Four needles 3.3 cm. long, eaeh containing 2 mg. radium element as sulphate, screened by 0.6 mm. platinum, wminserted into a rubber tube large enough to lill the trachea and left in for six days. The subsequent history is not given. F. CAVERS

Diirerential Diagnosis of Cancer and Tuberculosis of the Lung, L. BERNARD.Le diagnostic diffbrentiel du cancer et de la tuberculose du poumon, Gaz. m6d. de France pp. 379-384, 1932. The author has observed three types of pulmonary cancer that may simulate pulmonary tuberculosis. The first simulates the ordinary type of phthisis, with cough, expectoration, slight fever, and fatigue. The second shows the syndrome of mediastinal involvement, with constant dyspnea and pain and spasmodic cough. The third type simulates tuberculous pleurisy, but the pain is typically more severe and persistent in cancer than in tuberculosis, and the effusion is often 460 ABSTILILCTS hemorrhagic. Absence of the tubercle bacillus in repeated examinations of the sputum is an indioation of oanoer when the pulmonary lesion ia advanced. The radiologioal examination is of primary importance; the typical pioture of a pulmonary neoplasm is a heavy, homogeneous, clearly outlined shadow in the pulmonary field. In some oases the shadow may be less typioal and show rapid variations. In the type with pleurisy the radiologioal findings are of little value. In early pulmonary cancer, the patient’s general health is less affected than in tuberculosis; when the stage of cachexia is reached, the course is more rapid.

Phrenic and Pupillary Nerve Syndrome with Paralydm of the BrachiaI Plexua in a Case of Cancer of the Lung with Auociated Tuberculosir, A. Couacoux AND J. LE~BOULLET.Syndrome phr6nioo-pupillaire aveo paralysie du plexus brachial dans un cas de cancer du poumon avec tuberoulose associth, Aroh. m6d.-ohir. de l’app. resp. 6: 569-579, 1931. The patient’s first symptoms were those of pulmonary tuberculosis with repeated hemoptyaie and tubercle bacilli in the sputum. Subsequently, although the hemoptysis continued, the bacilli disappeared. The radiogram showed a dense shadow with clearly defined outlines suggesting oancer. The syndrome of pressure on the cervical sympathetio (Bernard-Horner syndrome) developed, with vasomotor disturbances evidenced by redness and edema of the oheek. There was also a paralysis of the brachial plexus with root pain, areas of anesthesia and hyperesthesia, atrophy of the small muscles of the hand, and vasomotor and trophio symptoms in the area of the eighth oervical and first doresl. Finally there was a paralysis of the phrenic nerve. These symptoms indioated a lesion of the pleural arch, probably cancer. At autopsy the right lung showed oaaeous tuberoulous lesions in @e lower part and a aompact tumor mwin the upper part, which proved to be a carcinoma originating in the epithelium of the bronohi. The author notes that the cervical sympathetic syndrome is often a symptom of apical tuberoulosis, but it is rarely associated with paralysis of the brachial plexus; only one suoh owis found in the literature in oancer of the lung. The assooiation with paralysis of the phrenic nerve is also unusual. A number of#cases of coexistence of cancer and tuberculosis of the lung have been reported. The etiological relationship of tuberculosis to cancer is discussed.

Primary Carcinoma of L~Bwith Case Report, E. J. SIMONS.Journal-Lancet 51 : 642-547, 1931. The author follows a general discussion of primary carcinoma of the lung by the report of a case in a young man of nineteen who had for two yem and a half worked in the sand blast department of an automobile factory. Hie symptoms inaluded pain, loss of weight and strength, dyspnea, and mme aough with blood- streaked sputum. Two days before death edema of the right hand and forearm developed. At autopsy a friable reddish brown mwwas found involving the right lower and middle lobes and the lower part of the upper lobe. It waa adherent to the diaphragm and parietal pleura,’ and was inseparable from the mediaetinum. The lower half of the left lobe and the bronchial, tracheo-bronchial, and mediastinal nodes were involved. Microscopio examination showed adenooarcinoma.

Cam of Primary Carcinoma of the Lung, J. B. ALEXANDER. Post-Grad. M. J. 9: 29-30, 1933. A man of fifty-one had a two months’ history of slight dyspnea, pain in upper chest, and dry cough with a alight amount of sputum, onoe blood-stained. He had lost considerable weight during the past year. Roentgenograms showed a dense ahadow corresponding to the area of abnormal clinical findings. Lipiodol filling INTBATHORACIO TUMOBB 461

demonstrated blocking of a large branch of the right bronchus, and this substance did not enter the dull shadow. With the bronchoscope a bulging polypoid growth was seen in the right middle bronchus. A piece removed for examination showed bronchial carcinoma. F. CAVEIRS

CucinOma of the Bronchus, A. A~AMS.Lancet 2: 288-289, 1932. A man aged thirty-six, previously in good health, complained of fatigue, cough, expectoration, dyspnea, slight staining of sputum, and pain in the lumbar region. Radiographs revealed a well marked shadow of uniform density in the right upper lobe, sharply limited by the upper interlobar septum. Sputum examinations failed to reveal any tubercle bacilli. A clinical diagnosis of neoplasm of the lung was made. A month later lumbar pain increased and weakness of both legs developed, with increased knee jerks and ankle clonus. A few days later a complete paraplegia extended to the level of the umbilicus. Because of retention of urine a aatheter was passed and 63 ounces of urine withdrawn. A few minutes later the patient collapsed and died. Post-mortem examination revealed an oat-celled carcinoma of the bronchus with a large metastasis apparently extending into the spine by way of the root of a spinal nerve, producing the neurological symptoms by involvement of the lower segments of the spinal cord. WILLIAMJ. HOFFMAN

A Simple Bronchial Neoplasm, S. ALSTEAD. Lancet 2: 339, 1932. A man of sixty-eight was sent to the hospital with a diagnosis of broncho- pneumonia. He gave a history of bronchitis of many years duration. Recently he had suffered from disriness, weakness, swelling of the ankles, and breathlessness after ordinary exertion. There was a slight pyrexia, and the patient’s condition steadily deteriorated. Physical signs and radiography revealed consolidation limited to the basal half of the right lower lobe. Suddenly, on the eleventh day, the patient collapsed and died. Post-mortem examination disclosed a pedunculated polyp attached to the wall of the right bronchus, just below the bifurcation of the trachea. The pedicle was 3.6 am. long and the tumor was 1 cm. in diameter. Microscopically it consisted of fibro-areolar tissue with a considerable amount of fat and smooth muscle, covered by columnar epithelium. Although the tumor was histologically benign, death was almost certainly caused by the sudden occlusion of the right bronchus by the polypus-probably temporarily swollen from inflammation. WILLIAMJ. HOFFMAN

Recurrent Haemoptysie due to ?Benign Bronchial Turnour, H. V. MORLOCK. Proc. Roy. SOC.Med. 26: 626, 1933. A man of fifty-four had for twenty years suffered from repeated hemoptysis varying in amount from 1 to 20 ounces. Nothing abnormal was found on physical and roentgen examination of the chest, but the bronchoscope showed a stalked tumor on the posterior wall of the right main bronchus. A piece was removed and was diagnosed as “ oat-celled neoplasm.” The tumor was removed by diathermy, and up to the time of reporting, nine months later, the patient had remained well, without sign of recurrence. F. CAVIURS Multiple Cavernous Angiomatosis of Pleura, G. MARTENS.Uber multiple Cavernome der Pleura, Frankfurt. Ztschr. f. Path. 44: 272-276, 1932. The author infers from the available literature that tumors of the pleura are extremely rare, and that the benign tumors, which are less common than the malignant, are mostly accidental autopsy findings. A man of fifty-six, for about five weeks before entering the hospital, had pain in the epigastrium which he 462 ABSTRACTS described as shooting aoroaa towards both sides of the chest and whioh was relieved by hot applications. He was dyspneio and oyanotio and had bleeding gums, enlarged cervical nodes, an enlarged thyroid gland, and a large wee of dullness, on percussion over nearly the whole of the left lung. Pleural punoture yielded dark blood; after 250 0.0. had been withdrawn, the dyspnea was relieved. Two days later the patient died suddenly. Autopsy revealed about three liters of blood in the left pleural cavity, and multiple small hemorrhagio nodules scattered over the left pleura, including both leaves and the diaphragmatio portion; also, oomplete collapse of the left lung. Histologio examination of several of the nodules showed blood-filled spaces, some of whioh were lined by endothelium. There are no illustrations. F. CAVBIRS

Surgical Treatment of Medirstinal Tumors, S. W. HARRINQTON.Ann. Surg. 96: 843-856, 1932. Thia paper is baaed on the author’s experience with 38 oases in whioh intrathoracic neoplasms were removed by operation. Of these, 23 ocourred in tho anterior or posterior medisstinum. Of these mediastinal tumors, 18 were benign (8 neurofibromse, 2 cellular fibromas, 7 teratomse, one oongenitd oyet); the remaining 5 were malignant, one being a sarcoma-like epithelioma whioh probably arose by malignant degeneration of a dermoid, 3 fibroseroomas (2 of them probably benign tumors at first), one an adenooarainoma of intrathoraoio thyroid tiasue with erosion of the spine. The author conaidere that all mediastind tumora are potentially malignant and that the high proportion of benign tumors in his wries is probably due to the removal of the growth before it had undergone malignant ohange. He discusses the signs and symptoms and the methods of surgiod approach whioh he has employed. There were three operative deaths. One patient, with neurofibroma, died four days after operation from pneumonia with bloody pleural effusion, the latter resulting from diffuse oosing from the bed of the tumor where it had been adherent to the lung. The adhesions were probably the result of exaessive x-ray therapy given before admission to the author’s clinic. The tumor had not become smaller, and the author ooneidera that any mediastinal tumor whioh does not show reduotion in sise within the first week or ten days after radiation should not be treated further with x-rays if surgioal intervention is oon- templated. Sixteen of the 23 patients were alive and free from symptom at the time of reporting, three months to six years after operation. There are seven illustrations, mostly excellent roentgenograms. F. CAV~RS

Tumors of Thymus Origin, Diagnosis, Clasdilcation and Nomenclature, T. IBCHII.Ein Beitrag zum Problem der thymogenen Geschwtilste, sugleioh sur Kritik tiber die Diagnostik, Einteilung und Nomenklatur, J. Oriental Med. 16: 19-21, 1932. The author reports a large mediastinal tumor, histologioally diagnosed as malignant thymoma. The chief cellular elements were characteristic. of thymus tissue, inoluding: (1) syncytially arranged reticulum cells (the so-oalled thymus medulla cells); (2) small lymphoid cells (the smelled thymus cortex cells); (3) irregular strands of epithelial oells (Hammar); (4) thymus giant oelle; (5) oor- puscles of Hassall, and here and there myeloid oells or unicellular Haasall’s cor- pusoles. The various cell types in suah growths originating in the thymus, the author believes, are of epithelial origin and are to be regarded as speoial types of epithelial oelle. He therefore ooncludes that suoh growths should be designated “ thymoma malignum ” or possibly “ thymoma oaroinometosum.” THE DIGEBTIVBI TRAOT 463

Merential Dhgnooie of Mediastinal and Cervical Tumors, R. SANDERA.Zur Diff erentialdiagnose der Mediastinal- und Haletumoren, R6ntgenpraxis (Hft. 16) 4: 710-712, 1932. In the case reported the first symptom was slight difficulty in swallowing. The roentgenogram showed a shadow in the right upper mediastinum that pressed on the esophagus and pushed it to one side. Shortly afterwards a swelling on the right side of the neck developed. Further study with Valsalva’s testincreasing the internal pressure in the thorax-caused the shadow to disappear from the mediastinum into the soft parts of the neck; on relaxing the pressure, the shadow again appeared in its former position. This indicates a cystic tumor with an easily movable fluid content and elastic walls extending into the soft parts of the neck. A similar case has been reported by Picco, in which diagnosis was made by roentgen examination after injection of uroselectan into the cyst.

THE DIGESTIVE TRACT Cucinoma of Oesophagus with Complete Double Recurrent Laryngeal Nerve Paralysir, I. B. THORBURN.Brit. M. J. 1: 366-367, 1933. In a man of thirty-eight with a three months’ history of dysphagia, together with left pleuritic pain which had supervened during the preceding seven days, the vocal cords were seen to be fixed in the cadaveric position. Roentgenography with barium showed obstruction at the level of the manubrium sterni. When more dilute barium was given, some fluid was seen to pass into the trachea, and for that reason a diagnosis of fistula was made. Six days later the patient died with aspiration pneumonia. At autopsy an annular carcinoma of the esophagus was found two inches below the level of the cricoid cartilage, extending downwards for an inch and a half and involving the recurrent laryngeal nerve on each side. The mmewhet unusual feature of complete paralysis of both vocal cords without any history of dyspnea is explained as probably indicating that one cord had become completely paralyzed before the other was affected. The diagnosis of esophagobronchial fistula was disproved at autopsy, no communication between the two tubes being found. F. CAVERS

Cancer of the Oemphagus after Corrosion with Lye, R. MAQNUSSON.Acta chir. Scandinav. 69: 473-478, 1932. A man of forty-one died with aarcinoma of the esophagus. “ When 18 months old he happened to empty a bottle containing concentrated lye. After being severely ill in bed for a long time he pulled round and got much better, but had great difficulty with swallowing and was never able to take anything except liquids or finely minced food.” Early in 1930, after some physical exertion he was suddenly seired with severe pain in the right side of the chest, and the pain recurred simultaneously with difficulty in swallowing. In July, x-ray examination showed an irregular stricture extending from the level of the third to the seventh thoracic vertebra, and subsequent films showed crater formation in the esophageal wall. Three months later the patient died from cardiac insufficiency. At autopsy the esophagus showed ulcerated carcinoma, also radiating scars, caused doubtless by the corrosive liquid swallowed in infancy. The author considers it likely that the cancer started in one of these scars, but this could not be demonstrated because of the extent of the neoplasm. The carcinoma was situated between the upper and middle physiological narrowing8 of the esophagus, an unusual localization, and the patient’s age was considerably below the average for thia lesion as set forth in various collected series of caaes, both significant facts, F. CAVXIRS 464 ABSTRACTS

Mucoid Carcinoma of the Gastro-Intestinal Tract; So-called Colloid Cancer, T. S. R~FOBD.Surg. Gynec. & Obst. 55: 409-437, 1932. Raiford reports a series of 18 cases of primary gastro-intestinal muooid carci- nome and 105 cases of sdenocarcinoma with varying amounts of muaoid degeneration. The degree of malignancy and ctonsequently the prognosis are widely different for the two groups of cases. Tumors associated with mucoid degeneration show the same degree of malignancy as adenocarcinomas of the same grade without mucus formation. Consequently the prognosis is comparable to that of pure adenocaroinoma and depends largely upon the duration of the tumor, its growth, and presence of metastases. True mucoid Carcinoma, on the other hand, is more malignant. The cells retain their ability to proliferate in spite of the hypersecretion of mucus, and degeneration is less common. Metastases occur earlier and grow more rapidly. It is also more difficult to remove the tumor completely, and peritoneal implants are frequent. Only 18 per cent of the patients surviving operation for true mucoid caroinomae have remained well over five years, or if operated upon within the past five years, are now living without signs of recurrence. On the other hand, five-year cures have been obtained in 66 per cent of the adenocsrcinomas with mucoid degeneration. The article is illustrated with photomicrographs and photographs of gross epecimens. BENJAMINR. SHOBE

Carcinoma of the Stomach--An Analytical Survey, GATEWOODGATEWOOD. Ann. Surg. 96: 588-594, 1932. Four hundred and seventeen patients with carcinoma of the stomach were admitted to the Presbyterian Hospital in Chicago between Jan. 1, 1920, and Dec. 31, 1929. Fifty per cent of them had inoperable growths at the time of their admission to the hospital. Of the operations performed, 23 per cent were exploratory only, 7 per cent were palliative for relief of starvation (gastrostomy and jejunostomy), 41 per cent were gastro-enterostomies, and 28 per cent were gastric resections. The hospital mortality for gastro-enterostomy was 26 per cent, and for gastric resection, 32.6 per cent. A careful follow-up gave the ultimate results in 95 per cent of the exploratory operations, 98 per cent of the gastroenterostomies, and 100 per cent of the gastric resections. The average postoperative length of life after exploration was 6.1 months, after gastro-enterostomy, 8.7 months, and after resection, 4 years and 9 month. Of the patients leaving the hospital after resection, 46 per cent lived three or more years. Thirty-eix per cent survived after five years, but 5 of these subsequently died of carcinoma. Five patients were living eight or more years after resection, and a few have died without evidence of recurrence. Pain was complained of in 75 per cent of the cases. It was the first symptom in more than one-half of the patients. Free hydrochloric acid was present in 20 to 30 per cent of the cases, with no striking difference between the operable and inoperable ones. Only one patient had hyperacidity. Occult blood in the stools was found in 95 per cent of all cases and in the stomach contents in approximately the same percentage of those cases in which examinations were made. BIDNJAMNR. SHORE

Cancer of the Stomach in Beel, A. WIDBTHEMANN.Uber Magenkrebse in Basel, Ztschr. f. Krebsforsch. 38: 334-349, 1933. Having discussed the proportion of deaths from gastric cancer in Basel to all canoer deaths, the author goes on to say that susceptibility is scarcely less after the age of eighty than in the sixth and seventh decennia. THE DIONWIVB TahOT 465

The clinical course of cancer of the stomach was approximately the same whether the patient was young (under thirty), middle-aged, or old (over eighty). No relation to body weight could be made out, In 36 oases out of 303 (12 per cent), the carcinoma had developed in stomachs where there were either ulcers or scars, but in only 4 of these could it be proved that the cancer had arisen directly from the ulcer. WM. H. WOGLOM

Cancer of the Stomach, F. N. G. STARR. Canad. M. A. J. 28: 188-190, 1933. The author emphasizes the need of obtaining all the facts in the history of a patient suspected of gastric malignancy and trying to sift the real facts from the imaginary, before proceeding to physical examination, analysis of gastric contents, and roentgenography. As to the last, he remarks: “ It is only a waste of the patient’s money as well as of oneJs own time and temper to have this done by anyone but an expert.” F. CAVERS

Early Diagnosie of Carcinoma of the Stomach, T. I. BBNNETT. Practitioner 130: 141-156, 1933. The author begins with the statement [with which not everyone will agree (see, for example, Alvarez, W. C.: J.A.M.A. 97: 77,1931, abst. in Am. J. Cancer 15: 2949, 1931)] that today in any particular individual the question of whether or not cancer of the stomsch is present can be answered accurately in ninety-nine out of every hundred cases.” He describes several cases in which the first symp toms were very slight and on the other hand some in which they were due to intestinal obstruction, general peritonitis, thrombosis of one of the larger blood vessels, generaliaed edema of apparently renal type, symmetrical gangrene of the hgem of both hands, etc. Since the stomach is the most frequent site of malignant disease in both sexes, the possibility of its presence should always be kept in mind even when symptoms do not immediately suggest it. The most complete olinioal examination (including close attention to history, searoh for an abdominal tumor and for nodes especially on the left side of the neck, examination of the liver, and assessments of degree of anemia and of wasting) will often prove negative or at most only suggestive. On the other hand, x-ray examination will reveal cancer of the stomach, even in its early stages, in nearly every case, though “ only the genuine expert ombe expeoted to give a correct report in a really difficult case.,’ Complete clinical and roentgenographic examinations and gastric analysis can be carried out in three days. Eight illustrations are given, five being drawings from roentgenograms and three graphs of free hydrochloric acid determinations. F. CAVERS

Earlier Diagnosis of Carcinoma of the Stomach, J. F. WEIR. J. Iowa M. SOC.22: 496-500, 1932. At the Mayo Clinic it has been found that in 50 per cent of the cases gastric cancer is inoperable when the patient first comes to the Clinic, the growth is resect- able in only 25 per cent, while the average duration of the symptoms is ten months. A plea is made for better physical examinations, more frequent x-rays, and, if neceesary, biopsies of the gastric lesion, in order to improve these statistics.

Diagnode of Carcinoma of the Stomach, H. R. JENKINSON.J. Iowa M. SOC.22: 630-533, 1932. If the death rate from cancer of the stomach is to be reduced, diagnosis must be made early. Roentgen-ray examination is essential and the most important of all diagnostic methods. 466 ABSTRAOTlJ

Carcinoma of the Stomach, BYRONB. DAVIS. West. J. Surg. 40: 31-39, 1932. A thorough discussion is given of the symptomatology of gaefri~cancer, the proper treatment of chronic gastritis, and the precancerous nature of gastric ulcers, benign papillomas, and atrophic gastritis. Eighty per cent of the author’s patients had achlorhydria, which he asserts ie usually the result of the chronio gastritis preceding the development of gastrio canoer. Cancer developing on the basis of gastric ulcer is often associated with free hydrochloric acid in the stomach contents. The presence of lactic acid usually indicates carcinoma. Davis has observed that, before pyloric obstruction by carcinoma occurs, the stomach often empties more rapidly than under normal oonditions. G~ORG~T. PACK

Etiological Relationship between Chronic GdcUlcer and Gastric C8rdnoma. J. A. KITT~LSON.Journal-Lancet 52: 10-14, 1932. A critical review of the possibilities of chronic gastrid ulcer becoming trans- formed into gastrio cancer. Kittelson states that 5 to 15 per cent of the ohronio ulcers of the stomach may become caroinomatous. Several case reports are cited in which chronic gastric lesions that microscopically were simple ulcers were ad- jaoent to perigastric lymph nodes containing metastatic carcinoma, a paradox which suggests that these ulcers were carcinomatous from the start but were. digested by the gastric juice. A selected list of forty-five references is appended. GBORGBT. PACK

Recent Developments in the Treatment of Gastric Lesions, WALTMANWALTI~,~~. Surg. Gynec. & Obst. 55: 355-359, 1932. Restoration of gastro-intestinal continuity after resection of the stomaah for carcinoma is usually obtained by the use of the Polya or Billroth I types of anastomosis. Total gastrectomy has been performed ten times at the Mayo Clinio (five times in the last five years), and probably should be done in more cases. The question has frequently been raised as to the effect of lorn of the entire stomach upon the general physiological processes. In this respect, it may be noted that one of the patients suoceasfully operated upon by W. J. Mayo lived for almost four years. Physiological and ohemical studies oarried out over a period of four months following a succeesful total gastrectomy performed by Welters in Septem- ber 1929 did not reveal any appreciable change in the number of erythrocytes, in the concentration of hemoglobin, in the carbon dioxide-combining power, or in the conoentration of blood chlorides. Removal of an uloerated infected gastric oarcinoma in the presence of metastases to the liver is believed to be justifiable palliative cancer surgery. There is no reason why such neorotic sloughing tumora should not be removed, and actual or impending obstruction relieved, if by such a procedure the remainder of the patient’s life may be made more comfortable. BBNJAMINR. SHORB

Surgical Treatment of Cancer of the Stomach, G. fi~~n~.Canad. M. A. J. 26: 164-170, 1932. A review ia given of results of operation in canaer of the stomach, chiefly of Finsterer’s work, from which the author concludes that no case of gastric cancer should be judged inoperable unless there are metastases in the liver, the supra- clavioular glands, or the pelvis. Without operation, patients die “ a lingering, miserable death; with operation nearly one-third can be saved, and the remainder rendered comparatively comfortable for a year or more. THE DIOESTIVIE TRACT 467

Application of Roentgen Radiation to the Bdum-5lled Stomach. Contribution to the Radiation Treatment of Inoperable Gastric Tumors, THOMASSCHOLZ. Radiology 18: 269-276, 1932. The author proposes the use of scattered radiation for the treatment of oancer of the stomach. This he produces by exposing the barium-filled stomach to x-rays at 145 k.v. and 5 mm. Al filter. He cites one case, involving the pyloric region, which received several series of suoh treatments each year over a period of five years. The diagnosis had been made on radiographic examination and a gastro- enterostomy had been performed. At that time a tumor was seen in the pyloric region and enlarged regional nodes were found. Unfortunately a biopsy was not done. Treatment with x-rays was started soon after the gastro-enterostomy. Seven years later the patient was clinically well and the tumor mass could not be visualired radiographically. The author also reports that he had 13 failures from roentgen therapy in cancer of the stomach where barium was not used to produce mattered radiation. Seven of the 13 patients had been treated with: 200 k.v. and 8 with 150 k.v. MAURICIULIUNZ

Cam of Pulmonary Tuberculoele, Pernicious Anemia, and GarMc Carcinoma, G. WALLBR.Ett fall av lungtuberkulos, pernicias anemi ooh ventrikelkar- ainom, Svenska l&k.-tidning (Svenska foren. invhrt med. forhandl.) 29: 87-92, 1932. A case report is given in detail of a woman fifty-eight years of age with bilateral pulmonary tuberculosis, found to have a leukopenia and achylia. Five years later she developed a carcinoma of the stomach.

Schwanuomt~of the Stomach and Duodenum, E. PICARD.Schwannomes de l’estomao et du duod6num, Rev. belge d. sci. m6d. 4: 587-592, 1932. The author notes that schwannomas-tumors originating in the sheath of Sohwann-were first described in 1910, by Verooay, who pointed out that a number of tumors formerly described as sarcoma or fibroma were really of this type. Schwannomaa may develop in the nerve fibers of the sympathetio as well as of the central nervous system; and thus may occur in the gastro-intestinal tract, the walls of which contain many fibers of the Meissner and the Auerbach plexuses. Tumors of nerve origin in the gastric wall were first described in 1924 (Gosset, Bertrand and Loewy: J. de chir. 23: 577, 1924). The author reports 2 cases. In the first the growth was on the greater curvature; it had caused but slight symptoms, but formed a visible and palpable mass. An extensive resection was done and the patient made a good recovery with good gastric function. Histologic examination showed the tumor to be composed of small elongated cells with oval nuclei and fibrillar protoplasm, but no signs of malignancy, no mitoses or atypical cells. In the second case the tumor was in the duodenal wall and had caused some digestive disturbances. The tumor, a part of the duodenum, and the pylorus were removed, with anastomosis by the Billroth I method. The tumor showed the same cellular structure 88 in the previous case, but was not so vascular. Although such tumors of nerve origin in the gastro-intestinal tract are rare, the author believes that a large percentage of tumors previously described as gastric or intestinal sarcoma have been of this type.

Bed@ Tumors Of the Stomach, G.P. LAROQUEAND E. L. SHIFLETT. Ann. SWg. 96: 24Cb249, 1932. This paper directs attention to the occurrence of non-malignant tumors and polypoid masses of hypertrophied muoosa of the stomaoh in individuals with a 468 ABSTRAOTS clinical history and roentgenograms suggesting stomach disease. The patient reported was found at operation to have a polypoid mmof hypertrophied gastrio mucosa which was easily prolapsed through the pylorus. A partial gastric resection was done and the pathological diagnosis of syphilis of the stomach with ulceration and polypoid hypertrophy of the mucosa was made. BENJAMINR. SHORE

Polypoid Tumor of the Stomach with Diarrhea, NOBDMANAND LAPOND. Tumeur polypeuse de l’estomac B forme diarrhdique, Loire m6d. 46: ll+lll, 1932. The Buthors report a case in a young woman who had had pkrsietent diarrhea for a number of years. Death was due to heart disease. At iutopsy a non- ulcerated polypoid adenoma with smaller polyps surrounding it waa found on the posterior surface of the greater curvature of the stomach. There were no lesions in the intestines:

Tumors of the SdIntestine, HE~NRYW. CAVE. Ann. Surg. 96: 269-285, 1932. Cave reports 15 cases of tumors of the small intestine, 14 of which were observed at the Roosevelt Hospital from 1911 to 1032. Growths of the ampulla of Vater are not included. There were two adenomaa, one fibroma, one granuloma, one leiomyoma, one aberrant pancreatic tiesue, five caroinomas, one Hodgkin’s disease, two lymphosarcomas, and one metastatic carcinoma of the omentum, probably of intestinal origin. These tumors were found at all ages and were more common in males than in females. Poorly formed bowel movements, malaise, and unusual intermittent twinges in the abdomen are frequently the earliest symptoms, The prognosis in benign tumors is good, but in the malignant group is particularly unfavorable. From a study of them 15 cases it was learned that the immediate results were anything but satisfactory, the diagnoses inaccurate, and the operative mortality high. Short abstracts of the cases with photographs of grom specimens are included, BENJAMINR. SHOR~

sucomcl of the Small Intestine, N. MIJMEY.Colorado Med. 29: 12-18, 1932. Mumey has summarised the data on 152 sarcomas of the small and large intestines, collected from literature. To these he haa added two personal case reports of perforating lymphosarcoma and fibroserooma of the small intestine. Sixty-five per cent of sarcomas of the gastro-intestinal tract occur in the small intestine. The incidence of sarooma in this location, as estimated from collected necropsy records, varies between 0.014 and 0.14 per oent. Of the 152 aollected oases, 122 (80 per cent) were in the small intestine. Of these, 33 (27 per cent) were in the jejunum and 49 (40 per oent) were in the ileum, Thirty cases (19.8 per cent) were equally distributed between the oolon and rectum. The following symptoms are usually encountered: (1) abdominal pain of indefinite character; (2) irregular stools alternating with constipation and diarrhea; (3) loss of weight; (4) anemia and cachexia; (6) palpable abdominal tumor which may be movable or fixed; (6) occasional intestinal perforation. Inteetinal obstruction is lese frequent than with carcinoma. A symptomatic clasdfication based on the clinical varieties of this tumor is given: (a) latent cases disoovered at autopsy, (b) an abdominal tumor or indefinite abdominal distention, (c) symptoms of intestinal obstruction or perforation, (d) jaundice of unascertained origin, (e) clinical resemblance to tuberculous peritonitis, appendicitis, or ovarian cyst. The difference between the symptoms of sarcoma and carcinoma of the small intestine are shown by the author in the following tabulation. THE DIOEBTIIQ TBAOT 469

Diflerential Diagnosis Sarcoma Carcinoma 1. Stenosis rare Stenosis frequent 2. Peristalsis not visible Peristalsis visible 3. Marked anemia and cachexia Anemia and cachexia not marked 4. Rapid course Slow course 5. Growth large and more fixed Growth smaller and more movable 6. Hemorrhage rare’ Hemorrhage common 7. Age over forty years Age under fifteen years [The average age of patients with carcinoma of the small intestine in the abstractor’s experience is forty-three years, except in the case of the carcinoid tumors, which often occur in young subjects.] GEOMXT.PACK

Duodenal Ulcer with Carcinoma, L. ARISZ. Acta Radiol. 13: 41-42, 1932. An account in English of two cases previously reported in Dutch (Nederl. tijdschr. v. geneesk. 74: 4740, 1930. Abst. in Am. J. Cancer 15: 1053, 1931).

