The Abstracts Which Follow Have Been Classified for the Convenience of The

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The abstracts which follow have been classified for the convenience of the reader under the following headings: Experimental Studies,Animal The Abdominal Wall Tumors The Digestive Tract Nature of Cancer, Etiologic Theories The Liver and Biliary Tract General Clinical Observations The Pancreas Diagnosis and Treatment: General Mesenteric Tumors Tumors of the Skin The Spleen The Oral Cavity, Upper Respiratory The Femele Genital Tract Tract, Submaxillary Glands The Genito-Urinary System The Eye The Nervous System The Thyroid and Parathyroid Glands The Bones and Joints The Thymus Gland The Lymphatic System The Breast Statistics, Cancer Research, Education, Thoracic Tumors: Heart, L u n g s , Public Health Bronchi, and Mediastinum As with any such scheme of classification, overlapping has been unavoidable. Shall an article on “Cutaneous Melanoma, an Histological Study” be grouped with the articles on Histology or with the Skin Tumors? Shall Traumatic Cerebral Tumors go under Trauma or The Nervous System? The reader’s choice is likely to depend upon his personal interests; an editor may be governed by no such considerations. The attempt has been made, 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 expressed may on occasion seem to an author not to represent adequately his position, opportunity is offered any such to submit his own views for publication. The JOURNALwill not only welcome correspondence of this nature but hopes in the future to have a large number of author abstracts, so that the writer of a paper may present his subject in his own way.

470 EXPERIMENTAL STUDIES, ANIMAL TUMORS Tumors of Animals, OTTOTEUTRCHLAENDER. Die Tiergeschwiilste, Fortschr. d. Med. 50: 1-4, and 4348, 1932. This is a general lecture delivered before the Gottingen Medical Society and, as such, it contains no new material. It is, however, a useful rbsumb of the ideas held by a lifelong investigator of cancer. Mammals, birds, fishes, amphibians, and reptiles have all been found liable to tumors; only the invertebrates appear at present to be spared. The lowest form so far found affected is the cartilaginous fishes. The great majority of animal tumors closely resemble those of the human subject in both morphology and biology, though there are a few, such as carcinoma of the perianal glands of the dog and Borrelk “ tumeur molluscoide ” of the mouse, that do not occur in man. Hence deductions in respect to human tumors are permissible within reasonable limits, though one would hardly presume to suggest a diet for cancer patients on the basis of an experiment with rats and mice, particularly if the investigation had been carried out with transplanted neoplasms. The Rous chicken tumor is regarded by Teutschlaender as a true sarcoma, but he does not believe that its transfer by means of a filterable agent can be used to support the parasitic hypothesis. The production of neoplasms with tar or pitch, which the author has repeatedly found to be sterile, is strong proof that cancer is not a specific infectious disease within the meaning of the bacteriologist, and the carcinogenic action of ultraviolet light and other forms of radiant energy may be interpreted in the same way. All these irritants, however, are but indirect causes; the actual specific cause, the ens malig?;itatis, comes not from without but from within, and since the preliminary reaction is at first confined to the cells at an irritated site, the specific cause must reside or originate in these elements. The instant at which this very essence of malignancy appears is the critical moment in carcinogenesis, the “ irritation threshold,” and the nature and origin of the endogenous etiological agent are the real problem of cancer. Four stages in carcinogenesis are described: (1) a preparatory stage of inflammation; (2) benign tumor formation; (3) latent malignancy; (4) malignancy. The irritation threshold lies between the second and third, and after it has been passed the presence of the irritant is no longer requisite. Experimental and occupational cancers unite in showing that the cooperation of three factors is necessary for the production of a malignant tumor: (1) a factor exogenous to the cells involved, though not necessarily external to the body as a whole; (2) predisposition, which must be both local and general; (3) exposure, or opportunity for the agent to exert its action. Tbough all three must be present, their relative magnitude may vary; thus the more powerful or more suitable is one, the more feeble may the others be. WM.H. WOGLOM

471 472 ABBTRAUTS

Production of Malignant Tumors by the Inoculation of Embryonal Tissues, EUGENIEKLEE-RAWIDOWICX. Erzeugung von bbartigen Geschwtilsten durch Ubertragung von Embryonalgewebe, Deutsche med. Wchnschr. 58: 1439- 1440, 1932. Experimental Production of Malignant Mouse Tumors by the Inoculation of Embryonal Cells into Tarred Animals, EUQENIEKLEE-RAWIDOWICX. Experi- mentelle Eraeugung von bosartigen Mausetumoren durch ubertragung von Embryonalzellen auf geteerte Tiere, Ztschr. f. Krebsforch. 38: 35-51, 1932. Mice were given subcutaneously once a week 0.05 C.C. of a high-boiling-point tar fraction in a 1 : 10 dilution in olive oil. After from five to twenty-one such treatments had been administered, 0.5 or 1.0 C.C. of mouse embryo in a little Ringer’s solution was injected at a new site and the tar was discontinued. Among 33 surviving mice, 5 sarcomas and 1 carcinoma developed within a relatively short time, that is to say, in from thirty-nine to eighty-two days after the introduction of embryo. No malignant tumors appeared in animals treated with tar alone, and in other controls given only embryo emulsion nothing but transient embryomas could be found. The one sarcoma that was transplanted proved to be easily propagable and is now in its twenty-eighth generation. The writer suggests that the tar, which begins to exert its action after the ninth injection, may effect some alteration in metabolism, pointing out that this irritant requires a longer period to initiate the malignant change in adult celle than in those of the embryo, whose metabolism more nearly resembles that of the tumor cell. [The photomicrographs (in Ztschr. f. Krebsforschung) sustain the writer’s contention, with the exception of Fig. 11, illuatrating the carcinoma, which is not convincing to the abstractor.] WM. H. WOQLOM

Mesoblastic Tumours Following Intraperitoneal Injections of 1 :2 : 5;: 6- Dibenzanthracene in a Fatty Medium, HAROLDBURROWS. Proc. Roy. SOC. London, Series B, 111: 238-246, 1932. Experiments are recorded in which peritoneal sarcomas were produced in 27 rats and mice out of 200; 107 died without tumors and 66 are still living. The actual tumor incidence is much higher, however, than these figures would suggest, for the work is not yet finished. Among the 10 rats first injected, all of which are now dead, 8 developed definite tumors; of the remaining 2, one died and was eaten by ita cage-mates, so that no post-mortem examination was possible, while the other, killed early in the experiment, had a peritoneal thickening which suggested that tumor formation might have occurred later. The average life of the eight rats with sarcoma, after the beginning of the experiment, was forty weeks, the shortest period being twenty-three and the longest forty-nine weeks. Direct extension of a neoplasm into the pleural cavity through the diaphragm occurred in 2 instances, and the invasion of muscle was a common finding in microscopic preparations, but no extraperitoneal metastases were found. The carcinogenic agent employed was 1 : 2 : 6 : &dibenzanthracene, in the form of an 0.1 per cent emulsion in olive oil and a watery solution of gum acacia. The dose at first was 0.5 C.C. for rats and 0.05 C.C. for mice, administered once a week, but these amounts were soon raised to 1.0 C.C. and 0.1 C.C. The respective parts played in carcinogenesis by the hydrocarbon itself and by the fatty vehicle in which it was given must remain undetermined until the completion of the entire experiment. Control animals bearing no tumors live much longer than mice and rats with tumors, and the investigation cannot be regarded as finished until the last control is dead, which may be a matter of several years. WM,H. WOGLOM EXPERIMENTAL STUDIES, ANIMAL TUMORS 473

Production of Tumors Morphologically Resembling Sarcoma in Nereis diversicolor O.F.M. by Inoculation of B. tumefaciens Sm., J. ANDR~~THOMAS. Production de tumeurs d’apparence sarcomateuse chez l’ann6lide Nereis diversicolor O.F.M. par inoculation de Bacterium tumefaciens Sm., Compt. rend. Acad. d. sc. 193: 1045-1047, 1931. The oocytes of Nereis diversicolor sometimes degenerate, giving rise to a reaction which terminates in benign fibroblastic tumors. The inoculation of B. tumefaciens into the neighborhood of such growths caused the transformation of these benign lesions into growing, invasive masses which resembled sarcoma in their histology. The time required to bring about this change in the two instances described was two and nine days respectively. WM. H. WOGLOM

Experimental Malpighian Metaplasia of the Gastric Mucosa of the Dog, ANTONIO MORATTI. Metaplasia malpighiana sperimentale della mucosa gastrica di cane, Tumori 18: 101-139, 1932. Eight dogs were used to determine the carcinogenic power of nicotine: (1) In two dogs portions of cigars were placed in the gallbladder. Chronic inflammatory changes in the gallbladder were the only result. (2) Two dogs were given a series of injections of a sterile 10 per cent solution of nicotine into the mammary gland. Chronic inflammation only resulted. (3) A Pavlov pouch was made in four dogs. Nicotine was applied daily to the gastric mucosa, either by moistening it with a solution or by blowing smoke against it. Only one dog survived an appreciable length of time. In this animal, after two years of treatment, an area grossly typical of leukoplakia appeared on the mucosa. It was excised and proved to be an island of squamous metaplasia in the gastric epithelium. The author considers nicotine a carcinogenic agent. C. D. HAAGENSEN

Transfer of Human Cancer to Apes: Experimental Investigations, SERGIUS VORONOFFAND GEORCIALEXANDRESCO. Die ubertragung des menschlichen Krebses auf Affen, Wien. med. Wchnschr. 82: 1103-1105, 1140-1143, 1165- 1168, 1932. The authors made 194 inoculations of human cancer into 72 baboons or chimpanzees-some but a few months of age, others old. In the hope of providing a favorable soil, castration, thyroidectomy, splenectomy, unilateral suprarenalec- tomy, or ligation of the pancreatic ducts was performed; in a few cases the juice of guinea-pig embryos was added to the tumor before inoculation, while in others blockade of the reticulo-endothelial system with trypan blue was tried; the effect of various physiological (oestrus, pregnancy, etc.) or pathological (chronic enteritis, tuberculosis, etc.) states was also investigated. Fiftytwo grafts were deposited in the subcutaneous tissues, 25 in muscle, 88 in viscera (mamma, liver, spleen, teatis, ovary, brain), and 29 in serous membranes (meningea, peritoneum, great omentum, tunica vaginalis) , Moat of them disappeared after from one to three months. The best result was obtained in two weakly young baboons, and particularly in an immature chimpanzee in whom the graft, after ten months, still shows a distinct tendency to increase in size; Thia implant, cut from an atypical mammary cancer of high malignancy, had been placed in the left breast, together with a sterile extract of guinea-pig embryo; at biopsy, six and a half months after inoculation, it showed well preserved carcinomatous tubules, strands of infiltrating epithelium, many mitotic figures, and giant cells. Another fragment of the same tumor, implanted in the right breast without the addition of embryo juice, was absorbed after one month. WM. H. WOGLOM 474 ABSTRAOTS

Tropism of Neoplasmatase for Various Organs according to Experiments with the Ehrlich Mouse Carcinoma, ERNSTFRKNKEL. Beitrllge zur Organotropie der Neoplasmatasen. Nach Versuchen am Mausecarcinom Ehrlich, Ztachr. f. Krebsforsch. 37: 313-322, 1932. The author has already described transfer of the Ehrlich mouse carcinoma and of sarcoma 37 by inoculating brain from animals bearing these tumors. As similar experiments with other organs have not been highly successful in his own hands or in those of other investigators, it seemed possible that the etiological agent (neoplasmatase) might have an elective affinity for nerve tissue (see Am. J. Cancer 16: abst. pp. 1000 and 1263, 1932). In order to answer this question it was necessary only to inoculate various organs from tumor bearers. When this had been done, it was found that the lung was most often successful in eliciting carcinoma; then followed, in order, spleen, brain, liver, and blood. The tumors thus produced often resembled the Ehrlich carcinoma, with which the experiment was done, but not infrequently the result was a " temporary tumor " or B granuloma. It is concluded that the agent must be fixed physically or chemically in the organa, for none of these contained metastases. Furthermore, thz result cannot be ascribed to an occasional cancer cell that had lodged in an organ without giving rise to an actual metastasis, for 6 million cells are required to reproduce a steadily growing Ehrlich carcinoma; 800,000 will elicit only a temporary growth. The various organs of the same mouse frequently gave different results, so that unequal distribution of the agent among them must be assumed. Bometimes it happened that the agent in an organ proved stronger than in the tumor itself, a paradox to which the author attributes great importance. WM.H. WOQLOM

Influence of Placenta on Transplantable Sarcoma of the Mouse, LTJDWIKGROSS AND STANISLAWWAJDA. Uber den Einfluss der Placenta auf transplantable Sarkome bei Mllusen, Ztschr. f. Krebaforsch. 37: 416-422, 1932. The authors found that a suspension of full-term human placenta in physiological saline solution distinctly retarded the growth of the " so-called Vienna " mouse sarcoma when injected subcutaneously every second day in amounts of 0.2 C.C. The effect, more certainly achieved in females than in males, was not constant, however, having been produced in but 62 per cent of the treated animals. No tumor was actually cured. Treatment of the placenta with ether abolished this activity and heating to 60' weakened it somewhat. Cow and rabbit placenta proved inert, as did human umbilical cord and Wharton's jelly. Insulin at first retarded but later stimulated the growth of the sarcoma. Praelobin (the sex hormone of the anterior lobe of the hypophysis) stimulated the tumor a little, while folliculin had no effect. Finally, it was found that the amount inoculated (apart from very small doses) and age, weight, and sex of the host had no effect upon the ultimate size of the growth. WM.H. WOQLOM

Influence of the Intestinal Flora on Tumor Growth and Susceptibility in Mice, E. FREIJNDAND B. LIJSTIQ. Uber den Einfluss der Darmflora auf Tumor- empflnglichkeit und Tumorwachstum bei Mllusen, Ztschr. f. Krebsforsch. 37: 347-354, 1932. Freund and Kaminer assert that extracts of blood, organs, or intestinal contents from normal people destroy tumor ceb, while those from tumor patients do not. The authors have used this reaction to investigate the susceptibility of mice to a transplantable carcinoma [unspecified], and report that in mice whose intestinal contents destroyed less than 25 per cent of cancer rells (caroinophilic intestinal flora) the tumor took in 100 per cent and grew rapidly, whereas in those with EXPERIMENTAL STUDIES, ANIMAL TUMORS 475 normal flora (about 50 per cent of cancer cells destroyed) inoculation was positive in but 85 per cent and the tumor grew more slowly. WM. H. WOGLOM

Influence of Various Diets on Tumor Susceptibility and Tumor Growth in Mice, E. FREUND,B. LUSTIO,AND B. KELLNER. Uber den Einfiuss verschiedener Ernlhrung auf Tumorempfanglichkeit und Tumorwachstum bei MLusen, Ztechr. f. Krebsforsch. 37: 355-361, 1932. The authors report that merely by changing the diet of mice they have been able to transform normal intestinal flora into the carcinophilic or carcinophobic variety. WM. H. WOGLOM

On the Action of Radium D, E, and F with Colloidal Bismuth upon Growing Tumors, A. G. C. TAYLOR.Brit. J. Radiol. 15: 446-456, 1932. The author studied the effects of a mixture of colloidal bismuth and radioactive salts on the growth of the Jensen rat sarcoma. The salts were obtained from old radon seeds and consisted of Radium D, E, and F, which form a constant source of beta rays, together with a small proportion of alpha particles. The bismuth is not toxic in low concentration, but when mixed with sufficient radioactive solution, it exercises a retarding effect on tumor growth. The mixture is injected around the tumor in uivo, but very little finds its way into the tumor itself. The concentra- tions which cause retarded growth are at the same time highly toxic (the animals died in one to three weeks). Since, however, this tumor strain regresses when the host is in poor health, it is not poseible to evaluate the real effect of the injected substance. [The choice of Jensen rat sarcoma for such experiments is unfor- tunate.] CHARLESPACKARD

Influence of Radiation from the Solar Spectrum upon Experimental Tumors, CESARETEDESCHI. Influenza di alcune radiazioni dello spettro solare sui tumori sperimentali, Pathologica 24: 94-99, 1932. Ehrlich adenocarcinoma was inoculated into mice, and groups of six animals each were exposed daily to sunlight, screened with red, yellow, and green screens, respectively. A control group of 15 animals was exposed to natural sunlight. Such radiation with light of different wavelengths had no apparent effect on the growth of the tumor. In a second experiment mice three months old were painted on the back with gas tar, and groups of eight animals each were exposed to sunlight of the different wavelengths, as in the first experiment. A control group of 15 animals were exposed to natural sunlight. Because fewer of the animals exposed to light of the longer wavelengths (red and green) developed cancer, Tedeschi concludes that the longer waves in the solar spectrum have a restraining influence upon cancer of the skin arising from tarring. [The number of animals used is obviously too small to permit of any conclusions being drawn from these experiments.] C. D. HAAGENSEN