Carcinoma of the Jejunum, W. PORZELT.Beitrag sur Klinik des jejunumkrebses, Deutsche Ztschr. f. Chir. 238: 115-121, 1932. Porselt reports a case of a stenosing carcinoma situated high in the jejunum of a twenty-five-year-old man. The patient made a good recovery after resection of the growth, but the time has been too short for an adequate follow-up. The article is well illustrated with roentgenograms and a photograph of the grow specimen. BENJAMINR. SHORE

Intestinal Obstruction Caused by a Tumor, B. KELLNER.Durch eine Geschwulst verursaahter Darmverschluas, Centralbl. f. allg. Path. u. path. Anat. 56: 196-197, 1932. Kellner reports a case of intestinal obstruction in a woman sixty-five years of age aaused by a benign tumor of the ileum. Adhesions to other loops of intestine had caused strangulation of the bowel. The growth itself was subserous, firm, and measured 5 X 43 X 3 cm. Histologic study showed it to be a fibromyoma. BENJAMINR. SHORE

SoUtarp Hem~ngiomaof the Small Intestine. A Consideration of the 0- of Hemaagiomas, J. KUHLE. Ein solitiires Htimangiom des Dilnndarms; gleich- seitig eine Betrachtung ilber die Entstehung der Hllmangiome, Vichow’s Aroh. f. path. Anat. 287: 527-537, 1932. Kuhle reports the successful resection of a segment of ileum containing an hemangioma in a youth sixteen years of age. A history of repeated severe intestinal hemorrhages over a period of two years led to exploratory laparotomy for an undiagnosed condition. The author discusses the various types of angiomas, both of the skin and internal organs, and quotes from various authors opinions concerning the hietogenesis of these tumors. The article is illustrated with photographs and a photomicrograph. BBNJAMINR. SHORE

Myxofibroma of the Ileum: Report of a Case, L. M. Laasox. Proc. Staff Meet. Mayo Clin. 7: 118-119, 1932. A woman of sixty-five gave a history of slight digestive disturbances of long duration and increasingly severe constipation over the past five years. For a few days she suffered an attack of severe cramp-like pain in the right lower quad- 470 ABs!mAaTs rant, obstinate constipation, and vomiting. Roentgenographio and fluoroscopic examination revealed a tumor in the ileum, about 30 om. from the ileocecal valve. The tumor was resected and proved to be a submuoous myxofibroma. Two Cases of Acute Intestinal Invagination in Adulta Caused by Benign Intestinal Tumors, SANTY.Deux cas d’invagination aigu6 de l’adulte provoquee par une tumeur Mnigne de l’intestin, Lyon chir. 29: 359-364, 1932. A woman, aged fifty-seven years, when first seen in 1925, had for several months had increasingly obstinate oonstipation. She was admitted to the hospital because of a sudden attaok of oolic lOodi5ed in the umbilical region and acoompanied by rapid abdominal swelling. A large tender mas8 was felt in the left lower quadrant. At laparotomy no trace of the right oolon and cecum could be seen; the oeoum and the wending and transverse portion8 of the colon had invaginated into the descending colon at the left angle. There were no signs of oirculatory trouble, and complete diainvagination was effeoted by careful traction and pressure. The cecum contained a tumor of mandarin sire. The author performed first an ileo- transverse anastomosis and fifteen days later resected the ceoum and terminal portion of the ileum. The oeoal tumor, whioh was of phalloid shape with uloerated surfaoe, oaoupied the site of the lower lip of the ileocecal valve, and waa a pure fibroma. The patient had remained well seven years after operation. A seoond patient, a woman of twenty-four,. gave a history of oolicky pains for several weeks, ending in an attack of excruoiating pain in the left lower abdomen. Her medical attendant felt a tumor in this region, but merely gave morphin. On revisiting her eight hours later he found the lump had inoreased greatly in sine and sent her to the hospital, where the author first saw her fifteen hours after the attaok began. He performed immediate laparotomy and found that the palpable mass, 35 om. long and 8 to 10 om. in diameter, was a jejuno-ileal invagination. When disinvagination had been effeoted, 120 om. of the ileum showed incipient gangrene and had to be reseoted. The oause of the invagination waa a stalked polypoid adenoma the sise of a harelnut. The author notes that in both cases the colicky pains first occurred in the morning, when the small intestine would be normally empty; also that, whereas in the first case the bowel was still healthy three days after invagination had occurred, in the seoond it was gangrenous after only fifteen hours. In the ensuing discussion Goullioud mentioned a case of invagination of the terminal 33 om. of the ileum into the ceoum and ascending colon due to a hard, stalked fibromyoma. F. CAWRS Ileo-ileal Invagination Caused by Lipoma, P. BERTBAND.Invagination il60- il6ale par tumeur benigne de l’intestin grble; rdseotion intestinale, Lyon ohir. 29: 508-510, 1932. A woman of fifty-four died with symptoms of peritonitis eight days after operation. The author believes she would have lived had he united the ileum to the transverse colon and then, to atone for the exclusion of the right colon, made a ceoostomy, instead of making an ileocecal button anastomosis, which proved at autopsy to have given way for half the ciroumference of the bowel, thus causing the fatal peritonitis. The idea of the former procedure crowd his mind while operating, but he dismissed it as too risky. F. Cavloas Two Caser of Melaem Cawed by Innocent GrocRthr of the SdIntestine, H. H. C. G~~QOBY.Brit. J. Child. Dis. 29: 197-201, 1932. A girl of five years had at the age of eighteen months psseed dark blood olots per mum four times, at intervals of a few weeks; this happened again a year later, and after two further attacks the ohild was brought to the hospital. The blood THE DIOEBTIVE TRACT 47 1

count was that of a secondary anemia following hemorrhage, and the hemoglobin 25 per cent. Sigmoidoscopy and a barium meal showed nothing of significance. At laparotomy a tumor the size of a large cherry was found in the ileum about 10 cm. from the ileocecal valve; there were two similar but smaller tumors in the mesentery and some calcified lymph nodes; the tumor was removed and the child was well when last seen. Histologically the growth was a fibro-adenoma, very vascular in parts. A second patient, a girl of eight years, had from early infancy until her fourth year had attach of abdominal pain and straining at stool, with passage of mucus and blood. After an interval of four years with no symptoms, there were two more attach. Sigmoidoscopy and a barium enema revealed nothing. At laparotomy a localised thickening of the ileum was seen about 6 cm. from the ileocecal valve. A V-ehaped resection was done. The tumor was flat and ribbed. It did not obstruct the bowel but had an ulcerated surface which had evidently been bleeding. Histologically the thickening was due to proliferation of the lymph follicles lying between the muscularis and the muscularis mucosae. There are no illustrations. F. CAVERS Symptoms, Diagnosis and Treatment of Carcinoma of the Colon, P. R. WRIQLEY. Clin. J. 62: 63-69, 1933. In thin general discussion the author is mainly concerned in warning the general practitioner of the danger of delay in obtaining surgical treatment for carcinoma of the colon. He cites figures from the Manchester Infirmary to show that the operative death rate there has been very high, even when all that the surgeon could do was a simple colostomy for intestinal obstruction. From the point of view of prognoeis, the two contrasting types of colonic carcinoma are (1) the massive, fungating or " cauliflower " growth which projects into the lumen of the bowel, producing early ulceration, hemorrhage, and sepsis; (2) the infiltrating growth which encircles the bowel and is relatively poor in cells and rich in fibers. The second or scirrhous type, though smaller, in more malignant than the large fungating growth since it metastasizes to the lymph nodes at an earlier stage. Symptoms and differential diagnosis are discussed, with reference to illustrative cases, and treatment is briefly dealt with. There are no illustrations. F. CAVERS Early Diagnosis of Cancer of the Colon and its DifBculties, J. GIRARD. Le diagnostic prhoce du cancer des ciYons, ses difficult68, Progrhs m6d., pp. 289-290, 1932. Among the early symptoms of cancer of the colon are those due to irritation of the solar plexus, of which the most important are the reflex gastric symptoms- pain in the epigastrium, eructations, and a sense of fullness; there may also be palpitation and vertigo. These symptoms are such as to suggest a gastric neurosis, and the possibility of an organic lesion may be overlooked. They are most likely to occur in neoplasms of the ascending and transverse colon. Either Constipation or diarrhea which persists in spite of treatment may be an early symptom of cancer of the colon, especially the descending colon and sigmoid; this may be accompanied by paroxysmal pain in the region of the tumor. When such functional symptoms occur in patients over fifty years of age, repeated x-ray examinations should be made until cancer of the colon can be definitely diagnosed or excluded.

Cancer of the Colon, F. H. LAHEYAND S. M. JORDAN.New England J. Med. 206: 1125-1131, 1932. In 100 consecutive cases of carcinoma of the colon disturbances of colonic function, constipation and diarrhea, occurred more frequently than any other 24 472 ABSTRAOTB symptom; only 9 per cent of the entire series showed no such disturbances. Constipation occurred in 66 per cent, diarrhea in 27 per cent, and alternating constipation and diarrhea in 8 per cent. In carcinoma above the rectum, pain is a frequent symptom. Sixty-five per cent of the patients showed some lose of weight when first seen. Secondary anemia oocurs more frequently in oarcinoma of the cecum and ascending colon than in other type of canoer of the colon. The definite diagnosis of oarcinoma of the colon above the rectum depends chiefly upon fluoroscopy with the barium enema. The authors are convinced, from their experience at the Clinic, that procedures based on the two- and three-stage Mikulics plan are the safest for resection of the colon (see following abstract). Resection of the Right Colon and Anastomoris of the Ileum to the Tranmene Colon after the Mihrlicz Plan, F. H. LAHEY. New England J. Mqd. 206: 316-322, 1932. Also in Surg., Gynec. & Obst. sl: 923-929, 1932. Lahey describes a teohnic devised by himself for reeection of the right colon after the Mikulics plan, by which “ at least moderate degrees of intestinal obstruction can be treated without a preliminary ileostomy.” With this method the whole right colon can be resected and if neoeseary part of the tramveme colon. Two Ochsner clamps are placed on the colon at the level at which it ia to be removed, the bowel is cut with the oautery, and the ends sterilised with the cautery. As muoh of the mesentery as desired and all involved glands can be removed. The ileum, which is used for anastomosis to the transverse colon, ia also out with the cautery between two clamps, and the ends are sterilised. The ileum is then placed in apposition to the transverse colon (as colon to colon with the MiLulics method), and held in position by front and baok tacking sutures. A fairly long spur is made by approximating the two segments for a sufficient distance. As a rule, “ the double-barreled ” oolon and ileum should be implanted in the lower end of the incision, but in some cases it may be implanted in the upper end; the wound is then closed about the bowel ends. This prooedure may be varied by a step which the author describes as “ stag- gering ” the ileum, and which is “ possibly original ” with him. He has found it of detinite value in relieving partial obstruction. For this procedure more ileum than colon is pulled out and left outside the Oohsner olamp; a rubber-covered clamp is placed on this loop of ileum, after the wound has been sutured and protected with dry gause dressing; and towels are clamped around the projecting ileum. The Ochsner clamp on the end of the ileum is removed; a glass tube is tied into this long segment of ileum, the rubber olamp removed, and the ileum drained for several days. The extra segment of ileum is then cut away with a cautery so that the ileal stump is on the same level as that of the oolon. At the end of a week to ten days the partition severing clamp has been applied and locked with one jaw in the colon and one in the ileum, so that the external ends of the aolon and ileum form a oommon opening when this clamp outa through. The patient is then disoharged from the hospital for a five to six weeks’ interval. Although there ia some irritation to the skin from the liquid discharge from the ileum in this interval, it is better to allow an interval of at least five weeks, as in this time the edema disap- pears and the peritoneum becomes firmly fixed. At the second stage the wound ia reopened, the skin, muscle, and fasaia are separated from the projecting loop of bowel, now consisting of the oommon ileum and colon, until this loop is left with adherent peritoneum walling off the peritoneal cavity. The edges of this spur of intestine are refreshed by cutting away the end of the temporary ooloatomy with its adherent skin and ligating any bleeding vessels; and then turned in ,with a Connell stitch, as in gastro-enteroetomy. Reinforoing inversion stitohes are placed over the flret layer. Drains are placed in the upper and lower ends of the wound leading down below the musole, and THE DIGEBTIVE TBAOT 473

muscle, fascia, and skin are closed in layers. Although the wound does not always close by first intention, it is extraperitoneal, and when properly drained does not require a second operation. The author has found that this is a safe and satisfactory procedure for resection of the right colon, Eight illustrations show the various steps of this procedure.

Exteriorization and Obstructive Resection of Carcinoma of the Sigmoid, W. D. HAWARD. Surg., Gynec. & Obst. 55: 501-504, 1932. Carcinoma of the sigmoid flexure is usually of the stenosing, scirrhous type, rarely producing a tumor but very prone to cause obstruction. In the right half of the colon the tumor is most frequently in the cecum, is large and fungating, and may be palpable even to the patient himself. Such a tumor is likely to produce, without apparent cause, that form of secondary anemia which is probably due to interference with the absorptive action of the cecum. Obstruction is the ultimate complication in all cases of caroinoma of the oolon. This is usually due to a secondary inflammatory process causing additional swelling and may be transitory in character. Obstruction is not an unmixed evil, for it may compel the life-saving Operation of cecostomy. If this is suacessful, a second operation may be done to remove the growth, so that there is secured the advantage of an enforced two-stage operation. Resection without a preliminary colostomy cames with it three times the danger encountered if preliminary colostomy is done. Exteriorisation and obstructive resection of growths of the sigmoid avoid the accidents incident to suture operations and have the added advantage of temporary exteriorisation of the Mikulice operation. The immediate removal of the growth itself by occluding forceps on both limbs of the intestine does away with the undesirable presence of the growth and the likelihood of cancer implantation on the wound, which has been computed to be about 7 per cent. The proximal oooluding clamp can be removed on the second or third day, while the lower forceps may be left until it becomes detached. Restoring the continuity of the tract by an enterotome forceps and extraperitoneal closure of the fistula prolong the stay of the patient in the hospital only about ten days longer than does suture anastomosis. BEINJAMINR. SHORE

Carcinoma of Descending Colon Causing Invagination, L. B~RARD.Tumeur du gros intestin avec invagination, Lyon chir. 29: 367-371, 1932. A woman of thirty-nine had noticed symptoms of increasing intestinal obstruction for nearly a year. A mobile mass was felt in the left lower abdomen, and x-ray filme following a barium enema showed blockage in the middle portion of the sigmoid. The latter was found at operation to be dilated, owing to invagination into it of the lower part of the descending colon. Thie was disinvaginated by oareful pressure and found to contain a large tumor. The segment of colon with the tumor wa~resected, and the growth found on histologic examination to be a colloid oarcinoma. In the ensuing discussion Tixier mentioned the case of a man of forty-five on whom he had recently operated; the findings were precisely the same a~ in BBrard’s case. Chalier described a case in which the patient, when twenty-seven years old, had had vaginal hysterectomy for an unrecorded ovarian lesion; when she was fifty-six years old he operated for carcinoma of the posterior vaginal wall; then, two years later, for cecocolonic invagination due to a submucous fibrolipoma of the oecum; and a month after that for a large pelvic lump which proved to be an ovarian carcinoma. Delore stated that of 9 cases of intestinal invagination in adults operated upon by him, 4 were associated with tumors, fibroma, fibromyx- om, malignant melanoma, and oarcinoma. F. CAVEIRS 474 ABSTBbOTB

Carcinoma of Deaconding Colon Removed after Mobilization of Entire Left Colon, A. CHAMER. Cancer du c8lon descendant extirpd apds mobilisation en maase du c8lon gauche, Lyon chir. 29: 480, 1932. The case reported is sufficiently described in the title.

Familial Polypode of Colon with Supervention of Carcinoma, J. COLVINSTOREY. M. J. Australia 2: 663-664, 1932. The author reports the following autopsy findings in a man of twenty-eight years whose first symptoms had dated bwk eighteen months. In the large intestine multiple polypi were present. These commenced about 10 om. (4 inches) from the ileocecal valve and were numerous in the proximal half of the tramverse colon. Just below the splenic flexure more polypi occurred. In the sigmoid colon there was a large carcinomatous ulcer which had perforated, aausing general peritonitis. The patient’s mother had been operated on previously by the author and proved to have multiple polyposis with two distinct cancers. Of the patient’s five brothers, one died at the age of thirtygeven following operation for carcinoma of the transverse colon, but no post-mortem examination was done; a second wae under treatment for colitis, a third was being treated for “ stomach trouble and piles,” and a fourth suffered from “ piles.” The fifth brother and a sister were well. Lipoma of Colon, J. P. LOCKHART-MUMMERY.Proc. Roy. Soc. Med. 26: 590,1933. A man of fifty was referred to the author because of symptoms seemingly pointing to carcinoma of the pelvic colon-chronic colonic obstruction and frequent pssaage of small stools containing blood and mucus. Roentgen 6lms showed a well defined filling defect in the pelvic colon; at operation the tumor was resected with about four inches of bowel; it was a submucous lipoma. F. CAVBR~

Single Papilloma of the Transverse Colon Cawfng a Chronic Intussusception, R. V. HUDSON.Proc. Roy. Soc. Med. 26: 691-692, 1933. A woman of thirty-eight had for seven years had watery stools night and morning. A tumor was palpable in the transverse colon, and roentgenography after a barium enema showed a filling defect. At operation an irreducible intussusception of the transverse colon was found and was resected, with good recovery. The tumor was a large, villous papilloma. Two illustrations are given. F. Camss Early Diagnosis of Malignant Disease of the Colon, W. H. OQILVIIU.Practitioner 130: 163-171, 1933. The author emphasires the fact that patients with cancer of the colon are often seen first by the surgeon when acute obstruction hae occurred and an emergency operation of a palliative nature is the only possibility, with a primary mortality of between 30 and 40 per cent. If diagnosis is made and operation performed before the stage of obstruction, there is good prospect of cure. The early symptoms, extending over many months, are increasing constipstion with a tendency to increase the use of an habitual laxative or to resort to one for the first time; distention of the lower abdomen, especially after meals; colicky pains referred to the hypogastrium; lose of strength and of weight, the latter more noticeable because the patient’s increasing girth gives the impression of fattening. Symptoms more definitely referable to the aolon follow, differing in sequence according to whether the growth is on the left or right side. In about 75 per cent of cases the growth is in the left colon; since it is usually of the scirrhous type, the next symptoms are those of increasing obstruction. The spells of constipation THE DIOEElTIVE TRAOT 476

become longer and alternate with periods of offensiye diarrhea due to irritation of the bowel above the growth by retained fecal masses which become liquefied by fluid secreted from the inflamed mucosa. A cancer of the right colon is usually a fungating mass projecting into the bowel lumen and not constricting its wall, and as the right colon is of greater caliber than the left, constipation, distention, and colic are less marked and the patient is more likely to complain of symptoms due to ulceration-diarrhea and anemia. The author outlines the points requiring attention in clinical and x-ray investigation. Two roentgenograms are shown. F. CAVERS

Carcinoma of the Rectum, J. H. BARCLAY.Newcastle M. J. 12: 15-30, 1932. The average duration of life in untreated rectal cancer is said to be seventeen months from the date of discovery. At the Royal Victoria Infirmary of Newcastle- on-Tyne, from 1923 to 1930, 143 rectal resections for carcinoma were done by Krseke’s sacral method, with 13 deaths (9.1 per cent). Barclay presents the data on 60 consecutive cases of rectal carcinoma treated at the Infirmary. The average age of the patients was fifty-five years, the ages varying from twenty-six to seventy- five. There were 34 men and 16 women. Five of the patients entered the hospital with the diagnosis of acute intestinal obstruction. Only 44 per cent were classified as operable. The procedures employed included perineal resection of the rectum in 14 cases; abdomino-perinealresection in one; abdominal excision in one; local excision followed by radium in one; whitehead’s operation in one. The operative mortality was 10 per cent. GEORQET. PACK Cucinoma of the Rectupl, W. A. FANSLER.Journal-Lancet 52: 255-258, 1932. This is a general survey of cancer of the rectum with a discussion of diagnosis and an evaluation of methods of treatment. Early Dingnode of Malignant Dieeaee of the Rectum, C. GORDON-WATBON. Practitioner 130: 172-180, 1933. Carcinoma of the rectum, though easily diagnosed on clinical examination, seldom attracts the patient’s attention at an early stage because its onset is insidious, painless, and often symptomless for many months. Since the condition is at first a local disease limited to the mucosa and submucosa and can be cured by radical surgery in the great majority of cases, its early diagnosis is of vital importance. At the Mayo Clinic, and now at other clinics, a routine investigation including a rectal examination is carried out on all new cases whatever the nature of the complaint, and many unsuspected symptomless cases of rectal cancer are thus detected. At St. Mark’s Hospital for Diseases of the Rectum the majority of patients who come for treatment do so when the disease is so advanced that there is little or no hope of cure by radical surgery. It is seldom that the patient can help in early diagnosis, and when hemorrhage occurs from an early operable growth it is too often attributed to bleeding piles by a patient who, feeling well otherwise, applies to a druggist rather than a doctor for a remedy. Too often doctors omit a rectal examination in snch cases. During the three years 1928-1930, among 215 cases regarded as suitable for and submitted to radical surgery, it was found on histologic examination that in 101 cases lymphatic invasion had already occurred. Of the 215 cases, 129 (74 without and 55 with lymphatic invasion) were followed up, with the following results: opnvrted on in 1930 17 without lymphatic invasion...... 16 alive after one year 24 with lymphatic indon...... , . , . .. 14 alive after one year 476 ABSmaTs

Opemted on in 1989 20 without lymphatic invasion...... 19 alive after two ym 16 with lymphatic inwion ...... 6 alive after two yesre Operated on in 1998 37 without lymphatic invasion...... 28 alive after threa years 16 with lymphatic invasion...... 1 alive after thrw years At St. Mark’s Hospital rectal canoera are olseaified in three groups: (a) those whioh have not penetrated the muscular coats; (b) those which have infiltrated the muscular wall but have not yet invaded the lymphatics; (c) those whioh have invaded the lymphatios. “ Out of 216 oonseoutive oases of exoision of the reotum only 38 (18 per oent) were a oases. It must be the aim of praotitioners to inorease this peroentage, and this oan only be done if those who have peeaed middle age are submitted to a rectal examination more frequently. The annual overhaul, so popular in the United States, has undoubted benefits whioh might well be emulated in this country.” The author then deala with early symptoms, rectal examination, and differential diagnosis. There is one illustration. F. CAVBRS D~o~Bof Carcinoma of the Rectum, C. G. BRBTTHAUER.J. Iowa M. 1300.22: 537-540, 1932. The author maintains that about 75 per oent of all reotal oanoers are inourable when a positive diagnosis is established. If this situation is to be improved, the laity must be eduoated to consult a physioian when rectal symptoms are first noted; and phyaioians must be educated to make a oareful reotal examination in all oases with the slightest suspicious symptoms. In fact tde author advises that a reotal examination should be included in the routine examination of all middle- aged and elderly persons. Examination .should include a stool examination, digital examination, proctoscopic examination, and fluorosoopio examination with a barium enema when the lesion is high in the reotum or the lumen narrowed so that the prootosoope cannot be pesaed.

Ischiorectal Abocens-A First Sign of Carcinoma of the Rectum, L. H. ROOTB. New England J. Med, 206: 1050-1051, 1932. A man sixty-eight yem of age complained of soreness of the reotum for three months prior to the development of anal 6stula and isohioreatal absm on the left side. The abscess was drained, and found to contain little pus but a good deal of neorotio tissue. A biopsy at that time indicated adenoma, but a seoond biopsy showed oolloid oaroinoma. Treatment of Cancer of the Rectum, R. SOUPAULT.Le traitement aotuel du oanoer du reotum, J. de m6d. de Paris 52: 91-93, 1932. Soupault discusses the various types of operation whioh may be performed for oanoer of the reotum. He prefers the abdominoperineal method and reoommends a few modifications in order to simplify the teohnia of the abdominal operation. Thirteen suoh operations have been done, with one death. A perineal anus ia used. Modern Treatment of Cancer of the Rectum, A. L. ABBL. Clin. Med. & Burg. 39: 33-34, 1932. This article is essentially a desoription of the usual teohnio employed in the onestage abdominoperineal reseation of the reotum for oaroinoma. Six of the author’s 76 patients did not survive the operation, a mortality of 7.9 per oent. The peroentage of five-year oures by this teohnio should be nearly 80 per oent. G~~ORQBT. PACK THE DIGESTIVE TRAUT 477

Carcinoma of the Rectum, Report of Eighteen Radical Resections, with Historical Review, E. P. HAYDEN,New England J. Med. 206: 97S991, 1932. The author presents a brief review of the development of the various types of radical resection of carcinoma of the rectum, and reports 18 personal cases. In 6 of these 18 cases abdomhoperineal resection was done in one stage; in 9 abdominoperineal resection in two stages; in one case each, colostomy and posterior resection, resection with anastomosis, and the Hartmann operation. There were 2 postoperative deaths, both due to pneumonia; 6 of the patients have died since discharge from the hospital, all but one from recurrence; in 2 of these cases death did not occur until more than two years after operation; 3 patients are living, with recurrence, one of these three years and a half after operation; 7 are living without recurrence, but none over a year and a half since operation. All of these cases were in a fairly advanced stage; 811 patients who recovered from the operation were relieved of symptoms, and those with recurrence lived in comparative com- fort until the recurrent growth W8S well advanced. The author is of the opinion that an abdominoperineal resection in onestage with permanent colostomy is the treatment of choice in rectal cancer, but the two- stage procedure must be used in some cases-older, less vigorous, and stout patienteto avoid too high an operative mortality and to make it possible to operate in the less favorable cases.

End-Results of Perineal EXCiBiOn and of Radium in the Treatment of Cancer of the Rectum, W. B. GABRIEL,Brit. J. Surg. 20: 234-248, 1932. This report has been compiled from the follow-up records of St. Mark's Hospital, London. The 6rst part deals with 370 cases of rectal carcinoma treated by perineal excision, and the twenty-two years covered (1910 to 1931) are divided into two periods of eleven years each. Most of the data are presented in a series of tables. The operability rate has risen from 41.6 in the first period to 54 per wnt in the second. The operative mortality has fallen from 16 per cent for the first 100 cases (1910-1922) to 10 per cent for the third 100 (1927-1929). Other tables show the operative mortality in relation to the stage of the disease as estimated by Dukes' scheme of classification, the immediate causes of operative death, the late results of the operation (after five and ten years), results classified according to the proved depth of spread of the growth (A, B, and C stages in Dukes' system). The second part deals with 89 cases treated by radium, alone or combined with exoision, from near the end of 1928 to the time of reporting. In operable squamous carcinoma of the anus 6 out of 12 cases gave good results with radium. In operable adenocarcinoma there were 2 good results in 12 cases treated. In no owhas an inoperable cancer been rendered operable by the use of radium. F. CAVERS Cancer of the Rectum with Special Reference to Radium Therapy, J. F. MON- TAQUIU. Internat. J. Med. & Surg. 45: 15-18, 1932. External irradiation of carcinoma of the rectum is not advocated 8s a routine procedure; its chief indication is for the palliation of advanced rectal cancer. Even when seven pelvic portals for the x-rays or radium packs are used, a tissue dose su5cient to destroy the cancer cannot be delivered without injury to the skin and other intervening tissues. Montague prefers the interstitial use of gold radon seeds of one to three dllicuries strength, implanted 2 cm. apart in the substance of the cancer. They may be inserted through the proctoscope from below or through a sigmoidoscope passed through a colostomy, through the perineum, and, in the female, through the posterior vaginal wall. [With rare exceptions, however, the results so obtained are not curative.] GB~ORGB~T. PACK 478 ABSTBILOTS

Epithdomr of Anus Treated by Radium, J. P. LOCKHART-MUMMERY.Proo. Roy. Soo. Med. 26: 589, 1933. The patient was a woman of fifty-eix; the uloerated tumor was treated by radon seeds and radium needles inserted beneath and around it; total dosage 882 mg. hours [liltration not stated]. Two weeks later no sign of the tumor remained; at the time of reporting, nearly a year later, the anus is quite normal. F. CAVERS

Carcinoma of the Rectum Invading the Vagina md Uterus, Treated by Perinert Excision md Vaginal Hysterectomy in Continuity, W. B. GABRIEL. Proc. Roy. 800. Med. 26: 690-591, 1933. The patient was a woman of fifty-two; the growth had spread by direct oon- tinuity forwards in the rectovaginal septum, and metastatic lymph nodes occurred in the perirectal tissues. [After history not given.] F. CAVPRS

Large Ulceratiag Columnar-celled Carcinoma of the Rectum, G. GORDON-TAYLOR. Proo. Roy. Soc. Med. 26: 593, 1933. A woman of fifty-five had a large, ulcerating carcinoma nearly encircling the bowel and extending through the posterior wall of the vagina, leaving a rectovaginal fistula. The author removed rectum, pelvic colon, uterus, and vagina by an abdominoperineal operation. The patient was in good health and free from recurrence when Been three years later. The author has operated on six similar oases in which the growth was too extensive for a simple perheal operation; all six patients survived operation, but all died within two years. F. CAVERB

Primary Epithelial Turnore of the Vermiform Appendix, G. VANS. SMITH. Arch. Path. IS: 78-82, 1933. Of 7865 appendices examined mioroscopically, 22 showed primary tumors, of which one was a columnsr-cell carcinoma and the others oarcinoids. [It may be noted, for statistical purposes, that 3232 of these appendixes showed (( normal conditions " according to the table given.] Of the 21 carainoids, 20 were located in the distal third of the appendix either as a nodular swelling or as an induration without change in caliber; the remaining appendix contained a firm, round tumor 1.6 om. in diameter at its bas@,its lumen being obliterated throughout. In 14 the lumen was obliterated proximally; in the remaining 6 the tumor projected upwards in the lumen in polyp fashion or simply filled it at the point of growth. Histologically in each case of carcinoid the picture was that of a round or ovoid mass of epithelial cells, with a suggestion of adenomatous structure, the cells varying moderately in sire but showing only slight pleomorphism and no hyper- ohromatiem, that is, very low if any malignancy. With a modificetion of Haeegawa's silver nitrate method all showed the characteristic granules of reduced silver. A study of 261 appendices by this method showed that argenta5 oells are fewer in appendices from older subjects and in those with sufficient inflammation to give symptoms. F. CAVERS

THE BILIARY TRACT Primuy Carcinormr of the Liver Aasocirted with an Old Echin- Infection, W. MULLER. Primi'ires Leberkarsinom bei alter Echinokokkusinfektion, Centralbl. f. allg. Path. u. path. Anat. 56: 161-164, 1932. A Muse primary carcinoma of the liver was observed at autopsy in association with an old eohinococoue infection in a man eighty-three years of age. This ie in THE BIIJAEY =CT 479 accord with the well known fact that carcinoma of the liver usually develops in an organ which is already the seat of other chronic changes. The article is illustrated with photographa and photomicrographs. BENJAMINR. SHORPl

Cancer of the Liver with Fever, Complicated by Right-Sided Hemiplegia and .Aphaeia, VINNAY,GONNET, AND SmvAJEAN. Cancer du foie A forme febrile compliqut? d’h6mipl4gia droite et sphasie, Loire m6d. 46: 51, 1932. A patient is described in whom the symptoms suggested a suppurative process below the diaphragm. At an exploratory operation the liver was found to be enlarged and indurated, but not nodular. A specimen removed for biopsy showed carcinoma. Since no autopsy was permitted, the cerebral symptoms could not be fully explained.

Congenital Cysts of the Liver, OLIVERK. PARRY.J. M. SOC.New Jersey 29: 580, 1932. A single case report of a benign cyst of the liver in a woman of twenty-six.

Carcinoma of the Hepatic Duct, VERNONC. DAVID. Ann. Surg. 96: 381-384, 1932. Attention is called to the great similarity of the clinical course of carcinoma of the hepatic duct to common duct stone where repeated severe colics, intermittency of the jaundice, non-dilated gallbladder, and chronicity are characteristic. At operation the findings resemble but remotely those of bommon duct stone and are characteristic of carcinoma of the hepatic duct, in that the oommon duct and gallbladder are normal whereas the hepatic duct is converted into a firm, fibrous cord resembling in every way dense scar timue. Unless this fact is known, the diagnosie at operation is likely to be missed. When strictures of the hepatic dhct from carcinoma oan not be removed by operation and therefore jaundice continues, postoperative hemorrhage is likely to occur and may end fatally. The histories of two patients with carcinoma of the hepatic duct are given to illustrate these points. BENJAMINR. SHORE

Diffuse Carcinoma of the Biliary Passages, E. CHABROLAND R. WAITZ. Le cancer diffus de la totalit6 des voies biliaires, Bull. et m6m. Soc. m6d. hap. de Paris 48: 14961498, 1932. At autopsy on a man of fifty-two who within less than three weeks before death had become deeply jaundiced and shown signs of ascites, there were found numerous tumor masses involving the gallbladder, the biliary passages, the hilar region of the liver, the spleen, and a large part of the peritoneum, which was studded by numerous miliary deposits. Histologically the growth was a duct-cell carcinoma, containing such a large amount of fibrous tissue that the authors compare it with linitis plastics. From the description and the single photomicrograph given it seems certain that the growth had been of gradual development, with the excep tion of the small peritoneal deposits, and had been in existence long before giving rise to symptoms. F. CAVERE

Primaxy Cancer of the Gallbladder, A. R. SALMON.Le cancer primitif de la v6si- cule biliaire, Rev. de rnbd., Paris 49: 77-89, 1932. Of 17 cases of primary cancer of the gallbladder observed by Salmon, 14 were in women; the ages ranged from forty-three to seventy-eight years. Thirteen of the 17 patients had gallstones. Opinions as to what percentage of patients with gallstones develop cancer of the gallbladder vary; on the basis of hie own clinical 480 ABSTUOTS experience, Salmon plaoes the figure at 4 or 5 per oent. Adenoma of the gallbladder is oonsidered to be a preoanoerous lesion; in his pathologioal studies of a number of oalaulous gallbladders, the author has found that the oalouli irritate the gallbladder wall and oause glandular hyperpleais; in most oases the lesion remains at this stage; but in some the adenomatous formation invades the musole layer; then in one more stage oanoer is formed. Pathologioally there are three types of Ballbladder canoer: colloid, the mbst frequent; scirrhous; encephaloid. Clinically there are four types: the tumor form, the ioterio, dyspeptic, and pseudo-lithiasia forms. These types were discussed in a previous article (see abst. in Am. J. Canoer 15: 1778, 1931) Gallbladder cancer extends more frequently into the liver than into the biliary ducts; of the author’s 17 patients, 14 showed liver involvement. In gallbladder oanoer surgery is generally useless by the time that a definite diagnosis is made. The only suocessful method of treatment is prophylactio-aholeoystectomy in all cases of ohronio oholeoystitis with lithiasis.

THE PANCREAS Hypoglycemia Assodated with a Tumor of the Islands of Langerhanr and with Adrenal InruSciency, Respectively, J. RABINOVITCHAND F. W. BABDIUN. Am. J. M. So. 184: 494503, 1932. The authors point out that in the majority of oases in which attach of hypoglyoemia supervene as a result of an island-cell tumor of the panoreas an accurate diagnosis is seldom made, though the olinioal pioture of hyperinsulinemia is unique and typical. The neurologic symptoms shown by the patients are often oonfusing, and the aondition is frequently diagnosed as a lesion of the central nervous system, such as epilepsy or syphilis. During the last two years two oases of hypoglycemia have been studied at the Missouri Baptist Hospital. The first has been reported by Smith and Siebel (Am. J. Path. 7: 723, 1931. Abst. in Am. J. Canoer 16: abst. p. 892,1932); it was their Case 4, and was aseociated with carcinoma of the panoreaa involving the islands of Langerhans. The seoond oase is of special interest because it apparently Mers from those previously described in that the primary oause of the hypoglyoemia wm an unusual lesion of the adrenal glands. A man of twenty, admitted to hospital in a state of stupor, had been well until two months previously, when he beoame deapondent and melanoholio and would not eat for several days at a time, He consumed large amounts of sugar, saying he felt better and more alert after doing so, but soon afterwards fell again into a stupor. Blood examination showed a hypoglyoemia of 25 mg. per 100 0.0. Soon after admission the patient beaame deeply comatose; in the oourse of an intravenous injection of gluoose he recovered for a short time, but relapsed into coma when the glucose was diaaontinued. Two days later he died; before death the blood sugar rose to 70 mg. per 100 0.0. At autopsy a nodule 5 om. in diameter was found on the anterior surface and tail portion of the pancreas, but histologio examination showed this to be simply a localised area of ahronio inflammation and not a neoplasm. In both adrenals the medflary tissue was replaced entirely by a mass oonsisting of nests of lymphocytes surrounding a central oollection of reticulo-endothelial cells. In the spaces between these nests there was infiltration of lymphooytes and oooasional giant cells, the latter being of foreign body type. This replaoement of the adrenal medulla by lymphoid tissue is regarded m the cause of the hypoglycemia. There are two good photomiorographs. F. CAVBRS PERITONEAL AND BETBOPBBITONEAL TUYOBS 481

Cancer of the Pancreas in a Boy, C. E. HURTADO.CBncer del phcreas en un nido, Ana. SOC. mhd.-quir. del Guayas 12: 98-102, 1932. A short account is given of a cancer of the pancreas in a boy of twelve who died a few days after admission to the hospital. Autopsy revealed a carcinoma of the pancreas which had become adherent to adjacent organs. JOHANNESP. M. VOQDLAAR

Secondary Cancer of the Pancreas, R. LEMIEUXAND E. MORIN. Cancer second- sire du pancreas, Bull. SOC. med. d. h8p. Universitaires de Quebec pp. 20-26, January 1932. The authors’ patient presented an advanced carcinoma of the lesser curvature which perforated into the pancreas. The splenic artery was thrombosed.

Pancreatic Cyets, D. SMITH.Brit. M. J. 1: 11-13, 1933. The comparative rarity of pancreatic cysts is indicated by some of the collected series cited by the author. Gulecke, for instance, reviewed 260 eases found in the literature up to 1912 (Ergebn. d. Chir. u. Orthop. 14: 408, 1912). The case here reported is that of a woman of forty-eight, who for about five years had had pain in the epigastrium. Later, pain in the gallbladder region had developed and recently this had become more severe, being followed by vomiting. Preparatory to radiographic examination of the gallbladder on suspicion of cholecystitis or cholelithisais, the patient was given a barium meal, which showed marked spread- ing out of the duodenum and a displacement of the transverse colon downwards, whence a diagnosis of pancreatic cyst was made. At operation the thin cyst wall ruptured, with outpouring of dark blood-stained fluid; extensive fat necrosis was present, and there were dense adhesions around the stomach and adjacent viscera. The patient became collapsed, the cavity was packed, and no further procedure was deemed advisable; death occurred nine hours after operation. The tumor was evidently a simple retention cyst due to chronic pancreatitis, with hemorrhages, which had exieted for an unusually long time. Despite the total destruction of the pancreas, neither hypoglycemia nor glycosuria had been present. Two roentgenograms are given. F. CAVERS

PERITONEAL AND RETROPERITONEAL TUMORS, MESENTERIC CYSTS

Paeudomyxoma Peritonei, JOHNW. JDFFBIEB. Ann. Surg. 96: 215-218,1932. Jeffries reports two cases of pseudomyxoma peritonei which he has observed in males. The first was a man forty-six years of age who was operated on for saute appendicitis. Besides a short, thick, and acutely inflamed appendix which did not appear to be perforated, a large collection of whitish-yellow, semigelatinous fluid was found beneath the omentum. Two perforations were found in the oecum. The patient made a satisfactory recovery and has remained well for over a year. The second patient was a man sixty-seven years of age. At operation a large cyst was found occupying the entire lower abdomen and pelvis, while the entire peritoneal cavity was involved by a pseudomucinous process. The cyst was attached in the right iliac foeea and the appendix could not be identified. A brief review of the literature and a discussion of the signs and symptoms of pseudomyxoma peritonei are included. There are no illustrations. BDNJAMINR. SHORD 482 ABSTBAOTS

Value of Pydography in the Diagaods of Tumor8 of the Hypochondrium, C. LIOPOUTREI.De l'inter6t de la pytllographie dam le diagnostic des tumeurs des hypochondres, J. d. sci. m6d. de Lde 50: 163-166, 1932. The author has found that pyelogaphy may be of value in the diagnosis of tumors of the hypochondrium because intraperitoneal tumors do not distort the course of the ureter, but retroperitoneal growths do. Moreover, in retroperitoneal tumors the type of ureteral distortion may indicate the site of the tumor. The lower pole of the kidney is external to the ureter; if the tumor is in the region of the lower pole it bends the ureter inward, and the concavity of the ureteral curve is outward. With a growth in the lumbar fossa, the kidney is pushed outwards and the ureter bent so that the concavity of its curve is inward. Five illustrative cases are reported.

Meaentedc and Omentd Cysts, E. W. PETIORSON.Ann. Surg. 96: 340-349,1932. Peterson reports five cases of mesenteric and one of omental cyst operated upon without mortality. In one case the pathological diagnosis of cystic degeneration of a tuberculous lymph node was made and in another case thh was considered highly probable. Of the three remaining cases, one was an intraperitoneal cyst of nephrogenic origin, one was an embryonic mesenteric cyst of the chylous type, and the other was an embryonal mesenteric cyst which had undergone carcinomatous degeneration. The omental cyst was observed in an acutely ill four-yearsld patient. The mass was lobulated, cystic, well encapsulated, and measured 11 X 8 X 4 am. It was multilocular and filled with yellowish, jelly-like material. Histologic examination showed the cyst to be lined with endothelium, and the diagnosis of congenital peritoneal cyst of the omentum with acute secondary infection was made. Enucleation, resection, or drainage must be selected in the treatment of the individual case. Peterson suggests that in selected instances of single, thin- walled, mrous, sanguineous, or chylous cysts the removal of the greater part of the cyst membrane with closure of the incision in the mesentery and bringing the remaining segment of cyst in contact with the raw surface of the mesentery will prove to be a satisfactory operation. Abstracts of the six oase histories are given. BENJAMINR. SEORM A Study of Mesentedc Cysts, with Report of Two Recent Caees, J. 0. WARFIILD, JR. Ann. Surg. W:329-339, 1932. Two oases of mesenteric cyst are presented in children six and two and a half years of age respectively. Examinations of the fluid are not reported and histologic examination of the cyst walls is not recorded. A rather general discussion of mesenteric cysts with a review of the literature is included. BENJAMINR. SHOBI

Retroperitoned Cyst Originating in the Wolfera Body, GOLINVAUX.Kyste r6tro-p6riton6al d'origine Wolfienne, Rev. belge d. sci. mtld. 4: 524-528, 1932. A man, after an acute attack of abdominal pain and diarrhea, continued to have some tenesmus and some mucus in the stools. There was an asymmetrical enlargement of the abdomen with a tumor maas on the right side. Radiographic examination showed the intestines pushed forward by what was apparently a retroperitoneal tumor, transparent to the x-rays and therefore evidently cystic. At operation the tumor was found, as it were, " floating in the retroperitoneal tissues, but entirely removable. It was a unilocular cyst, Wed with a clear liquid containing a few cells, not identified. Histologic examination of the wall of the THE SUPMNAL GLANDS 483 cyst showed it to have originated in embryonic remnants of the Wolffian body. The patient made a good recovery. The author refers to a good report by Koenig on retroperitoneal cysts (Zentralbl. f. Chir. 58: 902, 1931. Abst. in Am. J. Cancer 16: abst. p. 148, 1932). Cyst of Mesentery Complicated by Volvulus of Small Intestine and Right Colon, P. RIOINHOLD.Kyste du m6senthre oompliqu6 de volvulus du grhle et du cdlon. Wseotion du kyste et de l'intestin grhle adjacent. Wduction du volvulus. GuBriaon, Bull. et m6m. SOC. nat. de chir. 58: 523-528, 1932. A boy of five yeare had had frequent attacks of abdominal pain and distention since the age of two. At laparotomy there was foun'd a large mesenteric cyst. Since the author was unable to mobilize this in order to enucleate it, he punctured the cyst and exteriorised it with the adjacent bowel in order to do a resection, On further examination he found that there was a complete volvulus of the right half of the colon and of the portion of ileum occupied by the tumor (about 60 om. from the ileocecal valve); he succeeded in reducing this and resected the cyst with the adjacent portion of ileum. The cyst was serous, containing clear yellow fluid. In the discussion following the presentation of the patient, Mom described a similar mesenteric cyst which underwent traumatic rupture; immediate operation resulted in cure. F. CAVERS

THE SPLEEN Calded Cyst of the Spleen, F. H. SCOTBON.Brit. M. J. 1: 367, 1933. A calcified cyst of the spleen was found at operation on a man of forty-four who complained of pain in the left upper abdomen. Roentgenography showed some deformity of the duodenal cap and a calcified cyst in the painful region. The radiologist thought the duodenal deformation was due to ulceration, but at operation the stomaoh and duodenum showed no sign of this. As the gallbladder and appendix were the seat of dense adhesions, these organa were removed, as well as the spleen. After decalcification the cyst wall was found to consist of fibrous time without a lining of epithelial or endothelial cells. The contents appeared to consist of pure cholesterol without blood cells or blood pigment. There are two illustrations. F. CAVERB Congenital Hamartoma in Erpthremic Splenomegaly, A. FONTANA.Amartoma congenito in splenomegalia eritremica, Pathologica 24: 100-103, 1932. A man of forty-six, luetic and a sufferer from chronic lead poisoning, showed an enlarged spleen and had attacks of acute pain in the left hypochondrium. There were no pathological changes in the circulating blood. Splenectomy was performed and the patient was well and without complaints three months later. Pathological examination showed myeloid metaplasia of the spleen with many miniature cells of the red blood series. A small, distinctly oircumscribed nodule WBB found imbedded in the spleen, which consisted of normal splenic tissue with some myeloid changes. The author reviews the literature and discusses theories of genesis. JEANNIOTTEMUNRO

THE SUPRARENAL GLANDS Cree of Neuroblasto~of the Suprarenal Gland (Hutchison Type), J. V. C. BBAITHWAITE.Proc. Roy. SOC. Med. 26: 279-282, 1933. A male infant of fifteen months was brought to the hospital after having been taken to the family physician two weeks previously because he looked ill and was 484 ABBTBAOTS restless and hia eyelids were swollen and yellowish-red. Vomiting then began suddenly and aontinued every day until the child’s death eleven days after admission. While he was under observation the swelling of the eyelids increased and the head began to enlarge, with engorgement of the superfiaial veins. Bilateral proptosis developed, extensive orbital hemorrhages ooourred, and there were hard, shotty glands in the neok, axillae, and groins. Nothing abnormal waa deteoted on examination of the abdomen, on lumbar punoture, or on urine investigation. At autopsy bdateral tumors were found in the frontal, parietal, and temporal lobes, involving the orbits. In the right lumbar region of the abdomen was a large tumor weigbing one pound and extending aoroas the midline to the left side, up to the diaphragm, and down to the iliao foesa. There were metastases in the panoreas. The author reoalls that these neuroblastomaa of the suprarenal rarely ooour after the age of four yem and that, although arising from cells of eotodermal origin, they are hiatologioally more like saroomas than caroinomas. There are two syndromethe Pepper syndrome, in whioh the liver is chiefly involved, the original tumor being quite small, but the liver enormous; and the Hutohiaon syndrome, in whioh the striking feature is the formation of metastases in the skull, espeoially round the orbit. The present oase is of interest because of the unusual occurrenoe of metastasis appearing simultaneously in both orbits. In all previously published case# when the right suprarenal has been t,he seat of the primary growth, metastases have appeared first in the right side of the aranium, and when the left suprarenal was responsible metastases appeared first on the left side. This is due to the different lymphatia drainage on the two sides. On the left, the adrenal lymphatios oonneot with lumbar glands, some pass down into the groin, while others pase upwards to the glands mundfhe aorta and thenoe to the skull. The lunge are never involved, and the liver seldom. On the right side the lymphatios pass straight to the main trunks along the vena cava. Also the suprarenal touohes the bare area of the liver. Therefore metastases are oommon in the liver and lungs. Presumably in this oase the primary tumor spread rapidly mom the abdomen and involved the suprarenal on the other side, and afterwards metastases appeared simultaneously along both lymphatio routes. [This report has been abstraoted at some length because the sbstraotor has read several rather long papers dealing with suprarenal tumors in general in whioh these neuroblastomaa, though long ago desoribed with their Hutohison and Pepper syndromes, were not even mentioned. Exceptions are the exoellent aooount given by Gibson in 1927 (J. Urol. 18: 33-59) and Soott and Oliver’s paper on “ Sym- pathetio Tumors of the Adrenal Medulla ” whiah appeared earlier this year (Am. J. Cancer 17: 396,1933). Numerous cases have also been reported,usually singly.] F. CAVBRS

Adrenal Neuroblastoma, F. W. LAW. Lancet 2: 1101-1103, 1932. The author disoueses briefly the adrenal neuroblastomaa and adds a oase report. The two main types as desoribed by Pepper and Hutohiaon are outlined in detail. The author’s case occurred in a male child eleven months of age who suacumbed seventeen days after admimion to the hospital. The primary tumor was found at autopsy in the left adrenal and proved to be typioal adrenal neuroblastoma. The metastases, however, were of atypioal distribution and partioularly involved the suboutaneoue tissue. The author is unable to olassity the oaae as either a Hutohison or Pepper type. R. 8. FIIR~USON THE FEMALE QENITAL TRAUT 486

THE FEMALE GENITAL TRACT Roentgenography as a Diagnostic Aid in Gynecologic and Gynecologic-urologicd DiEeMes, H. 0. KLEINB. Rhtgenbilder als diagnostische Hilfsmittel bei gyntikologisohen und gyntikologisch-urologischen Erkrankungen, Arch, f. Gptik. 149: 347-307, 1932. A case is first described in which x-ray pictures demonstrated the presence of a calcified fibroid with its typioal coral-stem shadow. Such calcification is com- moner in the subserous fibroids on account of their poorer vascular supply and in this case operation demonstrated a right-sided intraligamentous subserous fibroid. In the second patient, a woman of sixty-two years who had undergone a vaginal hysterectomy many yearn before, the x-ray demonstrated a laminated shadow the siae of an apple in the region of the right adnexa. Such a finding in the true pelvis is regarded as typical of a calcified ovarian cyst. Later examination of the specimen obtained at operation showed a total necrosis of the ovarian parenchyma and a laminated calcification with some ossification. In a third case a dermoid cyet showed the shadow of teeth and areas of ossification. The remainder of Kleine’s paper ‘is not definitely concerned with tumors, but describes the appearance of an old hematocele resulting from an ectopic pregnancy, discusses the differential diagnosis between a phlebolith and ureteric stone, the recognition of bladder stone and of calcified mesenteric lymph nodes, and finally the appearance of pelvic kidneys. The paper is illustrated with clear reproductions of roentgenograms of the conditions described. H. C. TAYLOR,JR. Pregnancy in Association with Tumors, F. ROQUES. Clin. J. 62: 93-99, 1933. The author discusses the association of pregnancy with fibromyomas, with ovarian tumors, and with malignant disease of the uterus. (1) Pelvic fibroids are more easily detected than abdominal ones, which is fortunate, since the former are more likely to obstruct delivery, whereas abdominal fibroids rarely cause serious troubles during pregnancy, except those due to degeneration of the tumor. The author advises conservative treatment (rest in bed and opiates), since operative interference, apart from hysterectomy, is followed by abortion in from 17 to 50 per cent of cases, and, since fibroid-bearing women are relatively infertile, often involves risking the patient’s only hope of motherhood. Again, the surgeon may open the abdomen with the intention of performing myomectomy only to find that he must remove the uterus because of multiple fibroids, or myomectomy may be possible only after removal of the products of oonoeption owing to the location of the tumors. Finally, the risks of morbidity and mortality in myomectomy are probably increased by the coexistence of pregnancy. (2) Ovarian tumors, since they predispose to sterility, rarely complicate pregnancy. The treatment of choice is removal of the tumor as soon as it is diagnosed, since the risk of abortion is hardly increased by the operation and as long as the tumor is present there is danger of torsion of the pedicle, rupture, hemorrhage, and other secondary changes. If, however, the diagnosis is made before viability, it is better to wait until the fetus is viable and then perform ovariectomy and cesarean section. (3) Carcinoma of the cervix is not a frequent complication of pregnancy, partly because it occurs largely in the later years of menstrual life, when conception is not common. Four poeeibilites are considered: (a) With operable cancer and a non-viable child the pregnancy should be disregarded and radical hysterectomy performed, but if a child is greatly desired operation may be postponed until viability, by treating the tumor with radium. (b) With an op erable cancer and a viable child, cesarean section is indicated, to be followed by 486 ABS!I’RACTS radical hysterectomy. (c) With inoperable cancer and a non-viable child, up to twenty weeks of gestation, the uterus should be emptied and the groyth treated by radium, since it is unlikely that the patient will live until full term; if the patient is first seen after the twentieth week, it is justifiable to treat the growth with radium, allow the pregnancy to go to term, and then deliver the child by cesarean section. (d) With inoperable cancer and a viable child, the latter should be delivered by cesarean section and radium applied to the growth. F. CAVBRB Early Diagnoaia of Malignant Disease of the Uterus, W. F. SEAW. Practitioner 130: 189-198, 1933. The author summarises hie discussion of the early diagnosis of uterine malignancy as follows. “ Excessive and frequent hemorrhage is a symptom which always suggests the poseibility of malignant disease of the cervix or body of the uterus, more especially in a parous woman who is approaching the time of the menopause, and still more in any woman who exhibits this symptom after the menopause. Every case should be thoroughly investigated, and it is never justifiable to treat this symptom empirically and to defer examination. Malignant disease of the cervix is easily recognised as a friable area, either on the outer surface of the cervix or at the external 08. In the majority of cases experience allows us to say with certainty that the patient has or has not mmlignant disease in this region, but in any case of doubt examination should be made under anesthesia and a small portion of the cervix removed for microscopic examination. In women over forty years of age, and especially in women who have paesed the menopause, a negative examination of the cervix should always be followed by a diagnostic curettage. This will definitely difierentiate between carcinoma of the body and other changes in the endometrium such as senile endometritis and mucous polypi. In the event of the latter being found, the patient’s symptoms are cured by the curettage-if carcinoma is discovered a panhysterectomy can be performed while the patient is under the anesthetic. If only women would recog- nise that increased hemorrhage, and especially irregular bleeding between the periods and hemorrhage after coitus, is definitely abnormal and would seek advice whenever this occurs, and if we as a profession would refuse to treat any such case without a thorough investigation, these early cases would not be so frequently overlooked.” F. CAVERB Evolution, Diagnosis, and Treatment of Epithelioma of the Body of the Uterus, P. PBTIT-DUTAILLIB.Evolution, diagnostic et traitement de 1’6pith6liome du corps uthrin, Rev. g6n. de clin. et de th6rap. 46: 737-739, 1932. On the basis of his clinical experience the author notes that hemorrhage often is a later symptom in cancer of the body of the uterus than in Dancer of the cervix. One of the earliest subjective symptoms is a loss of weight without evidence of any acute or chronic disease. The injection of lipiodol for radiographic study is not advised in cases in which cancer is suspected. The proper means of diagnosis is curettage with histologic examination of the material obtained. Abdominal hysterectomy is the treatment of choice, and may be total or subtotal. Radium is used, however, when the age and general condition of the patient contraindicate operation, The author has treated 20 cases of cancer of the body of the uterus; 10 were treated by radium, with 2 five-year cures.

Epitheliomur of the Uterine Cervix Secondary to Uterine Fibroma, L. SATJV~. Lee 6pith6liomtw du 001 ut6rin secondeires aux fibromee ut6riq MBdecine 13: 258-262, 1932. In 1930, when this subject was discussed before the French surgical society, the author had seen 17 cases of secondary cancers of the cervix after subtotal hyster- TRE FEMALB GENITAL TRAOT 487

ectomy; within the year he had 2 more cases. There has not been a year in his surgical praatice that he has not seen one such case. He is of the opinion, also, that with modern technic total hysterectomy is no more di5cult or dangerous an operation than subtotal hysterectomy. He therefore favors total hysterectomy in the treatment of uterine fibroma to avoid all danger of secondary cancer of the cervix.