Influence of Vital Staining with Isamine Blue on the Development and Growth of Tar Cancer, G. A. KREUZWENDEDICHVON DEM BORNEAND R. E. J. TEN SELDAM. Der Einfluss yon Isaminblauspeicherung auf Entwicklung und Wachstum von Teergeschwiilsten, Krankheitsforschung 9: 394-402, 1932. This is essentially the same as an article in Zeitschrift fur Krebsforschung 36: 93-96, 1932, though in somewhat longer form (see Am. J. Cancer 16, abst. page 991, 1932). WM. H. WOGLOM 476 ABSTRAUTS

Histogenic Chemotherapy and Oncolytic Power, M. FERRO. Chemoterapia istogena e potere oncolitico, Tumori 6: 1-10, 1932. In Fichera’s Institute at Pavia the author studied the oncolytic power of extracts of thymus, spleen, liver, muscle, and testicle for the cells in cancer of the breast. He concluded that the spleen and thymus were the most active lytic agents. Since the details of the technic and the findings in these experiments are not given it is impossible to follow the author in his far-reaching conclusions. C. D. HAAGENSEN

Asserted Resistance of the Offspring of Tumor-bearing Rats to Inoculable New Growths, J. FLAKS. Uber die Angeblich geringere Empfindlichkeit fur Impftumoren bei den Jungen tumorkranker Ratten, Ztschr. f. Krebsforsch. 37: 414-415, 1932. The author has been unable to confirm the resistance to transplantation described in the young of tumor-bearing mothers by Marx (Ztschr. f. Krebsforsch. 35: 170, 1932. Abst. in Am. J. Cancer 16, abst. p. 743, 1932). In the course of his own work with the same tumor, the Jensen rat sarcoma, he has frequently had occasion to inoculate nurslings of mothers bearing this growth, and the transplantation has always succeeded as well as in the young of normal rats. WM. H. WOGLOM

Syphilis and Neoplasms, C. LEVADITIAND N. CONSTANTINESCO.Syphilis et n6oplasmes, Compt. rend. Acad. d. sc. 194: 662-663, 1932. The relation between syphilis.and cancer which has been brought to light by clinical study suggested the idea of approaching this problem experimentally. A number of investigations are in progress concerning the production and evolution of neoplasms in syphilitic animals and somewhat resembling the work of Casti- glioni (Arch. ital. di anat. e istol. pat. 2: 475, 1931. Abst. in Am. J. Cancer 16: 996, 1932), who found that tar cancer developed more rapidly in syphilitic rabbits. In this preliminary note the authors record their observation that in mice with latent syphilis, and bearing transplanted sarcomas or carcinomas, the syphilitic virus penetrates the neoplasm and remains there for at least twenty-one days. WM. H. WOGLOM

Genetic Analysis of Dissimilar Carcinomata from the Same Gland of an Individual Mouse, ARTHURM. CLOUDMAN.Genetics 17: 468-480, 1932. Three independent tumors of similar histology in different regions of the mammary gland of a single individual gave variable results upon transplantation, [Similar differences were reported by Woglom (J. Cancer Research 4: 1, 1919) nearly fifteen years ago, but the paper is not mentioned.]

Arginase and Argiiline in the Metabolism of Tumors, G. KLEJNAND W. ZIESE. Arginase und Arginin im Stoffwechsel der Tumoren, Ztschr. f. Krebsforsch. 37: 323-346, 1932. Working with accurate and sensitive methods of arginine determination and employing carefully selected and comparable tumors, the authors have investigated the distant action of neoplasm upon host. It is shown that even the young- est growth activates the arginase in skeletal muscle. Animals resistant to inoculation showed this change in their musculature months after implantation of the graft, and the reaction persisted similarly where tumors had been extirpated. Unlike other investigators, the authors did not find an increase in the arginine content of tumors. The quantity of free arginine in tumor and muscle was about EXPERIMENTAL STUDIES, ANIMAL TUMORS 477

three times as high in tumor-bearers as in the muscle of normal animals, and the amount of protein arginine correspondingly diminished. The tumors employed were the Ehrlich mouse carcinoma, the Flexner-Jobling rat “ sarcoma,” the Jensen rat sarcoma, and the Roue chicken sarcoma. [Most investigators prefer to call the Flexnqr-Jobling tumor a carcinoma.] WM. H. WOGLOM Properties of the Causative Agent of a Chicken Tumor. VI. Action of the Asso- ciated Inhibitor on Mouse Tumors, JAMESB. MURPHYAND ERNESTSTURM. J. Exper. Med. 56: 483-492, 1932. Thinking that the inhibitor which the senior author and his collaborators have demonstrated in transplantable chicken tumors might be less specific in its effects than is the etiological agent, they have tested it on mouse tumors. It was found that the inhibitor from slowly growing strains of chicken sarcomas I and X definitely retarded the growth of mouse sarcoma 180, but exerted no effect upon mouse carcinoma 63. The inhibitor was inactive, also, in the case of mouse sarcoma 37, perhaps because of its unusual malignancy, or perhaps because there may be some question as to the nature of this growth, which is supposed to be a sarcoma but which originated in the stroma of a carcinoma. Extensive control tests with extracts of rapidly growing chicken tumors and of tissues from normal and immune fowls showed no inhibitory action. No demonstrable effect was exerted on the mouse tumors by sera from im- munized rabbits, which neutralize the chicken tumor agent, or by those from fowls highly resistant to the chicken tumors. WM. H. WOQLOM Biochemistry of the Rous Chicken Sarcoma. II. Biochemistry. 7. Chlorine, VLADIMfR MORAVEIC.Biochemie des Rous-Sarkoms der Htihner. 11. Biochemie. 7. Chlor, Ztschr. f. Krebsforsch. 37: 293-298, 1932. The amount of chlorides in the whole blood, the blood serum, and the organs of fowls bearing the Rous sarcoma tends to fall, while in the tumor it rises to as much as four times the content of the surrounding muscle. WM. H. WOGLOM Biochemistry of the Rous Chicken Sarcoma. II. Biochemistry. 8. Sulphur, VLaDIaafR MO~VEK.Biochemie des Rous-Sarkoms der Hiihner. 11. Bio- chemie. 8. Schwefel, Ztschr. f. Krebsforsch. 37: 299-304, 1932. The total sulphur in blood, liver, and muscle is not altered by the presence of the Rous sarcoma. There is a diminution in the tumor, however (70 mg. per cent fresh weight, as compared with 160 mg. per cent for the surrounding normal muscle) . WM. H. WOGLOM Biochemistry of the Rous Chicken Sarcoma. 11. Biochemistry. 9. Phosphorus, VLADIMfR MOR~VEK.Biochemie des Rous-Sarkoms der Huhner. 11. Bio- chemie. 9. Phosphor, Ztschr. f. Krebsforsch. 37: 305-312, 1932. The total phosphorus in the blood serum of fowls bearing the Rous sarcoma rises, that in the lungs falls, whereas the content of whole blood and of liver remains unchanged. The tumor contains much less phosphorus than does normal muscle. WM. H. WOQLOM Experiments with the Chicken Endothelioma of Murray, G. ROUBSY,CH. OBER- LINQ AND M. GTJ~RIN. Recherche8 sur l’endoth6liome de Murray cher la Poule, Compt. rend. SOC. de biol. 110: 473-475, 1932. . This is essentially the paper of Gubrin and Bonciu appearing in Bull, Assoc. frang. p. 1’6tude du cancer 21: 518, 1932 (abet. in Am. J. Cancer 17: 184, 1933). Waa. H. WOQLOM 478 ABSTRACTS

Propagation of Fujinami’s Fowl Myxosarcoma in Ducklings, W. E. GYE. Brit. J. Exper. Path. 13: 458-460, 1932. Gye has already confirmed Fujinami’s observation that this myxosarcoma of the fowl will grow in ducklings (Brit. J. Exper. Path. 12: 93, 1931. Abst. in Am. J. Cancer 16, abst. p. 20, 1932).1 In this article he describes its propagation in series for 18 generations, fully long enough to verify Fujinami’s contention that it can be cultivated in series in a foreign soil. In all, 44 ducklings were used; 39 died of their tumors or when moribund were killed for purposes connected with the experiment; the remaining 5 all developed growths which retrogressed. Chickens inoculated with cells, filtrates, or dried powder from sarcomas growing in ducklings developed neoplasms. Half-grown or older ducks formed tumors in response to injections of cell emulsions or of cell- free extracts, but the neoplasms always regressed, and the host thereafter was entirely immune to further inoculation. It may be that the forces which enable a duck to cure this sarcoma are the same as those which lead, though but rarely, to the disappearance of spontaneous new growths. If so, an investigation of Fujinami’s myxosarcoma in ducks might afford an opportunity to investigate the agencies that bring about spontaneous cure. WM.H. WOOLOM Infectious Myxomatosis (Sanarelli) in Pregnant Rabbits, DOUGLASH. SPRUNT. J. Exper. Med. 56: 601-608, 1932. Pregnancy did not change the general resistance of rabbits to infectious myxomatosis. However, the disease cannot be compared in this regard with the transplantable mouse and rat tumors, because there is a difference of opinion as to the effect which pregnancy exerts upon these neoplasms. The remainder of the paper discusses certain resemblances between myxomatosis and the infectious diseases. WM.H. WOGLOM Experimental Study on the Etiology of Granuloma Malignum, VINCENZOTRA- MONTANO. Ricerche sperimentali sulla etiologia del granuloma maligno, Pathologica 24: 85-90, 1932. Granuloma malignum lymph nodes were removed from four patients, ground up with sand, extracted with isotonic saline, and injected into the peritracheal lymph nodes of guinea pigs. For each case twenty animals were injected, and in addition six more animals were injected with extract which had been incubated at 60’ for one hour in order to kill any possible virus. The animals died or were sacrificed at intervals of from eight to one hundred and eighty days after inoculation. Nothing more than slight hyperplasia of the lymph nodes was found. Cultures were negative, as were also attempts at reinoculation. Tramontano concludes that the tubercle bacillus is not the cause of granuloma malignum. C. D. HAAQENSEN On the Relationship between Beta and Gamma Radiation in the Treatment of Tumours, J. C. MOTTRAM.Brit. J. Radiol. 5: 768-774, 1932. Mottram cites the frequent experience that tumors treated with radium or x-rays over prolonged periods do not show the same clinical reaction at the end of such periods as they did at the beginning. He calls attention to the fact that Russ (Brit. J. Radiol. 29: 275,1924), using the Jensen rat sarcoma as his material, was able by a previous treatment to raise the lethal in uitro dose some two and a half times. Using t\e same tumor and a slow-growing rat sarcoma, Mottram thinks that he was able, by giving exposures of gamma rays in vitro and then inoculating the tumors and testing small particles for the lethal dose, to demon- EXPERIMENTAL STUDIES, ANIMAL TUMORS 479 strate greatly increased resistance. An exposure of 350 minutes to 220 mgm. of radium was required to kill the tumors after a double exposure to gamma rays, while originally only 153 minutes’ exposure was necessary. In order to obtain a complete solution of the problem of the relationship of beta and gamma radiation to susceptibility, four sets of experiments were necessary: (1) sensitivity of Cells to gamma radiation after previous exposure to gamma radiations: (2) sensitivity of cells to beta radiation after previous exposure to beta radiation; (3) sensitivity toward gamma radiation after previous exposure to beta radiation; (4) sensitivity to beta radiation after previous exposure to gamma radiation. (1) Charts Nos. 2 and 3 show that the previous gamma-rayed cells survived subsequent exposures to gamma rays of 194 minutes, while the normal cells survived only 153 minutes. A repetition of this experiment was somewhat less striking but still showed that the previously rayed tumor was more resistant than the normal control. (4) Tumor cells which had previously received gamma radiation were just as sensitive to beta radiation as the controls (Chart 4). (2) Tumor cells given a single radiation with beta rays showed no increased resistance to beta radiation. Repeated exposures to beta radiation induced some resistance (Chart 5), though the cells may become even more sensitive than normal cells (Chart 7). (3) No increased resistance was found when gamma radiation was applied to cells which had been previously exposed to beta radiation (Chart 8). The author concludes that repeated sub-lethal exposures of rat sarcoma cells, whether to beta or gamma radiation, raise their resistance to this radiation; that tumor cells exposed to gamma radiation show no increased resistance to beta and those exposed to beta no increased resistance to gamma. In a discussion Dr. Mottram was asked how he eliminated the gamma rays so as to produce pure beta radiation. He replied that the beta radiation was obtained from a radium applicator with a very thin screen, hence some gamma radiation must have been mixed with it; whether he was correct in saying that he had exposed cells to beta radiation under such conditions he was not sure.

Transformation of the Epithelium of Mouse Carcinoma in Vitro, NIKOLAUSG. CHLOPIN. Uber die Verwandlungen des Mausecarcinomepit hels im Ex- plantat, Ztschr. f. Krebsforsch. 37: 235-255, 1932. This is a histological account of two mouse carcinomas (Ehrlich’s and Petroff’s) when growing in uitro. Their morphology was found to vary considerably according to the environment, but in any case the characteristic features of epithelium were absent, so that they may be said to differ from the normal in their inferior histioblastic potency. As any detailed discussion would be impossible without considering at the same time the changes undergone by normal epithelium proliferating under similar conditions, the inquiry will be continued (see below). WM.H. WOGLOM

Growth and Differentiation of Certain Epithelial Tissues Outside of the Organism, NIKOLAUSG. CELOPIN. Uber das Wachsturn und die Organisationsfahigkeit einiger Epithelgewebe ausserhalb des Organismus, Ztschr. f. Krebsforsch. 37: 256-276, 1932. The general character of epithelial growth in uitro depends upon external conditions, such as the composition of the medium, as well as upon internal factors, of which the most important is histioblastic potency, or that innate specificity acquired during ontogenesis. 480 ABSTRACTS

Several man typcs of proliferat'on may be distinguished: the formation of a typical thin membrane of cells; of a thicker sheet containing tubules or cyst-like cavities; of a surface layer more or less enclosing the explant; and finally, the emergence of very loosely connected or even isolated and quite undifferentiated cells. The first three are normal for epithelium growing in U~~TO;the fourth, anomalous, variety, it must be emphasized, does not represent unrestricted proliferation by cells freed of all specific characteristics, as has been supposed by some investigators; on the contrary, in so far as these atypical forms are not a result of mere degenerative changes, they express but a transitory and irrelevant stage in the life of the culture. Epithelium that has undergone malignant transformation may still retain many of its characteristics or, like the mouse carcinoma whose growth has been described in the preceding paper [abstracted above], suffer extreme cataplasia. WM. H. WOGLOM

Observations on the Splitting of Peptides by Normal and Malignant Tissues, SIEGFRIEDL. MALOWAN.Untersuchungen iiber Peptidspaltung durch Normal- und Tumorgewebe, Ztschr. f. Krebsforsch. 37: 277-282, 1932. The destructive growth of the tumor cell has long been referred to enhanced proteolysis, and within the past few years Waldschmidt-Leitz and his collaborators have endeavored to elucidate this increased digestive capacity by assuming that glutathione present in the cancer cell in its reduced form activates the proteolytic ferment kathepsin. Several other investigators, however, have objected on various grounds to this conception, and in any case there remains always the possibility that cell extracts, which have been employed up to the present, do not fully represent the activities that go on during life. The author has accordingly repeated the experiment with cells growing in uitro. The result conflicted with the Waldschmidt-Leitz hypothesis and confirmed the work of Kleinmann and Werr and others (see Am. J. Cancer 16: abst. pp. 753, 754, 1932), for it was found that the Jensen rat sascoma did not split the two dipeptides investigated (glycylglycin and d, 1-leucylglycin) any more vigorously than did liver, kidney, or intestinal epithelium from adult rats: indeed, in some cases the tumor cells were less active. WM. H. WOGLOM

Loss of Vitality of Sensitized Tissue by Photodynamic Action, A. H. ROFFO. PBrdida de la vitalidad por la accidn fotodintimica de 10s tejidos sensibilizados, Rev. mBd. latino-Am. 17: 231-235, 1931. Roffo studied the growth of tissue from the heart of a fifteen-day-old chick embryo and that from a rat sarcoma in media containing eosin and erythrosin. Some of the cultures were treated with ultraviolet light. The tumor tissue grew less than normal tissue in the media containing a concentration of 1 : 10,000 of either of the dyes mentioned. There was no growth when the tumor cultures were treated with ultraviolet light. The normal tissue showed growth after irradiation for one hour at a distance of 20 cm. No specifications are given concerning the intensity and wavelength of the ultraviolet light used. Two illustrations are shown. JOHANNEBP. M. VOGELAAR