Glycogen Regulation in Malignant Tubore of the Uterue, ROBERTOBOLAFFI. Contributo all0 studio dells glicoregolarione nei tumori maligni dell' utero, Riv. ital. di ginec. 14: 37-58, 1932. Bola5 did sugar tolerance tests on a series of 10 patients with non-cancerous gynecological lesions, and on a series of 15 patients with carcinoma of the uterus. The blood sugar rose to a higher level, and fell again more slowly, in the cancer aeries. Ten of these cases were treated with radiation, and the sugar tolerance test was repeated from ten to fifteen days later. The curves obtained were now approximately normal. In the 5 others in which hysterectomy was done repetition of the test showed a similar return to normal values. A bibliography is included. C. D. HAAGENSEN

Surgical Treatment of Carcinoma of the Uterine Cervix, J. L. FAURE.L'evolution du traitement du cancer du col utbrin par l'hysterectomie large, Irish J. M. So. pp. 308-311, June 1932. In this brief paper the author, looking back on nearly forty years of surgical experienoe of uterine cancer, oompares the results obtained by him year by year sin@ 1896. He states that ('good )) cases operated on during the three years 1924 to 1926 showed " lasting cure " in 96 per cent, but he does not state the total number of cases, the operative mortality, or the length of time over which the patients were followed after operation. F. CAVERS

Treatment of Carcinoma of the Uterine Cervix, J. L. FAURE.Sur le traitement des cancers cervico-utbrins, Bull. Acad. de mbd., Paris 107: 755-758, 1932. This paper, which contains no new obeervations, is according to the author hie last word in a polemic camed on for some time between him and Regaud. The latter has been wanting to know what Faure means by " good cases )) (see preceding abstract), in which he claims to have obtained strikingly successful surgical results, in particular whether these cases fell into the first two degrees of the international Geneva classification of malignancy. Faure answers that the Geneva convention was not really international because neither of the three delegates who drew up the cladcation was a Frenchman, and that he means by good cases those in which the mobility of the uterus has not been impaired. He reasserts that surgical treatment is still far ahead of irradiation and remains the treatment of choice. F. CAVERS

Radium Treatment of Cancer of the Uterine Cervix, J. MAYO. Middleeex Hosp. J. 33: 15-21, 1933. The author briefly summarizes the clinical aspects of cervical cancer, and proceeds to describe the Stockholm (Radiumhemmet) and the Paris (Radium Insti- tute) methods of radium treatment. The former was used at the Middlesex Hospital up to two years ago; since that time most of the cases have been dealt with by the Regaud and Lacsesagne technic. " The problem for the radium worker is to irradiate not only the uterus, vagina and parametria in such a fashion as to 488 mmam sterilise the growth, but ale0 to try to perform the same office for the dected glands. The more so, as the tendency is for him to receive a high percentage of sdvanced and totally inoperable cases, the earlier ones perhaps being treated surgically.” F. CAVQRS

Primuy Mortality in Radium Therapy of Cancer of the Cervix, N~GRBAND GUILHQM. La mortalite immediate dens la curi6th6rapie du cancer du col de l’ut6rus, Prat. m6d. franp. 13: 192-196, Feb. (B) 1932. Among 427 patients with cervical cancer treated at the Toulouse Cancer Center from 1924 to 1931, there were 13 deaths (3.04 per cent) within one month after treatment. Of these, 6 followed infection, 6 occurred after discharge from the hospital and cannot be definitely classified, one was due to cardiac failure in twenty- four hours, and one to collapse on the introduction of a vaginal speculum. The authors review the pathogenesis of these complications and ascribe lese importance to the direct depressing effect of irradiation on local, general, and humoral resist- ance than to the bacterial infection associated with these cancers before any treatment is begun. Acutely fatal infections in rather young subjects with relatively localised cancers form a group due to faulty irradiation technic. In a second group, in women forty to seventy-five years old with more advanced disease, death comes later and is due to hepatic and renal failure to handle the flood of toxins absorbed from the irradiated sone. Logical prophylaxis consists in postponing radium treatment until appropriate measures have brought about the cure of existing infections and an improved function of all the viscera. Distance radiation should accompany and may eventually supplant internal treatments. NBLSONB. SACKETT Two Cuer of Cancer of the Body of the Uterur with Secondary Growtha in the VyirU and Vulva Treated by Operation and Radiation and Free from Recur- rence after Ten and Thirteen Your Rerpectively, H. R. SPQNCQB.Proc. Roy. 800. Med. 26: 257-262, 1933. The title of this paper makes an abstract unneceseary, except perhaps to point out that the author himself does not think the small amount of postoperative irradiation given (x-ray in the first case and radium in the second) had anything to do with cure in these ctwes. F. CAVERS Care of Intererting Adenocardnoma (the So-called Adenoma Malignurn) in the Portio VagbaU of the Womb, J. TOYOSHIMA.Jap. J. Obst. & Gynec. 14: 472-475, 1931. A report of a papillary cystic adenocarcinoma of the portio in a woman of thirty-aeven. Photomicrographs and a photograph of the extirpated uterus are shown. Metutrtic Cucinoma Caueing Dyetocia, R. MBYQR-WILDISEN.Karainom- metantsee ale Geburtshindernis, Schweis. med. Wchnschr. 62 : 1065-1056, 1932. A case of dystocia caused by a large mass of metastatic carcinoma in the pouch of Douglas is reported in a thirtysne-yearsld patient. At the time of Cesarean section, a biopsy specimen was taken from the mass. Histologic study showed it to be composed of epithelium and large numbers of psammoma bodies. The primary tumor was considered to be ovarian, although these organs were mabroscopi- cally normal. BBNJAMINR. SHORQ Cucinoma of the Cervix Impeding Labor, Report of Clse, J. GARLANDSHQRRILL, Kentucky M. J. 30: 277, 1932. Single case report. THE FEMALBl 0E"PAL TBAOT 489 Myourcorrm of the Uterw with Pulmonary Metastasis, K. HERMAN. uber ein Myosarkom des Uterus mit Lungenmetastase, RBntgenpraxis (Hft. 5) 4: 211-213, 1932. A forty-eight-year-old patient with general cachectic symptoms for three months was operated upon for a large pedunculated, mid-abdominal tumor, which proved to be a myoma with sarcomatous changes. After a period of improvement, cachexia returned five months later with attacks of angina pectoris. Roentgen examination confirmed the presence of metastases in the right lung, involving the hilus, pleura, and lower lobe. The patient died in three months. NELSONB. SACKETT

Sarcomatous Uterine Polypus Treated by Radium and Later by Hysterectomy, W. GOUOH. Brit. M. J. 1: 461, 1933. A woman of forty-six had an offensive discharge with blood clots for sixteen days. The uterine fundus was palpable one inch above the symphysis, and a large, smooth, rounded mass protruding from the cervical canal was partially removed piecemeal and found to be a polymorphous-cell sarcoma. As there was a considerable maw of growth still within the uterine cavity, radium was inserted for seventy-five hours, the total dosage being over 4000 mg. hours. Three months later panhysterectomy was performed; on histologic examination no trace of sarcomatous tissue could be found in four separate regions that were sectioned. F. CAVERS Ectopic Gestation with Uterine Polypus Simulating Inevitable Abortion, G. DIETRICH. South African M. J. 7: 46, 1933. Report of a case in which the presence of a uterine mucous polypus occupying the lumen of the cervical canal masked the signs of a ruptured tubal pregnancy. F. CAVERS

Lipomyoma of the Uterus and Diabetes MelIitus, H. BANIECKI.Lipomyom des Uterus und Diabetes mellitus, Virchow's Arch. f. path. Anat. 287: 483-490, 1932. Baniecki reports the case of a lipomyoma of the uterus associated with diabetes mellitus in a woman sixty-one years of age. The growth was solitary, measured 10 om. in diameter, and was well encapsulated in the fundus of the uterus. Histo- logic study showed extensive hyaline degeneration of the muscle and large colleo- tions of fat cells. Two similar cases of uterine lipomas occurring in patients with diabetes mellitus have been reported in the literature (Dworsak, H. : Frankfurt. Ztschr. f. Path. 34: 2&36, 1926, and Springer, A.: Zentralbl. f. Gynllk. 52: 800- 811, 1928). BENJAMINR. SHORE

Intentitid Fibrompyoma of the Cervix Uteri, L. DE L. HARWOODAND L. A. MAONAN. Fibro-myome ihterstitiel du 001 utbrin,. Union m6d. du Canada 61 : 305-308, 1932. The occurrence, symptoms, and technical difficulties of removing interstitial myomata of the cervix are discussed, and a case is reported. NELSONB. SACKETT

Pregnancy or Fibroids, P. GRAFFAONINO.New Orleans M. & 9. J. 84: 589-594, 1932. Admitting the value of the newer pregnancy tests and of x-rays, the author redirects attention to a valuable differential sign in the uterus exposed at laparotomy. Whereas in pregnancy the round ligaments remain symmetrically placed, 490 ABSTBAOTS while moving far apart and relatively lower on the corpus uteri, in fibroide the ligaments remain close together, ride on top of the uterus, and often are asymmetri- oally plaoed. N~LBONB. SACKBTT

Conduct of Difacult Labom Due to Fibroid6 of the Corpw, Lower Uterine Seg- ment, or Cervix, J. A. MANSBIN. Conduite B tenir dens les aooouohements dystooiques dus B une ddgdn6resoence fibromateuse du oorps, du segment in- fdrieur ou du 001 de l’utdrus, Union mdd. du Canada 61: 422-424, 1932. The author ignores fibroid8 in pregnanoy and labor unless they give rise to symptoms of pressure, torsion, degeneration, hemorrhage, or obstruction to the onooming fetus. In these cases the appropriate myomectomy, hystereatomy, or Cesarean section is practised. NBILBONB. SACK~TT

Radiotherapy of Fibromu, P. LBHMANN.A propos de la radiotherapie des tlbromerr, Bull. et mdm. Boo. de m6d. de Paris pp. 306-311, April 23, 1932. In the treatment of uterine fibroma Lehmann uses what he terms semideep irradiation, with a filter of 5 mm. aluminum; five or six cutaneous fields, three anterior and two or three posterior; and a total of two and a half to three hours of treatment in several doses. Thie dosage he has found effeotive in establishing the menopause in women of forty-five and over, and sometimes in younger women. Menstruation does not cease at onoe, but if the second menstrual period after the radiation is not moditled, or if the hot flashes of the menopause are not noted, a seoond treatment is given. Deep radiotherapy is used only when it is neoeReary to establish the menopause by the first treatment, or with young and obese women. In agreement with Guilbert, Lehmann prefers x-rays to radium in the treatment of fibromas, as it is necessary for the radiation to sat upon the ovaries, not merely on the tumor itself in these oases. While menstruation should always be stopped for the successful treatment of fibromas, the menopause need not be permanently established in young women if the menstrual period! are normal when they re-appear. If the flow is excessive a permanent menopause must be obtained by repeated treatment. Among the women treated by the author 10 (thirty-two to thirty-eight years of age) have become pregnant after a complete cessation of menstruation for about a year; the ohildren in these oaseq were normal. Not only does radiotherapy oontrol the hemorrhages, but it also reduces the siae of the fibroma to a variable degree; this reduction in sise is most marked in multiple fibromas and in aoft fibromas in whioh myomatoua elements predominate, but b slight in white, hard fibromas. Several of the author’s patients subsequently required operation, and in none of these were there any operative diffioulties due to adhesions. Radiotherapy does not, socording to the author’s experienoe, oause the development of oancer in a fibromatous uterus.

Roentgen Therapy of Bleeding Uterine Fibroids, P. SANTYAND P. JAPIOT. Traite- ment des fibromes hdmorragiques par la radiothdrapie, Lyon ohir. 29: 756 759, 1932. The authors advooate hystereotomy in inetanoes in whioh the tumors are very large or numerous or in which oomplioations are present, whereas bleeding tumors are best treated by x-ray unlw they are large or oomplioated by adnexal idamma- tion or evident infection; operation is indioated when the tumor is pedunoulated. Their caaes in whioh x-ray treatment has been given during the past eight years are divided into three groups. Group I is made up of 11 patients showing marked anemia and weakness due to excessive bleeding, with the tumor usually not larger Tm R'BMALM UBNITAL TRAUT 491

than a four months' pregnancy. The age of these patients varied from forty-two to fiftysne years. When the anemia was high grade the spleen was irradiated [an entirely useless procedure], and in all cases the ovaries were given a total dosage of 6000 to 6OOO R (Solomon). In every case the treatment resulted in arrest of hemorrhage, and after five or six months the tumor showed distinct regression. In Group I1 there were 11 patients with medium-sized bleeding fibroids, the hemorrhage being of menorrhagic type and necessitating rest in bed for a few days monthly. Some of these patients showed a moderate degree of anemia. The same x-ray dosage as in the btgroup was given to the ovaries, and sufficed to arrest hemorrhage without irradiation of the spleen. Group I11 included 16 cases of fibromatous uterus at the menopause; the tumor was smaller than in Groups I and 11, and bleeding was arrested more promptly. During the eight-year period the authors made a careful investigation, including curettage and histologic examination of every case, so as to ensure that no patient with an intra-uterine polyp or a carcinoma of the uterine body should be sent for x-ray treatment instead of operation. When in doubt as to primary corpus carcinoma or malignant degeneration the authors operated. During the eight years they considered it advisable to treat 452 cases surgically-that is, only 8 per cent were treated by irradiation. F. CAVERS Radiation Treatment of Uterine Hemorrhage of Benign Origin, J. H. BRIDEN- BAUQH. Radiology 18: 34S352, 1932. A report of 309 cases of uterine bleeding, grouped as unclassified, menopausal, and fibromyomas. Of the 309 patients, 300 reacted satisfactorily after the employment of x-ray and radium therapy. The unexplained group consisted of ten women who had improved under medical measures and curettage and who received from 200 to 400 milligram hours of radium in the uterus. The second group included 31 women in whom conservative means had failed and whose bleeding was stopped either by one pelvic cycle of x-ray therapy or lo00 milligram hours of radium in the uterus. Of the 268 fibromyomas, 162 fled the pelvis, and 24 reached the umbilicus. There was one frank failure. In two cases the tumors had to be removed, though the bleeding had been stopped, and in six patients treatment had been incomplete. The author believes that surgery should be preferred in young women where the uterus may be preserved, and in very large, necrotic, calcified, pedunculated, or submucous fibroids. He believes that x-ray therapy is superior to radium in large tumors and does not think that 200 k.v. and 0.5 mm. aopper filter is preferable to 150 k.v. filtered through 0.25 mm. of copper. He usually administers 300 r with the latter technic every ten days for eight treatments, or until the tumor has diminished to one-half its original size. In patients who are unable to come for a full course of x-ray therapy he adds radium, giving 1600 milligram hours in a uterine applicator. MAU~ICELENZ Origin, Clinical Aspects and Therapy of Endometrioel8 (Heterotoph of the Uterine Mucou), L. SEITZ. ffber Genese, Klinik und Therapie der Endometriosis (Heterotopien der Uterusschleimhaut), Arch. f. Gynilk. 149: 529407, 1932. In regard to the origin of endometriosis, outside of the uterus itself, Seitz believes that no single theory hao universal application. Ae illustrative of this point of view he presents two cues. The first patient was a young woman of twenty-one years, suffering from so-called chocolate cysts of the ovaries, of endometrial origin, in whom a retrograde transplantation of endometrial tissue through the tubes could be excluded because tbe patient had never menstruated. In the second case, however, such a transplantation was probable, since a vaginal obstruction was found which had caused the formation of an hematometra and hematosalpinx, whose presence demonstrated that uterine material had almost certainly originally been forced from the endometrial cavity on to the peritoneum. 492 ABSTBAOTS

In oonaideration of the pathology of the endometrial growth, kits makes an apparent dietinotion between the “ ordinary ” adenoses, whose epithelium does not reaot to the ohanges of the oycle, and the true endometriode whose glands read with typioal funotional ohanges to the hormonal stimulation, or at least respond with bleeding. As a further oontribution to the pathologic anatomy of endo- metrioah, he reports two 08888 of hematosalpinx resulting from endometriosis and leading to the development of what he terms chooolate tubes. In thie oonneotion he suggests that the muoh disputed tubal menatruetion may in some inetanoes result from the presenoe of small heterotopio ialands of endometrium in the tubal lumen. In regard to the growth capacity of the endometrial tissue Seitr notes certain aharaoteristics, suoh aa infiltrative growth and a histolytio aotion on neighboring oells, which suggest the behavior of malignant tumors. From a olinioal standpoint the infiltrative, retrooervioal endometrial growths in partioular are to be regarded for praotical purposes ae malignant. A case is reported in whioh suoh an endometriosis was found in assooiation with an adenoaaroinoma of the reotum in a thirtysne-year-old woman. The olinical seotion of Seitr’ paper is based on a study of 66 oases observed in the university clinio at Frankfurt during the two yearn before the writing of the paper. Three olinioal forms are easily recognisable: (1) endometriosis of the uterus or endometrioeis interne; (2) retrocervioal endometnosis with infiltration of the posterior ligaments of the uterus; (3) endometriode of the ovaries (ohoaolate opts), of the tubes, and of the pelvio peritoneum, with the formation of. conglomerate turnore. In regard to symptomatology, 18 per aent of the patients were found to be free of symptoms, 40 per oeet had wooiated dieease of the adnexa or fibroids whioh dominated the olinioal pioture, while in 38 per cent the symptoms were due exclusively to the heterotopio growth. The dominant olinioal symptom is dpmen- orrhea, whioh is due to the oolleotion of seoretion and blood in more or lees closed ~p~ce~,the inoreased tendon on nerve fibers, and also the ooossional rupture of the oyst and development of extensive intrapentoned adhesions. It is partioularly by this symptom of dysmenorrhea, but also by the frequent presenoe of menor- rhagia, that endometriosis is to be distinguished from ohronic pelvio inflammatory dieesse. No general form of treatment directed toward the absorption of implants has in 8eitr’ experienoe brought EUOOW, althbugh he feels that spontaneous remiasion, probably beeed on internal seoretory ohanges, may ooour. There is a tendenoy to improvement at the menopause, but a owis reported of a woman of forty-eight, three to four yeam after the olimaoterio, in whom a large chocolate oyst was observed to grow and cause symptoms. IPoentgen treatment hre been reported ae unsucoeeaful for endometriosis interne by eeveral observem, but the effeot of a roentgen oaetration upon endometriosis externa haa been regarded ae more favorable. Seits himeelf is of the opinion that the elimination of the ovarian funotion does not always bring a oomplete oure and oites a owin whioh the symptoms oontinued after a total hpter- eotomy with removal of both tubes and ovaries. He sums up the indications for the x-ray treatment of endometrid aa fOUOW6: 1. In women near the menopause, in whop the diagnoeis of endometnosis oan be made with more or less oertainty, full oaetration dose exoept in oaees of retrooervioal endometnosis, is to be reoommended. 2. In young women in whom operation is contraindioated, an attempt with temporary amenorrhea may be made, although the tendenoy is for the symptoms to return with the renewed onset of menatruetion. 3. In patients who refuse both operation and temporary aastration, a light radiation of from one-third to one-half of the oaatration dose may be undertaken, THE FEMALE GENITAL TRACT 493

On account of the difficulty of diagnosis, a surgical operation is, however, the rule. In suoh cases a conservative procedure ie justifiable. Seits reports that 14 operations performed with the conservation of the uterus and of one ovary all resulted in a symptomatic cure of at least two and one-half yeam' duration. This shows that a oure of endometriosis occura without complete exolusion of the ovarian activity and indicates that, although the presence of the ovarian function is indeed a prerequisite for the development of endometriosis, it is not a direct cause, and finally, that in young patients it is muoh better to perform such an operation and to preserve the ovarian funotion than it L to resort to oestration by the x-rays. In regard to the retrocervical type of endometriosis, Seits ie muoh leas optimistic and reports that the radical operation, with removal of the parametrial tissue, does not always prevent the extension of the endometriosis, nor does the exolusion of the ovarian funotion prevent further growth. In suoh a case, however, success has bean obtained by the use of very heavy doses of radiation. [This long paper of Seits affords not only an excellent general introduction to the entire subject of endometriosis but presents several new and interesting observations. In particular, his emphasis of the symptomatology and results of treatment is a useful departure from the usual custom of writing almost exclusively upon histogenesis.] H. C. TAYLOR,JR.

Intraperitoneal Fibroma of the Round Ligament, J. PETIT. Fibrome intrap6ri- toneale du ligament rond gauche, Bull. et m6m. Soo. net de ohir. 58: 736-738, 1932. Three months before entering hospital, a woman of twenty-three had noticed a lump in the left lower abdomen, whioh sometimes oaused difficulty in micturition and which had gradually grown larger. On examination a diagnosis of ovarian opt waa made. At laparotomy the tumor wes found to have developed from the internal third of the left round ligament and to be adherent to the sigmoid. The af€eated portion of the ligament was resected, and good recovery followed. The tumor weighed 2,500 gm. Histologic examination showed it to be a soft vascular fibroma. F. CAVERS Primary Carcinoma of the Falloph Tube, G. Cona. Epithdlioma primitif.de la trompe, Lyon chir. 29: 381-382, 1932. A nulliparous woman of lifty-eight, who had passed through the menopauae at lifty-two, had for about eighteen months noticed increasingly profuse white discharge. Clinical examination was difficult owing to obesity; diagnostic curettage of the uterus was negative. Shortly after this, the patient complained of pelvio pain, and bimanual palpation revealed a rather soft mess, the sise of an orange, in the left pelvis, diagnosed as a cystic ovarian tumor. There was no as- oites. At operation the left fallopian tube was found to be enlarged and was removed with the uterus; the maas that had been palpated occupied the free terminal portion of the tube, but the entire organ was infiltrated by the tumor, a papillary oaroinoma which had evidently arisen near the fimbriated end. F. CAVERS

Chorionepithelioma of Fallopian Tube, T. T. O'FARRELL. Brit. M. J. 1: 370-371, 1933. A woman of thirty-five was admitted to hospital in a condition of shock and with a history of uterine hemorrhage, not exaessive, for fourteen days, followed by seven days of pain in the lower abdomen together with increased hemorrhage. On examination the uterus was found to be normal, but a aystic mass was palpable behind and on both sides of it. A diagnosis of ruptured tubal pregnancy was 494 ABSTBAOT8 made. At operation the pelvio cavity was found filled with blood dot, and M the fimbriated end of the tube looked aa if an eotopia pregnanoy had ruptured through it, the tube wasremoved. Roentgenography of the lunge showed nothing abnormal. In the material removed no embryo was found. The lumen of the tube oontained ohorionic villi of about fourth week type. At one plaoe there was definite invasion of the musculature; here typical villi were few, but there were marked proliferation of the Langhans oeb, many of whioh contained mitotio figures, and oomparatively few synoytial cells. The author suggests that this is an early 0888 of tubal ohorion- epithelioma. In the disaueaion whioh followed the reading of the paper divergent views were expressed on this point. [It is not stated in the report whether the Asohheim-Zondek test was applied.] F. CAVERS Precodous Puberty as a Result of Chorionepitheliomrtour Growth, HERMANN SIEWUND.Pubertas praecox als Folge ohorionepitheliomatbser Wuoherun- gen, Aroh. f. Gynllk. 149: 498-514, 1932. A ohild five years and eleven months of age was brought to the olinio on aooount of genital bleeding. The body height was 122 om. (12 om. above the average) and the development of the breasts, the ooourrenoe of hair, and the appearance of the external genitalia corresponded to those'of a girl at the beginning of puberty. The hymen permitted the passage of a finger. Examination by this means showed a uterus corresponding to that of a twelve- to fourteen-year-old ohild, a small left ovary, and a right ovary containing a nodule the siae of a bean. The patient was kept under observation, and five months later a large tumor was suddenly die- covered in the abdomen, reaching nearly to the navel. The seoondary aex oharac- teristics were now more pronounoed. Examination of the urine disclosed the presenoe of thirty to sixty thousand units of anterior pituitary hormone per liter. X-rays showed a normal sella turoica but a eignifioant aaoeleration of bone growth. Operation oonsisted in extirpation of the tumor of the right ovary and of the left, whioh contained a metastasis. The tumor itself waa partly solid, partly oystio, measuring 17 X 11 X 10 om. insire. On oross-seotion the tumor oonsisted partly of solid tissue, partly of tiny cysts with areas of brownish red growth. Im- plantation of partioles of detoxified tumor tissue into infantile mice produoed in most oases the anterior pituitary reaction 1, while from the brownish red region it was possible to obtain definite reactions 2 and 3. The oontents of the oyst also contained anterior pituitary hormone. The presenoe of hormon'e in the tissue was confirmed by Prof. Zondek, to whom material was sent for study. The hiatol- ogy of the tumor was oomplex, but the predominant type of cell waa round or spindle-shaped. The cells were of different sire but principally large, with pale staining cytoplasm. Following the operation the urine oontinued to show the presence of anterior pituitary hormone. About three weeke after treatment the patient developed a pleural effusion and x-ray showed the presence of numerous pulmonary metastases. Death took place shortly afterward. Post-morten examination showed that generalired metastases had ooourred throughout the lungs, liver, pancreas, thyroid, kidneys, bones, and brain. Histologio examination of the metastatid nodules showed on the margin of the hemorrhagio areas numerous small and medium-aiae oells, with round vesicular nuolei whioh were very similar to the Lang- hans cells. There were also large syncytial cella, with several ohromatin-riah nuolei. The hypophysis showed hypertrophy, with a alight resemblance to the pituitary of pregnanay. It is believed by the author that the corroboration by the biological demonstration of anterior pituitary hormone, of the histologio appearance of the primary tumor and the metastases, oompletely aonfirms the diagnosis of this tumor as a chorionepithelioma. THE BEMALE OBlNITAL TEULOT 496

In conclusion Siegmund discusses the condition of the uterus. At the time of the operation this was soft and congested, while five weeks later, post mortem, it was small, firm, and pale. This change he suggests is due to the fact that the ovaries were removed at the time of the operation so that no hormone remained available for the production of the uterine cycle. It is probable, however, that the human placenta also produces folliculin, because it is known that pregnant women in whom the ovary has been removed early in the period of gestation continue to produce the estrus hormone. In the present case, after the removal of the ovary, Siegmund obtained no reaction in five castrated mice after the injection six times of 1 cm. of urine. This test, however, demonstrates only that not more than 160 units per liter were present. H. C. TAYLOR,JR.

Sexual Transformation as the Result of Ovarian Tumor (Arrhenoblastoma), E. SQDLIB. Geschlechtsumstimmung durch Ovarialtumor (Arrhenoblastoma), Arch. f. GynEik. 149: 223-236, 1932. Introductory reference is made to the three types of arrhenoblastoma recently described by Robert Meyer: the typical form, similar in structure to the tuba1 adenoma of the testicular type (Pick); the atypical form, which without exception produces masculinization; and the transitional form, which suggests the relationship between the other two. Sedlis then proceeds to describe a case with marked changes in secondary sexual characteristics. A sixteen year old girl complained of amenorrhea for thirteen months following two years of normal menstruation. She had also noticed a deepening in the pitch of the voice, a low of weight, a shrinkage of the breasts, and a marked increase in hair over the lower abdomen and thighs. The external genitalia were normal except for an overdevelopment of the clitoris, which measured 5 om. in length. X-rays of the skeleton disclosed a number of changes suggesting intersexuality. Reotal examination disclosed a tumor in the left adnexa, the siee of a child’s head. Study of the blood and urine for anterior pituitary and ovarian hormone was undertaken only after operation, neither being found in demonstrable amount. Operation consisted in the removal of the left ovarian tumor, which had the gross appearance of a cystadenoma. Menstruation returned one month later and shortly afterward the extensive hair began to disappear. The body form, in particular the hips, became more rounded and the breasts increased in size. Only the voice remained relatively unchanged. The tumor itself consisted of a multilocular cyst, with three large chambers and solid tissue in between. The histologic description is made by Dr. Robert Meyer. The tumor parenchyma consisted in the main of large, irregular, cellular areas, separated by regions consisting predominantly of connective tiwue enclosing small, more cellular islands. The principal cells were of two types, some approaching the spindle form and suggesting a sarcoma, while others were larger, cuboidal, or cylindrical, with swollen cytoplasm containing fat particles. A very prominent feature of the tumor was the development of numerous small cystic spaces, which in places became confluent and produced large cysts. This characteristic suggests that these arrhenoblastomas may at times be mistaken for a simple cyst. [The case has been most completely studied except perhaps for examination of the blood and urine for smaller quantities of hormone. The pictures of the patient before and after the operation demonstrate dramatically the changes produced by the tumor. The report is further illustrated by photomicrographs.] H. C. TAYLOR,JR. 496 ABSTBhOTS

Wold3.n Tumor of the Ovary with Metastafdr to the Uterine Cervix, P. ROCHET, J. F. MARTINAND BR~NAT.GBn4ralisation cervico-ut6rine d’une tumeur de l’ovaire, Lyon chir. 29: 346-348, 1932. A woman of forty-eight had for three months had vaginal hemonhage with peaesge of clots; at first the bleeding was intermittent; later it WBB continuous, though not so profuse. The cervix WBB swollen and its vaginal surface was friable and bled readily on being touched, At operation, done on a diagnosis of early cervical carcinoma, the left adnexa were found to be obscured by dense adhesions binding them to the sigmoid. When these were dissected away, a small encephaloid tumor was seen in the site of the left ovary. Hysterectomy was performed, with removal of the ovarian tumor. The latter was found on histologic examine tion to present the structure of a wolffian carcinoma, and, as wolffien-like tubules were also found in the cervical tumor, it is suggested that the ovarian tumor was primary and the cervical one a metastasis probably derived from fragments of the ovarian neoplasm carried through the fallopian tube into the uterus. .The uterine body showed inflammatory changes but no neoplastic tiseue. Two photomicrographs, though not very clear because of the poor quality of the paper, on the whole support the histologic diagnosis of wolllhn tumor. F. CA~W Uncommon Types of Rupture of 0vUi.n Cystomrs, E. GILARDINO.Rotture non comuni di cistomi ovBTici, Riv. ital. di ginec. 14: 70-100, 1932. Sixteen cases of rupture of ovarian cyst are briefly described. In two of these patients the cyst was felt to rupture while it was being palpated. In five others there WBB a history of trauma, but it was deemed insufficient to have actually caused the rupture. The most interesting case WBB that of a woman aged thirtysne who had a large cys!. Abdominal pain and vomiting suddenly occurred, and a diagnosis of twisted pedcle was made. During one of the spasms of vomiting a large amount of blood-tinged fluid gushed out of the vagina. At operation the oyst was found to be adherent to the posterior surface of the uterus; at this point B perforation into the uterus had occurred through which a large part of the contents of the cyst had escaped. An exhaustive bibliography is included. C. D. HAAG~NBEN Tonion of ovuiur Cpbirr Children, K. 0.PITERS. Zur Kasuistik stielgedrehter Ovarialrysten bei Kindern, Med. IUin. 28: 1465, 1932. Peters reports a twisted dermoid cyst of the ovary in a three-yearsld patient. He calls attention to the fact that in these cases the general peritoneal symptoms are marked, that disturbances of the bladder with insignificant changes in the urine are common, and that the high mortality often reported is due to generalized peritonitis following necrosis of the tumor. BENJAMINR. SHOR~

THE GENITO-URINARY TRACT Hypemephma and OIESOW Metarkrer, GBIPEKOVBIN.Hypern6phromes et m6tssfases omuses, Ann. Inst. chir. de Bruxellee 33: 26-36, 1932. The author defines hypernephrome aa a tumor developing in aberrant suprarenal tissue within the kidney. Metastases to the bones are common in these tumors; any bone in the skeletoa may be involved. The author has seen but 3 cases of hypernephroma; 2 of these were in an advanced stage, and death ensued shortly after operation. The third patient, a woman of sixty-three, had had intermittent hematuria for B year, of increasing severity. In the last few months THE OENITO-URINAlZY TRACT 497 she had suffered progressively increasing pain in the kidney region, hips, and but- tocks. Pyelography showed marked deformation of the calices in the left renal pelvis; this kidney was functionless. It was removed; all normal renal tissue was dbplaoed by a tumor that was found histologically to be an epithelioma made up of cells of the suprarend type. The patient rallied from the operation, but in about two weeks began to complain of pain in the hips and thighs. Roentgeno- grams showed almost complete destruction of the body of the second lumbar vertebra; the third lumbar was later involved, with resulting paralysis of the lower extremities, and death. Hypernepluoma of the Left Kidney, H. W. S. WRIGHT. Proc. Roy. SOC.Med. 26: 481-482, 1933. A woman who had recently lost weight and appetite was admitted to the hospital with a diagnosis of gastric cancer. She had marked secondary anemia. No definite signs of gastric trouble were found, but pyelography led to diagnosis of renal tumor, whioh was located at the junction of the upper and middle thirds of the organ. Nephrectomy was performed. The renal vein was Wed with the growth nearly as far up as its union with the vene cava. F. Cavnas

Sarcoma of the Kidney of the Adult, E. 8. JUDDAND J. M. DONALD. Ann. Surg. 96: 1028-1031, 1932. Judd disousses the primary sarcomas of the kidney in the adult and cites a oase. A man forty-six years of age complained of a large mass in the left upper quadrant of the abdomen. A nephrectomy was undertaken and a tumor 16 X 14 X 13 om., weighing 1200 grams, was removed. It proved to be a fibrosarcoma, Grade IV, with giant cells. Judd reviews the symptoms in 28 similar cases and advises nephreotomy and postoperative roentgen therapy as the treatment of choice. R. 8. FBRQUSON Leiomyowcoma of Kidney, H. P. WINBBURY-WHITE.Proo. Roy. SOC.Med. 26: 485, 1933. In a man of seventy who complained of intermittent hematuria for nine months, with pain in the left kidney region, excretion tests revealed only poor functional activity of the left kidney, but pyelograme showed a renal growth. Nephrectomy was done, and at the time of reporting, a year after operation, the patient was in good health. The tumor consisted of large masses of unstriped muscle, spindle- cell sarcomatous tissue, and numerous blood spaces. F. CAVEIRS

Uniloc- Cyst of Kidney, R. H. J. SWAN. Proc. Roy. Soc. Med. 26: 488,1933. In a woman of fifty-four complaining of pain in the right lumbar region and frequenoy of micturition, a large tender mass was palpable in the right abdomen. Cystosoopy showed nothing abnormal, and indigo-oarmine came down in deep oolor from the right side in six and the left side in five minutes. Roentgen examination showed that the right kidney shadow was greatly enlarged, particularly about the lower pole, which was rounded and much broadened. Pyelography revealed some dilatation of the lower calices. In a medial longitudinal section of the removed kidney [illustration given1 this apparent dilatation of the lower calices was seen to be due to a cleft between the calix and the wall of the cyst, which would have made a partial nephrectomy di5cult. F. CAVIDRS Early Diagnosis of Malignant Disease of the Bladder, A. E. ROCHIL Practitioner 130: 208-218, 1933. The author cites a restricted selection of literature (three text-books and four ehort papers in British journals) as a basis, in oonjunction with his own experienw, 498 ABSTBAOTB for his discussion of the early diagnosis of malignant disease of the bladder. He covers the subject adequately, however, in an srtiale addreeaed mainly to the general practitioner. He concludes that for practical purposes all bladder growths are potentially, when not actually, malignant; that the common early symptom of papilloma and carcinoma is painless intermittent hematuria, oyatitis being rare with papilloma and common with caroinoma; that physical mgna are usually absent in papilloma and early carcinoma; and that the early diagnosis of malignant disease of the bladder depends mainly on the routine cyatoscopy of patients with painless hematuria or pemisting cystitis. The author does not consider that histologic examiliation of epithelial bladder tumors is of appreciable diagnoetio or prognostic value. F. CAVXIRS

The Management of Bladder Tumors, FRANKW. HABRAH.Ohio State M. J. 28: 175-179, 1932. Harrah believes that, determined by amenability to treatment, the cliniaal malignancy of bladder tumors is diminishing. He urges wider scceptance of clinical grading in preference to microscopic grading and states that “other factors than cellular malignancy play a part,” though he does not enumerate these factors. His paper is baaed upon 34 cases observed during the preceding three years and seven months: 8 benign epithelial papillomas of the bladder and 26 cancers of the bladder. Six of the latter patients refused treatment. Of the 20 treated patients with malignant tumors of the bladder, 13 had papillary carcinomas, 4 infiltrating carcinomas, 2 adenocaroinomas, and 1 epidermoid carcinoma. There were five deaths in this series. Two patients are alive and apparently well after three and one-half years. The author feels that fulguration will adequately arefor most kenign papillomas. He advoaates the implantation of radon seeds in oases which resist treatment by fulguration. Surgical excision is recommended for the mlrlignant tumors of the bladder. R. 8. FERGUSON Modern Conception of Bladder Tumor Therapy, WILBURH. HAINBE.Urol. & Cutan. Rev. 36: 178-180, 1932. Also The Treatment of Bladder Tumors, Pennsylvania M. J. 35: 549-551, 1932. This is a rather rambling discussion touching upon various matte?, some of which seem to have little application to the author’s subject. Though formerly conservative, he now advoaates wide excision or total cystectomy in the treatment of bladder tumors. R. 8. FXIBGUSON Radiation Therapy of Malignancies of the Bladder and Prohte, IRAKAPLAN. Urol. & Cutan. Rev. 34: 40-42, 1932. Kaplan believes that long continued irradiation with small amounts of radon element will produce improved results in carcinoma of the bladder and of the prostate. [It does not appear to the abstractor that the tissue dose delivered to the tumor by the author’s technio-which he desaribes as ‘‘ new ”-would be sufficient for tumors of any considerable siae. No details are given of oases so trested and no mention of results is made.] R. S. F~Rousozi

Sldn Metut.eer in Cucinoma of the Bladder, H. C. ROLNICKAND C. P. O’NBIILL. Arch. Derm. & Syph. 26: 882-885, 1932. The authors were able to find but one reported case of akin metastasis from carcinoma of the bladder in the literature. The patient was a colored man forty- eight yeam of age who noted simultaneously the appearanae of blood in the urine and the presence of small nodules in the skin of the abdominal wall, three months before admission to the hospital. On admission nodules were present in the skin THE OEINITO-URINABY TRACT 499

and subcutaneous tissues about the umbilicus, right nipple, right groin, and posterior cervical region. They varied in diameter from a few millimeters to 1.5 centimeter. Cystoscopy revealed a diffuse ulcerating and infiltrating carcinoma of the bladder. One of the skin nodules was removed and was diagnosed as a tranaitional-oell carcinoma. Multiple metastases were found in the pelvic peritoneum, the mesentery, mesocolon, and iliac lymph nodes. [Skin metastases from bladder carcinomata are certainly not so infrequent as the authors indicate. The writer has seen three instances recently.]

Case of Carcinoma of the Bladder and a Gastric Fibromyoma, IQNAZIOCHIOFALO. Su di un caso di carcinoma della vescica e fibromioma gastrico, Arch. ital. di anat. e istol. pat, 3: 35S364, 1932. At autopsy of a man aged eighty-two, dying after suprapubic cystotomy, a carcinoma of the bladder and a fibromyoma projecting externally from the greater ourvature of the stomach were found. c. D. HAAQENBHN

Myoma of Bladder, S. G. MACDONALD.Proc. Roy. Soc. Med. 26: 481, 1933. The author describes a firm, round bladder tumor occumng in a woman of seventy-three. It grew from the margin of the internal meatus on the left side and was enucleated; it had caused inaontinence and later retention. Histologically it was a pure leiomyoma, with no more stroma than the fine fibrous tissue strands found normally in the bladder muscle. F. CAVERB

Cyst of Urachue with Calculus Formation, A. C. SIDDALL.Chinese M. J. %: 894-898, 1932. A case report is given of a Chinese female with a cyst of the urachus containing loo0 0.0. of fluid. The cyst also contained a urostealith.

Early Dh@OSiS of M-t Disease Of the Prostate, H. P. WINBBURY-WHITE. Practitioner 130: 217-224, 1933. The author cites almost exclusively recent articles dealing with the extensive North American material and uses these, together with his own experience, as the baais of a useful and instructive paper. It has been shown that one out of every four or five cases of prostatic obstruction is carcinomatous, that carcinoma may begin in the medial and lateral lobes as well as in the posterior lobe, and that the prostatic capsule left behind after enucleation may provide a nidus for malignant change. Also malignancy may develop in simple hypertrophy. Suspicion of this may be aroused when difficulty is experienced with the enucleation, or the change may be detected on microscopic examination; sometimes both of these signals are mieeed and the first intimation of malignancy occurs when the patient returns several months after the operation with prostatic carcinoma obvious on rectal examination. " Careful serial sectioning of the gland after removal is a safeguard and will protect the surgeon in many cases from an unpleasant surprise if he has already given a good prognosis." The frequency of widespread and distant metastasis, especially in the bones, is shown by Bumpus, who in reviewing his 1,000cases gave an incidence of about one- third with skeletal metastases. Frequently in cases which on rectal examination seem to offer some prospect of help by operation, roentgenography shows bone invasion; and too often unnecessary operations have been performed to deal with growths which have later proved to be metastases from an undetected prostatic cancer. The author gives personal cases to illustrate these points. As to symptoms, Bumpus found in his 1,OOO cases only 650 with increased frequency and di5culty and only 37 with oomplete retention, while there was no 500 AB8TBAaTS case of gross hematuria. In the great majority the mioturitional disturbanues are of short duration and are not prominent until the disease is well advanoed. ‘I Most oases are reoogniaed on reotal examination, but most of them are unfortunately so advanoed that there ie no rospeot of cure. However, some oases ooour with early looal ohanges, suoh as sm sareas of induration or areas suggestive of inflammation, and oareful examination in oases like this seem to offer the best prospeot that more early proetatio oanoers will be disoovered and that a greater percentage will be oured. In advanued oases suprapubio oystostomy to relieve any obstruation present is aa muoh aa om be done surgically. When no evidenoe ie found of extension beyond the bladder, a good exposure, by the perineal route, of the prostate, seminal veeioles gnd bladder will enable long radium needles to be inserted into the whole of the involved area; by this means suoh marked ohanges have been effeoted that subsequent lvsotal examination has failed to reveal a date whioh aould be reoognised aa carcinoma.” F. CAVE~RS

Lymphonarmma of the Prostate, R. S. FERGUSONAND F. W. STIOWABT.J. Urol. 28: 93-104, 1932. The authors report in detail an instance of lymphosaraoma, probably primary in the prostate. Three previously reported oases in the literature are disauased. Photographs and miorophotographs illustrate the report. R. 8. FEJRGUSON Specimen of Carcinoma of the Urethm, H. W. 8. WRIGHT. Proc. Roy. Soo. Med. 26: 481, 1933. The author desoribes a tumor loaated in front of the triangular ligament, in a man who had had urethral strioture for over thirty years and had passed his urine through a sinus in the perineum. Behind the strioture was a para-urethral abeeess, and on opening this the tumor was found. After suprapubio cystotomy radon seeds were implanted; the patient died two weeka later from apoplexy. F. CAVERS Euly Dingnodo of Mdigmat Direare of the Tertscle, C. H. CARLTON.Prao- titioner 130: 226-299, 1933. Few manifestations of oanoer are more terrible than a malignant testis. It strikes without warning in early or middle manhood, aoaompanied with such alight disoomfort that the patient does not realise its gravity. Cure depends on the modem radiaal exoision, and for this to sucoeed the disease must be reoognined early. The author illustrates this by oiting two oases seen almost simultaneously by him. The first had a six weeks’ history of teatioular swelling, the seoond a twelve weeh’ history. Both were submitted to radiaal operation; the man with the shorter history is driving a looomotive more than three years after operation; the other is dead. As 8 rule, the patient is a fiblooking man aged twenty to fifty; he may be a baby or an ootogenarian. The author dieouaeae differential diagnosis, and after having exoluded various other oonditiona whioh oauea awelling of the testiole or epididymis or both, he arrives at the three possibilities: syphilis, hematooele, or malignant disease, all three or any two of whioh may ooexist. Charaoteristio features of these oonditions he tabulates as follows: Syphilis Hematode Csncer Lorn of tantiaulsr mtion...... alwayt3 often sometimem Solid and hard ooneistmoy...... often always somstimea Impmaionofweight ...... light haw h=v Thiokeningof epsrmstio Cord...... rare Often U8Wbl

“ Unleaa we are satisfied beyond all poseible doubt (not reaaonable doubt but possible doubt) that the owe is not one of malignant disease, we must explore, and THE OENITO-URINABY TahOT 501 if then we &ill remain uncertain we must proceed with the radical extirpation of testicle and aasociated lumbar lymphatics. We are not bound to a& only on proof. The circumstances warrant acting on suspicion; better to remove ten innocent testicles than allow a single malignant one to escape. A syphilitic fibrosed testicle ie of no value, nor ie one which has been the seat of a chronia hematocele of muoh more.” F. CAVBIRS

Malignant Tumor of Testicle with Positive hchheim-Zondek Reaction (Friedman ModMcation), L. W. JOHNSON AND W. W. HALL. U. 8. Nav. M. Bull. 30: 616-618, 1932. The authors review the literature on the appearance of prolan A in malignant tumors of the teatis and cite a case to illustrate the diagnostic value of the Asch- heim-Zondek test. The patient was a man forty-one years of age who had been conscious of a maw in the left lower quadrant of the abdomen for two years. On examination no testis was found in the left scrotum and the mwin the abdomen was the eise of an orange and freely movable. The tumor was removed, and mioroscopic examination showed it to be an embryonel carcinoma. An Aschheim-Zondek test (Friedman modification) was done immediately after the tumor had been removed and proved to be positive. Eleven days later the reaction was negative. [The test is much more valuable when conducted on a quantitative basis, using immature female mice after the Zondek technic. Rab- bits do not react well to the injection of extracts of prolan obtained from urine and cannot be used to detect small amounts of prolan.] R. 8. FERGUSON Chorioma of the Testicle, R. PROUBT.Sur le placentome du testicule, Bull. et m6m. Soc. nat. de chir. 47: 1660-1653, 1931. The author aomments on a case reported by Chevaesu as chorioma of the testicle. No new facts are presented.

Upomyxofibroma of Scrotum, G. R. LIVERMORB.Brit. J. Urol. 5: 49-54, 1933. A man of forty-five had noticed, six years before admission to the hospital, a lump in the left side of the scrotum, which had steadily grown larger. Recently, after lifting a heavy box he had felt pain in the scrotum, which swelled rapidly until it measured nearly two feet in circumference and about nine inches long. The testicles were pushed upward and lay in front on the maw, but were not enlarged or tender or adherent to it. On removal the encapsulated tumor was found to consiet in places of more or lew purely lipomatous, fibromatous, and myxomatous tissue, while in other parts these components were blended in various proportions. There are four excellent illustrations. F. CAVIQRS Primary Malignant Tumor of the Tunica Vaginalis, Nom. Tumeur maligne primitive de la vaginale paridtale, Bull. SOC.frang. d’urol., pp. 196-201, May 9, 1932. A boy of eighteen years was admitted to the hospital because of a tumor in the right scrotum. This had increased in sise for three months without pain. On examination it was found to consist of two superimposed nodules on the posterior surface of the testis. The lowermost maas was the sise of a pigeon’s egg; the other was twice as large and separated from the first by a narrow groove. Both nodules were hard and irregular. At operation the epididymis and entire tunica vaginelie were removed. Microscopic examination resulted in the diagnosis of endothelioma of the tunica vaginalis. Eight months after operation there waa a recurrence in the right groin, and the patient complained of painin the left chest. A large mm ww ale0 found in the midabdominal region. Two photomicrographic drawings and a picture of the gross specimen illustrate the text. R. S. FERGUSON 602 ABSTRAOTS

Cue of Induobid Cancer, 0. LAYBB~T.Sur un caa de cancer profemionel, Echo m6d. du nord 36: 457-460, 1932. Cancer of the scrotum waa discovered in a man who was an oiler. The scrotum was ulcerated, and the patient attributed the sore to the irritation of his overalls, which were always soaked with the oil. Examination of the ulcer showed definite induration at the base; tb scrotum was freely movable over the testicles; there were enlargement and induration of the inguinal nodes. Biopsy revealed a prickle- cell epithelioma in a stroma showing inflammatory cellular infiltration. It was removed with the electric knife; the nodes were treated by deep radiotherapy, 5,000 r to each side in daily treatments of 1,OOO r, and disappeared entirely. No follow-up report is made. primug Itpitholioma of the Navicuh Pousa, POTBLAND G. HOUPLIN. L’Bpi- thdlioma primitif de la foeea naviculaire. Echo m6d. du nord 36: 373-378, 1932. The authors note that primary epithelioma of the urethra is a relatively rare lesion, and localisation of the tumor in the navioular fosm is one of the rarest types. They report a case in a man sixty-four years of age, in which the first symptom was an induration of the lower part of the glans penis, followed by ulcerations around the meatus. 6ymptoms had been present two yeere when the patient came for examination, Palpation revealed a hard maw in the right posterior- inferior quadrant of the glans penis, and a alight enlargement of the left inguinal nodes without induration, Cathetenration showed a slight obstruction at the site of the tumor. Partial amputation of the penis was done, to about 1 am. above the balanopreputial groove. Examination of the section showed the tumor just below and a little to the ri@t of the navicular fossa; it had not invaded the corpus cavemosum but was confined to the glans. Histologically it was a psvement-cell epithelioma. The patient made a good recovery. The authors review similar cases reported in the literature, and note that the prognosis is much more favorable than in cancer higher up in the urethra. Partial amputation of the penie usually effects a cure. Carcinoma of the Penis, L. G. GOLDBBIRO.Am. J. Surg. 18: 283-284, 1932. The author reports a case of cancer of the penis treated by conservative amputation. Of interest in the etiology of the tumor was the fact that an incomplete circumcision had been done leaving the mucous membrane of the prepuce adherent to the glans penis. R. 8. FEIBGUSON Carcinoma of the Penis in a Mm of Eighty-five, H. DODD.Tram. Med. SOC. London 54: 143-144,1931, A single case report.

THE NERVOUS SYSTEM A Seder of Tumours of the Netvow Syatem Clarsi5ed According to Modem Methodo, M. GILMOUB. Edinburgh M. J. M.: 83-92, 1933. The author report6 a series of tumors of the nervous system “ aa an example of tbe application of modem methods of clssaification to such neoplaams.” Only two were classified accureitely during life; one of these patients is still alive four months after operation. The remaining twelve were cldedat autopsy, though the clinical diagnosis of epZioma was made during lie. Of the fourteen tumors, only three were fibrillar mtrocytoma (patients’ ages, nine, thirty-four and fifty- THE NElEVOUB SYSTEM 603

mven years); one was an astroblastoma (woman of fortygeven years); six were spongioblsetoma multiforme (ages from twenty-one to fifty years); two were cerebellar medulloblastoma (one solid in a boy of eight years; one cystic in a woman of fifty-six); one a neuroblaetoma of the adrenal medulla, in a boy of two years; one a ganglioneuroma found at autopsy on a girl aged sixteen years who died with acute nephritis and pericarditis. Ten photomicrographs are given illustrating the histology of the tumors. F. CAVIOBS Concerning the Diagnosis of htncranIal Tumors, E. TYTQAT.Remarques concernant le diagnostic des tumeurs c&6brales, Rev. belge sci. m6d. 4: 632- 634, 1932. Brief general remarks concerning the neurologic symptomatology of intracranial tumors. EDWINM. DEIOBY Clinical Aidr in the Dingnods of Brain Tumors, N. W. WINKBLMAN. Pennsyl- vania M. J. 35: 764-757, 1932. The easily recognized syndrome of intracrenial pressure, consisting of headache, vomiting, and choked disk, ia not present in all cases of brain tumor, and for that reason brain tumor should be suspected when suspicious symptoms and signs are present, even though the syndrome be absent. Expanding lesions are probably more common in the brain than in any other one organ of the body except the breast and uterus. Brain tumors may come on acutely, and in older people are edyconfused with cerebral vascular lesions. In all obscure cerebral manifestations brain tumor should be suspected. Convulsions may be the only symptom. The earlier one is able to recognize the presence of a tumor the better will be the clinical results. EDWINM. DEEBY ~eurorurgiccllConrideratiom for the DUO&and Localization of Brain Tumors, T. FAY. Pennsylvania M. J. 35: 762-764, 1932. General remarks which present the contemporary status of neurosurgery. EDWINM. DEIORY

Pmychdr: Itm Importance M a Rerenting Symptom of Brain Tumor, L. J. ADELSTEINAND M. G. CARTER. Am. J. Psychiat. 12: 317-329, 1932. It is generally recognised that patients with brain tumors may show evidence of psychic disturbances, but that patients showing psychotic episodes may have tumor of the brain as the underlying cause has not been given its proper prominence in differential diagnosis. All cases presenting a psychosis should receive a thorough neurologic examination to rule out a posaible organic basis. Visual and auditory hallucinations are of localising value only if separate and distinctly apart from a psychosis. Leeio~of the frontal lobe produce mental symptoms more frequently than those of any other part of the brain except the corpus callosum. Mental symptoms associated with brain tumor may be regarded as focal in nature only if the neurologic examination bears out such a localization. EDWINM. DEERY

Intracnni.l Tumors and Their Surgery, J. DIO BUSECHBR.Tumeulg cMbrales et chirurgie endocranienne, Rev. belge sci. m6d. 4: 536-540, 1932. General remarks dealing with the clinical handling and care of patients SUB- pected of having intraoranial tumors. EDWINM. DEEBY Brain Tumors and Intracranid Surgery, L. VAN BOOABRT.Tumeura &r$bralea et chirurgie endocranienne, Rev. belge sci. m6d. 4: 529-632, 1932. General remarks reflecting the accepted points of view, baaed upon some 70 case8 of brain tumor, 64 of which were verified at operation or necropsy. EDWINM. DEERY 2s 504 UBTRAOT8 Cerebnl Tumors in Children. I tumori cerebrali nel bambino, Pediatria 40: 21S-220, 1932. This is a short review containing no original material. JEAN^^ MUNRO

Symptonutology of Gliomta, R. BBNBIKE.Zur Symptomatologie der Gliome, Zentralbl. f. inn. Med. 53: 1112-1123, 1932. General remarks of neurologic nature reflecting the usually accepted facts regarding intracranial tumors. EDWINM. DEBIBP

Study of Gliomas by the Method of Thue Culture, D. S. RUSSBILLAND J. 0. W. BLAND. J. Path. & Bact. 36: 273-283, 1933. Although the tiesue culture method has until now been little employed in the study of the gliomas, it would appear to be indicated as a means of checking and supplementing the ordinary method of histologic study of these tumors and of testing the reliability of their present claasification. “ Tissue culture should not only allow the forma of individual migrating cells to be studied with greater accuracy than in sections of fixed tissue but, if growth can be obtained, should indicate the stability of the different types of cells.” The authors have cultivated 20 examplee of glioma, and of these 12 gave pod- tive results, that is, active migration of tumor cells. These included medullo- blastoms, oligodendroglioma, spongioblastoma multiforme, astrocytome. Two examples of ependymoma and one of papilloma of the choroid plexus failed to grow, which the authors attribute to the fact that these are slowly growing, circumscribed, relatively benign tumors. Mitotic figures were seen in only two examples of spongioblastoma multiforme. Several media were tried; the most setisfactory was a mixture of one part heparinised human plasma and two or three parts of chick embryo extract. In all cams the first change in the culture was the protrusion of a fringe of fine proceases at the edge of the transplant, followed by the emergence of cells which, whatever their final shape, tended to be of elongated bipolar form, often arranged in a long chain. The cells in forming these chains moved out as units and climbed by ameboid movement along the surface of the chain to reach its free end. The authors’ observations support the classification of Bailey and Cushing, in which specificity is claimed for a number of types of glioma, for the migrating cell in each type preserves to a large extent ita individuality. In spongioblastoms multiforme alone there wm great variety of cell form, many of the cultures showing a mixture of spongioblastic and astrocytic forms with small polygonal and apolar cells, some of the cultures approaching rather closely the picture of undoubted mtrocytoma. On histologic grounds there seems good reason for believing that in most if not all cases spongioblastoma multiforme is derived from setrocytoma by anaplasia, and it is interesting to note that tissue culture reveals an approximation between these two types. Twenty-eight photomicrographs illustrate this paper. F. CAVBIRS Buophil Adextomati of the Pituitary Body and Their Clinical Mrnifemtatiom (Pituitary Basophillrm), HARVEYCUBEING. Bull. Johns Hopkins Hosp. SO: 137-196, 1932. The pituitary gland is probably the master gland of the endocrine series. With this gland, as with OtherR, it has come to be recognised that the degree of secretory activity of an adenoma arising in it is the factor which evokes the recognisable symptom-complex in all hypersecretory states. Twelve cases are described, of which seven occurred in females. The average age of onset of the malady was eighteen years. The female patients all appeared to THE NElBVOUb SYSTEM 506 have been definitely under-sized. The average duration of the disease was slightly over five years. The following features were found characteristic of all cases: (1) a rapidly acquired, peculiarly disposed, and usually painful adiposity confined to face, neck, and trunk, (2) a tendency to become round-shouldered, (3) a sexual dystrophy shown by amenorrhea in the female and impotence in the male, (4) an alteration in normal hirsuties shown by hypertrichosis of faae and trunk in females, (5) a dusky or plethoric skin with purplish striations, (6) vascular hyper- tension, (7) erythremia, (8) backache, abdominal pains, fatigue, and ultimate extreme weakness. A basophilic adenoma of the pituitary body was found in three cases, an “ undifferentiated adenoma ” in two cases, and an “ adenomatous-like atruoture ” in one case. The suprarenal glands showed a cortical hyperplasia in two cases, and a small adenoma in one case. ‘’ While there is every reason to concede that a disorder of somewhat similar aspect may occur in association with pineal, with gonadal, or with adrenal tumors, the fact that the peculiar polyglandular syndrome, which pains have been taken herein conservatively to describe, may accompany a basophil adenoma in the absence of any apparent alteration in the adrenal cortex other than a possible secondary hyperplasia, will give pathologists reason in the future more carefully to scrutiniae the anterior pituitary for lesions of similar composition.” EDWINM. DE~RY X-ray Diagnoei8 and Treatment of Tumor8 in the Region of the Sella, A. B. BLACK. Glasgow M. J. 118: 179-183, 1932. In the making of roentgenograms of the sella, slight deviations from the true lateral position will cause apparently marked deformities. It is important that the position of the patient’s head be carefully adjusted in relation to the central ray. Hypophyseal tumors are intrasellar growths acting to widen and deepen the fosea. Extrasellar tumors cause the sella to become flattened and widened, with a tendenoy towards saucer shape. Of all intracranial tumors, the pituitary adenomas appear to show the most favorable response to roentgen therapy. A short description of the machine and methods of irradiation used are included. EDWINM. DB~RY Remarh on the DiagnoaiS of ChiadLesions from an Ophthalmological Aspect, 8.8. M~I~HAN.Glasgow M. J. 118: 172-178,1932. Patients with chiasmal lesions nearly always seek medical advice first on aacount of visual disturbances. The correct diagnosis from an ophthalmologic point of view is based upon the history, the appearance of the optic nerve heads, and the visual fields. The complaints are usually those of increasingly defective vision and headache. The optic nerve heads show atrophy but no papilledema. Perimetry shows a bitemporal hemianopic defect. EDWINM. DNERY Bedm of Ledom in the Vicinity of the Optic Chiasma: Seven Cases Verified by Operation, J. E. PATDIBSON.Glasgow M. J. 118: 149-171, 1932. The cases reported are as follows. Case I: Early chromophobe pituitary adenoma, transfrontal operation; recovery with marked improvement in vision. Case 11: Advanced chromophobe pituitary adenoma, with large intracranial extension; transfrontal operation; slight improvement in vision. Case 111: Advanced pituitary adenoma with almost complete loss of vision; transfrontal operation; no restoration of vision. Case IV: Chromophobe pituitary adenoma; transfrontal operation; improvement in vision. Case V: Hydrocephalus simulating a suprasellar growth; transfrontal exploration; recovery with amelioration of symptoms. Case VI: Large meningioma growing from wall of right cavernous sinus; partial removal; no improvement. Case VII: Suprasellar meningioma; oomplete removal; recovery with marked improvement in vision. 506 ABSTRACTS

The writer prefers operation first and roentgen therapy afterwards when dealing with the pituitary adenoma. A serious loss of vision may occur during roentgen therapy, and it would seem, therefore, that this method is suitable only for cases where there is very little visual loss to begin with. EDWINM. DEERY

Radiotherapy of Pituitary Tumors, W. HARRISAND H. SELINSKY.Radiology 18: 777-782, 1932. The authors report benefit from roentgen therapy in 7 of 13 non-verified pituitary tumors observed from nine months to six years. While the symptoms did not disappear completely in any of the cases, improvement was noted in the following complaints in the order of their frequency: headache (7); visual disturbances (7); somnolence (4); polydipsia and polyuria (3); overgrowth of bones (3), amenorrhea (3). The authors advise a trial with radiotherapy before deciding upon operation in every case of pituitary neoplasm, except where the intracranial pressure is increased and loss of vision is progressive. In these cases they favor immediate surgical interference. They emphasiee the lack of primary mortality due to the treatment and call attention to the fact that failures are frequently due to the mistaking of a radioresistant craniopharyngeal pouch cyst for a radiosensitive pituitary adenoma. The treatments consist of one or several series each consisting of nine exposures to a frontal and left and right temporal fields. The voltage used in 180-200 k.v., the filter 0.5 mm. Cu plus 1 mm. Al; 172 or 344 r to one of these fields are given every two or three days until a total of 860 r have been administered. After each series an interval of three to six months is allowed. MAURICELBNZ