Incidence of Mammary Cancer in a Cross between Two Strains of Mice, C. C. LITTLEAND B. W. MCPHETERS. Am. Naturalist 46: 568-571, 1932. A non-yellow (dilute brown) strain of mice high in the incidence of spontaneous mammary adenocarcinoma was crossed with a line of yellow mice low in cancer incidence. Two-hundred-and-sixty R virgin females lived long enough to be NATURE OF CANCER, ETIOLOGIC THEORIES 48 1

included in the final reckoning, of which 136 were yellow and 134 non-yellow. In these two classes the incidence of cancer (including adenoma, as a preliminary stage of carcinoma) was 38.97 per cent for yellows and 59.70 per cent for non- yellows. As the difference was 5.18 times its probable error, the authors hold that there is no doubt that a significantly higher proportion of non-yellows than of yellows developed cancer of the breast in this particular hybrid generation. The authors are not yet prepared to account for the difference, but for several reasons think it improbable that a general metabolic factor is involved. This paper furnishes the first evidence of an interrelationship between a color variety of mice and the incidence of spontaneous mammary cancer. WM.H. WOGLOM Intracranial Epidermoid Cholesteatomas of the Horse, G. PALLASKE.Uber die epidermoidalen Cholesteatome der Schadelhohle des Pferdes, Frankfurt. Ztschr. f. Path. 43: 126-132, 1932. In veterinary pathology two types of cholesteatoma are recognized, both occurring almost exclusively in the horse. The plexus-cholesteatoma of Joest, so common in the brains of older animals, is not considered here, the article dealing only with the intracranial growth known in human pathology as pial cholesteatoma or epidermoid. Only 7 instances of this latter neoplasm have so far been recorded. It appears as a slowly growing, intradural or extradural cyst with relatively thin walls, which, in spite of its name, does not appear always to contain cholesterol. WM. H. WOGLOM

Hamartomas of the Spleen in Dogs, DINOMONARI. Gli amartomi della milza nel cane, Arch. ital. anat. e istol. pat. 3: 33-43, 1932. The author, who is a veterinary, has noted that in dogs, and particularly in young dogs, peculiar intrasplenic nodules are frequently found. The structure of these nodules is similar to that of normal spleen, except that the blood sinuses and the lymphocytic foci are more prominent. Monari has found such nodules but rarely in other animals, and points out that they are also rare in man. He calls these nodules hamartomas, and believes that they originate from some congenital disturbance in the development of the spleen. Several photomicrographs and an extensive bibliography are included. C. D. HAAGENSEN

NATURE OF CANCER, ETIOLOGIC THEORIES

Present Views on the Fundamental Problem of Cancer, M. A~KANAZY.Nuestras ideas actuales sobre 10s problemas fundamentales del cancer, Rev. med. de Barcelona 16: 405-416, 1931. The author emphasizes the necessity of grouping cancerogenic factors in four groups: The first two groups concern general and local predisposition; the last two concern special influences which must be exerted upon a given tissue in order to produce the growth of a malignant tumor. The recognition of an additional cancerogenic factor, namely irritation through an element of exogenic origin, as certain chemical substances, must be regarded as a genuine and important advance in the analysis of neoplastic phenomena. The occurrence of x-ray cancers has shown the importance of the invisible rays among these exogenic factors. Results so far achieved in cancer research make it possible to speak of prophylaxis of malignant tumors. From the point of view of heredity, matrimony should he discountenanced between persons in whose families cancer occurs in the same 482 ABSTRAOTS

organ. As to local predisposition, inflammatory processes of prolonged duration require removal. With respect to exogenous factors, measures are available to prevent their deleterious effects. Is Cancer to be Regarded as a Cell Mutation? GEORGE^ GRICOUROFF.Le cancer peut-il &re consider6 comme une mutation cellulaire? Paris m6d. 22: 237-244, 1932. Various methods of approach have all yielded results suggesting that cancer originates by somatic cell mutation. Yet objections to the hypothesis are not wanting. Chief among these is its failure to explain the transfer of certain neoplasms of the fowl by means of a filterable agent; here it would be necessary to assume, as has been recently proposed, that a filtrate is able to determine immediately that specific mutation responsible for the tumor in question. WM.H. WOGLOM Tropism and Cancer, P. LIMAY. Tropisme et cancer, NBoplasmes, 10: 294-296, 1931. In both vegetable and animal qrganisms, the mechanism of growth is controlled by the properly balanced antagonistic action of the growth-stimulating substances, or trephones, and the growth-inhibiting substances. Trephones are normally present in embryonic tissues; after birth, in the higher animals and man, they are present in the leukocytes. If a tissue is injured, tropism brings the leukocytes to the site of the injury, and with them the trephones necessary to tissue repair. When this is complete, the leukocytes and the trephones normally disappear from this site. If the healing process is prolonged, or the irritation is continuous or repeated, there is a disturbance of the equilibrium between the trephones and the growth-inhibiting factors; there are then cellular dedifferentiation and cancerization.

Genetic Origin of Tumors Supported by Their Simultaneous and Symmetrical Occurrence in Homologous Twins, J. MCFARLANDAND T. S. MEADE. Am. J. M. Sc. 184: 66-80, 1932. The correspondences between homologous twins have attracted attention since Galton wrote his “ Hereditary Genius” in 1871. From the literature, McFarland and Meade have prepared tables of tumors occurring in homologous twins. There appear to be 20 such reports, as follows: Adenofibroma of breast. ... Ecchondrosis ...... Cystoma of kidney...... 1 Cystoma of ovary...... 1 Nevi ...... 4 Papilloma...... 1 Carcinoma of. breast...... Carcinoma of ovary...... Carcinoma of uterus...... Glioma ...... Melanoma of eye (doubtful) Retinoblrrstoma ...... Sarcoma of testis...... Tumors occurring in homologous twins appear always to be similar, symmetrical, and simultaneous. Furthermore, there is no reported case in which one homologous twin suffered from a tumor without his fellow being similarly affected. No such ‘‘ coincidences ” are recorded among heterologous twins. In addition, leukemia in 3 instances and Hodgkin’s disease in one instance have been reported NATURE OF CANCER, ETIOLOGIC THEORIES 483 as simultaneously affecting homologous twins. The former sometimes appears to be inherited in man, and is closely associated with cancer inheritance in mice. All these observations are strong evidence for the genetic determination of tumors in twins. Tables of malformations and of mental abnormalities in homologous twins are given; also an extended bibliography. M. E. MORSE Favorable Soil for the Development of Cancer, C. LAVILLE. Sur le terrain favorable au d6veloppement des cancers, NBoplasmes, 10: 282-293, 1931, According to Laville’s theory, in individuals constitutionally inclined toward an alkalosis of the pH of the blood, any form of trauma adds to this primary alkalosis a secondary alkalosis, 80 that a state of alkalosis becomes permanent, resulting in a modification of the bilirubin metabolism. In such a state of alkalosis, which is comparable to that of a mild hemolytic icterus, there is an increase of potassium, which stimulates cellular division, and a diminution of ionic calcium; there is also a definite increase in blood sugar. Finally, as the author has found, there is a disappearance of the bilirubin pigment, which exerts a moderating action on cell growth and division. All ot these factors tend toward increasing the power of multiplication of embryonic and pseudo-embryonic cells. In areas that are traumatized or irritated and are in the process of cellular repair, this process of repair is stimulated, especially in the absence of the modifying action of the bilirubin pigment. According to the concentration of the OH ions of the blood, all degrees of neoplastic growth may occur from keloid and benign tumor to rodent ulcer of a particularly malignant type. Cancerization thus may be defined as a process of cellular repair which is uncontrolled because it takes place without the normal metabolic control of growth.

Present Status of the Studies regarding Vital Radiation, ELISAMORELLI. Stato attuale degli studi sderadiazioni vitali, e sulla loro importanza nell’insorgenza delle proliferazioni atipiche, Boll. d. lega ital. per la lotta contro il cancro 6: 10-16, 1932. This is a general review of the so-called mitogenic rays and their presumed relation to the development of cancer. The author believes that “ these studies have shed new light on the biology of the cancer cell . . . and open up unsuspected fields of research. It is not too much to hope that they represent at least a step toward the solution of the complicated problem.” No new data are presented. C. D. HAAGENSEN

Problem of the Divining Rod, WALTHERGERLACH. Zum Problem der Wun- schelrute, Naturwissenschaften 20: 883-885, 1932. Gerlach believes that a thorough airing of the whole divining-rod question is necessary because, in southern Germany at least, a considerable portion of the population has recently been not only excited by threats of epizootics and by the deliberate inculcation of carcinophobia by quacks, but actually intimidated into spending hundreds of thousands of marks for devices with which to avert malev- olent rays which these charlatans announce that they can detect with their divining rods. An investigation was accordingly begun in the Physical Institute at the Uni- versity of Munich, and a number of dousers were asked to survey the institute for areas in which dangerous rediatiods were present. They were also asked to make a similar survey to demonstrate the value of a “ screening apparatus ” widely sold as a protection against radiations. While the “ specialists ” were surveying an upper floor, the screening apparatus was removed and replaced without the fact 484 ARSTRAUTS being discovered by the dousers. The results showed clearly that the whole performance was merely an exhibition of impudent charlatanry. [This article has been abstracted because twice of late reputable scientific journals have published papers in which it was seriously suggested that terrestrial rays are the cause of cancer. For abstracts of the articles see Am. J. Cancer 15: 348, 1931, and 16, abst. p. 1288, 1932.1 WM. H. WOGLOM

Magnesium in the Soil and Cancer, L. ROBINET. Terrains magnksiens et cancer, Bull. de 1’Assoc. franp. p. 1’6tude du cancer 21: 464-72, 1932. The author reviews statistics of the incidence of cancer and the occurrence of magnesium in the soil in different parts of the Grand Duchy of Baden and concludes that the incidence of cancer is inversely proportional to the richness of the soil in magnesium. H. Q. WOODARD

Nourishment of Patients with Cancer According to the Modem Point of View, FRANCESCOP. TINOZZI. L’alimentazione dei cancerosi second0 le moderne vedute, Ann. ital. di chir. 11: 69-77, 1932. Tinozzi reviews the question of the relation of diet to cancer, paying particular attention to the claims of those recent authors who regard alkalosis as a causative factor. He carried out an experiment on this point. A series of rats were kept on a high calcium diet. None of them developed neoplasms. Further details of this experiment are not included. C. D. HAAGENSEN

Glycogenesis and Cancer, M. G. RAPPIN. Glycogen6se et cancer, Bull. de 1’Assoc. franp. p. 1’6tude du cancer 21: 489-91, 1932. The author discusses several recent publications and concludes that a diet such as liver which is rich in glycogen favors the development of cancer. H. Q. WOODARD

The Relationship between Benign and Malignant Tumors, H. T. DEELMAN. tfber die Beziehung zwischen gutartigen und bosartigen Geschwiilsten, Ztschr. f. Krebsforsch. 37: 383-397, 1932. Authorities do not agree on how frequently a benign tumor undergoes malignant transformation, though all concur in the belief that such a change does take place. Very likely no definite figures can be given, for there is a wide variation among the different types of benign neoplasms ; thus mammary fibro-adenomas rarely become cancerou8, whereas papillomas of the urinary bladder frequently suffer malignant change. It is impossible to say just when the alteration sets in, for the boundaries between benignancy and malignancy are not always apparent to the microscopist, as the study of experimental tar tumors has demonstrated. WM.H. WOGLOM Problem of the Carcinoid, FRIEDRICHFEYRTER. Zur Frage der Karzinoide, Verhandl. d. deutsch. path. Gesellsch., Tagung 26: 286-289, 1931. The affinity for both chrome salts and silver shown by cells of carcinoid tumors from the gastro-intestinal tract has led to the belief that these growths are derived from the so-called yellow cells of Schmidt, which lie in the intestinal epithelium. The author has found no evidence, on the whole, against this hypothesis so far as carcinoids of the jejunum, ileum, appendix, and large intestsine are concerned, though the reservation must be made that the cells of carcinoids even in these situations do not always develop after the manner of Schmidt’s cells; thus mucoid materid or occasionally goblet cells or Paneth’s granular cells may arise. With GENERAL CLINICAL OBSERVATIONS 485

these exceptions there is no objection to be urged against the current view regarding the origin of carcinoids in the region just cited, It was quite otherwise in the author’s experience, however, with carcinoids of the duodenum in general and the papilla of Santorini in particular; here there were noted a finely reticular architecture, a lack of affinity for chrome salts and silver, the presence of large pale cells, and of structures resembling the pancreas in their possession of compact eosinophile granules. These carcinoids resembled the island cell tumors of the pancreas, and some light may be thrown on their origin by the observation that large clear cells like those in the islands of Langerhans are to be found singly or in groups along the course of Wirsung’s and Santorini’s ducts. WM. H. WOGLOM

Origin of Teeth in Dermoid Cysts, E. S. J. KING AND P. MACCALLUM.Arch. Path. 14: 323-334, 1932. King and MacCallum give a history of the theories concerning teratomata from mediaeval times to the present.

Certain Tendencies in the Study of Cancer, N. GOORMAGHTIGH.Quelques tendances actuelles de la canc6rologie, Clinique, 26: 196-200, 1931. The author reviews certain phases in the recent study of cancer, especially the experimental production of cancer and the question of susceptibility to cancer. He concludes that the true nature of cancer is still unknown.

GENERAL CLINICAL OBSERVATIONS

Association of Cancer and Tuberculosis, ANTONIOBOBBIO. Sull’associazione di cancro e tubercolosi Cancro 3: 16-26, 1932. The author reviews the 1754 cases of cancer which have been diagnosed in the Anti-Cancer Center of Turin during the six years, 1926-31. There were six instances in which histologic examination showed both cancer and tuberculosis in the same organ: in two cases the tuberculosis was associated with carcinoma of the cervix, in two with carcinoma of the breast, and in one case each with adenocarcinoma of the corpus and carcinoma of the vulva. In six other cases tuberculosis was found in lymph glands or other tissue adjacent to carcinoma. These cases were: three cases of carcinoma of the breast with tuberculosis of axillary or cervical glands; one case of carcinoma of the penis with tuberculosis of inguinal nodes; one case of carcinoma of the temporal region with tuberculosis of submaxillary nodes; one case of “ endothelioma ” of carotid lymph nodes and tuberculosis of the overlying skin. The author believes that the low incidence of tuberculosis (2.85 per 1,000) among his cases of cancer indicates that the disposition of the individual patient opposes one or the other of the two diseases. C. D. HAAGENSEN

Metabolism of Cancer Patients and Those SusceptiPle to Cancer, R. REDING. Le metabolisme du sujet cancereux et canc6risable, Bull. de 1’Assoc. franp. p. 1’6tude du cancer 21: 399-447, 1932. From his own work and the literature, the author considers that the cancerous organism and that susceptible to cancer differ from the normal in showing: (1) uncompensated alkalosis of blood, urine, and interstitial fluids; (2) displacement of the isoelectric points of muscle and blood toward the alkaline side; (3) lowering of the surface tension of serum, cerebrospinal fluid and the interstitial 486 ABSTRACTS fluid of tumors, and increase in the viscosity of serum; (4) lowering of the electrical resistance of malignant tissue; (5) decrease in the total and ionized calcium of the blood, and increase in blood potassium (condition in malignant tissue similar to that of blood); (6) increase in plasma cholesterol, and fatty acids and decrease in lecithin; (7) decrease in the total albumin and fibrinogen of the blood, increase in globulin, and alteration in the albumin-globulin ratio; (8) increase in cellular hydration; (9) decrease in tissue respiration, increase in tissue glycolysis, and a tendency to lacticemia; (10) alteration in the oxidation-reduction equilibrium; (11) alteration in glucose metabolism with a tendency toward the diabetic form of sugar-tolerance curve; (12) alteration in the vago&sympathetic tonus with arterial hypotension and impairment of the circulation. The author considers that the alkalosis is the primary abnormality, and the cause of all the others. Numerous authors are mentioned in the text, but there is no bibliography. [It appears to the abstractor that the evidence on many of the points considered in this paper is not sufficient to support the theory.] H. Q. WOODARD

Pathogenesis of the Paradoxical Obesity in Many Cases of Cancer, MATHIAS. Zur Pathogenese der paradoxen Fettsucht in manchen Krebsfallen, Verhandl. d. deutsch. path. Gesellsch. 26: 289-292, 1931. Wohlwill and others have maintained that the obesity that is found in some patients with cancers of long duration, with metastases, is due to metastases in the pituitary causing dysfunction of the internal secretion. Some of the author’s own observations confirm this hypothesis, since in some of his cases that came to autopsy definite metastases were found in the pituitary. Obesity in patients with pernicious anemia or severe secondary anemia is to be attributed to lack of oxygen and imperfect oxidation-an anoxemic obesity. This is not infrequent in gastric, prostatic, and breast cancer, and squamous-cell epithelioma of the uterus, in all of which loss of blood or bone metastases are clinically important.