Resection of Pituitary Adenomata, C. H. FRAZIER.Surg. Gynec. and Obst. 55: 330-335, 1932. The writer employs a transfrontal approach to the region of the optic chiasm. The skin incision is so planned that it is practically all within the ‘‘ hair-line,” i.e., there is no supra-orbital limb to the flap. The skin flap is reflected forward while the bone and temporal muscle are turned down temporalward. The approach to the chiasm is intradural, the dural opening being parallel to and immediately adjacent to the anterior limb of the osteoplastic flap. The sells is reached along the sphenoidal wing rather than directly from before backward. EDWINM. DEERY

Three Different Types of Tumors Arising from the Infundibular Rests of the Craniopharyngeal Duct, H. A. MCKINLEYAND A. WEIL.Arch. Path. 14: 287-288, 1932. At the anterior surface of the infundibulum, islands of squamous epithelium are found, an upper and a lower group, separated by the pars tuberalis. Tumors arising from them groups of cells include adamantinomas, simple squamous epithelial papillary cysts, and more complicated teratomas. Three cases are briefly described: an adamantinoma, a squamous epithelial papillary cyst, and a benign suprasellar growth composed of squamous epithelium and glandular tubules. EDWINM. DEERY

Hydrocephalus Simulating Tumor in the Production of Chiasrrml and Other Purhypophysial Lesions, A. H. H. SINCLAIRAND N. M. DOTT. Trans. Ophth. Soc. United Kingdom 51: 232-246, 1931. The contents of this paper is indicated by the title. THE mBVOUS SY8TEM 607

Melano-epdtheliomaof the Brain (Metastatic), W. M. CRAIQAND J. W. KIORNOFUN. 8. Clin. North Amerioa 12: 989-999, 1932. Two cases are reported. In case I a pigmented nevus had been removed from the skin of the baok two years previously. A large solitary melano-epithelioma was found in the left frontal lobe. The second patient had had a mole which had inoreased in size and then atrophied some seven years previously, A large melano- epithelioma of the left frontal lobe was found. Case I1 oame to nearopsy and no other lesions were found. EDWINM. DIOERY Meningioma of Frontal Lobe, C. P. G. WAKELEY,Proo. Roy. SOC.Med. 26: 305, 1933. A girl of eighteen years had a large, hard lump on the forehead, whioh had been first notioed about fitteen months previously. Roentgenograms showed the appearanoe typioal of meningioma oausing hyperplasia of bone over the tumor. The latter was removed with part of the falx oerebri. The pathologist reported that paraffin blooks were difficult to cut, owing to the toughness and ocoasional oalaifioation of the tumor. Examination showed dense, fully formed, almost non- oeuular, dural fibrous tissue with narrow bands and small islands of proliferating perithelial cells in the olefts or planes between the dense fibrous tissue around the vessels. There are no illustrations. F. CAVIURB

Cerebnl M-nu: Removal of Tumour, C. WORBTER-DROUQETAND C. P. q. WAKIOLEY.Proc. Roy. SOC. Med. 26: 304-305, 1933. A man of thirty-nine years had suffered for over three years from Jaoksonian attaoks affeoting the left leg. Latterly the fits had beoome more frequent. Nega- tive findings are reported for the blood Wassermann, cerebrospinal fluid Wasser- mann, and Lange tests, and for roentgenography of the skull. A tumor the aise of an egg was removed from the right motor oortex; it arose, apparently, from the falx. No histologio report; no illustrations. F. Cav~lss Retro-orbital Meningionu, F. TIR~IION.MBningiome rBtro-orbitsire, Rev. gBn. de olin. et de th6rap. %: 401-405, 1932. A woman twenty-nine yearn of age had three years previously shown a slight direot exophthalmos of the left eye that was reducible. Vision WIM diminished, and there was oongestion of the optia diso. In three years the exophthalmos increased very little and was still reducible. Vision in the eye was almost entirely lost, and the ophthalmoscope showed atrophy of the optic nerve. The movements of the eye were practically normal. For the past six months the patient had noticed a low of sensation on the left side of the head and faoe. Neurologioal tests showed oomplete anesthesia in the region of the htbranch of the trigeminal nerve, and alight hypesthesia in the region of the seoond and third branahes. These symptom indicated a tumor posterior to the sphenoidal fissure. This diagnoeis was ooniirmed by the roentgenogram, which showed a tumor mass, not olearly outlined, in the frontal region. Tumors in the frontal lobe are either gliomas or meningio- mas. A ooneideration of the symptoms in this case in aomparison with other reported oases indicates that the tumor 2s a meningioma. The question of surgioal intervention is a di5oult one, 88 the operation is dangerous and the patient's general condition is good. Cue of Brain Tumour Illustrating the Value and a Posaible Fallacy of Ophthaho- scopy, A. H. H. SINCLAIRAND N. M. Don. Trans. Ophth. Soo. United Kingdom, 51: 246-257, 1931. A woman of twenty-six had had several epileptio seisures during the past year. Just before admission to the hospital she had a transitory diplopia, whioh led to 508 ABSTBACTB an ophthalmosoopio examination., This showed papqedema, whioh immediately suggested the possibility of tumor. The results of the examination made the diagnosis of a meningioma (or endothelioma) attaohed to the dura and bone in the right upper temporal region “ absolutely certain.” At operation the tumor waa oompletely removed; the qatient made a good reoovery and was entirely relieved of symptoms. Four weeb after disoharge from the hospital, there was no residual eeneory or motor impairment, and the optic dieos were practioally normal.

?Cerebellar Tumour, I. J. WOOD. Proo. Roy. SOC.Med. 26: 515, 1933. Brief osse history. The symptoms and signs shown by the patient, a girl of eight years, suggested the diagnosis of oerebellar tumor. F. CAVER8

Typical Midline Syndrom8 Caused by a Tumor of the Vermis, J. EUZIBBBAND H. VIALLEFONT.Syndrome typique o4r4belleux de la ligne m6diane par tumeur vermienne, Aroh. Soa. d. so. m6d. et biol. de Montpellier 13: 564-571, 1932. Desoription of the neurologio signs found in a young man of nineteen years, who had suffered with oerebellar symptoms for two months. Neoropsy showed a voluminous aystic astrooytoma of the fourth ventriole region. EDWINM. D~~RY

Spntaneotu Discharge of Cerebrospinal Fluid From the Nares in the Coune of a Brain Tumor Which Bad Caused Blindneu. Transitory Improvement of Vision, J. EUZIBBEAND H. VIALLIFONT.fiooulement spontant5 par le nes de liquide o4phalo-raohidien, au cours d’une tumeur oddbrale ayant entrefn6 la o6cit4. Amdlioration transitoire de la vision, Aroh. SOC.d. so. m4d. et biol. de Montpellier 13: 536-539, 1932. A man of thirty years had shown eymptoms and signs of an unlooalised intraoranial tumor for over two years, before beaoming blind. A spontaneous dieoharge of olear fluid from the nose occurred and lasted a week. This episode was followed by a return of light peroeption whioh lasted three days. EDWINM. Dnna~

Ependymal Cyst of the Third Ventricle, Associated with Diabetes Mollitus, F. B. BYBOMAND D. S. RUSSELL.Lanoet 2: 278-282, 1932. A oase L reported whiah shows the sssooiation of progreesive diabetes mellitus with a tumor in olose anatomioal relation with the vegetative nervous oenters of the hypothalamus. A neoropsy was obtained, and an ependymal oyst of the roof of the third ventricle was found. The panoreas was normal. It is assumed, but not definitely proved, that the oerebral lesion wss the cause of the diabetes. EDWINM. D~~BY

C-0 Of P@~Io~Of the Choroid Pl~x~r,A. E. SOWBFO~D.Aroh. Db. Child- hood 8: 63-56, 1933. For about two weeks after reoovering from measles a girl of seven years oomplained of headaohe and oramplike pains in the limbs. She then began to vomit nearly all her food and later lost oontrol of the reotum and bladder. Neurologioal examination and lumbar punoture showed nothing abnormal. The ohild remained in a semicomatose state, with frequent vomiting, and just before death developed bilateral optic atrophy. At autopsy a rounded tumor waa found in the lower portion of the left qerebral hemisphere, to the outer eurfaoe of whioh the growth sent a tongue-like prooess. Histologio examination showed the tumor to be a papilloma of the ohoroid plexus, aovered by villous prooesses oontaining a oore of vasoular oonneotive tissue and olad with a single layer of cuboid oelle. THE XCBBVOUS SYSTBM 509

The rarity of these tumors is stressed by reference to Cushing’s estimate that they form not more than 0.5 per cent of brain tumors. From the available literature cited the author concludes that only 55 cases have hitherto been reported, 29 wowring in the fourth ventricle and 16 in the lateral ventricles. Two illustra- tione are given, F. CAVERS Tumors of the SpUCord: Diagnosis and Treatment, A. W. ADSON. Texas State J. Med. 28: 364-360, 1932. Many intraspinal tumors are benign and operable. It is therefore of the ut- most importance to recognize the early symptoms and deal with them before mrious damage to the spinal cord takes place. Tumors arising from the nerve roots, blood vessels, and meninges invariably pass through three distinct cycles: ht,a root cycle with pain; secondly, a partial compression of the spinal cord with Brown-Sequard syndrome; finally, a complete compression of the cord with lose of all motor and sensory functions below the level of the lesion. Besides the history and neurologic examination, spinal manometric studies, roentgenograms, and the injection of a radiopaque 02 provide aids in making a diagnosis. The surgical mortality is about 4 per cent. Recovery from neurologic signs after tumor removal varies from a few months to two years, depending upon the degree and duration of the paralysis before operation. Surgical technic is briefly disauesed. EDWINM. DEERY Progressive Paraplegia, 3Xntmnedullary Spinal Tumour, D. DIONNY-BROWN. Proc. Roy. Sou. Med. 26: 306-306,1933. The nature of the vascular gelatinous intrathecal mass found at autopey in this oase ie left in doubt. The author states that the pathologist’s report had not been received at the time of writing! F. CAVERS Three Cases of Tumor Involving a Peripherd Nerve, J. R. LHIARYONTH.S. Clin. North America 12: 1001-1007, 1932. Case I was a 8arcoma of the ulnar nerve. The tumor had interfered with aonductivity. After histologic verification it was treated with roentgen therapy. Case I1 proved to be a lipoma of the musculospiral nerve, which was completely removed. Case I11 was a recurrent neurofibromatosis, which was treated by both exoision and roentgen therapy. EDWINM. DEBRY Von ReckUaghausen’s Disease, with Report of a Case Involving the External Auditory Cad, HBNBY0. WIBDER. Laryngoscope 42: 364-370, 1932. A white woman of thirty-one had had an obstructing growth of the left external auditory meatus for the past eight years or more. She also exhibited numerous small outaneous growths typical of von Recklinghausen’s generalised neurofibro- mat&. In addition, she had a marked scoliosis and scabbard tibiae. Examination revealed a soft mass, 2.5 om. in diameter, occluding the left external auditory meatus and attaahed over half its circumference to the concha. It extended down the canal to the tympanic membrane. A similar mass 5 om. in diameter was present on the scalp. Both these masses were so soft that they simulated lymphangiomata, but puncture failed to reveal any fluid. No biopsy wm performed, but the clinical opinion was that these lesions were part of a generalised neurofibromatosis. WILLIAMJ. HOFFMAN Case of von Recklhghaumds Disease, J. POULAIN.Un aas de maladie de Recklinghausen, Clinique 27: 219-220, 1932. Surgery is rarely indicated in Realdinghausen’s disease, although the cutaneous fibromm which are a part of the alinical syndrome may reach a considerable size. 510 JUW!MQTS

In the aaee reported the patient WM a woman forty-eight yearo of age, who had had small fibrous tumors mattered over the entire body shoe childhood. Two tumors had reaohed a oonsiderable sire: one on the upper eyelid on the right side, whioh hung down on the cheek, and one on the right flank and back. The latter tumor WM removed and weighed 4 kg. The wound, although large, healed well, but the tumor reourred rapidly. When removed, two months after the first operation, it weighed 3 kg. A month later there WM no sign of reourrence. Hiotologio examination showed no evidenoe of saroomatous degeneration.

THE BONES AND JOINTS Euly Dhgnoda of Malignant Dfreue of Bone, E. P. BBOCXMAN.Practitioner 130: 199-206, 1933. The author’s experienoe leads him to agree ~thKolodny’s statement that “ there uefew ohaptere in medioine where exaot diagnoms in hampered by so many di5oultiea 81 in malignant dim- of bone.” Thanks to the work of the Amerioan Rbgiotry of Bone Sarooma the nomenclature and clasoifioation of malignant bone turnom have been, if not @ally eettled, at any rate rendered simple and dear. The oommonest of the primary tumors in ooteogenio sarooma, whioh oooum oo rarely after the age of forty-five that a bone tumour in a pereon over that age is almoot certainly not a eatooma, exaept in Paget’s dieem, in whioh Mvooma ia known to supervene at a late stage. The author oiteo two OM M exoeptiono to the general rule that pain is the firat symptom; one WM an early owe discovered in routine x-ray examination of a kneejoint for a recent strain of the internal lateral ligament; the other an extensive growth of probably long duration deteoted on x-ray examination of a painleee swollen ankle. The site of a bone swelling is important, 6inoe praotioally 60 per cent of oeteogenio MvcomM start in the lower end of the femur and 26 per oent in the upper end of the tibia. A growth in the middle of the shaft of a long bone is probably either a Ewing’s sarooma or a reoondary growth. In the roentgenogram the ‘‘ typioal ” radiating epiouleo do not dwap oaour; indeed, the Bone Registry reoorda show that only 18 per oent of all dogenio IuToomm have this appearanoe. In a doubtful cam, roentgen therapy rhould always be tried, aiwe it will usually produoe a temporary inoreseed formation of bone and thus settle the diagnosis; it haa no influenoe on an inflammatory aondition. Ewing’s tumor in rarely diagnoeed acourately, being usually treated for a considerable period M a obronio osteomyelitis, a deplorable etate of affhwhen routine roentgenography, whioh should be praotised in all OM of bone swelling, gives suoh a oharaoteristic pioture. Giant-aell tumora and true myelomrs are ale0 usually diagnosed readily by roentgenography. Beoondary malignant growths of bone present diffioulty in the fairly frequent ow8 in whioh the primuy growth oannot be dboovered. In moet OBBBB euch 6eoondary growths do not oauoe pain, but when the body of a vertebra ia involved pain is an early rymptom and ia not relieved by rest. “ The early dialploeis of malignant growths of bone must oontinue to be diffioult, and it would oeem that, though certain symptoms may suggeot their prmenoe, by the time they beaome at all obvious the growth in already in an dvanoed stage.” F. CAVERB hrmon of Bone, MALCOYTROMPEON. Am. J. Burg. 19: 230-243, 1933. Thompson gives in abtraat form the various oharaoteriotioo of benign and malignant tumors, inflammatory lesione, and metabolio dieturbanoes in bone. No new material is added. BIDHUMIN R. 8RORB THE BONm AND JOINTS 511

Dimmion of the Dingnods and X-ray Treatment of Malignant Disease of the Bone, 8. MOOB~.Am. J. Surg. 18: 403-416, 1932. Moore introduces his subject with a discussion of the classification and ter- minology of malignant diseaee of the bones. In the hospitals allied to the Wash- ington University School of Medicine in St. Louis there have been 228 cases of sarcoma with 96 examples of primary malignant bone tumors in 123,285 hospital admissions over a period of eighteen years. Unless the several malignant affec- tions of the skeleton can be diagnostically differentiated, no intelligent method of dealing with them can be evolved. If the patient is young, with involvement of the bones distal to the knee or elbow, and the tumor is single, one can assume that it is a primary growth. If there is a diffuse bone lesion involving many portionsof the skeleton and indicating a centrifugal spread, one is not dealing with a primary bone tumor. Radical surgical removal is recommended for all osteogenic sarcomas of the extremities in which evidence of metastasis to distant organs ia lacking. Surgery should also be used as a palliative form of therapy for large ulcerating tumors or when pathologic fractures of the long bones cause pain and inconvenience. Radia- tion ia used in all cases of endothelial myelomaa, multiple primary bone tumors, and in all cases of secondary involvement of the skeleton. The author believes that there have been enough examples of the cure of giant-cell tumors by irradiation 80 that this agency should be the first choice in the treatment of these cases. Exaeptions to this are to be made when the tumor is of such great siae and so located that repair cannot be hoped for or when a joint has been destroyed so that recovery would result in a stiff or useless limb. Amputation is preferred in this latter group of cases. The article is illustrated with drawings, photographs, roentgenogram, and photomicrographs. B~NJAMINR. SHOBEI

Thomtraat Meriography of the Limbs, R. DOS SANTOS,C. LAMASAND J. P~R~IBA CALDAS. L’srtBriographie des membres, Bull. et m6m. SOC.net. de chir. 58: 636-663, 1932. The eenior author of this interesting paper, which is illustrated by a series of eighteen fine roentgenograms (contrast arteriograms), has used thorotrast (tho- rium dioxide) as contrast material in arteriography. Judging from the present report he has obtained very satisfactory results. Thorotrast has proved to be free from the drawbacks of the materials previously used for this purpose (sodium iodide, utoselectan, abrodl), namely, general toxicity, irritation of vessels, and pain. The most striking results have been obtained in the demonstration of aneurysms and other vascular lesions, but the pictures of bone turnore (8 cases atudied) are extremely interesting. The method serves to distinguish ischemia in caaea of osteomyelitis and syphilis from the new vascular formations observed in tumors, especially sarcomas. This new vessel formation, on the other hand, is quite &tinct from the inflammatory hyperemia seen in tuberculosis and other non-neoplastic processes producing rarefaction of bone. One of the most interesting cases described is that of an osteogenic sarcoma of the left radius in a girl of three years. This was a hard, painful tumor of orange sise. The arteriogram shows the characteristic copious network of new vessels. Deep x-ray treatment was given until pain and tumor had disappeared and freedom of wrist movement restored, when the arteriograms showed complete disappearance of thg abnormal circulation. F. CAVERS

Pathological Fractures, P. L. HIPSLIOY.M. J. Australia 2: 743-746, 1932. In this general discussion of pathological fracture the author includes a brief discussion of osteogenic sarcoma, Ewing’s tumor, and multiple myeloma, all of which are frequently associated with fractures. Osteitia fibrosa and osteitis deformans are ale0 mentioned. 512 ABSTRACTS

Factors Influencing the Types of Metastatic Carcinoma of Bone, E. E. DOWNSAND W. S. HASTINGE.Am. J. Roentgenol. 29: 1-7, 1933. An apparent parallelism between the capacity of primary tumors to produce connective tissue and the appearance of bony tissue in their metastases has been noted. In a series of 30 cases of various kinds of carcinoma with bone metastases a close parallelism was found between the connective-tissue reaction in the primary tumor and the type of its bone metastases. One of the best examples of the tumor without any power of desmoplasia is the hypernephroma; in none of these cases was a tendency towards sclerosis found in the bone metastases. The article is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHORE

Roentgen Therapy in Bone Metastasis of Carcinoma, K. W. STENSTROMAND L. G. ERICKSEN.Radiology 18: 741-753, 1932. The authors have studied the records of patients treated at the University Hospital (University of Minnesota) with high-voltage roentgen therapy since July 1926 in regard to metastatic carcinoma of the bone. The survey covers cases of carcinoma of the prostate, breast, thyroid, cervix, and corpus uteri, and of hypernephroma and melanoma. Tables show the findings in detail, including the bones involved, method of diagnosis, type of metastasis (osteoclastic or osteoblastic), the time interval between radical operation of the primary lesions and first treatment of bone metastasis, also between this treatment and the last time the patient was seen, number of complete treatments, and improvement of pain and of the lesion as shown by x-ray films. Most of the patients, particularly those with metastatic lesions of the osteoclastic type, benefited by high-voltage roentgen therapy. Though the improvement was of rather short duration for the group as a whole, it was quite remarkable in some few instances, and the authors conclude that it is of definite palliative value. Several cases are reported.

Clinical Classification and Characteristics of Sarcomas and Giant-Cell Tumors of Bone, H. HELLNER.Klinische Einteilung und Abgrensung der Sarkome und Riesenselltumoren des Knochens, Fortschr. a. d. geb. d. Roentgenstrahlen 47: 1-20, 1933. Hellner discusses the classification of sarcomas of bone and believes that at the present time division of theae tumors from the clinical, radiologic, and pathological standpoint8 into osteogenic sarcomas and Ewing sarcomas is sufficient. Classi- fication of individual tumors into central, peripheral, periosteal, or myelogenous types is unsuitable. Myelomas belong to diseases of the hemoblasts and should be separated from true bone tumors. The giant-cell tumors are considered to be granulomatous in character, benign, and not truly neoplastic. The characteristics of several types of bone sarcoma are given, and statistics are quoted from the literature. The article is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHORE

Osteogenic Sarcoma, Classification, Treatment, and Results. R. SOEUR.Sar- comes ost6ogCniques, classification, traitement; resultats, Scalpel 85: 465-487, 1932. A survey of bone tumors, the scope of which is indicated by the title. Noth- ing new is included. TIW Born AND JOINT8 513

Changw in Bone Sarcoma after htravenoue Injections of a Colloidal Solution of Metallic Arsenic, A. C. HENDRICKAND E. F. BURTON. Canad. M. A. J. 28: 19!2-194, 1933. The author reports a case in which a swelling diagnosed as a sarcoma involved the lower third of the femur. Treatment consisted in high-voltage x-ray. After seven months, roentgenography revealed a fracture, and the patient was then giveq, in addition to x-ray therapy, intravenous injections, three times a week, of colloidal arsenic. After four months the fracture had united, and three months later the areas of bone destruction in the lower end of the femur appeared to be diminishing in sise, and the general appearance indicated quite definite increase in calcium content throughout the involved section of the bone.” In a previous paper (ibid. 24: 642,1931, abst. in Am. J. Cancer 16: abst. p. 704,1932) four cams of bone tumors treated in this way were reported; two of these patients are still living. F. CAVBIBS Primary Sarcoma of the Skull, HAROLDL. Foss. Pennsylvania M. J. 35: 567- 568, 1932. A woman of forty-six had a growth on the scalp over the occipital region, measuring 5 om. in diameter, a recurrence of a tumor removed a year earlier. The mwwas excised and found to be a spindle-cell sarcoma. It recurred rapidly and ten days after operation an extensive cautery excision was performed. In all, eleven recurrences were removed. Microscopic examination of the specimens showed spindle-shaped cells with hyperchromatic nuclei and many mitotic figures. A year after the last and most extensive operation there was no sign of local recurrence. Cue of 0steouucom.a of the Femur, MILDONADO. Un case de osteosarcoma del fdmur, Ana. SOC.mt5d.-quir. del Guayas 12: 111-113, 1932. An account is given of a fracture due to trauma taking place in the femur already the site of a sarcoma. Increased pain, complete disability, and rapid increase in siae followed. Both the tumor and the fracture were observed with x-rays. JOFIANNIOBP. M. VOQEUAR Sarcoma of the Femur Following Amputation and Radiotherapy, HENRYW. MIOYBIBDINQ.Surg. Clin. North America 12: 878-880, 1932. The patient reported by Meyerding was a man thirty-four years of age who, after three months of disability in the right knee fell and sustained a pathological fracture of the lower third of the femur. Roentgenograms showed a large tumor involving the aondyles and lower part of the bone, with no evidences of pulmonary metastases. A diagnosis of sarcoma was made and amputation was performed. The pathologist’s diagnosis was medullary sarcoma with foreign-body giant cells. Two series of low-voltage x-ray exposures were given to the pelvis. The patient hee no evidence of local recurrence eight years later. The article is illustrated with roentgenograms, but unfortunately photomicrographs and a description of the histologic appearance of the tumor are omitted. BIDNJAMINR. SHORID

Malignant Giant-cell Turnour of Bone, E. 8. J. KINQ. Brit. J. Surg. 20: 269-278, 1932. After a brief general survey of giant-aell tumors the author remarks that most of the modern reports emphasise the apparent impracticability of distinguishing between benign and malignant growths except by keeping the patient under prolonged observation. He reports a case of giant-cell tumor occurring in a man of fifty-eix, who sought treatment in 1928 for a lump on the right wrist. The latter 514 ABSTRACTS

had been injured in a fall five years previously. Some time after the fall the patient noticed a swelling on the outer side of the lower part of the forearm. This had remained almost stationary in size until two months ago, when it began to be painful and to swell rapidly. The x-ray appearances were typical of benign giant- cell tumor. Roentgen treatment was given, but increase in size continued and pain was not relieved. The author removed the lower quarter of the radius and introduced a bone graft. Six months later fracture occurred through the graft, owing to recurrence of the growth, and the forearm was amputated at the middle. A year after this a nodule was seen in front of the elbow (enlarged epitrochlear lymph node?). This grew rapidly in size, and amputation was then performed through the neck of the humerus. Shortly after this second amputation the patient complained of cough and of loss of weight and appetite. Roentgeno- grams of the chest revealed shadows suggestive of metastases in both lungs. Two months later death occurred; autopsy could not be obtained. The author says that the portion of the original tumor examined histologically showed the characters of benign giant-cell tumor-numerous giant cells of myeloid type, a cellular stroma containing a large proportion of spindle cells, and considerable hemorrhagic areas. Later he examined other parts of the tumor and found larger numbers of mitoses and greater preponderance of spindle-cell tissue. He therefore emphasizes the importance of making a thorough histologic investigation of every giant-cell tumor, since histologic differentiation of the malignant from the benign forms should be possible. During the last few years the author has seen six cases in which the question of type and malignancy of the growth arose, all of which proved to be malignant. There are ten illustrations, including good roentgenograms and photomicrographs. F. CAVERB

Giant-cell Tumor of the 0s Calcis: Report of a Case Treated by Resection and Tendon Transplantation, L. J. MILTNERAND F. E. WAN.J. Bone & Joint Surg. 14: 406409, 1932. In a recent review of the literature Moore (Radiology 16: 232, 1931) found only four cases of giant-cell tumor of the calcaneus; to these he added three cases found in a study by Bloodgood and his associates, of 1740 bone tumors. The authors report an additional case, occurring in a man of twenty, who complained of pain in the right heel which had grown progressively worse for two years. X-ray showed expansion of the bone, the cortex of which seemed to be intact. After careful consideration, the following plan of treatment was carried out: (1) the diseased bone was removed in its entirety through a wide U-shaped incision; (2) the Achilles tendon was lengthened and its lower end fixed to the postero-inferior part of the astragalus through drill holes in this bone, as it was hoped by this means that the calf muscles might still be of use even though placed at a great mechanical advantage; (3) the foot waa held in 45O plantar flexion during the tenodesis and, following closure of the wound, a long leg cast was applied with the ankle in the same position. On removing the cast, two months later, the Achilles tendon was found to be strongly active in its new position. During the next month a removable splint in 45" plantar flexion was used, and the patient received daily baking and massage. A suitably fitted boot was provided enabling him to walk well and without pain. Histologic examination showed the typical characters of giant-cell tumor with cyst formation. There are five illustrations. F. CAVER8 Ewing Bone Sarcomas, J. BORAK.Zur Kenntnis der Ewingschen Knochensar- kome, Arch. f. klin. Chir. 172: 301-338, 1932 Borak bases his discussion of the pathology, diagnosis, and treatment of Ewing bone tumors upon the study of 8 cases which he observed between 1923 and 1931. There were 5 males and 3 females, the oldest patient being twenty- THM BONRS AND JOINTS 515

seven and the youngest five years of age. These tumors, like other round-oell sarooma.9, are radiosensitive. Retrogression oan be observed hietologioally a few hours after radiation, olinioally after a few days, and radiologioally after a few weeks. This therapeutio test is useful hi the diagnosis of oentral bone tumors, as those which do not respond to radiation are probably not Ewing tumors. The article is illustrated with photographs, roentgenograms, and a photomiorograph. BENJAMINR. BEORB Cue of Primuy Angio-Endotheliomn of the Pubic Bone, J. E. BARRY. Canadian M. A. J. 26: 202-204, 1932. Malignant angio-endotheliomasof bone are extremely rare, only 2 cases being reported by the Registry of Bone Barooma. In the author’s case the patient was a male sixty-five years of age, whose first symptom was a sudden sharp pain in the right groin. Examination showed a tumor involving the right pubio bone, isohium, ilium and femur; no evidence of a growth in other bones or in the viscera oould be found. Histologio examination showed the tumor oells to be polyhedral and flattened or oylindrioal, with pale cytoplasm, well defined oell membrane, and somewhat eccentrio nuoleus; multinucleated oells were also preeent. The oells showed an alveolar arrangement representing blood vessel ohanneb, some of the channels oontaining red blood oells and tumor oeb, or tumor oells alone. Trabe- culae of osteoid tissue and bone were soattered throughout the tumor; and there were many areas of necrosis. The regional lymph glands were invaded by tumor oells.