Relation of Chronic Varicose Ulcer to Epithelioma, JO~EPETENOPYR AND IEIDORE SILVERMAN.Ann. Surg. 95: 754-768, 1932. At the King’s County Hospital, Brooklyn, N. Y., over 1,000 cases of chronic leg ulcers were seen in the period 1921-1931. The same period showed only 19 cases of epithelioma of the leg, 14 of which from the surgical service of Dr. Tenopyr constitute the basis of the present study. Of these, only 4 gave a history of chronic varicose ulcer of long duration. Two others gave a history of ulcers of a few years’ duration, which the authors believe may well have been malignant from the beginning. Five gave a definite history of primary skin carcinoma. One developed in an old osteomyelitic wound, one following a compound fracture, and one a burn scar. The patients were all of cancer age, most of them in the fifth decade; only 3 women were affected, although varicose veins and ulcers are much more common in women than in men. The authors believe, as a result of this study and of a review of the literature, that the weight of evidence is strongly against the common belief that chronic ulceration over long periods plays an important r8le in the causation of cancer. A bibliography is appended.

Treatment of Fractures of the Clavicle. Stratified Squamous Epithelioma, P. MBNDIZABAL.Tratamiento de las fracturas de la clavicula. Epitelioma malpighiano baso-celular, Gac. med. de Mexico 62: 481-486, 1931. The author reborts an epithelioma arising in a man seventy-eight years old, over the sternum, following a kick by a cow. The size of the mass, 14 x 6 cm. makes it of particular interest. H. RIVERO DIAGNOSIS AND TREATMENT 487

Sudden Gangrene of Fibromas during Grippe, ROUHIER.La mortification brutale des fibromes dans le cours de la grippe, Bull. et m6m. SOC.nat. de chir., 57: 1202-1205, 1931. The author reports 3 cases in which a previously symptomless uterine fibroma suddenly produced severe symptoms as the patient was recovering from an attack of grippe. In two cases there was a sudden attack of abdominal pain with nausea and fever, in one case severe hemorrhage. In two cases a hysterectomy was done, and in the third case-a younger patientis myomectomy. In all these cases, the tumor was gangrenous, although there was no torsion and no sign of infection. The author is of the opinion that the sudden change in the fibroma was due to bacterial toxins rather than to infection.

Angiomas of Striated Muscles, with a Discussion of the Pathogenesis of Angiomas in General, 0. BARTOLI. Sugli angiomi dei muscoli striati con qualche con- siderazione a riguardo della patogenesi degli angiomi in genere, Ann. ital. di chir. 11: 16-24, 1932. Bartoli’s patient was a man aged twenty-four with multiple circumscribed, nodular, intramuscular angiomas. One was situated at the left margin of the anterior portion of the tongue, and there were three in the right sternomastoid muscle. One of these was at the level of the thyroid cartilage and two were at the clavicular insertion of the muscle. All were removed surgically. Their structure was that of cavernous angioma. The author believes that such angiomas arise as the result of dilatation of capillaries with congenitally weak walls. They should not be classed as angio- blastomas. One clinical photograph and a short bibliography are included. C. D. HAAOENSEN

Tar Cancer, P. DAVIDAND BRASSART.Sur le cancer du goudron, J. d. sci. m6d. de Lille, 50: 483-485, 1932. Two successive and rapidly developing (two months) cancers of the skin are reported in a man sixty years of age, whose business it was to repair tar-painted iron utensils. In the course of his work, flakes of tar were continually settling on his face, where they were retained by the perspiring skin, and he was exposed also to flying acid droplets of various sorts. The authors have not encountered in the literature any case where dry tar was incriminated, and they confess to a little doubt regarding its r61e in the present instance . [As the first tumor regressed under diathermy coagulation and the patient did not return after having reported the appearance of the second one, no microscopic examination is mentioned.] WM. H. WOQLOM

DIAGNOSIS AND TREATMENT Diagnosis of Malignant Tumors from Exudates and Puncture Fluids, HERBERT KARP. Cytodiagnostic maligner Tumoren aus Punktaten und Sekreten, Ztschr. f. Krebsforsch. 36: 579-605, 1932. The author has carefully re-studied the cytology of exudates with a variety of technics, in the hope of clarifying the diagnosis of malignant tumors of the pleural, endocardial, and peritoneal cavities. He states that cells from benign and malignant tumors have neither morphological, chemical, nor other characteristics which enable a definite morphologic diagnosis to be made in all instances. In 488 ABSTRACTS

other words, it is never possible from the examination of the cells of a puncture fluid to make a certain diagnosis. However, there are certain facts which permit the diagnosis of the presence of tumor cells with moderate certainty. One of these is the relation between the nucleus and the nucleoli. The nucleoli of carcinoma cells are considerably larger than those of endothelial cells, measuring 4 to 12 p. The absolute size is, however, much less important than the ratio between the sire of the nucleus and that of the nucleolus. By careful measurements the author shows that the area of the nucleus in endothelial cells is 25 to 100 times as great as that of the nucleoli, while the nuclear areain tumor cells is only 4 to 20 times as large as that of the nucleoli. This is a sub- stantiation of the views of MacCarty, who regarda large nucleoli as a pathognomonic characteristic of the malignant cell. This relationship, however, is not found in the cells of sarcoma. Other suggestive morphological appearances are the very large vacuoles which may appear in tumor cells, and which are not usually observed in endothelial cells. By the use of these criteria the author has been able, in certain instances, to make a correct diagnosis of malignant growth from sputum, cerebrospinal fluid, duodenal juice, and puncture fluid obtained from certain tumors. The best technic is that of the vital method recommended by Quensell (Acta Med. Scandi- nav., 1928, Supplement I), which consists in staining the fresh preparation with a mixture of methylene blue and Sudan 111. Two photomicrographs illustrate the author’s statements, and a very complete bibliography is appended. New Blood Test for the Diagnosis of Cancer, F. KRAUS. Eine neue Blutreaktion zur Krebsdiagnose, Ztschr. f. artz. Fortbildung. 28: 624-625, 1931. The author discusses the blood test described by H. J. Fuchs, which is briefly as follows. In a mixture of fibrin and serum from normal human blood, the fibrin is not destroyed, but fibrin from a normal subject is destroyed by serum from a patient with an infectious disease or a malignant tumor; and serum from a normal person destroys the fibrin from such cases. This reaction is made more specific by the fact that the serum from such cases destroys fibrin from all other human subjects except those showing the same type of disease. The Fuchs test is a chemical one, depending upon the chemical analysis of the fibrin-serum mixture for - the proteolytic products of destruction of the fibrin. It is thus a quantitative as well as a qualitative test. It has been found to be correct in 90 per cent of cases. In cases of cancer effectively treated with radiation a diminution in the intensity of the reaction is observed. Fuchs has recently simplified the test. Influence of Roentgen Rays and Radium on the Serum Reaction of Tumor Patients (CaR), M. v. FALKENHAUSENAND HANS J. FIJCHS.Der Einfluss von Rontgen- und Radiumbestrahlung auf die Serumreaktion bei Tumorkranken (CaR), Ztschr. f. Krebsforsch. 37: 362-366, 1932. The Fuchs reaction [digestion of normal fibrin by serum from cancer patients, and of fibrin from cancer patients by normal serum] not only demonstrates the presence of a malignant growth, but indicates quantitatively, the authors believe, the various stages in the struggle between tumor and host. WM.H. WOGLOM Proteolytic Ferments in the Serum. 15th Communication. Changes in the Serum of Tuberculous Guinea Pigs, HANSJ. FUCHS.uber proteolytische Fermente im Serum. XV. Mitteilung. Untersuchungen uber die Umstim- mung des Serums von tuberkulosen Meerschweinchen, Ztschr. f. Krebsforsch. 37: 367-373, 1932. The author and his colleagues have so extended the Fuchs test that it will now DIAGNOSIS AND TREATMENT 489 disclose the presence not only of malignant tumors, but of tuberculosis, syphilis, and other infectious diseases. This article is concerned exclusively with tuberculosis. WM. H. WOGLOM

Diagnostic and Prognostic Significance of Lymphocytosis in Cancer Patients, P. J. BUCHMANN.Valeur diagnostique et pronostique de la lymphocytose chez les canc&eux, Neoplasmes 11: 5-21, 1932. Buchmann did repeated white blood cell counts on 409 patients with cancer, in 375 of which there was a pronounced and stable lymphocytosis. He concludes that lymphocytosis is a characteristic feature of untreated cancer. Only in the advanced stage of the disease, when the organism has exhausted its resistance, does this lymphocytosis disappear. Radical excision of the tumor and the adjacent lymphatics causes a prompt fall in the percentage of lymphocytes. The appearance of promyelocytes and myelocytes in the circulation indicates bony metastases. In cancer there is usually, also, a slight decrease in the number of red cells, a slight fall in the percentage of hemoglobin, and an increased rate of sedimentation. [The author fails to present concrete and detailed data in support of these findings.] C. D. HAAGENSEN

Diagnostic Significance of Radiation Effects in Cancer and Infectious Diseases, R. HUBERT.Uber die diagnostische Bedeutung von Strahlenwirkungen bei Krebs und entziindlichen Erkrankungen, Strahlentherapie 44: 379-382, 1932. When healthy persons, or those with chronic infections, are treated with ultraviolet rays, the blood shows either an increase in serum cholesterin or else no change, but in patients suffering from carcinoma or acute infections the amount of serum cholesterin shows a sudden drop. The same reactions follow when x-rays are used. This test should be of value as a means of diagnosis in cancer. CHARLESPACKARD

Practical Points on the Microscopic Grading of Cancer, A. C. BRODERS. New York State J. M. 32: 667-671, 1932. The grade of malignancy of a tumor is by far the most important factor in prognosis. Clinical malignancy depends on cell activity, which, in turn, depends on the degree of dedifferentiation. In general, the cells of a given neoplasm are of about the same degree of malignancy in different parts of the growth, and retain the same grade throughout the course of the diseaee. The grading of malignant tumors is based on an estimation of the relative proportions of partly or completely differentiated, and of more or less undifferentiated cells. Carcinomata are graded from 1 to 4, aa follows: 1. The proportion of almost differentiated celh ranges from almost 100 to 75 per cent; of undifferentiated cells, from practioally 0 to 25 per cent. 2. Differentiated cells, 75-50 per cent; undifferentiated 25-50 per cent. 3. Differentiated cells, 50-25 per cent; undifferentiated 50-75 per cent. 4. Differentiated cells, 25-0 per cent; undifferentiated, 75-100 per cent. When doubt exists as to whether a carcinoma is of a higher or a lower grade of malignancy, it is better to class it in the former. Broders has found practically no differences in the grade of malignancy of cancers in young and in middle-aged patients. Photomicrographs illustrating the various grades of malignancy are given, and there is a limited bibliography. M. E. MORSE 490 ABSTRAOTS

Atypical Epithelium and Malignant Growth, H. T. DEELMAN.Atypisches Epithel und bosartige Neubildung, Ztschr. f. Krebsforsch. 37: 374-382, 1932. This article discusses the differential diagnosis of squamous-cell carcinoma and atypical growth of the surface epithelium. A decision is not always easy to reach, for the epithelium surrounding chronic inflammations, fistulae, etc., may undergo a vigorous proliferation which is directed not only outward but also downward, and in borderline cases it will be difficult or even impossible to say whether the lesion is benign or malignant. The histological distinctions are ill defined, though the biological diff erences-and these are of the highest importance-are not. Indeed, it may be said that there is an indeterminate histological zone between atypical epithelium and cancer, but that there is no such biological zone; either the lesion is cancer or it is not. Often it will be necessary, therefore, for the pathologist to enlist the help of the clinician. The points upon which the author chiefly relies are the morphology of the cells, whether normal or abnormal; the number of mitotic figures; the character of the invading margin; the presence or absence of ulceration, inflammation, or of free groups of epithelial cells in the underlying connective tissue. WM. H. WOGLOM Treatment of Cancer, K. FUNKE. Die Behandlung der Karzinome, Wien. med. Wchnschr. 81: 1297-1301; 1333, 1931. The fact that metastases to distant organs may have taken place before radical surgical removal of the primary growth is undertaken makes the end-results of the mechanical removal of cancers unsatisfactory. During the past ten years over 80 forms of treatment for cancer have been tried clinically and experimentally, but to date no general cure has been found. Funke discusses in a general way a few of these methods of treatment, including x-rays, radium, colloidal lead, electrocoagulation, streptococcus toxins, induced pyogenic infections, isamine blue, and various ointments. He concludes that the early diagnosis and radical surgical removal are the important factors in the control of cancer at the present time. He believes, however, that in the future better results may be expected from a combination of surgery with medical and dietetic treatment. BENJAMINR. SHORE Some Considerations on the Treatment of Cancer, PIERRENADAL. Quelques considbrations sur la thbrapeutique du cancer, Rev. de chir. 50: 601-610, 1931. The author notes that in the surgical treatment of cancer it is important to prevent local recurrences and distant metastases, both of which result, he believes, from the presence of cancer cells in the surgical wound, as this wound must be considered as undoubtedly contaminated with cancer cells at the time of operation. At the stage that most cancers are operated upon at present, he believes that metastases have not occurred at the time of operation, and if they do occur, are due to the spread of cancer cells from the operative wound. Various methods have been proposed to remove or destroy all cancer cells in the surgical wound. The author favors the use of osmosis, which has a more destructive action on young cancer cells in proliferation than on normal cells. To produce osmosis hypertonic solutions may be used, especially of magnesium salts, as such salta have a specially destructive action on cancer cells; or such osmotic substances as glycerine may be employed. Treatment of Cancer-Modem Technic and Charlatanry, LEON BERARD. A propos des traitements du cancer. Techniques modernes et gubrisseurs, Lutte contre le cancer 10: 6-17, 1932. Bbrard reminds us that although in modern times the surgical and radiation treatments of cancer have been perfected to the point where the possibility of cure DIAUNOSIS AND TREATMENT 491 by these methods is considerable, quack methods of treating the disease are just as prevalent as they were formerly. He lists a series of such fake cures which are now in vogue in France. These include: a proprietary preparation called ‘‘ Octozone,” several types of “ magnetic ” belts, bracelets, and collars, and various salts of magnesium. C. D. HAAGENSEN

Application of Chemotherapy in the Treatment of Carcinoma, G. ERNST. Die Anwendung der Chemotherapie in der Karzinombehandlung, Strahlentherapie 44: 97-108, 1932. Ernst describes a lithium-magnesium-iodine preparation called RIII, which has been used for a year in connection with the x-ray treatment of carcinoma patients, with some success. After a review of the literature on the subject of iodine in cancer treatment, he discusses the scientific basis for the formula of RIII. Lithium and magnesium are included because they are easily absorbed. Iodine (0.03 gm. per capsule) is in part joined to unsaponified hydrocarbons, and in part to the Li and Mg. Pectin is added as an adsorbent. It is mildly bactericidal. In the intestine, free iodine is produced; it is absorbed as iodide or iodate, and in the tissue acts as a sensitizer to x-radiation. Fifty-four carcinoma patients have been treated, with encouraging results. In 10 cases the general condition was improved and the effects of the radiation apparently increased. In 27 cases the improvement in appetite, weight, etc., was marked, but there was no increase in the effects of the radiation. In the other cases the results were uncertain. The favorable reaction was due to the RIII according to Ernst, since those patients who did not receive it did not fare so well, although they received the same radiation treatment. CHARLESPACKARD

Lead Treatment of Cancer, R. DALIMIER.Le traitement du cancer par le plomb, Progr6s mbd., 59: 646, 1932. This paper presents an excellent summary of the present day status of the lead treatment of cancer. The rationale of the use of lead is based on the well known effects of lead on the uterus in causing abortion in pregnant women. Blair Bell’s conception of the cancer cell holds that it is an adult cell which has regressed until it has become embryonal, so that it has regained the specific characteristics of the fetal chorionic cell. By this means he explains its extreme vitality, extra- ordinary power of multiplication and disordered growth, destructive invasion of tissues and blood vessels, and its intense glycolytic power. These cells thus constitute an autonomous system with all the powers and probably with all the vulnerability of chorionic cells. Because of the effect of heavy metals in the causation of abortion, Blair Bell believes that the neoplastic cell has a selective affinity for lead. Analyses following lead injections have revealed that the cancer cells contained more of the injected metal than did the normal tissues. Evidence against this assumption has been presented by Knox, Stone, and Craver, who found lead useless in chorionepithelioma. Chorionepithelioma is so rarely seen that few cases will ever be available to determine this point clearly, while opinions about the amount of lead held in the tissues are so contradictory that further work will be required before this point is settled. Little is known as to toxicity of the various forms of lead ih man, though Simpson, Wood and Ulmann have determined the lethal dose in various laboratory animals. The lead introduced into the organism accumulates in the spleen, liver, kidneys, and bone marrow. Many workers have failed to find any significant amount of lead in tumors of animals injected with this metal. Others have found it in greater amounts in cancer of the liver than in the liver itself, and in cancer of 492 ABSTRACTS the breast than in the normal breast. Intravenous injections of lead in animals resulted in some 70 to 80 per cent of disappearances of transplanted tumors. Contraindications to the use of lead are cardiopathies, renal insufficiency, infections, hepatic insufficiency, and cachexia. A curious fact is that some lead preparations are hemopoietic while others are markedly destructive of red blood cells. In 1929 Blair Bell published 500 cases treated with intravenous lead. Of this number, 50 were completely cured (10 per cent). A summary of the results obtained by various investigators follows. From this it can be seen that 635 patients were treated by lead therapy and that 59 were cured (9 per cent). Blair Rell...... 500 cases 50 cures Knox ...... 40 '( 4 Thompson...... 55 " 2 (( Simpson...... 19 " 1 (( Craver and Stone...... 21 " 2 'I - - 635 11 59 " One's impressions are divided between the encouraging results of Blair Bell and Cunningham and the futile efforts of others. Perhaps, concludes the author, it is only a question of method, and it may be that a search for more elective chemical forms of lead, and other methods of applying it to a less hopeless type of patient, will result in betterment of the results. WILLIAMJ. HOFFMAN

Method for Treating Malignant Tumors, HENRIHIRSCH. Wege zur therapeu- tischen Beeinflussung maligner Tumoren, Strahlentherapie 44: 109-124, 1932. Hirsch believes that cancer is primarily a constitutional disease and must be combatted by building up the defences of the body, as well as by surgery and radiotherapy. The chief defence against bacterial invasion and malignant growths is the reticulo-endothelial system of cells, found in the lymph nodes, marrow, spleen, and liver. Tumors grow when this system is not functioning properly. To restore and increase its activity, a great variety of agents appear to be useful. Heavy metals, and especially iodine, have this effect. Another chemical method consists of intravenous injections of magnesium or cerium combined with hypertonic sugar solution. When this is administered before radiation treatment, the effects of the latter are noticeably increased and the dose is better tolerated. The cerium and sugar increase oxidation and leukocytosis, a sign of heightened activity of the reticulo-endothelial system. A combination of iron and sugar is in some ways better than cerium. The author discusses the basis of organotherapy and states that extracts of thyroid, stomach, ovary, and liver, as well as insulin, fortify the defensive system. Although radiotherapy and surgery are still the chief methods of treating tumors, Hirsch pleads for a general treatment such as he has outlined. CHARLESPACKARD New Treatment for Cancer, A. C. MAGIAN. Un Douveau traitement pour le cancer, Bull. SOC.d'obst. et gyn6c. 20: 316-318, 1932. The use of placenta, either by a fresh graft or by injection of extracts, is reported as a useful adjuvant to surgery, radium, and x-rays in the treatment of cancer. In the operable types of breast and uterine cancer a fragment of fresh human placenta is inserted under the edge of the cut surfaces. For inoperable cervical cancer the piece of placenta is placed in the bleeding cavity of the ulcer and allowed to remain forty-eight hours, when it is removed and replaced by the tubes of DIAQNOSIS AND TREATMENT 493

radium. Following this operation injections of placental and ovarian extracts are employed. The method has been used in 30 cases, of which 20 are of recent date. The remaining 10 patients have survived five years without recurrence. In the discussion of the paper two pointed criticisms are made, one that it is impossible to determine what is the part played by the placenta in the cases treated also by surgery and radium, and secondly, that if placenta has any action upon cancer it is surprising that the disease ever occurs during pregnancy. HOWARD.C. TAYLOR,JR.

Aseptic Pus and Cancer, JOSEPHTHOMAS AND BELIN. Pus aseptique et cancer, Neoplasmes 11 : 22-28, 1932. Sterile abscesses were produced in horses by the subcutaneous injection of turpentine. Three women with recurrent cancer of the breast were treated over a period of three months by repeated local injections of this sterile pus. There was no apparent benefit. The treatment was suggested by the good results which veterinaries are reported to obtain with pyotherapy for wounds in animals. C. D. HAAQENSEN

Physical Agents in the Modem Treatment of Cancer, LEOPOLDFREUND. Moderne physikalische Behandlungsversuche des Karzinoms, Wien. med. Wchnschr. 81 : 839, 1931. Freund gives a historical sketch of the use of heat in the treatment of tumors from the heated iron of the ancients to the Paquelin cautery (1876) and the various applications of electricity. Among the attempts to treat cancer by mechanical means should be mentioned the methods of de Mondeville (thirteenth century) and Fallopio (sixteenth century), which sought to encircle the growth with a firm zone of scar tissue. The principle of all the methods-from the hot iron to diathermy-is the same: caustic action. Although showing some differences in their mode of action, they are all Aimply agencies for destroying completely circumscribed masses of tissue. A radical cure depends, as in surgery, on the physician’s judgment as to the extent of the neoplasm. In early circumscribed tumors cures are obtained by thorough coagulation. None of the electrical methods is selective for cancer tissue. The newest application is the use of waves between 3 and 100 meters. The short-wave condenser field has a very powerful action on the organism, in lesser intensity stimulating, in sufficient strength causing death. The effects depend on the production of heat, which appears in all parts of the tissue at the same time, in contrast to diathermy, where it appears first at the point of application of the electrodes, and then spreads to the depths. In the use of physical methods in cancer therapy, the same principles hold as in surgery, the most important considerations being early diagnosis and complete destruction or removal of the diseased tissue. M. E. MORSE

Results of Radiation Therapy of Malignant Tumors in 1931, HANSR. SCHINZ,A. ZUPPINQER, AND R. STEWART-HARRISON.Bilanz uber die Bestrahlungs- resultate bei malignen Tumoren im Jahre 1931, Roentgenpraxis (Heft 12) 4: 497-503, 1932. Also in Praxis 21: 319-322, 1932. This report is based upon the study of 224 cases of malignant tumors treated during 1931 and 252 cases previously treated in the radiotherapy department of the University Clinic in Zurich. Such favorable growths as those of the skin and female genital organs are not included, as the dermatological and gynecological departments have their own radiotherapy units. Of the 476 patients, 139 are living and well; 20 became symptom-free, developed local recurrences, and again 23 494 ABSTRACTS became symptom-free or were improved with further radiation; 22 were cured locally but died of metastatic tumors. In 197 cases immediate good results were obtained by the combination of radiation and surgery or electrocoagulation, but in 29 of these there have been local recurrences. Of the remaining 198 cases, no improvement was noted in 83, 41 are still under treatment, 35 could not be re- examined, 38 discontinued treatment, and one could not be followed. A comprehensive table shows the location and types of the growths treated and the results obtained. BENJAMINR. SHORE

Nature of the Reaction of Radium and X-rays on Malignant Growths, SIDNEY Rnss. Lancet 1: 874-876, 1932. The author reviews the commonly accepted views on the action of x-rays or gamma rays, pointing out that it has long been known that the rays exert a direct action on the cell, because, by exposing particles of normal tissues to radiation, the cells can be so damaged that no tumor ensues on subsequent inoculation. This led to the idea that the proper method of treating cancer would be to give large doses, sufficient to destroy all the cells. This, however, was found to result in a great deal of damage to the normal tissues of the body. The present tendency is to prolong the action of the radiation in order to give the healthy tissues time to recuperate. The chief exponents of this idea have been the workers at the Radium Institute in Paris, especially Coutard. That the cancer cell is more sensitive in certain phases of its existence has long been assumed, from the experiments on Ascaris eggs and similar material, and more recently from direct exposures of tissue cultures. On the other hand, there must be certain indirect effects of radiation on the healthy structures of the body, which may play a part in the lethal action on the tumor cells. Dominici, years ago, showed that several days after a dose of radiation there was an accumulation of plasma cells and lymphocytes in the stroma about the neoplastic tissues. Secondly, radiation has been observed to damage the capillaries, and thus shut off the blood supply, and finally, there may be some effecton the general physiological functions of the body, though concerning this field we as yet know but little. Perhaps the most important effects of radiation, therefore, are, first, those which interfere with or disorganize the delicate processes involved in division and maturing of cells; second, those which determine the release into the circulation and the tissues of the products of cell destruction; third, those which produce changes not only in the content and production of the blood, but also in the power of dealing with infection.

Our Experience with Coutard’s Method of Roentgen Radiation, HERMANN REGELSBERGER.Unsere Erfahrungen uber Roentgenbestrahlung nach Cou- tard, Miinchen. med. Wchnschr. 79: 856-857, 1932. This is a brief and very general recommendation of Coutard’s method in pulmonary, gastro-intestinal and pharyngeal carcinoma. No details as to technic or actual results are given. C. D. HAAGENSEN

Cost of the Coutard Method of Radiation of Malignant Tumors, H. G. ZWERC. Zur Kostenfrage der Bestrahlung maligner Tumoren nach Coutard, Zentralbl. f. Chir. 59: 1843-1845, 1932. Zwerg believes that few hospitals in Germany can afford to give the Coutard treatment to patients with malignant tumors. In the Konigsberg University clinic the cost per 5000 T is 250 marks. To this must be added at least 100 marks per patient to cover the hospitalization cost during the course of treatment, and this is exclusive of any physician’s fees. BENJAMINR. SHORE DIAGNOSIS AND TREATMENT 495

Some Further Observations on the Problem of the “Erythema Dose,” A. T. NISBET. J. Cancer Research Com. Univ. Sydney 4: 32-36, 1932. The author reviews briefly the advantages of high voltage and heavy filtration. For measuring dosage he uses a Solomon iontoquantimeter. To change R units into roentgen$ he assumes, on the basis of erythema tests, that 1 Solomon R equals 2.5 r. Values given by other workers vary from 1.6 to 3.5 r. The erythema dose varies with the thickness of the filter. For 1 mm. of copper it is 1200 r: for 2 mm. of copper it is 1800 r. (The intensity in rlmin. is not stated.) CHARLESPACEARD Initial Experience in Carcinoma Therapy with Very Hard X-rays, E. v. SCHUBERT. Vorlaufige Erfahrungen mit der Karsinomtherapie mit extrem harten Ront- genstrahlen, Strahlentherapie 44: 293-310, 1932. The apparatus used by the author in his gynecologic clinic is capable of running at 600 kv. and without interruption over a long period. Before the patient is treated, the pelvis is measured and a profile drawing made. With this, the proper position for treatment and the appropriate portal can be determined. The chief aim is to irradiate the minimum area for the optimum time. The dose ip made as low as possible, for high doses do not cause the tumor to recede more quickly, and they may induce the formation of connective tissue scar contractures. Two portals on opposite sides of the body are given 200 r on alternate days until the total dose is 5600 T in twenty-eight days. The pelvic organs receive 2800 to 3900 r, depending on the dimensions of the patient. The author believes that this dose may be lowered to advantage. The skin focal distance is 84 cm.; the intensity of the beam with a filter of 2 mm. Cu and 3 mm. Al is 3 to 4 rlmin. Whether the Coutard method of fractional doses over a long period is better than larger doses given in less time remains to be demonstrated. The patients react well. ’ No burns after a single exposure have been seen; the patients sleep; appetite increases, and there is no edema. After 8 to 10 doses some patients suffer nausea and diarrhea, which are easily controlled. The skin may remain undamaged if no more than 200 r is given every other day for two weeks. It peels actively when the dose is higher (285 rlday for fourteen days) but the corium is not injured. Pigmentation appears later. Telangiectasia has not been observed. In general, patients are ambulatory, though preferably they should remain in bed. During radiation the leukocytes fall to fifty per cent, and the lymphocytes to 25 per cent of their initial figures. The red cells do not change, the hemoglobin remaining stationary. The rate of leukocyte decline is an important, index; when too rapid, it serves as a warning that the dosage should be reduced. Anemic patients are given liver therapy. The bladder is not affected by these doses; the vagina may show a temporary erythema. No fistulas or irreparable injuries have been produced in the digestive tract, but bloody stools sometimes occur. Menstruation ceased completely in two cases which received four .times the castration dose. When this treatment is given to patients with necrotic tumors, the fever drops at once, the pain is lessened, and bleeding stops even more quickly than when radium is used. In general, the effects are more rapid than with radium treatment. The proper voltage is still to be determined. It may be that 900 kv. will prove best. Theoretically the effective wavelength at this voltage is 0.03 A., at which point according to Compton (Phys. Review 21: 483, 1923) the production of recoil electrons is maximum. CHARLESPACKARD Notes on X-ray Apparatus and X-ray Tubes, T. WILKINS. J. Cancer Research Com. Univ. Sydney 4: 21-25, 1932. The author believes that valve and condenser machines have given better service than those with mechanical rectification. Attention is called to various 496 ARSTRACTS sources of difficulty. For example, the water for a water-cooled tube was first supplied through flexible piping which under pressure subjected the x-ray tube to mechanical stress which resulted in fracture. Rigid piping removed this danger. A table is given showing the performance of 28 tubes. The maximum kv. was 200 in all cases; the milliamperage varied from 15 to 30. The life of the tubes varied from 20 to 1400 hours. CHARLESPACKARD

Technic of Radium Irradiation with Moulded Masks, MURDOCH,STAHEL, AND S. SIMON. Technique des irradiations de surface par masques moulbs, Cancer, Bruxelles 8: 197-199, 1931. A wax mask of the area to be treated is first made of the desired thickness. The radium tubes are placed on the outer surface in such positions that the entire area will be uniformly irradiated. The mask is then replaced on the patient where it remains until the proper dose has been given. It is convenient to have a certain number of standard masks so constructed as to save time in making ionization readings. In these the radium is so arranged as to have the proper skin distance for homogeneous radiation of a given area. Thus all the necessary factors are standardized and the application can be made more rapidly than if a special apparatus had to be constructed. CHARLESPACKARD

Four Cases of Sarcoma; Value of Radiotherapy, POUEY.Quatrc observations de sarcomes; utilit6 de l’actinoth&apie, Bull. et m6m. SOC.nat. de chir. 57: 1235-1240, 1931. The author reports 4 cases of pelvic sarcoma in women, in which radiotherapy was used, but in all but one case as an adjuvant to surgical operation. In the first case, a sarcoma of the broad ligament, the tumor was removed and radium implanted at the bdse at the time of operation; subsequently deep roentgen therapy was used. The patient has been well with no signs of recurrence for seven years; the tumor was a polymorphous sarcoma, definitely malignant. In the second case, after a primary operation for uterine tumor there were two recurrences, one in the ovary and one in the broad ligament; both of these were sarcoma. The second recurrence in the broad ligament was treated by implantation of radium after partial removal. The patient has been well for three years. In the third case, a sarcoma of the uterus, proved by biopsy, was treated by intra-uterine application of radium only. This was followed by definite improvement for a few months, followed by recurrence and death within less than a year from the time of radium treatment. In such cases, the author advises hysterectomy. In the fourth case, the lower pole of the tumor was in the vesico-uterine cul-de- sac. It was dissected out and a hysterectomy was done; radium was implanted in the cul-de-sac from which the tumor was removed. The patient has been entirely well for eight years. These cases, the author believes, indicate the value of radiotherapy in combination with surgery in the treatment of sarcoma, especially as a postoperative measure, to destroy any tumor cells that have not been removed surgically.

Occurrence of Pathological Mitoses and Multinuclear Cells in Tumors under the Influence of Radiation, ENGLMANN.Die Entstehung pathologischer Mitosen und mehrkerniger Zellen in Tumoren unter dem Einfluss der Strahlenbehand- lung, Zentralbl. f. Chir. 59: 724-725, 1932. This is a report of a paper read before the Surgical Society of Northwest Germany at Hamburg in December 1931. No new facts are brought out. M. E. MORSE THE SKIN 497

What Can Be Done in Some Cases of Advanced Malignant Disease, L. J. CARTER AND R. P. CROMARTY.Canadian M. A. J. 26: 302-305, 1932. This is a plea for treatment even of seemingly hopeless cases. Eighteen case histories are reviewed to show what can be done to benefit the patient with far advanced and apparently incurable cancer. These cases include carcinomas of the breast, cervix, stomach, colon, mouth, uterus, bladder, and rectum, and sarcoma of the soft tissues of the back and of the glands. One of the patients had died of pneumonia thirteen years after treatment for carcinoma of the cecum, without recurrence. The others, with one exception, were apparently well and free of disease. The time since treatment varied from fourteen to two years. The average duration of life since treatment was seven years. No stereotyped plan was followed, but each case received that type of therapy which in the authors’ judgment promised the best results.