Primary H.emangioaw of the Spine, LRIONARDBARNARD AND R. G. VANNUYS. Ann. Burg. 97: 19-25, 1933. The authors report two oases of hemangioma of the spine. The first patient was a woman twenty-two years of age with an indefinite lemon of the body, aroh, transveme prooess, and pedide of the third lumbar vertebra. The preoperative diagnoeis of hemangioma was confirmed by histologic study of a biopsy speoimen. Roentgenograms taken after operation and deep roentgen-ray therapy showed a reorudesoenoe of the lesion with increasing density in the bony structure of the vertebra. The seoond patient was a woman forty-two years of age in whom a porous tenth dorsal vertebra with diminution in the number of lamellee was demonstrated in roentgenograms. As there was no progress in the disease over a period of three years, nor any improvement following deep x-ray therapy, the diagnosis is rather indefinite. The artiole is illustrated with roentgenograms and a photomicrograph. BENJAMINR. BEORB Mydomn of the Lower End of the hdiur, C. P. G. WAKBLEY.Proo. Roy. Soo. Med. 26: 531-532, 1933. A man of twenty-eight had noticed about a year previously loss of power of grip in the right hand; pain and swelling had only recently supervened. Roentgen films showed the typioal appearance of “ myeloma ” expanding the bone. The swelling was opened, a soft hemorrhagio tumor removed, and the oavity swabbed out with absolute aloohol and Wed with ohips of bone taken from the right tibia. Three illustrations are given, two being good photomiorographs showing the features of giat-cell tumor. F. CAVERS Purcortd Fibromyxomn of Vertebral Column, Removed by Tnnspleunl Route, B~I~RDAND ARNULF. Fibro-myxome paraoostal de la oolonne verthbrale d6veloppd dans l’hhmithorax droit. Ablation par voie tranepleurale, Lyon chir. 29: 213-218, 1932. A woman of thirty-six oomplained of symptoms first noticed six years previously, a sensation of oold in the right side of the trunk and severe paine radiating 616 ABSTUOTS

from the spine to the sternum on that side of the thorax. Recently the intercostal neuralgia had become worse. X-ray films taken by the medical attendant showed a rounded shadow in the tight half of the thorax. On admission to the hospital the patient began to cough up large quantities of mucus containing debris resembling grains of tapioca. In the x-ray films the shadow was seen to lie in contact with the vertebral column. The blood Wassermann test was negative; the white blood cell count showed 11 per cent eosinophiles. The eoeinophilia, together with the multilocular, cyst-like appearance of the shadow and the grow characters of the sputum [not, apparently, examined microscopicallyl, suggested a diagnosis of intrathoracic hydatid cyst, or perhaps dermoid cyst. Aneurysm seemed to be ruled out by the negative Wassermann and absence of history or signs of syphilis. The outlines of the tumor were marked on the skin and an incision wan made starting 3 cm. from the spine; three ribs were resected and the tumor was removed without much difficulty. It meanured 10 om. in diameter, was of pale red color, and proved on histologic study to be a multilocular cystic fibromyxoma showing no sipof malignancy. The authors briefly &cuss the differential diagnosis of rounded intrathoracic roentgen shadows and advise that in every case in which the tumor seems to be acceseible operation should be performed. They submitted their x-ray films to several radiologists, the majority of whom said that they would not have diagnosed hydatid cyst in this cam because the shadow was not clear in the center with a dark outer none but showed clear areas scattered through the maas. [The only illustrations given, two roentgenograms, do not show these areas but merely a homogeneous shading.] F. CAVEBS

Rhabdomyoma of the Extremities, P. MACCALLUM.Australian and New Zealand J. Surg. 2: 296-308, 1983. The author describes two cases of malignant rhabdomyoma, one arising in the brachialis anticus, the other in the gastrocnemius. In the first case there was local recurrence after excision of the growth, with palpable axillary nodes; amputation through the shoulder joint was then performed, and the patient died a month later of “ pulmonary embolism.” Lung metastaeis was suspected, as the axillery nodes showed the same structure as the primary tumor, but autopsy was not allowed. In the second cgee there was local recurrence within eighteen months after excision, and the requrrent tumor ulcerated through the skin; the patient died two months after readmission to hospital, but no metastases were found at autopsy. The author discusses the pathogenesis of tumors arising in striped muscle, with special reference to *om showing malignant characters, clinically or histologically or both, and points out that in many cases thew tumors show such a degree of anaplasia that careful cytologic examination of specially fixed material, as compared with ordinary formalin specimens, is necessary in order to demonstrate their real nature and origin and to distinguish them from sarcomas arising from connective tissue. In the majority of rhabdomyomas there is little approach to the arrangement of voluntary muscle; the cells in some areas may be set in parallel bundles, while in others they interlace or are arranged quite irregularly. The individual cell components &OW great variety of form, the majority being of embryonal type, chiefly spindle-shaped. In general, the more slowly growing the tumor the nearer do its cells approach to Werentiated muscle. There are sixteen illustrations, mostly phototnicrographe of good quality. F. CAVERS THE BONm AND JOINT8 617

J\utr-uticutu OIoiiiCrtionr and Treatment of Osteomoe, PAITRB. A propos des oeeifications para-articulaires et du traitement des ost4omes, Sac. de m6d. mil. franp., Bull. mens. 26: 89-91, 1932. From a radiographic study of juxta-articular osteoma in the region of various joints, the author concltdes that they are new formations of bone tisaue in the soft parts, resulting from traumatism. They do not involve the joint structures, but there may be a slight area of decalcification in the immediate vicinity of the osteoma. The author has sought to diminish the incidence of such osteoma by the Leriche method of early infiltration of the injured ligaments with novocain. He has used this method for a year and has not observed any juxta-articular osteomata in patients so treated. For the treatment of developing osteoma, he has found prolonged immobiliaation of the involved part superior to radiotherapy. He has never seen an osteoma absorbed under the influence of radiotherapy; but has ocoeeionally had this result with complete immobilization. The latter is a logical method, as it allays pain and prevents " functional micro-traumatisms " that are sources of irritation, and thus the chief factor in the production and development of osteoma. Immobilization fails in many cases, however, so that the author does not feel that he can recommend it to the exclusion of other methods.

Internal and Extemal Paracondylar Osteoma of the Knee, P. RAZEMONAND M. LAMBRET.Ostt5omes paracondyliens interne et externe du genou, Echo m6d. du nord 36: 6e.68, 1932. The authors report a case '9 which the x-rays showed both an external and an internal paracondylar osteoma in the right knee joint following an accident with fracture of the internal meniscus. Internal paracondylar osteomas are frequently observed, but no other case was found reported of an external osteoma of this type. The latter grew more rapidly than the internal osteoma. [See also Patel: Lyon chir. 28: 782, 1931. Abst. in Am. J. Cancer 16: abst p. 1285, 1932.1

Osteolipomas, G. NEUQEBAUEB.Zur Klinik des Osteolipoms, Med. Klin. 28: 1531-1533, 1932. Neugenbauer reports the case of a woman fifty-seven years of age whose right leg was amputated at the mid thigh because of a painful, undiagnosed pathological lesion at the knee joint. Examination of the specimen showed a yellowish, irregular, degenerated area involving the lower end of the femur, joint surfaces, and upper end of the tibia. Histologio examination of time from this area showed a diminution in the bony trabeculae with a large increase in fatty tissue. The diagnosis of lipoma of the bone was made. The article is illustrated with a roentgenogram but no photographs or photomicrographs are included. BENJAMINR. SHORE

Chondronu of the Intervertebral Disks, B. J. ALPEW, F. C. GRANT,AND J. C. YA~KIN.Ann. Surg. 97: 10-18, 1933. The authors report a case of chondroma of the intervertebral disk in a woman forty-nine years of age, occurring three years after severe trauma to her back. At operation a whitish extradural mass was found impinging on the cord from in front and involving the nerve roots emerging from the third lumbar segment. The tumor was removed with a curette, and the patient made a satisfactory postoperative recovery with complete relief of the pathologic neurological signs. Chondromas or endochondromas of the intervertebral dish, fibrocartlaginous extensions of the disks, and cartilage nodes are terms which have been given to small cartilaginous extensions into the spinal canal causing compression of the spinal cord; all probably refer to the same process. It is benign and amenable to 518 ABBTBhaTB surgioal treatment. Similar extensions into the bodies of the vertebrse have been desaribed but are symptomlem. A short dieouseipn of the literature oonoerning these oartilaginous tumors ie included. BBNJAMINR. SHOX~ S.crococcygeal Chordoma: Report of a Came, H. C. Pa. Chinese M.J. 46: 486- 464, 1932. A Chinese man, sixty-two years old, had a tumor over the right buttook whioh had appeared two years earlier, some months after a fall. He oomplsined of pain along the right leg and thigh and diflioulty in urination and defeoation. The tumor waa firmly fixed to the bone and had invaded the gluteal mudm no that exohion waa neoeeesrily inoomplete. A year later the patient WM again seen. The tumor had gradually inorewd in sise and symptom had reourred. It now memured 18 X 10 X 6 om. AB before, x-ray examination showed rarefaotion of the saorum. No further operation was done. Numerous photomiorographs aeoompany the pathologio desoription of the primary growth. The author follows hb owreport with areview of the literature and tabulations of the reported oa9es with metastases and reourrenoe. Etiology, Dirqromim and Therapy of OsteStim Fibroma, J. SIQBL. Zur Aetiologie, Diagnose und Therapie der Ostitb fibrosa. Med. Kor.-B1. f. Wurttemberg 102: 237-240, 1932. The author oldes the oeteodystrophia fibrosa syndromes, with regard to etiology as follows: (1) osteitb fibroea, inoluding (a) generalired oateith fibroee (von Reoklinghausen’s diserse) oaused by endoorine dyafunotion and (a) looabed oeteitia fibrosa which may or may not be caused by endoorine dysfunotion; (2) oeteitb deformans, inoluding (a) multiple osteitb deformam (Paget) oaused by endoorine dysfunction and (b) solitary oeteitis deformam, whioh may or may not be oauaed by endoorine dyafunotion. The diagnosis is usually made by the x-ray examination, sometimes by biopsy. Dhgaomim and Treatment of Genenllzed Omteitim Fibroma with Hyperpunthy- roidfrm, R. C. ELMBLIB,F. R. FBASIER,T. P. DUNEILL,R. M. VICK, C. F. HAERIS,J. A. DAOPHINU.Brit. J. Burg. 20: 479-507, 1933. The authors present a detailed but aondensed report of their joint investigatiom of three ow0 in whioh the bone diseaae and signs of hyperparathyroidiem were acoompanied by parathyroid tumors, and one in whioh no parathyroid lesion waa found at operation. In two of the three former oases the olinioal and roentgenographic atudies extended over periods of mx and seven years. This gives speoial value to the findings, whioh are fully tabulated and mt forth in graphia form. The authors point out that an abnormally high level of mrum oaloium is not always found in thew ows, but in the three tumor o~esthere waa oonstant inorewe in the urinary eeoretion of aalaium. After removal of the tumor there was striking improvement in general health, oessation of pain, and no further fractures of bone. Thie careful and oritioal paper should be read by thom interested in the aubjeot. There are thirty-one illustrations, inoluding good roentgenogram and photomiorographs. F. CAVSIBS Pathological and TJmoretiarl Invemtigatiom Concoming voa Re&inghaumenLL’m Omtdti8 Xibrou and Itm Robtion to -*id Tumorm, H. HANKB.Patho- loghahe und theoretisohe Untersuohungen Bber Osteodystrophia fibrosa (von Reoklinghausen) und ihre Besiehung su Epithelkthperohentumoren, Aroh. f. klin. Chir. 172: 368-402, 1932. The author reports in detail the olinioal histories and autopsy findingo in two cases of generalired oeteititl fibrosa. The maoroeoopia and miorosoopio bony THE BONEIS AXD JOINTS 519 changes were typical. In each case bilateral tumors of the parathyroid glands were demonstrated at autopsy. In one case the tumors had the structure of adenomas and were composed of eosinophilic cells. In the other case the tumors showed areas of large clear cells with small eccentrically placed nuclei. No correlation between the histologic structure of the parathyroid tumors and the skeletal changes could be made. The article is profusely illustrated with roentgenograms, photogrephe of gross specimens, and photomicrographs. BENJAMINR. SHORE Parathyroid Osteodyatrophy (Oeteitie Fibrosa), J. W. STRUTHERB.Edinburgh M. J. (Tram. Med.-Chir. SOC.Edinburgh) 40: 37-44, 1933. The author first describes three cases of cystic osteitis fibrosa showing the typical syndrome, including spontaneous fractures, parathyroid tumor, and increased blood calcium. The patients were a man of forty-seven and two women aged thirty-eight and forty-eight. In the fist case, autopsy revealed, in addition to the bone lesions, numerous deposits of calcareous matter in various parts of the body, and an ovoid tumor one inch long below the left lower pole of the thyroid. The normal four parathyroid glands were also present; the tumor showed the histology of a parathyroid adenoma. All three patients were very frail and em& oiated, and all died soon after admission to hospital. The second alone was operated upon, dying a few days afterwards. The author also describes two cases occurring in children of six and nine years. The bone lesions clinically and roentgenographically resembled those of generalired osteitis fibrosa, but there was no evidence of parathyroid tumor or of disturbed calcium metabolism. F. CAVERS

Cam of Parathyroid Tumour Aslodated with Generalized Oeteitie Fibrosa, H. COHBNAND R. E. KBLLY. Brit. J. Burg. 20: 472-478, 1933. The patient was a woman of forty-eight years, with a history of appendicec- tomy and also nephrotomy for calculi. The parts of the skeleton affected were the mandible and the tibia on both sides. Although there was no apparent swelling of the neck during repom, a distinct fullness was noticed in the right side when the neck waa stretched backwards over a sand-bag. At operation this was found to be due to a tumor of the right inferior parathyroid gland, lying between the trachea and the carotid sheath and easily removed from the right thyroid lobe by dissecting a few adhesions and ligating the supplying artery. A smaller tumor embedded in the right thyroid lobe was also removed and found to be a thyroid adenoma. The condition in the bone (biopsy of femur) was typical osteitis fibrosa, the formation of imperfect bone being in excess of resorption. Before operation hypercalcemia was present, 13 to 17 mg. per 100 c.c.; the plasma inorganic phoe- phorus was 2.4 to 2.6 mg.; the average calcium excreted per threeday period, on a diet containing 160 mg. calcium daily, was 0.63 gm. in the urine and 0.61 gm. in the feces. After operation the serum calcium fell to 8 mg. per 100 0.0. and the plasma inorganic phosphorus was 2.8 mg. A month later the average calcium exoreted per threeday period, on a diet containing 160 mg. calcium daily, was 0.2 gm. in the urine and 0.45 gm. in the feces. The authors note that the chief feature of their case was that on purely roentgenographic evidence the condition of their patient had been previously diagnosed by others as leontiasis ossea, as osteitia deformans, and as chronic osteomyelitis. This illustrates the necessity for full metabolic investigation in oases of generalised bone disease. There are thirteen illustrations. F. CAVNRS 520 ABSTBbOTS

Oateitb Cyatica of the Upper End of the Humerus, BADOLLQ,CHIVALIBIB, AND A. DUPONT. Oeteite kystique de I’extr4mit4 sup6rieure de l’hum4rus, Loue m6d. 16: 205-207, 1932. In a spontaneous fracture of the upper end of the humerus the radiogram showed an area of osteitis oystics. Since operation was refused, the fracture was treated by aontinuous extension, and healed rapidly, the arm having good funation. Another radiogram showed that the oyst WBB largely filled in, only three transparent areaa remaining. Cue of FdOateitis Fibrou, G. B. WOOD^ WAGEBB. Lancet 1: 23-26, 1932. A girl of fifteen htoomplained of stiffnem of the right knee and diffioulty in walking at the age of twelve. She was treated for flat feet and improved temporarily. She then beoame knook-kneed and was operated on with some improvement. Her only aomplaint when she WBB first seen by the author was atifinem of both lege. There were no fraotures. The skull waa irregular, with three large, painleea bony boeees. Radiologioal examination showed extensive osteitis fibroma. Hietologio examination of a fragment o€ rib aonfirmed this diagnoeis. X-ray therapy waa given without obvious result. Radiographic Symptomatobgy of Osteitb Dofornuns (Periostd Bone Fom- tion), F. WINDHOLZ.Zur R8ntgensymptomatologie der Ostitie deformans Paget (perioatale Knoohenneubildung), Fortsohr. a. d. geb. d. RBntgenstrsh. 46: 188-193, 1932. Subperiosteal ossification has been observed in owof osteitis deformam and oeteitis fibroea oystioa and is of little use in the differential diagnosis of these oonditions. It has been found laolring in the initial stages of Paget’s diseaee and in the unafTected bones of patients with advanoed Paget’s diseaae. The artiole is well illustrated with roentgenograms. BBNJAMINR. SHORBI

THE LYMPHATIC SYSTEM, THE LEUKEMIAS, HODGKIN’S DISEASE

Lymphadonoma with Relapsing Pyreria, D. HALL. Lanoet 1: 136-138, 1933. A woman of sixty-three yeare, when fust seen by the author in 1927, gave a history of having noticed enlargement of oervioal nodes about 8 year prevloudy and of having declined advioe to have them removed. Soon after the swellings appeared she began to have attacks of fever (102’ to 104’) lasting for three to five daya in every fortnight. The febrile periods were aooompanied by breathleasnese and heavy sweating. Exaept for these periods she had felt better since a ooume of araenia and x-ray treatment to the neck. Examination revealed enlarged nodes dso in the left axilla and left groin, but no evidence of enlargement of spleen, liver, or medimtinal nodes. The blood count during a normal period showed 7,400,000 red oella and 13,100 white oells (31 per oent neutrophils, 67 per cent lymphocytes); hemoglobin 112 per cent, color index 0.8. Counts taken during a febrile period averaged nearly the same. Hodgkin’s disease waa diagnosed. The spleen now steadily increased in sine, but not the external lymph nodes; the patient lost weight; edema of the lower extremities developed, and death ensued twenty-one months after the appearance of the enlarged oervioal nodes. At autopsy the bronohial and retroperitoneal nodes were found enlarged, and histologic examination of these oonfirmed the diagnosis of Hodgkin’s dieease already made from biopsy of the external nodes. The bone marrow, taken from the middle of the femur, was of chooolate color; smears showed abundant normal red oella and a fair number of normoblaets, but no megaloblaats; there were large masses of lymphooytes, scanty neutrophils and ocoaaional eosinophils and baso- phils. F. CAVERS THE LYMPHATIO SYSTEX 521

Lymphourcoma of the Femur, E. A. POHL~AND GORTONRITCHI~. Radiology 18: 635-637,1932. A man of thirty sustained a fracture of the left femur in March 1931. In May the leg broke again. When the patient was first seen he had tender swollen bony masses over the head of the right radius, over several ribe, and on the right parietal bone, and a draining sinus in the mid-portion of an old surgical incision on the anterior aspect of the left lower thigh. While the presence of productive bone changes suggested osteomyelitis, there were also several areas of destruction which indicated metastatic malignancy. The latter impression was borne out by the fact that similar destructive lesions could be seen in the neck of the left femur, the right ilium, the right upper radius, right parietal bone, and 6fth and sixth right and eighth left ribs. Microscopioally the tumor proved to be lymphosarcoma. The growth in the femur was believed to be the primary one. Roentgenograms and photomicrographs illustrate the report. Partial Gastrectomp for Lymphoearcoma in Childhood, VEIRNBC. HUNT. Ann. Burg. 96: 210-214, 1932. Hunt describes the resection of a portion of the stomach in a boy three years and eight months of age for a lymphosarcoma of that organ. The child made a good postoperative recovery and at the time of the report had remained well for a short period after operation. The growth in the stomach was cuneate in shape, was situated at the pylorus, and measured 10 X 5 X 2 am. Sections showed an extremely cellular growth involving the muscularis of the stomach wall and covered by intact mucosa. Mitoses were numerous. The regional lymph nodes showed only hyperplasia and hypertrophy of the follicles. Hunt believes that his patient is the youngest in whom a radical surgical removal of a sarooma of the stomach has been recorded. The article is illustrated with a photograph of the gross specimen and photomicro- rnPh8. BBNJAMXNR. SHOBBI

Myeloleukaemoid Blood Picture Associated with Tuberculosis, R. P. CUET~RAND W. J. CROCKIMI.Folia haematol. 46: 359-366, 1932. A report of two cases showing the clinical characteristios of true myelogenous leukemia, but on necropsy proving to be non-leukemic, the real nature of the disease being tuberculous. A bibliography is appended. On the Ba~lMetabolism and Chemistry of Blood and Urine in Chronic Myelog- enous Leukemia, P. R. PAK. Japanese J. Med. Sci. VIII. Internal Med., Pediat. Psychiat. 2: No. 3, Proc. 130-34, 1932. In two cases of myelogenous leukemia, one mild and one severe, profound ohangee were noted in basal metabolism and protein metabolism, as expressed in the increased amino acid and uric acid in blood and urine, as well as in the blood and clinical pictures. X-ray irradiation of the splenic tumor brought about improvement in all these factors. I(. SUQIURA

Gout and Leukemia, H. BRUNNER.Gicht und Leukilmie, Ztaohr. f. klin. Med. 121: 700-710, 1932. A man sixty-five years old, who had had a chronic subleukemic myelosis for five years, had typical attach of gout in several joints, and tophi in the ears, over each elbow, and on the medial side of each hand. Since no changes could be shown in the vascular or renal apparatus to support a diagnosis of gout secondsry to renal insufficiency, the case was regarded as one of genuine gout. The greatly 522 ABSTRACTS increased uric acid content of the blood (13.9 mg. per cent on a purin-free diet) was explained partly by nuclear disintegration of the increased numbers of leukocytes, partly by the decreased excretion of uric acid by the kidneys. Nevertheless, the increased uric acid content of the blood cannot be regarded as the sole exciting factor of the gout, for in that case every leukemic patient would have gout. Ac- tually the association of the two disee'ses is rare. There must be an as yet unknown predisposing factor, an alteration in the mesenchymal tissues, which permits the crystallization of sodium urate in the various connective tissues. The subleukemic myelosis and the accompanying uricemia can be regarded only as the inciting factors in a patient predisposed to gout. L. F. CRAVBR

Incidence of Leukemia in Denmark, H. C. GRAMAND R. NIELSEN. Leukaemiens forekomst i Danmark, Ugesk. f. laeger 94: 437-443, 1932. During the nine-year period 1920-28 there occurred 544 cases of leukemia and 44 cases of pseudoleukemia in Denmark. There is an annual incidence of about 70 cases. The apparent increase during the years in question may be ascribed to improved methods of diagnosis. The disease runs a course of about one and one- fourth years. In young persons and children it is usually of the acute type, but nfter forty years of age the chronic type predominates. Males are affected more often than females. Statistics and nomenclature are confusing, but it seems evident that the lower laboring classes are chiefly afflicted. The disease is especially common in typographers and workers in restaurants.

Leukemic Priapism of the Clitoris with Appearance of a Carcinoma, HERBERT KULKA. Leukamischer Priapismus der Klitoris unter dem Bilde eines Car- cinoms, Arch. f. Gynak. 149: 450461, 1932. The case is reported of a seventy-two-year-old woman with a vulva1 tumor which had appeared within a few weeks, grown rapidly, and eventually broken down. Examination disclosed in the region of the clitoris a tumor somewhat larger than a plum, partly ulcerated, hard, non-painful, and rather fixed to the underlying tissue. In the groin of the left side was a small node, on the right side n mass of nodes 10 cm. in length. The patient received radium to the amount of 7,468 mg. hours and two roentgen treatments. The treatment was well borne and had a visible effect on the size of the tumor. Suddenly, however, the patient nfter some radiation developed a high fever, with 67,800 white blood cells, 93 per cent lymphocytes. Death occurred on the third day after the beginning of the ncute symptoms, with a leukocyte count of 221,400. Autopsy examination confirmed the diagnosis of lymphatic leukemia with infiltration of the lymph nodes, tonsils, liver, and spleen. A brief review is presented of four previously reported cases of leukemic mani- festation in the region of the genitalia. An analogy is drawn between the priapism noted in this case and that more commonly described in males. The original swelling of the clitoris is ascribed to a thrombosis of the corpora cavernosa, and the gradually increasing tumor to an extravasation of lymphocytes within the clitoris and their subsequent growth in that region. H. C. TAYLOR,JR.

Monocytic Leukemia: Two Cases, J. W. ORR. Lancet 1: 403-407, 1933. The author's first patient was a man of forty, with swelling of the face, neck and hands, which was diagnosed as myxedema and which subsided under thyroid administration. Extensive enlargement of accessible lymph nodes led to blood investigation, which showed as its most striking feature an enormous increase in rnonocytes (57 to 66 per cent of the white cells). Death occurred just a year after admission to hospital. Autopsy showed enlargement of the nodes in practically every part of the body, with monocytic infiltration of all the hematopoietic organs. THEI LYMPHATIO BYBTBM 523

The second patient, a man of seventy-one, had an attack of influensa which kept him in bed for three weeks and which was followed by four days of vomiting and diarrhea. For several months before this attack he had been losing weight and becoming increasingly pale. Ditrerential counts showed from 44 to 88 per cent monocytes. Death occurred five weeks after admission, and the autopsy iindinge were similar to those in the first case. In neither case was the total leukocyte count appreciably above normal during the period of observation. Naegeli has disputed the existence of monocytic leukemia and considers that cases described under this name consist in a monocytoeis of the blood with myeloid hyperplaaia in the tissues. In the two present cases, however, the tissue changes showed no resemblance to myeloid hyperplasis except that some of the infiltrating cells were oxidam-positive. There are five illustrations. F. CAVERS

Reticulo-mdothdomatoliomrtorir, OvuiUr Endothdoma and MonocJtic (Hiotiocytic) LeuLemi., R. GITTINSAND J. C. HAWKSLEY.J. Path. & Bact. 36: 115-131, 1933. Three somewhat rare conditions-reticulo-endotheliomatosis, ovarian endothelioma, and monooytic leukemia-occurred together in a female infant of eleven months. She had been doing well until a month before admiaaion to the hospital, but during that period had lost rapidly in weight. The abdomen was considerably enlarged, and in each iliac fossa there was a large, hard, smooth, rounded maw rising out of the pelvis. Nothing abnormal was noted on rectal palpation, and neither liver nor spleen was palpably enlarged. Blood examination showed: red cells 4,400,000; hemoglobin 55 per cent; platelets 200,000; white cells 6,000. The differential leukocyte count was: neutrophila 16 per cent, baaophils 0.3, metamyelocytes (mature) 1.8, lymphocytes 74.6, monocytes 6.7. There were some polychromaaia and poikilocytosis, also some normoblaats. Seven weeks later the blood picture showed reduction of red cells to 1,200,000 and of hemoglobin to 26 per cent; increase of white cells to 24,600; neutrophile 2.1 per cent, lymphocytes 73, monocytes and premonocytes 20. The masses in the iliac regions hed grown Considerably larger, and were diagnosed as ovarian tumors. At laparotomy the abdominal cavity contained clear, straw-colored fluid, and two reddish mawes completely replacing the ovaries were removed. A month later the child died after a bout of diarrhea. The authors, who made a histologic examination of most of the organs of the body, give their findings in detail. They also give references to the available literature, in which they found only nineteen previously reported cases of monocytio leukemia. They consider that the wooistion of endotheliomata of both ovaries with general hyperplasia of the endothelial tissue, providing a leukemic blood picture, leaves little doubt as to the intimate relationship of these lesions. That is, this oase provides strong evidence, in their opinion, in favor of the neoplastic theory of leukemia. Eight illustrations are given. F. CAV~RS

Cue of Lymphocytic Leukemia, F. H. REYNOLDS.Indian M. Gas. 68: 84-86, 1933. A man of forty-five had been given outpatient treatment on and off for several years, for malaria. On his last visit for treatment he was examined as usual, and showed nothing abnormal except slight enlargement of the spleen. About a month later he was admitted with enormous enlargement of the spleen and liver; blood films showed no malarial parasites, but there was irregular pyrexia. Blood counts showed 50,000 white cells per c.c., 90 per cent being large and 5 per cent small lymphocytes. The nodes of the neck, adae, and groins of both sides were enlarged. Death occurred sixteen daJie after admimion. 524 ABSTRACTS

The author emphasizes the sudden onset and short duration of the disease; also the fact that acute lymphocytic leukemia is usually a disease of childhood. There was no history of syphilis or tuberculosis, but the author suggests that the constant attacks of malaria may have been a predisposing cause of the leukemia, Autopsy was not permitted, the man being a Gurkha. F. CAVERS Aleukemic Leukemia in an Eleven Months Old Infant, T. VARQA. Aleukiimische Myelose bei einem 11 Monate alten Siiugling, Monatsschr. f. Kinderh. 53: 211-216, 1932. An eleven months old infant was brought to a hospital with a history of six weeks of fever, cough, loss of weight, and weakness. The baby was emaciated and pale and showed edema of the face. There were multiple shotty lymph nodes; the spleen and liver were large. Blood findings .were: 2,900,000 red blood cells, 18,000 white blood cells, 46 per cent hemoglobin, 69 per cent lymphocytes. There were a few immature red cells, some anisocytosis and polychromatophilia, no immature white cells. Biopsy of a cervical node showed the inner zone made up of massed connective tissue infiltrated with small round cells and pierced by numerous small blood vessels with thickened walls; the outer zone showed swollen reticulo- endothelial cells and sinuses packed with atypical cells recalling bone marrow cells. These cells took neither eosin nor basic dyes but showed many granules and gave the peroxydase reaction. The author reviews the literature of the disease in childhood and discusses the differential diagnosis of this condition, which is very rare in infancy. JEANNETTEMUNRO

Aetiology of Hodgkin’s Disease, with Special Reference to B. Tuberculosis Ads, C. E. VAN ROOYEN. Brit. M. J. 1: 50-51, 1933. The author points out that many writers, notably Sternberg (1898) and Ewing (1927), have drawn attention to the apparent resemblance in the tissue changes in Hodgkin’s disease and tuberculosis. According to Ewing “ tuberculosis follows Hodgkin’s disease like a shadow.” Yet many writers have failed to find evidence of tuberculosis in patients with Hodgkin’s disease. Lemon reported, for instance, that out of 191 patients with this disease under observation at the Mayo Clinic, only 8 showed evidence of tuberculosis, and that out of 26 cases of the disease in which the mediastinal nodes were involved there was only one showing definite signs of tuberculosis. Twort (1930) was unable to isolate any one organism with constancy or to reproduce the disease in animals with pathological material, and therefore concluded that the condition is of neoplastic nature. More recently L’Esperance claimed to have reproduced the disease in birds, from whose tissues she recovered the avian tubercle bacillus, to infection with which she attributed the origin of Hodgkin’s disease in animals and man alike (Ann. Surg. 93: 162, 1931. Abst. in Am. J. Cancer 15: 1895, 1931). The author reports six cases in which Hodgkin’s disease was diagnosed histologically by biopsy or autopsy. In no case were signs of tubercle found. In one case great improvement followed deep x-ray treatment and subcutaneous injections of Coley’s fluid over the affected area (lymph nodes of both sides of the neck). Four bantam chicks and four pigeons were inoculated intravenously and intraperitoneally with an emulsion of lymphadenomatous material, including enlarged nodes, spleen, and bone marrow; the birds were kept under observation for seven to ten months, but no signs of disease were found. Five chickens were then used for grafting experiments, the graft being given respectively (1) extraperitoneally, (2) intraperitoneally, (3) into the liver, (4) into the shaft of the femur, (5) intra- muscularly; in no case were signs of tubercle observed. The author admits that the occurrence of human infection by the avian tubercle bacillus has been proved and the organism isolated, but that such infection does not give rise to the oharaoteristic lesions of Hodgkin’s disease. F. CAVERS THE LYMPEATIO SYSTEM 525

Redts of Experimentation in Malignant c)rmolomr, R. WEISMANN-NIWB,V. OUMANSKY,AND J. D~LABUI.Lee r6sultats de I’exp6rimentation dam la granulomatose maligne, Gas. d. Hbp. 105: 1635, 1932. The authom report that cutaneous tuberculin reactions in cases of Hodgkin’s disease are usually negative, lees frequently so with avian tuberculin, but that on this baais one is not justified in forming conclusions as to the tuberculous etiology, avian or otherwise. L. F. CRAVIR

Some Features of Hodgldn” Diaeage, E. T. CONYEBAB~.Guy’s Hosp. Rep. 83: 63-62, 1933. The author analyzes and discusses the features presented by 35 cases in the records of Johns Hopkins Hospital during the ten-year period 1922 to 1931, including only cases in which the diagnosis was confirmed by histologic examination at biopsy or autopsy. These cases he compares with 25 oases recorded at Guy’s Hospital during the five years 1923 to 1927, with reference to age and sex incidence, associated diseases, early signs and symptoms, localisation, other clinical features, presence of neurological changes, duration and mode of termination, and results of blood examination. The essential features of the disease are similar in the American and English series. While in England the age incidence is spread out over a wider range, the third decade shows the heaviest incidence in both countries, and there is also a parallel predominance of male over female cases, more marked in the later age groups. In America, possibly owing to more careful enquiry into family history, tuberculosis is much more often found to be an associated disease than in England. The primary Bites are much the same in the two series; neither the Pel-Ebatein type of pyrexia nor blood eosinophilia was commonly seen in either series. Al- though nervous structures are involved by the disease in about half the cases of both series, localised deposits in or extending from lymphatic tissues are responsible for the majority of the lesions, and apart from pruritus a generalised reaction of the nervous system to the disease is not in evidence. F. Cavms

“ Atypical ” Lymphogranuloma, H. PFENNIO~BTH.Beitrag sur Frage der ‘‘ atypischen ” Lynaphogranulomatose, Frankfurter Ztschr. f. Path. 44: 85- 104, 1932. While agreeing with Sternberg that the term “ atypical ” lymphogranuloma should not be allowed to become a scrap bmket for all sorts of &sewwhich have nothing to do with lymphogranuloma, the author takes pains to analyse the natural variations in localization, course, and histological structure of this disease. Casea are not uncommon in which the pathologist is unable at Grst to verify the clinician’s diagnosis of lymphogranuloma, but which later are shown to be such. E’rom the histologic point of view, the author discusses at some length the occurrence, in cases which are undoubtedly true lymphogranuloma, of variations in morphology, number and arrangement of various of the cellular components, such as the lyfhphocytes, plasma cells, eosinophiles, epithelioid, and Sternberg giant oells. The variations in the Sternberg cells are discussed in regard to their occurrence in unusually large numbers, in unusually small numbers, morphological peculiaritiea, such as similarity to megakaryocytes (one case report with autopsy; clinical course suggesting typhoid or aleukemia), similarity to phagocytes, and effects of irradiation. The author then discusses various diseases which should be excluded from the category of “ atypical ” lymphogranuloma. They are (1) granuloma consisting of but one type of cell, such M plasma-ceU lymphogranuloma, plasma-cell pseudoleukemia, plasma-cell granulomas of the nasopharynx and cervical nodes, etc.; 526 ABSTRACTS

(2) granulomas with a picture resembling Gaucher’s disease; (3) reticulo-endo- theliosis; (4) various diseases in which a diagnosis of lymphoganuloma has been made only by exclusion. Over a hundred references are given. L. F. CRAVBR

Atypical Hodgldn’s Disease, E. G. B. CALVBRTAND H. H. SANQUINETTI.Brit. M. J. 1: 52-54, 1933. The authors report a case in which they found differential diagnosis diffiault because of unusual signs and symptoms, and which also presented unusual features at autopsy, A woman of thirty-one years had been suddenly seized, nearly two years previously, with severe lumbar pain, had had backache ever since, and had latterly lost considerably in weight-about sixty pounds in the last four months. She looked very ill and weak. In the dorsolumbar region there was pronounced scoliosis, convex to the right, with considerable tenderness over the spinous processes of the second to fourth lumbar vertebrae. While under observation the patient had three attacks of fever separated by longer almost afebrile periods; blood counts showed continuous high leukocytosis. The latter is described as being of inflammatory type, polyrnorphonuclears averaging 85 and lymphocytes averaging 12 per cent. During the afebrile periods the patient showed great general improvement, but she died four months after admission to the hospital. Autopsy showed greatly enlarged mediastinal and peribronchial lymph nodes, smaller deposits in the lungs, and a chain of much enlarged nodes extending from both groins along the iliac arteries and aorta up to the pancreas and spleen. The nodes on the left side were mostly suppurating, and there was a large abscess in front and on the left side of the lumbar vertebrae, burrowing into and destroying the left psoas muscle and eroding the bodies of the third and fourth lumbar vertebrae so that a finger could be passed into the spinal canal. Several of the deposits and enlarged lymph nodes were examined microscopically and the structure found uniform in all cases. In the nodes the lymphocytes were practically replaced by proliferating endothelial cells, together with many mono- and multi- nuclcar giant cells with centrally placed nuclei (Sternberg cells). The breaking down of the left prevertebral nodes and the formation of the abscess above de- ecribed may be attributed to secondary infection, but unfortunately this proba- hility was not explored when autopsy was made. F. CAVERS Prognosis in Lymphogranulomatosis from a Study of Clinical Symptoms; Effects of Roentgen Therapy. T. HOHENTHAL.Om prognosen vid lymfogranulo- rnatos med beaktande av de kliniska symtomen, av rontgenbehandlingen och av dennas inverkan pi symtomen, Finska ltik.-stillsk. handl. 74: 678-693, 1932. Hohenthal reports 12 cases of lymphogranulomatosis. Leukocytosis and lymphopenia were usually though not invariably present. The percentage of eosinophiles was not high, averaging from 0.1 to 5.2 per cent. The prognosis, as well as duration of the disease, seemed independent of the degree of anemia, leukocytosis, and eosinophilia. Fever was usually absent in the slowly progressing cases. In the two cases in which the duration of the disease was apparently prolonged by roentgen treatment there was a slight lymphocytosis. The glandular swelling varied in distribution and degree and had no bearing on prognosis. In the slowly progressing cases neither the spleen nor liver were enlarged, The blood picture seemed influenced by the roentgen treatment only in a reduction in leukocytes. The time of beginning treatment seemed to have no effect on the further course of the disease, the duration evidently depending on the more or less chronic nature of the process. The effect of roentgen treatment seemed to be almost exclusively symptomatic. In only two cases did it seem probable that it led to prolongation of life. The duration of the disease, calculated from the appearance of the first glandular swelling, varied from one to four years. THE LYXPHATIO ayamM 527

Notem on Some Cue8 of Malignant Lymphogranuloma~~in Childhood Treated by Roentgen Therapy, P. SIOHINOLFIAND M. SCAR~~LLA.Rilievi su alcuni oasi di linfogranulomatosi maligns nell’infansia trattati con la roentgenterapia, Gior. di clin. med. 12: 699, 1931. The authors give detailed clinical accounts of 12 cases of malignant lympho- granulomatoeis. Biopsy was performed in 5 cases. There were 10 boys and 2 &la in the series. The most frequent age of onset was three to four years. One ohild showed symptom at 6fteen months. The average survival period was two and one half yearm but one patient lived eight years from the time of onset. The children were given arsenicals by mouth and roentgen therapy to all the sites of the dieesse. In recent soft infiltrations, medium x-ray dosage was used; heavy dosage waa tried in the more advanced, fibrous, and previously irradiated cases. The authors believe the blood picture should be of help in controlling the dosage. They were able to bring about frequent long remissions in most of the cases by their treatment. The article is illustrated by photomicrographs. JEANNETTEIMUNBO

Extra-Glandular Ledom of Lymphogrmulomatods, P. FOULON.A propos de quelques lhions extra-ganglionnaires de la lymphogranulomatose, Ann. d’anat. path., 9: 726-744, 1932. The author has made a special study of lesions of lymphogranulamatosis in different organa. In the liver various lesions have been observed: typical granulomatous nodules with Sternberg cells in Glisson’s capsule; portal granulomatous nodules sometimes extending in the form of a specific lymphangitis into the liver parenohyma, much in the fashion of a neoplasm. In these lesions the lymphatics play the ohief r61e in the spread of the speoific nodules, but the author has also observed a ease in whioh the nodules were scattered throughout the liver parenohyma with no relation to the portal lymphatios. The cellular elements were typical Sternberg cells, for the most part, while some of the Kupffer cells showed ohangee indioating a transformation into Sternberg cells. There may be various non-epecific forms of hepatitis ooexisting with the specifto lymphogranulomatous leeiona. In the lungs, the specifio lymphogranulomatous lesions may be of four types: nodular lesions; lymphangitic infiltrations; Muse lesions; solerosis. The alveolar oeb of the lung appear to undergo a transformation into Sternberg cells. Splenic lesions are more typical of lymphogranulomatosis than either hepatio or pulmonary lesions. They are also of two types: in one type the reticular or endothelial elements of the spleen are involved diffusely in the speoifio ohangee; in the other the lymphogranulomatous nodules develop in the manner of a metas- teeia. Lesions of the metastatio type, however, do not neoessarily indioate a true metesteeie of a neoplaatic nature; they may represent a strict localisation of the aotion of the oausative virus (on the theory that lymphogranulomatosis is an infeotive process).

Cueof Intestinal Lymjthogranulomatosir, P. FOULONAND F. BUSSER. Un oas de lymphogranulomatose intestinale, Ann. d’anat. path. 9: 649-863, 1932. A case of lymphogranulomatosis of the intestine is described in whioh the ahief symptoms were a sense of oppression without actual pain in the epigaatrium, vomiting, and alternating diarrhea and constipation. X-ray examination indicated a atenosing lesion in the last third of the duodenum. At operation an inoperable tumor mass was found at the root of the mesentery, pressing on the lower part of the duodenum. Small nodules were found along the entire length of the small inteetine at the insertion of the mesentery. Histologiody the intestine showed a 628 ABSTIUOTS

lymphooytio infiltration, the oella being ohiefly lymphooytes with a few lympho- blssta; but in certain areas1 there was a definite hyperplasia of reticular elements, among them Sternberg oefls. The diagnoeia of atypioal lymphogranulomatoais was made on the basis of these findings.

Abdomiarl Hodqkin'e Dir&ase,J. FEIQBNBAUM.Canad. M. A. J. 28: 170-182, 1033. Two cams are described, both ending fatally. In the fir& patient, the organs involved (autopay limited to abdomen) were the liver, spleen (only alightly enlarged), panorese, adrenal medulla, and entire jejunum. In the seoond, the ohief looelisation WBB in the splean. Both patients had fever. " Abdominal Hodgkin's dieeaae may resemble almoet any intra-abdominal pathologioal state, and the lid of phbilities to be ooneidered b a long one." The author gives a summary of some of the recent literatute on the subject, and two photomiorographe. F. CAVERS

Hep.tomegdy, Splenomegply. ?Hodgkin's Disease, L. P. E. LAURENT.Proc. Roy. Soo. Med. 26: 376, 1933. A man of thirty-eight cbmplained of weakness for ten months and pain in the baok and loins for one month. The liver and spleen were enormously enlarged, and in the right axilla were two enlarged nodes [no mention of biopsy of these]. X-ray films of the ohest showed no enlarged medisetinal nodee; the left aide of the diaphragm WBB pushed upwards by the enlarged spleen. Roentgen treatment to the three regions involved aaused the axillary mwes to disappear, and in three months the liver and spleen had become muoh smaller. F. CAVER~

A Cur of Lymphogmnuloquatosiie, P. GEIPE~LAND K. LINS~R.Ein Beitrag mr Lymphoqanulomatose, Aroh. f. Dermat. u. Syph. 164: 47-60, 1931. The patient here desoribed was presented before the German Dermatological Congress in 1925, and the case WBB reported in brief in that year (Verhandl. d. dermatol. Gesellsch.). The disesee began in 1920, and the patient died in 1929. He was twenty-two yeara old. The first symptom wse the development on the soalp of small nodules, apparently related to the hair folliclee, and oontaining central, infeoted, necrotia weas. As the disease extended, the small nodules fused, forming large plaques covered with s~al~,whioh ocoasiondy healed spontaneously. Three yeere later the procese had extended to the skin of the faoe and maembled neorotio aone. Still later the skin over the sternum and that on the baak beoame involved. The leaione developed from the follicles and showed at the outset an inflammatory prooess in thq sweat glands. The individual lesions fused, forming larger or smaller, brownish red, somewhat eosematous, often ulmrated areas, whioh were oovered with orusts. The patient now began to show the effects of the dieeeee, losing weight and suffering from coughing attacks and dyspnea. Radiologioal examination showed a right-sided spontaneous pneumothorax. The plates suggested a bilateral pulmonary tuberculosis. Fxamination of the tbsues showed outaneous and subcutaneous granulation tissue with numerous epithelioid ~ll~.The blood showed alight eoeinophilia. The patient became rapidly worm. X-ray therapy was of some value, but recdrrenoe of the trouble was rapid. Autopsy showed an extensive involvement of the skin of the whole body; the lung6 showed chronic pneumonia, and a more or less extensive organisation of the exudate. The bronohi were muoh altered and were often irregularly dilated and filled with pus. The lymph nodes macroscopioally were not muoh changed, but microscopioally they were greatly altered, oontaining are- of granulation tissue EDUCATION, STATISTIC8 629

with typical Sternberg cells. The spleen was practically free. In addition to the lesions above described, there were striking changes in the vessels, the lumina of which were much narrowed by the proliferation of the endothelium. There were also areas of softening in the lungs, which are unusual in Hodgkin’s disease. Sternberg, who examined some of the tissue, said that the leaions are certainly not entirely typical, but may be those of a lymphogranulomatosis. This peculiarity of the lesions is fully recogniaed. The lesions may be divided into specifia and non-apecific. In the non-apeoific type, the Sternberg cells may be missing, and the lesion be a simple granulomatous one. Some writers have charaoterised this form as an eczematoid type. All that can be said of the writers’ case is that the patient died after nine years with chronic pneumonia and multiple granulomatous changes in the lymph nodes and skin. L~ILAC. KNOX Two Cues of So-Called Lymphogranulomatosis, G. DRUVBLA propoe de deux cas de soidisant lymphogranulomatose, Scalpel 84: 1414, 1931. One case of inguinal lymphogranulomatosis and one of mycosis fudgoides are reported. The former involves the lymph nodes, the latter represents an abnormal proliferation of the hietiocyte, the embryonic form of the lymphocyte and of the macrophage. While they both involve the same type of tissue, one is an infec- tious, the other a neoplastic process. In the case of mycosis fungoidee, a severe generalired pruritus preceded the appearance of the mycotic tumors on the feet. Diagnosis was made by biopsy, which showed infiltration of the derms’ by poly- nucleara, plasmatocytee, lymphocytes, and histiocytes, the latter especially numerous around the blood-vessels; and also by the adrenalin test. The latter oausea contraction of the spleen, producing a sudden increase of red cells in the blood in normal persons, but in mycosis fungoides a sudden increase of eosinophiles. The x-rays are the most efficient therapy of mycosis fungoides and relieve the pruritua temporarily. Injections of sodium bromide and calcium gluconate also proved of value. Bxtra-Gastric Lymphogranulomatous Tumor Resembllag a Carcinoma of the Stomach, EBICHZDANSKY. Extreventrikuliirer, mit dem Magen verwach- sener lymphogranulomatgser Tumor, ein Magenkarsinom vortiluschend, Fortschr. a. d. Geb. d. Roentgenstrah. 46: 477, 1932. Zdansky reporta a case of extragastric lymphogranulomatosis resembling a caroinoma of the stomach. The patient, a woman sixtysne years of age, gave a history of indefinite gastric disturbances and showed a chylous ascitee. Roent- genograms of the stomach demonstrated an irregular constricted area lacking peristalsis near the pylorus. The patient died as a result of inanition and intee- thud hemorrhage. Autopsy showed greatly enlarged retroperitoneal nodes which were adherent to the lesser curvature of the stomach. The stomach wall itself WM entirely normal. Other lymphogranulomatous nodules were found in the liver and spleen. The deformity of the stomach is well illustrated by roentgenograms. BENJAMINR. Saosi

EDUCATION, STATISTICS Cancer and Cancer Research, Ono STBAUBS.tfber Krebs und Krebsforschung, Med. Klin. 27: 629,066,704,1931; 28: 1505,1540,1578,1932. Straws’ annual reviews of cancer research. Bibliographies are included. M.uQnmcy--A Group Problem, JOHND. LAWSON.California & West. Med. 37: 307-308, 1932. The author presents the arguments for group practice in the study and treatment of cancer. A group of specialists is able to digest the literature, furnish 630 ABSTRAOT8 the neoeesary funds for the equipment, and aollaborate with eaoh other in such manner M to oreate a situation advantageous to the viotim of malignant dieease. Diagnosis oalle for the ~~rvioesof the olinioian, the roentgenologiet and the pathologist, as well aa the specialist in whose department the tumor would be olaesified. Treatment also ie dependent upon cooperative effort. Since radiation therapy will be instituted in pr8otidy every 0888 either alone or in oornbinstion with surgery, and Since the detaib of treatment are dependent largely on biopsy findinga, a doee relationship between the radiologist and pathologist is a neodty.

Problem of Cancer in Rehtion to the General Practitioner, M. DONALDSON.J. State Med, 41: 96-104, 1933. The author points out that the problem of prevention is a very different and muoh more diffioult matter when we turn from the infeotive diseases to oanoer whioh, so far as we know at present, is not dependent on outside sources. Apart from preventive measures in oonnection with industrial canoer, “ no amount of publio hygiene oan help us, and we are fomed baok to efforts oonoerning the individual.” He suggests to general praatitioners that, just as antenatal clinios were praotiody foroed upon them, so the demand for preventive medioine may form them to undertake periodioal examinations. “ A soheme for euoh examina- tione will enable thousands of people, who are at present nervous, to dome and be examined without feeling that they are doing anything oowardly and unusual. Seoondly, it will stimulate investigation into preoanoeroue oonditions and new methods of diagnoeia. Lastly, it will undoubtedly oatoh thousands of owes in the early stage when there b a real chance of a permanent oure.” F. CAV~RB

Cancer .II a Public Health Problem, C. 0. STALLPBBASB.hblio Health 46: 1SO-166, 1933. This is a briskly written appeal for the linking up of various individuals and publio bodies in organised efforts to reduce oancer mortality. [The author’s reading hea been fairly wide but unoritioal; for instanoe, few studente of the eubjeot would assert that oanoer has ever been proved to peas by direot transplantation from one pereon to another.] F. CAwBs

Third Annual Cancer Conference, J. Cancer Regearoh Comm. Univ. Sydney 4: 66-80, 1932. This report of the Australian Cancer Conference held at Canberra, Maroh 29-31, 1932, touohes upon various administrative matters in oonneotion with the organisations for oanoer oontrol in the VIU~OUE statea, particularly IKJ oonoema the distribution and handling of radium. Up to Deo. 31,1931, a total of 9,431 patienta had reoeived radium treatment at aanoer oenters in Australia. The resulta of treatment in various organa are tabulated, and mortality tables are appended.

Report Furnirhed by the Uoivenity of Sydney Cancer Research Committee to the Britiah Empire Cancer Campaign, J. Canoer Raaearoh Comm. Univ. Sydney 4: 103-108, 1932. This re~portdwribes uertdn administrative changes in re-spct to the organha- tion of the University of Sydney for oanoer research and radium treatment, presents some statintics as to treatment during the year, and summarism briefly the linea of researoh being followed. As most of thia work im reported elsewhere, it need not be abstracted here. EDUOATION, STATIST108 531

Inrtltute of Experimental Medicine for the Study and Treatment of Cancer. Director: Profeuor A.-H. Roffo. Activities of the Institute During the Year 1931, A.-H. ROFFO. Institut de m6decine exfirimentale pour 1’6tude et le traitement du cancer, Buenos-Aires. Directeur: Profesaeur Dr. A. H. Roffo. Compte-rendu du mouvement de Hnstitut pendant l’annb 1931, N6oplasmeu 11: 193-206, 1932. Thie article tabulatea the number of cancer patients (1650) treated at the Institute of Experimental Medicine, Buenos Aires, according to age, site, and type of neoplasm, and personal history (past illnesses, diet, onset of menstruation and menopause, number of confinements, alcohol, tobacco, etc.). The general educa- tional program of the Institute has raised the number who come with early lesions from 3 per cent of the total number of patients in 1928, to 53 per cent in 1931. WM. H. WOGLOM Cancer Campaign in Belgium, A. P. DUSTIN.Recherche8 et lutte contre le cancer en Belgique depuia la guerre, Bruxelles-mdd. 12: 1057-1084, 1932. In this report of a lecture the author states that every form of malignant growth occurring in civilised peoples has been found in natives of the Belgian Congo. He gives a general account of various aspects of malignant disease, in which he presents the fundamental points in clear and non-technical language without unduly sacrificing accuracy to simplicity. He describes the present activities of the Belgian anti-cancer league and of the state-seaisted cancer centers that have been established in Belgium since the Great War. [The ground covered in this lecture is much the same as in a recent paper by the same author (Abst. in Am. J. Cancer 16: abst. p. 979, 19321.1 F. CAV~PRS Campaign yrlnrt Cucinoma Uteri in the Dutch East Indim, R. REMMPILTB. De beetrijding van carcinoma uteri in Nederlandsch-Indig, Geneesk. tijdschr. v. Neder1.-Indit! 72: 1286-1298, 1932. In this interesting and instructive article Remmelts expresses his opinion as to what should be done to combat cancer of the uterus in the large population of the Dutch colonies, emphasising the fact that the sooner a patient is treated the better the chance for a complete cure. The figures for cervical carcinoma vary from 19 to 90 per cent in this respect. The clinic of the Medical University in Betavia has at its disposal 80 mg. of radium bromide for treatment of cancer patients. The patients are followed as carefully as possible after leaving the hospital. This is done with the help of the patients themselves, their relatives and associates, and physicians in other places. The number of patients treated for carcinoma uteri in the university clinic is very ad,and the cases are generally in an advanced stage. Since van der Hoeven egtimated that in 1925 450 women died in Holland from carcinoma of the uterus, it h~probable that in the colonies about ten persons die every day from this disease. Thie estimate ia based on the fact that the population of the colonies is about ten times that of Holland and on the supposition that the frequency of cancer is the same. Remmelts is of the opinion that a systematic investigation of the portio uteri with the colposcope may be highly important. In order to obtain patients at an early stage, Remmelts emphasiaea the need of a thorough medical investigation of any complaints with reference to the uterus (e.~.irregular bleedings) and a systematic gynecological examination once a year of all primiparae and multiparae above thirty-five yeare of age. It is highly important to follow patients treated for uterine carcinoma in order to detect reourrenoes as soon as possible. Poor patients should be kept under medical oare longer than is necessary for the mere technical treatment of the cancer. JOHANNBISP. M. VOQ~PLAAB 532 ABSTBAOTS

Supplementary Report of iCmcW Committee, C. E. Dmcmss. J. Michigan M. Soo. 31: 98-108, 1932. This ireport of the Canoer Committee of the Miohigan State Medioal Society is based on a series of que@ionndres as to facilities for diagnosis, treatment, and follow-up. It consists of L series of maps illustrating the various points covered, which must be consulted in the original. The State has no oancer center combining (1) complete diagqmtic facilities; (2) first-rate surgical personnel; (3) adequate deep-therapy equipment; (4) adequate radium supply; (6) a radium emanation plant [which is not neceesary]; (6) follow-up service.

Cawm of Death Among Jswr in New York City, CHAFLLBSBOLDUAN AND LOUIS W~INBR New England J. Med. 208: 407-416, 1933. A comparison of cancer incidence in various races hae frequently been made and has led to the discovery that there may be slight variations in the merent organs affected which may or may not be due to social conditions, and therefore open to correction if definite proof can be found for underlying differenoes. As New York is the largest Jewish oity in the world, the death certifioates on file in the Bureau of Records of the New York City Department of Health offer an opportunity for the study of the comparative incidence of canoer in different sites with a fair degree of adcuracy, since the number of deaths from this disease in Jews and non-Jews amounted to over 2,000 per year in each group.

DMma =M Cmcm 01 Cawcam Snm mom Jowm AND NONJWIBEWms ~oa lo00 Urn FROM Aut CAUSESIN TBO 8- Aou Gaowp, NOWYo= CM,1031 (BOLDUANAND WBINBB) An interesting finding is that oanoer of the digestive tract in Jewish males is almost three times that of non-Jews at age thirty-five to thirty-nine; while at age seventy to seventy-four thp rates are: for Jews, 126; for non-Jews, 104 per 1,OOO. On the whole, the rate amopg Jewish males is about 60 per cent higher than among nondewe. Among Jewish:females, also, the rate averages 60 per cent above that of Jewish males and is comspondingly above that of non-Jewish whites. Cancer of the bucoal cavity is from three to four times higher among non- Jewish males than among Jews. In cancer of the uterus )he figures for non-Jews are, in general, over 60 per cent higher than those among the Jews. EDUOA'PIOX, STATIST108 633

Cancer of the male genital organs shows higher figures among Jews than among non-Jews, but unfortunately details are not given as to cancer of the penis, which is said practically not to occur among Jews. The value of a collection of this type is not great because the numbers are still too small for final evaluation, but the writers say that the compilations will continue until a sufficiently large number of deaths will give all figures significance. However, the findings in general agree with the conclusions reached by Sorsby in his book on Cancer and Race (reviewed in Am. J. Cancer 15: 2825, 1931). Through the kindness of Dr. Bolduan we are permitted to reproduce a chart which shows some of the more striking figures. The great irregularity of some of the curves indicates the insufficiency of the numbers considered.

Cancer Mortality in Germany with Respect to Age Constitution, W. HALLPRMANN Die Krebssterblichkeit in Deutschland unter Bertickaichtigung des Altersauf- baus der Bev6lkerungI Ztschr. f. Krebsforsch. 38: 75-93, 1932. The crude death-rate from cancer in Germany rose between 1905 and 1929 by about 60 per cent, and has risen since 1892 by approximately 100 per cent. That this augmentation is referable in part to better diagnosis is shown by the high rates reported from those countries where the best medical skill is available, as well as by a concomitant fall in the number of deaths recorded for senile asthenia. As cancer is predominantly a disorder of advanced life, any increase in the higher age-groups such as has unquestionably been taking place in Germany would be reflected as a higher mortality from this disease. The statistical error thus introduced can be eliminated by comparing only figures for one and the same age- group at different periods, or by converting the crude death-rates for these periods to those for a standard population. Neither procedure, however, can be carried out for mortality records prior to those of 1914 because the material is inadequate to the purpose. A comparison of mortality statistics for the period 1914-1929 according to age- group shows an increase in the number of deaths from cancer only for those above sixty years; this amounts to 12 per cent for men between sixty and seventy and to 14 per cent for women of the aame age, while in men and women over seventy the figures are 49 per cent and 47 per cent respectively. By the second method the increase is shown to be 20 per cent for men during the past fifteen years, and 24 per cent for women, or about half aa much aa would be deduced from the crude death-rates. This augmentation is without doubt a result of better diagnosis and more reliable statistics, not of any actual rise in the frequency with which malignant dieeese occurs. Wur. H. WOOLOM Cllnico-rt.tirticcll Study of Malignnnt and Benign Tumors, G. A. CHIUR~O. Studio clinico-atatiatico sui tumori maligni e benigni, Atti d. R. Accad. d. Geiocrit. 6: 131-205, 1931. Thie paper presents a large number of statistics concerning the frequency of cancer in Italy. The data are presented without any attempt at correlation or critical appreciation. Included are figures giving: (1) deaths from cancer in Italy by triennial periode from 1878 to 1926, arranged according to type of growth; (2) cancer mortality in Italy in 1926 according to age, sex, and occupation; (3) cancer mortality in 1926.in the ditrerent provinces according to type of growth; (4) tumom treated at the obstetrical and gynecological clinic, aa well as at the Radiological Institute of the University of Siena in 1930; (5) tumors treated in the surgical clinic between 1914 and 1930. C. D. HAAOPNBEN 534 ABSTBAOTZ)

Is Cancer In-? G. WOLFF. Nimmt der Krebs SUP Zbchr. f. aertsl. Fortbild. 29: 522-526, 1932. The author expreseee the view that an increase in cancer mortality rates ki not shown if the deaths are corrected in accordance with age groups.

Contribution to the Study of Cancer in Tonkin, Lm ROYDEE BARBBIB(in collabors- tion with DR.JOYIUX). Contribution B 1’Btude des modalitee du cancer au Tonkin, Bull. Aesoc. franp. p. I’btude du cancer 21: 032-837, 1932. The authom report 7 cmes of cancer among the Europeans of Tonkin, French Indo-China, during the year 1931, and 191 CMB in the Asiatic population. [The accompanying tabulations and computatione seem herdly justified by the slender material.] WH.H. WOOLOM