THE SKIN

Malignant Tumors of the Skin, CHATELLIER.Tumeurs malignea de la peau, Toulouse m6d. 32: 729-751, 1931. The author presents a general discussion of malignant tumors of the skin under three headings: Epithelioma, sarcoma, and melanoma.

On the Multiformity of Carcinoma of the Skin, L. SAVATARD.Urol. & Cutan. Rev. 36: 349-355, 1932. The author classifies skin cancer in four groups as follows: (1) squamous cancer, a keratinizing metastasizing growth; (2) basal cancer, a non-keratinizing, non- metastasizing growth; (3) Jadassohn’s “ intermediate ” cancer, a non-keratinizing but metastasizing carcinoma; (4) the squamo-basal or mixed variety. With this classification as a basis there follow numerous case reports illustrating the clinical and pathological features of the various groups. The clinical diagnosis, the author states, is often difficult, and final decision must depend on microscopic section. Only general reference is made to treatment. Photographs and photomicrographs illustrate the various cases, and a short bibliography is appended. W. BAYARDLONG Anatomical-Clinical Study of the So-called Metatypic Form of Cancer of the Skin, G. SCIACCHITANO.Contributo anatomo-clinic0 all0 studio della cosidetta forms metatipica del cancro della pelle, Tumori 6: 59-88; 157-171, 1932. In a histologic study of 50 cases of skin cancer Sciacchitano found 6 examples of the metatypic or mixed form of carcinoma. The histories of these cases are presented in brief. Histologically the tumors were made up of strands of basal cells in which there were areas of squamous transformation and sometimes even well developed pearls. A good discussion of the classification and histogenesis of skin carcinoma is included, as well as four photomicrographs and an extensive bibliography. C. D. HAAGENSEN

Local Action of Insulin on Cancer of the Skin, S. F. GOMESDA COSTA. L’azione topica dell’insulina sui cancri della cute, Tumori 18: 140-156, 1932. L’action de l’insuline sur les cancers ulc6r6s de la peau, Presse m6d. 39: 1541-1543, 1931. Five cases of skin cancer treated with local applications of insulin are described. Although the exact histologic diagnosis is not given, it is clear from the clinical histories and the accompanying photographs that these were cases of basal-cell 498 ABSTRACTS carcinoma. The treatment was carried out over periods of from one to two months, and was given daily. It was applied as follows: “ After the disinfection of the ulcer with ‘ rivanol,’ the insulin was dropped onto it until its entire surface was bathed in the solution. When this had dried it was covered with a sterile dressing moistened with insulin.” The author reports that the ulceration healed over under this treatment in each of his cases. He admits, however, that when biopsies were made the underlying carcinoma still persisted, although he claims that it showed (‘ regressive changes.” To judge from his photographs, his most impressive case was one in which a small dose of roentgen rays had been given shortly before the insulin treatment had been begun [abstractor’s italics]. [The abstractor has seen small basal-cell carcinomas heal over superficially when the ulceration is carefully cleaned daily and a bland ointment applied. Larger basal-cell ulcers often heal over centrally of their own accord. Such epithelialization has, of course, no relation to the progress of the underlying carcinoma. Yet this phenomenon has often deceived workers into believing that one or another form of local medication had a curative value.] C. D. HAAGENSEN

Turban Tumor or Sweat Gland Carcinoma, J. W. JONES,H. S. ALDEN,AND E. L. BISHOP.Arch. Derm. & Syph. 26: 656-659, 1932. The author presents a typical example of that peculiar tumor of the skin of the scalp originally described by Spiegler as endothelioma capitis, but which is today generally recognized as an example of a peculiar type of slow growing epithelial tumor. A woman, seventy-four years of age, gave a history of successive crops of tumors appearing during the past forty years on her scalp. Up to the present she had counted 172 lesions. All began on apparently normal skin as small pink tumors which grew slowly without pain or discomfort. As they grew larger the color became darker and they bled easily on injury. The tumors covered the entire scalp and encroached on the forehead, the largest being 4 cm. in diameter and raised 1.5 cm. above the skin. The smallest was hardly bigger than a split pea. Two tumors were removed for histological examination, which revealed that the lesions were carcinomata, probably derived from the epithelium of the sweat glands, and relatively benign. This type of lesion may also be likened to the lymphango-endothelioma tuberosum multiplex of Kaposi, which is now con- ceded to be of epithelial origin. W. BAYARDLONG

Sweat-gland Tumor with Epithelial Metaplasia, M. WALTHERAND H. MONT- GOMERY. Schweissdriisentumor mit Epithelmetaplasic, Arch. f. Derm. u. Syph. 163: 420-426, 1931. A woman, twenty-nine years old, had a hyperkeratosis in the palm of the left hand, at the site of a fissure which had been present since childhood. This fissure had discharged and formed crusts from time to time in previous years. Histologically there was a marked hyperkeratosis and increase in the thickness of the stratum granulosum. The sweat glands were unchanged, but there was a metaplasia of the epithelium of their excretory ducts forming an epithelial structure made up of basal and spindle cells. In some areas there was a transformation of the epithelial cells into mucous cells, resembling the much-producing cells of the salivary glands. Two photomicrographs are shown. Hodgkin’s Disease of the Skin, JAMESR. LISA. Arch. Derm. I% Sypli. 26: 268- 270, 1932. Lisa reports a cme of Hodgkin’s disease in which the cutaneous lesion was the dominating symptom. The patient was a white man fifty-six years old who THE ORAL CAVITY 499 complained of extreme weakness and loss of weight. On the face were large, fungoid-like masses with ulcerated surfaces, and scattered over the body were innumerable subcutaneous masses varying in size from a split pea to a walnut, some slightly tender and some with a marked degree of hemorrhagic infiltration. The skin of the upper arms and forearms and the skin of the anterolateral aspect of the legs was deeply pigmented, inelastic, and so nodular that it presented a cobblestone appearance. The cervical and axillary nodes were moderately enlarged, discrete, and not attached to surrounding structures. No abdominal masses were palpable, and roentgen examination of the mediastinum was negative. The course of the disease was progressive, and death occurred about three weeks after admission. At autopsy the nodes were but moderately enlarged and presented the histological characteristics of Hodgkin’s disease. Nodules were found in the liver, heart, kidneys, and suprarenals. The skin of the arm cut with the resistance of cartilage, and the cut surface had a homogeneous waxy translucepce. Histo- logically the epidermis was preserved but atrophic. The dermis WEB diffusely involved by a dense layer of extremely cellular tissue with a fine intercellular network and a sprinkling of lymphocytes and polymorphonuclears. Monocytes with horseshoe nuclei were present in small numbers, as were also typical Reed-Stern- berg cells. The author states that cutaneous lesions occur in approximately 25 per cent of cases of Hodgkin’s disease, and in 10 per cent they are the dominating symptom. Most of the lesions do not have a characteristic histology. W. BAYARDLONG

Removal of Massive Growths of Molluscum Fibrosum; J. J. BUCHANAN.Internat. J. M. & Surg. 45: 178-179, 1932. A single case report.

THE ORAL CAVITY, UPPER RESPIRATORY TRACT, SUBMAXILLARY GLANDS

Analysis of 126 Cases of Malignant Disease of the Upper Air Passages Treated During a Period of Ten Years, 1921-1930, L. COLLEDGEAND R. PEACOCK. J. Laryng. & Otol. 47: 161-187, 1932. The authors’ material comprised 126 cases of malignant disease of the upper air passages, subdivided into the following groups: (1) larynx, intrinsic, 60 cases; (2) larynx, extrinsic, 48 cases; (3) mesopharynx (soft palate, tonsil, base of tongue), 8 cases; (4) maxillary antrum, 8 cases; (5) 8 cases in which radium was the sole or a supplementary method of treatment. Pathologic reports were available on all but 5 cases. All were squamous carcinoma except 4, which proved to be intrinsic sarcoma of the larynx, intrinsic endothelioma of the larynx, sarcoma of the tonsil, and a basal-cell carcinoma of the epiglottis. The ages varied from twenty-two to eighty-three years. Males predominated whatever the site of the tumor. Males had 9.5 times as many intrinsic malignant tumors of the larynx as did the females. Extrinsic tumors were six times as frequent in males as in females. The average age varied somewhat with the location of the primary tumor, from fifty to fifty-eight years. The treatment of 56 patients with intrinsic laryngeal cancer was radical surgical removal. Total laryngectomy was performed in 42 cases, laryngofissure in 11, and partial laryngectomy in 3. Forty-two total laryngectomies were done, with an operative mortality of 9 (21.4 per cent). Among eleven cases treated by laryngofissure there was one operative death. 500 ABSTRACTS

Thirty-one patients are free of disease out of a total of 56 treated surgically, (55.3 per cent), or out of the 45 surviving operation, 68.8 per cent. Of the 33 surviving total laryngectomy, 21 (63.6 per cent) remained alive and well. In the case of those treated by laryngofissure the percentage is 80. Excluding laryngofissure, 23 patients, or 65.6 per cent, are alive and well out of 35 who survived operation, Recurrence took place in the remaining 12 cases. Eleven of these 23 patients have been free of disease for three or more years. Among 12 eases recurrences developed in 10 within the first twelve months following total laryngectomy; in the other 2 cases the time intervals were two and two and a half years. The recurrence rate for laryngofissure was 20 per cent; for partial and total laryngectomy 34.2 per cent. Extrinsic carcinoma cases numbered 48. One patient refused operation and 24 were inoperable. Twenty-three cases were treated surgically. The operative mortality was 9 (39 per cent). Omitting 4 cases in which death followed lateral pharyngotomy with closure of the skin wound only and one in which median translingual pharyngotomy was followed by death, there remain 18 cases, in which lateral pharyngotomy or pharyngolaryngectomy was performed with suture of the pharyngeal mucous membrane to the edges of the skin wound. In this group the operative mortality was 5 (27.7 per cent). In the whole series of laryngeal carcinomata, including those in which laryngofissure, total or partial laryngectomy, pharyngolaryngectomy or lateral pharyngotomy was done, the operative deaths numbered 19: 14 from bronchopneumonia, one from secondary hemorrhage, one from heart failure; one patient died under the anesthetic and two from pulmonary embolus. The results of this radical surgical treatment of extrinsic carcinoma of the larynx have been as follows: Four out of 12 patients in whom lateral pharyngotomy was done are alive and well from less than one to two and one-half years; 8 of the whole group of 23 (34.7 per cent) remain well from less than one to two and one half years. Excluding all those patients who succumbed to the operation, 8 out of 14 patients (57.1 per cent) remain alive and well. The recurrence rate in those surviving operation was 42.8 per cent for the whole group. The interval between operation and recurrence is ten monthe or more. The presence of metastatic nodes in the neck was established in 13 out of 23 cases. Of these 13 patients, 2 remained alive and well two and a half years and ten months respectively. Of the remaining 11 patients, 4 died of recurrence and 7 succumbed to the formidable operative procedure of pharyngotomy and neck dissection. Among 40 radical operations of all types done in the hospital there were 17 fatalities; in 39 patients operated on in their homes there were 3 fatal results. Of those cases treated by laryngofissure, 80 per cent are free of recurrence. Eleven of the patients on whom total laryngectomies were performed had had a previous laryngofissure. Seven of this group are without recurrence. Suture of the skin and mucous membrane in lateral pharyngotomy prevents the development of aspiration pneumonia, so common when this is not done, and renders the operation much safer. The authors believe that in tumors of the jaw and nasopharynx radiation will constitute the treatment of the future. In the larynx and the pharynx they feel that radiation has not yet established itself. Nevertheless, they have three patients treated by radiation for carcinoma of the larynx who are now free of disease and possess normal appearing larynges, who otherwise would have required total laryngectomy. In other patients their radiation results have been so dis- astrous that they feel that radiation should be reserved for exceptional cases, maintaining that he who attempts this work should be prepared to perform any of the major surgical procedures on the larynx and lower pharynx or to employ .radiation if circumstances demand its use. WILLIAMJ. HOFFMAN THE ORAL CAVITY 501

Radiation Therapy in Otorhinolaryngology, K. ENQLMANN.Strahlentherapie in der Oto-Rhino-Laryngologie, Ztschr. f. Hals-, Nasen-, u. Ohrenheilk. 31 : 87- 128, 1932. Englmann’s paper is a careful study of the histologic effects produced by irradiation of 88 tumors in the domain of the ear, nose, and throat. The histologic varieties included squamous-cell, basal-cell, cylindrical-cell, prickle-cell, and anaplastic carcinoma, as well as lympho-epithelioma, melanoblastoma, mixed tumor, and sarcoma. The effects on cells of lethal and sub-lethal doses of roentgen and radium radiation are studied. Changes produced in the tumor bed, the differences of radiosensitivity of carcinoma and sarcoma, and the effects of roentgen and radium radiation on normal tissues are discussed and illustrated by 21 photomicrographs. WILLIAMJ. HOFFMAN

Treatment of Tumors, Especially of the Buccal Mucosa, by the Implantation of Thorium-X Needles, HANSJACOBY. Intratumorale Behandlung (Spickung) von Tumoren, namentlich der Mundschleimhaut, mit Thorium X-Nadeln, Bruns Beitr. z. klin. Chir. 154: 74-75, 1931. Jacoby has employed thorium-x needles in the treatment of malignant tumors, especially those of the buccal mucosa, lips, and tongue in 70 cases over a period of three years. The final results can not be judged in so short a time, but the author is certain that the palliative results, especially in advanced cases, have been satisfactory. BENJAMINR. SHORE

Carciooma of Oral Cavity, A. F. TYLER. Nebraska State M. J. 17: 185-189,1932. This is a short summary of well known facts concerning intraoral cancer, with a report of three cases. These were carcinomas of the soft palate, gums, and bone; floor of the mouth; and floor of the mouth and mandible. WILLIAMJ. HOFFMAN

Congenital Tumors of the Gum, Josfi M. JORGEAND SANTIAGONUDELMAN. Tumores congbnitos de la encfa, Bol. y trab. SOC.de cir. Buenos Aires 15: 1143-1152, 1931. The writers mention three cases of angiolymphangioma xanthomatosa in new- born children. The tumors, which originated from the labial side of the gum, two in the lower jaw and one in the upper, were purplish, elastic, incompressible, and not painful to pressure. They were removed successfully in order to make normal feeding possible. These cases are of interest as the first to be reported of lymphangioma of the gums, though similar growths have been described involving the tongue, floor of the mouth, cheek, and lips. A short description of the development of the jaws is given in order to explain the localization of the tumors near the medial plane. One schematic drawing and four pictures are contained in the text. JQEANNEBP. M. VOGELAAR

Metastatic Epithelioma of Mandible of Renal Origin, DECHAUME.Epithblioma mbtastatique du maxillaire inf6rieur d’origine rbnale, Bull. et mbm. SOC. de mbd. de Paris, No. 9: 350-353, 1932. Dechaume’s patient had a tumor of the mandible in the region of the first molar tooth. A node was palpable in the right supraclavicular region and two similar nodules in the thoracic wall showed metastatic carcinoma of renal origin. Clinical examination meanwhile had revealed the probable primary tumor in an abdominal mass in the region of the left kidney. WM.J. HOFFMAN 502 ABSTRACTS

Combination of Adamantinoma and Hemangioma, A. KUEHN. Ueber eine Kombination von Adamantinom mit Haemangiom als zentrale Kiefergesch- wulst, Deutsche Monatsschr. f. Zahnheilk. 50: 49-53,1932. The author describes an encapsulated tumor about.the size of a walnut. It was apparently a simple cavernous hemangioma, but careful study disclosed a small area of adamantinoma. Nine photomicrographs illustrate the article. WILLIAMJ. HOFFMAN

Malignancy of the Antrum and Mastoid, 11. DUIWY,AND A. I. WEIL. Eye, Ear, Nose and Throat Mo. 11:65-66, 1932. Dupuy and Weil presented two patients, who had had malignant disease of the maxillary antrum which had been inadequately treated, in order to emphasize the inexcusability of long delays before resorting to radical surgery. The first patient, a female child of eleven years, had a large tumor protruding from the left nostril. Biopsy revealed myxosarcoma. Radiographs showed extensive involvement of the left antrum and ethmoid cells. At operation the naso-antral wall and the anterior etlimoid cells were removed. Ten days later radium was applied through the naso-antral opening. The second patient, a man of forty-two years, had a sarcoma of the left maxillary sinus for at least a year. Two previous operations had established the diagnosis but failed to control the disease. The greater part of the left upper maxilla was resected and the Percy cautery applied to all suspicious looking areas. Both cases were of very recent date. Previous to performing these operations, it is the author's custom to establish a tracheotomy so as to permit him to pack the hypopharynx with gauze to prevent access of blood into the respiratory tract during the resection of the upper maxilla. Amytal, intravenously, is the anesthetic employed. WILLIAMJ. HOFFMAN

Malignant Tumors of the Maxillary Sinus, FAIREN.Les tumeurs malignes du sinus maxillaire, Oto-rhino-laryng, internat. 16: 83, 1932. Malignant tumors of the maxillary sinus are so rare that they account for only 1.5 per cent of cancer deaths. Connective-tissue growths are classified as round- cell, spindle-cell, fibrosarcoma, myosarcoma, lymphosarcoma, myelosarcoma, chondrosarcoma, and osteosarcoma. Epithelial tumors may be squamous-cell, basal-cell, or adenocarcinoma. The most frequent localization is the nasal or the orbital wall of the antrum. Death usually occurs eighteen months after recognition of the first symptoms and about three years after the actual onset. Radiography is important, but the best diagnostic procedure is biopsy. Treat- ment is 'difficult. Surgery sometimes affords a good result. Roentgen therapy cannot be employed unless free drainage for the purulent accumulations in the antrum is obtained. WILLIAMJ. HOFFMAN

Epithelioma of the Maxillary Sinus, FEDERICOE. CHRISTMANN. Epitelioma del sen0 maxilar, Bol. y trab. SOC. de cir. Buenos Aires 15: 1071-1091, 1931. Also in Prensa med. argent. 18: 1267, 1932. This is a report on a tumor in a fifty-seven-year-old man, reaching from the lower eyelid to the upper lip. Biopsy revealed it to be an epithelioma. The operative diagnosis was cystic epithelioma, probably originating from the wall of the maxillary sinus. Three months after the operation a radiotherapeutic treatment was given. Seven months later the patient was in a good condition. Four photographs demonstrate this remarkable recovery. JOHANNESP. M. VOGELAAR THE ORAL CAVITY 503

Osteomas of the Maxillary Sinus, RUIZ-ZORRILLA.Ostbomes du sinus maxillaire, Oto-rhino-laryng, internat. 16: 82-83, 1932. Of 117 osteomas of all sinuses, only two involved the maxillary sinus. Most osteomas are found in patients between fifteen and twenty years of age. Seventy per cent are found in males. They often occur in patients with other skeletal abnormalities. They are rarely multiple. They usually grow slowly and may last as long as ten years. Histologically they are benign, but they may cause death by compression of or extension to neighboring organs. WILLIAMJ. HOFFMAN Enchondroma, Papilloma, Adenoma, Fibroma durum, Angioma, and Lipoma of the Maxillary Sinus, BRUZZI. Enchondrome, papillome, adhome, fibrome dur, angiome, lipome du sinus maxillaire, Oto-rhino-laryng, internat. 16: 82, 1932. A brief description of benign tumors of the maxillary sinus, with a few words concerning their rarity. WILLIAMJ. HOFFMAN Fibro-angio-myxoma of the Maxillary Sinus, P. TESONE.Fibro-angio-mixoma sinuso maxilar, Rev. d. especialid. 6: 222-228, 1931. Tesone describes one of four similar cases of fibro-angio-myxoma of the maxillary sinus observed in children six to ten years old. The patient, an eight-year- old girl, who for the past four years had trouble with breathing and hearing, showed a tumor in the nasopharyngeal region. Careful examination of the nasal cavity after application of cocain-adrenalin'revealed that the tumor was connected by a stalk to the wall of the maxillary sinus entering through its opening into the meatus nasi medius. The tumor, which had a diameter of about 4 cm., was removed successfully. The new-growth consisted mainly of stellate cells lying in a mucinous intercellular substance. Tesone points out that it is imperative to make a thorough examination of the nasal fossae and its foramina in cases of apparently benign tumors in the nasopharyngeal region. JOHANNESP. M. VOGELAAR

Treatment of Cancer of the Tongue by Electrocoagulation, R. JULIEN.Traite- ment du cancer de la langue par l'electro-coagulation et le radium, Bull. m6m. SOC.de radiol. m6d. de France, 20: 77-82, 1932. Julien advocates a combination of electrosurgery and radium therapy in the treatment of carcinoma of the tongue. Prior to any operative interference, the oral cavity is rendered as clean a field as possible by careful cleaning or extraction of all diseased teeth and the removal of all metallic fillings and crowns-this latter step to avoid the danger of osseous necrosis from secondary radiation. The next step is a dissection of the glands of the neck and ligation of the external carotid artery. If during this dissection any nodes are ruptured, the area is carefully touched with 40 per cent formol, a procedure which the author states is effective in destroying cancer cells and without danger if carefully applied. In the next step, under local anesthesia, starting at the posterior limits of the lingual tumor, the mass is coagulated from. behind forward until all evident tumor has been destroyed. This portion is then cleanly cut away by the endotherm knife. Tubes of radium are laid in the operative wound and held in position by sutures which draw the wound edges over them. These radium tubes contain from 25 to 50 mgm. of radium bromide. The filtration is 1 mm. of platinum and 1 mm. of gold. The radium is left in situ for three days, delivering a dose of from 30 to 40 millicuries destroyed, according to the size of the area to be irradiated. The advantages claimed for this technic are: destruction of most of the tumor without. danger of dissemination, hemorrhage, or sepsis; reduction to a minimum 504 ABSTRACTS of the amount of irradiation and the duration of its application; placement of the radium in contact with the basal portion of the tumor without puncture of the tumor by needles which may favor dissemination. The disadvantage of the method is the frequent necessity of ligating the external carotid artery in order to avoid secondary hemorrhage. WILLIAMJ. HOFFMAN

Cancer of the Tongue Operated on More than Ten Years Ago, J. LE GRAND, Cancer dc la langue op6r6 depuis plus de dix ans, Normandie m6d. 43: 7-9,1932. Le Grand presented a patient on whom he had operated nearly eleven years previously for carcinoma of the tongue with extensive bilateral cervical metastases. While he was dissecting one side of the neck, metastatic nodes were found adherent to the internal jugular vein and he consequently ligated the vein and removed it. When he exposed the opposite vein, a similar situation was encountered. He did not hesitate to ligate this remaining internal jugular vein, and, in order to diminish the blood supply of the head and reduce the nervous congestion caused by this tilateral removal of the jugular veins, he ligated , also, both external carotid arteries. There was immediate congestion of the vessels of the head and face, but the remaining veins of the neck (vertebral, spinal, and nuchal) , after a time dilated sufficiently to provide adequate return circulation. There were no complications. The patient has been free of any evidence of disease, and his health has been excellent for nearly eleven years-a splendid result in what would have been regarded by most surgeons as a hopelessly inoperable case. WILLIAMJ. HOFFMAN

Radium Therapy of Angiomas of the Tongue, NICOLASCAPIZZANO. Radiurn- terapia de 10s angiomas de la lengua, Rev. de especialid. 6: 1156-1158, 1931. Angiomas of the tongue can be treated best with radium (0.5 mm. platinum filter) placed in the healthy tissue surrounding the new-growth. Two millicuries are given for each cubic centimeter of tumor tissue. A picture of an old woman shows an enormous angioma of the tongue which had been constant in size for 77 years. . This tumor was treated with strongly filtered radium with beneficial results. The radium treatment should be applied as early as possible because these congenital tumors may grow extensively and degenerate into angiosarcomas. JOHANNESP. M. VOGELAAR

Osteoma of the Tongue, D. M. GREIG. Edinburgh M. J. 39: 93-104, 1932. Osteoma of the tongue is a great rarity. It does not occur as a primary neoplasm but always in association with fibroma. Fibromas are usually found on the dorsum of the anterior two thirds of the tongue, near the mid line. Only two cases of sublingual fibromas have been reported. Histologically the tumors may be pure fibromas or they may be partially calcified, or show the characteristics of myxofibromas or fibrolipomas. In some of the tumors cartilage has been found, and these at once suggest mixed tumors of the salivary gland type, such as sometimes occur in the neck, floor of the mouth, or on the palate. Bourgeois in 1927 was able to collect only 29 cases of all types of fibromas of the tongue from the literature (Bourgeois, C. F.: Contribution h l’etude des tumeurs Fares de la langue (tumeurs fibreuses), Thbse de Paris, 1927). It is the degenerations of the fibromas that form the interesting feature in relation to osteoma. On occasions calcification only occurs in fibromas, but if the pedicle be broad or the tumor be embedded in the tongue so as to receive an adequate blood supply, revascularization of the deeper portions may take place and in the presence of a local accumulation of calcium, ossification is the inevitable result. In the few cases of osteoma of the tongue which have been recorded, the THE ORAL OAVITY 505 tumor has occupied the posterior or pharyngeal aspect of the organ. For bone to form in fibrous tissue, decreasing function is necessary, and this explains the inability to form bone in the actively motile anterior portion of the tongue. Short reviews of the five cases of osteomas of the tongue which have been reported in the literature are given. BENJAMINR. SHORE

Signs and Diagnosis of Cancer of the Nasopharynx, H. P. CEATELLIER.Signes et diagnostic du cancer du rhino-pharynx, Medicine, 13: 63-67, 1932. Cancers of the nasopharynx are predominantly epithelial in origin. Connec- tive-tissue tumors, which are much rarer, may be sarcomas or lymphocytomas. All these neoplasms exhibit progressive development. In the early period the tumor is limited to a portion of the upper pharynx, but as proliferation continues, the growth invades neighboring areas. The first stage, according to Chatcllier, may present little warning beyond vague local symptoms, as moderate pain or a unilateral mucopurulent or serous rhinorrhea. Because these symptoms are not alarming, the patient usually disregards them and is seldom seen by a physician during this early phase. At this time a thorough examination would probably reveal a chain of cervical nodes whose hardness and fixity would stamp them as metastatic. The symptoms and signs of the second period develop as soon as the tumor extends beyond the limits of the upper pharynx to invade neighboring structures, This invasion of the nasal fossae causes bilateral obstruct,ion and a profuse, thick, mucopurulent or sanguineous discharge. Epistaxis is not rare. Progressively the tumor extends down to involve the soft palate. Adenopathy is frequently seen at this stage and may be bilateral. The terminal stage is featured by the enlargement of the tumor so that respiration and deglutition are interfered with; repeated hemorrhages may occur; there may be extreme pain, and many patients die as a result of hemorrhage, aspiration pneumonia, or meningitis. WILLIAMJ. HOFFMAN

Treatment of Nasopharyngeal Fibromas by Physical Agents, A. RAYNAL.Con- siderations sur le traitement des fibromes nasopharyngiens par quelques agents physiques, J. radiol. et d’electrol. 16: 59-64, 1932. Because of the large size they may attain and the frequency of hemorrhage, nasopharyngeal fibromata assume an importance out of all proportion to their rarity. The disadvantages of purely surgical treatment are: the extent of the intervention sometimes required; the difficulty of total extirpation; the frequency of recurrence; the necessity for postoperative tamponade of the nasopharynx, which may give rise to an acute mastoiditis, and finally the possibility of secondary hemorrhage demanding an emergency ligation of the external carotid artery. Raynal has treated three cases with roentgen therapy, one case three years ago and two cases two years ago. In all three results were excellent. WILLIAMJ. HOFFMAN

Nasal Melanoma, G. CUBENZA.Sui melanomi nasali, Valsalva 8: 81-88, 1932. A man aged sixty-five had had right-sided nasal obstruction and discharge for two years. Fleshy tumor masses filling the right nasal cavity were removed and proved to be melanoma. A month and a half later, at the time of the report, the tumor had already recurred locally. The author includes, also, a histologic description of a “ melanotic carcinoma ” removed from the nose of a she-goat. A number of unsatisfactory photomicrographs are included. C. D. HAAQENSEN 506 ABSTRACTS

Anatorno-Clinical Study of Cancer of the Larynx, CABADESUS.Qtude anatomo- clinique du cancer du larynx, Oto .rhino-laryng. internat. 16: 92-93, 1932. This study of laryngeal cancer consists of two parts. In the first port>ionthe author describes the various tumors of the larynx and divides them into four groups: epithelial, connective-tissue, embryonal, and tumors of specialized tissue. His material coneists of tumors of the first two groups. The most frequent are the epithelial tumors, of three main types: squamous, basal, and gland-cell, occurring in 62 per cent, 18 per cent, and 16 per cent of the cases respectively, according to the literature, which is quoted. Casadesus’ practice has included no cylindrical- cell or gland-cell tumors. He believes this is explainable by the careful staining technic which he employs to demonstrate the epithelial fibrillae of squatnous-cell tumors, which otherwise might have been considered cylindrical or gland-cell tumors. Sarcoma comprises 4 per cent of the total number. Although the larynx is for the most part covered by cylindrical-cell epithelium, most of the neoplasms developed thereon are of the squamous-cell variety. Casadesus believes that metaplasia of the mucosa is produced under the stimulus of inflammations, both toxic and infectious (tobacco, syphilis) before changing into cmcer. Biopsy in the various types of cancer is minutely discussed, with its advantages, difficulties, and dangers. The lesions are classified clinically as vegetating, infiltrating, and ulcerating. The author believes that cancer of the base of the epiglottis is more frequent than cancer of the vocal cord, in direct contrast to views maintained by most other authors. Cancer of the vocal cord provides early symptoms and because of its location lends itself t.0 cure by conservative surgery. Other intrinsic cancer requires more extensive surgical procedures, as hemilaryngectomy or total extirpation of the larynx. Extrinsic cancers are usually inoperable when diagnosed. WILLIAMJ. HOFFMAN

Cancers of the Larynx, DUCUING.Cancers du larynx, Toulouse m6d. 32: 69, 1931. In Toulouse cancer of the larynx comprises 6 per cent of all cases. Most of them occur after fifty years of age. Nearly all are in males, and the author believes that excessive use of tobacco and alcohol and the presence of syphilis are etiologic factors. Ninety per cent of the author’a 130 cases were carcinoma; ten per cent were sarcoma. Three quarters of these cases were intrinsic cancers, and one-fourth were extrinsic. Their location in order of frequency was: true cords, ventricular bands, ventricles and subglottic region. Intrinsic cancers usually produce symptoms of dysphonia and hoarseness simulating a chronic laryngitis. Pain is usually not present. When the posterior commissure and corresponding arytenoid are involved, the cord becomes immobile and the situation is more grave. Extrinsic cancers produce pharyngeal signs at first; these rarely occur early in the disease. There may be dysphagia, salivation, foul breath, bleeding, or pain radiating to ear or neck. Any male over forty who is a heavy smoker, and who presents a dysphonia persisting longer than two months, should be suspected of cancer of the larynx. It must be differentiated from chronic laryngitis, Vincent’s angina, papilloma, pachydermia, perichondritis, tuberculosis, and syphilis. The younger the patient the more rapid the course of the disease. Extrinsic cancer evolves more rapidly, causes symptoms later and develops metastases earlier. Intrinsic cancer is featured by early signs, slow course, and late metastasis. The surgical procedures applicable in treatment are: tracheotomy, laryngo- THE ORAL CAVITY 507 fissure, partial laryngectomy, and total laryngectomy. Physical agents comprise radium and x-ray. For those cases wherein one may hope to achieve only some degree of palliation, one might boldly attempt a wide total removal of the larynx, but the risk of such a procedure in fairly advanced cases is so great that it would probably be better to rely on radiation therapy. ‘When the tumor is limited to the epiglottis or to the vocal cord (with commissures free and arytenoids mobile), the lesion may be removed by a trans-hyoidian epiglottectomy in the first case and by laryngofissure in the second. The author advocates Sebileau’s economic laryngectomy for those growths which have spread beyond the cord but have not yet invaded the commissure. When the commissure is involved, a total laryngectomy is required unless contraindicated for some reason. Evaluating the results of these procedures, the author advises early tracheotomy wherever it is likely to be required, calling attention to the frequency of grave pulmonary complications when this is delayed. With thyrotomy and laryngofissure the mortality is insignificant and the results are excellent if cases are properly chosen. Of 38 patients in a series reported by Semon, 22 were alive without recurrence from six months to ten years; 7 died of intercurrent infection; 9 had recurrences. Chevalier Jackson reported 80 per- cent without recurrence. The functional results following laryngofissure are good, the voice usually being hoarse but otherwise excellent. Classic hernilaryngectomy, according to the author, carries with it a 10 per cent operative mortality and provides only 10 per cent of three-year cures. Serious embarrassment of deglutition and respiration often follow. Hautant, since 1925, has performed this operation upon 65 patients, with two operative deaths and 21 recurrences to date. (He hau evidently used this operation with excellent discre- tion and treated by this method fewer advanced cases better handled by total laryngectomy). Economic laryngectomy (Sebileau) is a serious procedure. Among 22 cases reported by Winter there were 4 operative deaths. The late results are not bad, 13 recurrences in from one to five years. Total laryngectomy has a mortality of 15 per cent. Gluck reported 132 cases in 1911, 24 of which were without recurrence from four to fifteen years afterward, while 21 others were free of recurrence after three years. The results obtained by physical agents in the treatment of intrinsic cancer of the larynx are briefly mentioned. Hautant believes a cure results as often from radiotherapy as by surgical removal when the growth is limited to the vocal cord. Even in those instances where the tumor has spread beyond the cords to invade the ventricle, some benefit may be expected. Coutard and Valet had 7 patients out of 12 such who lived from one to three years. WILLIAMJ. HOFFMAN Diagnosis and Treatment of Cancer of the Larynx, F. 0. LEWIS. Med. Annals Dist. Columbia, 1: 88-91,1932. Also in Pennsylvania M. J. 3.5: 763-768,1932. Of 192 cases of laryngeal cancer seen by Lewis in the Radiological Department of the Philadelphia General Hospital, only 2 were early cases and 90 per cent were hopeless. In 100 advanced cases the average delay from the onset of hoarseness until the diagnosis was made was eleven and a half months, and nearly all these patients had been treated for chronic laryngitis without ever having had a mirror examination. The author stresses the importance of proper laryngeal examination, complete history and physical examination, biopsy, as well as serological, bacteriological, and roentgenological studies. The treatment for intrinsic carcinoma of the larynx is surgical: laryngofissure, partial or total laryngectomy, according to the extent of the disease. Lewis has performed laryngofissure in ten cases. The first patient ABSTRAOTS

died of recurrence; the other nine are well and without recurrence as follows: 1 for eleven years, 1 for six years, and the remaining 7 less than two years and a half. Extrinsic cancer of the larynx proceeds rapidly and silently, and usually metastasizes before its presence is suspected; hence it rarely is seen in an early phase. Perhaps more of it would be found early if globus hystericus could be entirely forgotten. X-rays and radium have not been used with success in the author’s cases; his surgical results are better. He has operated on four cases of epilaryngeal cancer. One patient is living and well five years and a half after operation; one patient died three years later of cardiac disease; one died ten days later from bronchopneumonia, and the fourth developed a recurrence and died about two years after operation. WILLIAMJ. HOFFMAN Suppurative Perichoadritis of the Thyroid Cartilage as an Early Sign of Laryngeal Carcinoma, A. MALAN. Pericondrite tiroidea suppurata segno precoce di carcinoma laringeo, Cancro 3: 74-79, 1932. Three cases of carcinoma of the larynx are described in which perichondritis and external abscess formation occurred. In the first case, that of a man aged seventy-one, the appearance of the abscess in the neck apparently preceded all other symptoms. It was opened, after which a fistula formed, which persisted until death six months later. In the second and third cases the abscess formation was preceded by some months of hoarseness, so that it could hardly be called an early symptom. C. D. HAAGENSEN

Position to be Taken by the Physician Regarding Cancer of the Larynx, P. RIGAUD. Position B. prendre par le m6decin a 1’6gard du cancer du larynx, Prat. med. frang. 13: 162, 1932. Of all the cancers treated at the anti-cancer center of Toulouse, those of the larynx give the least encouraging results. This is because these patients are referred too late. Rigaud emphasizes the following facts. Intrinsic cancer of the larynx is characterized by early involvement of the vocal cords and hoarseness, without glandular metastases; and later by respiratory difficulty. Any patient who is over forty years of age, presenting a chronic laryngitis of more than two months’ duration, should be suspected of cancer of the larynx. Extrinsic cancer affects the epiglottis, aryepiglottic folds, and arytenoids, and its early signs are related to mild difficulties of deglutition, pain radiating to the ear, and cervical adenopathy. The treatment advised is surgery for those cases still within the limits of operability and irradiation for all others. Rigaud asks the general practitioner to realize that the life of the patient with cancer of the larynx is in his hands, and requires of him early diagnosis and prompt reference to a center competent to treat this disease. WILLIAMJ. HOFFMAN

Late Results of Fractionated Radiation of Laryngeal Carcinoma, A. GuNsETT. uber Fernresultate beim fraktioniert bestrahlten Larynxkarzinom, Rontgen- praxis, 4: 214-222, 1932. Since 1922 Gunsett has treated carcinoma of the larynx by protracted fractionated daily roentgen therapy. Dosage has varied in the light of experience gained. For intrinsic carcinoma of the larynx he uses the Coutard technic, with 200 kv., 3 ma., 2 mm. copper and 1 mm. of aluminum filter, at 50 cm. target-skin distance. Daily treatments of 300 T delivered in one hour are given, to a total of 3,500 r to each side of the neck. Larger doses than this with a target-skin distance of 65 cm. are used in treatment of extrinsic carcinoma of the larynx, THE ORAL CAVITY 509

Twenty-three patients were treated: 13 with extrinsic carcinoma, 10 with intrinsic carcinoma. Protracted fractionated doses of irradiation to an extrinsic carcinoma will, if the dosage is great enough, get rid of the primary tumor, but recurrence is certain, though one patient so treated is now well and free of disease. Among the 10 cases of intrinsic carcinoma of the larynx there were 4 cures: one for nine years; one for six years; two for four years. WILLIAMJ. HOFFMAN

Clinical Note on a Carcinoma of the Pyriform Fossa of the Larynx, G BONATI. Nota clinica sopra un caso di carcinoma del seno, L’Atenio Parmense.4: 139- 146, 1932. The author discusses the clinical picture of carcinoma of the pyriform fossa and the difficulty in differentiating this condition clinically from crico-arytenoid arthritis. He reports the case of a man of seventy-two who had a rheumatic attack followed two weeks later by dysphagia, dyspnea, and aphonia, accompanied by mild chills and fever. The larynx showed an injected and immobilized right arytenoid swelling, the true vocal cords fixed in adduction, and an exudate on the false cords. There was some improvement under symptomatic treatment. A month later the patient showed some hard nodes in the neck and laryngoscopic examination revealed greatly increased changes similar to those seen earlier. Death took place from suffocation. Autopsy showed a carcinoma of the right pyriform fossa. The author feels this should be considered in differential diagnosis in all such cases in older individuals. JEANNETTEMUNRO

Report of a Case of Laryngeal Carcinoma, ARNOLDI. Bericht iiber einen Fall von Kehlkopfkarzinom, Folia oto-laryng. 35: 91-94, 1932. A cachectic male of seventy-six presented an extensive nodular tumor of the anterior commissure covering both vocal cords and rendering them immobile. Biopsy revealed only thickened epithelium composed of prickle cells. This was diagnosed as pachydermia with cornification but with no evidence of malignancy. Because of laryngeal stenosis, a tracheotomy was done. Two weeks later the patient died. Autopsy disclosed a high-grade pachydermia with epithelial nests, but the morphology was not characteristic of carcinoma. However, the lesion was probably carcinoma of a slow growing type. WILLIAMJ. HOFFMAN

Why are Cancers of the Tonsil Seen So Late? Means of Avoiding Delay, L. DUCUING. Pour quelles raisons les cancer8 de l’amygdale sont-ils vus trop tardivement moyens d’6viter ce retard, Prat. med. franc. 13: 166-167, 1932. The reasons why patients with cancer of the tonsil are seen so late, as given by Ducuing, are: (1) the tendency of the patient to regard a swelling of the tonsil as a simple ‘I sore throat ” and to lose precious time before consulting a physician; (2) the failure of the doctor to recognize the obvious neoplasm of the tonsil. A doctor who would readily consider a diagnosis of cancer when examining a patient complaining of any trouble with the rectum, esophagus, prostate, or stomach, rarely t.hinks of the possibility of cancer of the tonsil. If the tumor of the tonsil be ulcerated (in which case the most likely diagnosis is epithelioma), it is usually diagnosed as acute ulcerating tonsillitis, Vincent’s .angina, caseous tuberculosis, lupus, syphilis (primary, secondary, or tertiary), or even mixed chancre of the tonsil. If the tumor is non-ulcerated (in which case it is most likely to be a sarcoma), it may be diagnosed aR simple hypertrophy, myxoma, papilloma, or fibroma. When cervical adenopathy is the first evidence of disease, it is likely to be regarded as an acute infectious adenopathy or as a tuberculous gland. Later, when enlargement and fixity stamp it unmistakably as a neoplastic growth, it is likely to be regarded as the primary tumor. 510 ABSTRACTS

In an effort to offer some means of diminishing this delay in diagnosis, Ducuing emphasizes the following points, Cancer of the tonsil is by no means rare. Cancer of the tonsil should be considered whenever a tonsillar swelling lasts more than three weeks. “ Sore throat ” and “ earache ” are often the early symptoms of cancer of the tonsil. A cervical adenopathy which appears to be a primary tumor often is a metastasis from an unobserved cancer of the tonsil. In all doubtful cases, the physician ought to take a specimen for biopsy without any further delay. This procedure is easy and safe, and does not require special knowledge, skill, or instruments. It is the most important means at hand to avoid the gravest hazard to the patient, namely delay. WILLIAMJ. HOFFMAN

Malignant Reticulo-endothelioma of Tonsil and Lymph Nodes, L. BASSAL. RBticulo-endotheliome malin de l’amygdale et des ganglions lymphatiques, Prat. m6d. frany. 13: 149-153, 1932. A long survey of the histology of reticulo-endothelioma and the differential diagnosis between that tumor and lymphosarcoma and Hodgkin’s disease. WM. J. HOFFMAN Differential Sign between Tumors of the Submaxillary Gland and Cancerous Adenopathies of the Submaxillary Region, ESTRADE.Un signe differentiel entre les tumeurs de la glande sousmaxillaire et les adhopathies canc6reuses de la region sousmaxillaire, Prat. m6d. franp. 13: 174-177, 1932. Clinical differentiation between a tumor of the submaxillary salivary gland and a cancerous adenopathy of the submaxillary region is often difficult, especially if the submaxillary mass appears to be the primary tumor. Ducuing has described and Estrade, his externe, has published, a clinical sign by which these two confus- ing entities may be differentiated. The submaxillary salivary gland lies for the most part beneath the mylohyoid muscle, but sends a sublingual prolongation upward along Wharton’s duct. The submaxillary lymph node lies entirely beneath the mylohyoid muscle. When the submaxillary salivary gland is the site of a primary swelling, whether cancerous or inflammatory, this sublingual prolongation participates in the enlargement and projects upward, raising the floor of the mouth. If the enlargement involves the submaxillary lymph node, this upthrust of the floor of the mouth does not occur. Ducuing states it concisely : ‘‘ Adenopathies develop exclusively downward; cancers of the submaxillary salivary gland grow both upward and downward.” WILLIAMJ. HOFFMAN THE EYE

Minute Sarcomas of the Choroid, E. HEINBIUS. Ueber kleinste Aderhautsarkome, Arch. f. Ophth. 127: 45-86, 1931. The author reports a case of sarcoma of the choroid in a man forty-four years of age, who, after a severe blow over the right orbit, suffered diminution of vision in the right eye. Examination with the ophthalmoscope six months after this change in vision was first noticed showed a dome-like detachment of the retina, the center of which was almost midway between the optic disc and the papilla; the elevation causing this displacement had a glistening grayish appearance in the center, darker at its upper border. A diagnosis of sarcoma of the choroid was made and the eye was enucleated. The patient has been in good health without signs of recurrence for a year and a half. Histologic examination of the eye showed a spindle-cell sarcoma 6 mm. long and 2 mm. high, lying between the macula and the optic disc, with three processes extending toward the disc, one of which had invaded the disc, apparently by THE EYE 511

extension along one of the blood-vessels. Above the tumor there was a slight transudate lifting up the retina; the pigment epithelial layer was partly destroyed, but the retina showed only slight degenerative changes. There was a marked hyperemia of the choroid around the tumor. A few sarcoma cells were found surrounding a blood-vessel that entered the sclera; and in other portions of the eye, similar strands of sarcoma cells surrounding blood-vessels were seen in the sections. In his discussion of this case, Heinsius reviews other cases of small choroid sarcoma reported in literature. He finds 15 cases in which very small choroid sarcomas were discovered incidentally in eyes enucleated for other reasons; but 8 cases of very small growths in which the eye was enucleated because of the diagnosis of choroid sarcoma. In 7 other cases there were multiple small tumors either all sarcoma or melanoma and sarcoma; in 3 of these the growths were discovered only on pathological examination, in 4 they were diagnosed clinically. The smallest tumor in the group of single choroid sarcoma diagnosed clinically measured 2.5 x 0.15 mm.; the next largest was 4 x 1 mm. As a rule, the size of small choroid sarcoma that can be diagnosed clinically is between 4 x 1 mm. and 12 x 2 mm. Smaller tumors will usually be found only incidentally. In the 12 reported cases in which the eye was enucleated on the diagnosis of choroid sarcoma (8 single and 4 multiple growths), there is only one in which any statement is made in regard to end-results. In this case the patient died nine months after operation from metastases in the brain and the liver. That patients are not followed up by the ophthalmologists is due to the fact that, if the patient remains well, he has no reason to consult the ophthalmologist again, and if metastases develop, they do not involve the eye and he therefore goes to some other physician. In the author’s case the tumor cells were spindle cells, larger than the connective-tissue cells; a few of the cells scattered throughout the tumor contained pigment, and other pigment cells were present at the periphery; the latter showed a resemblance to chromatophores. In the small choroid sarcomas reported in the literature, all transitional stages from entire lack of pigmentation to markedly pigmented tumors are described. There is no definite indication, however, of the true relation of melanoma and sarcoma of the choroid in regard to pathogenesis, although many authors believe that there is such a relation, and this conclusion appears to be supported by the occurrence of small melanoma and sarcoma in the same eye. According to the histological findings and the embryonic development of the eye, it is probable that sarcoma of the choroid arises in the connective-tissue elements of the choroid, but whether in the non-pigmented or the pigmented cells, or in both, cannot be determined. There appears to be no definite relation between pigmentation and a tendency to malignancy in the choroid. The findings in the author’s case and in those reported by others indicate that extension of the tumor cells along the lymphatics or blood-vessels takes place early, while the tumor is still small, and hence that metastases probably occur at a relatively early stage. For this reason prompt enucleation of the eye should be done as soon as the diagnosis of choroid sarcoma is made, with exenteration of the orbit if necessary. Postoperative radiation is also to be recommended.

Retinal Angiomatosis and the Exudative Retinitis of Coats, E. VON HIPPEL. Angiomatosis retinae und Retinitis exsudativa Coats, Arch. f. Ophth. 127: 27-45, 1931. In the course of the previous year the author had studied 8 eyes which were removed on the diagnosis of glioma or probable glioma, in all of which this diagnosis proved incorrect on pathologic examination. In one case, which is described in detail, the patient was a young child (four and a half years), and the characteristic change was an angioblastic proliferation of the blood-vessels between the two 512 -4BSTRACTS layers of the retina, which was not of the type of true angiomatosis retinae, a condition usually found in adults, but resembled the angioblastic proliferation sometimes observed in Coats’ exudative retinitis. The author is of the opinion that these two conditions cannot always be sharply differentiated; in both, vascular malformations play the most important etiological r8le. In 3 other cases, also in children, the pigmented nodules with crystal formation and masses of pigmented cells containing fat granules that are typical of Coats’ retinitis were found in the retina, and in 2 of these cases angioblastic changes in the blood-vessels of the anterior portion of the retina. In these cases there was also evidence of a primary tuberculous lesion in the eye, which was apparently the etiologic factor in the Coats’ retinitis. In the fifth case there was no such marked change in the retina, but a mass of connective tissue on the inner side of the ciliary body, with strands of connective tissue extending into the deeper structures of the eye. The other 3 cases are not discussed in this article, having no relation to angiomatosis retinae or Coats’ retinitis. v. Hippel’s Disease (Angiomatosis Retinae), G. KNODEL. Zur Kenntnis der v. Hippelschen Erkrankung (Angiomatosis retinae), Virchow’s Arch. f. path. Anat. 281: 886-910, 1931. The author, in a review of the literature, finds 61 cases of angiomatosis retinae (von Hippel’s disease) reported. In these cases there is progressive loss of vision, and ophthalmoscopic examination shows the retinal vessels markedly tortuous and dilated, chiefly on the temporal side; in these regions, also, there are one or several yellowish or reddish nodules. Later extensive degenerative changes take place in the retina, with complete loss of vision. In about half the cases reported, both eyes have been affected, the second eye usually being involved soon after the first. A familial occurrence of this disease has often been observed. In 16 of these 61 cases of angiomatosis retinae there have also been clinical symptoms of a brain lesion causing increased intracranial pressure; 7 of these came to autopsy. Pathologically the retinal growth is made up of convoluted blood-vessels of a capillary nature-small blood-carrying spaces lined with endothelium-and connective tissue with varying types of cells; in addition, glia cells are present, and large cells containing a double refractive fatty substance-pseudoxanthoma cells. The growths in the brain in those cases that came to autopsy were found to be hemangioma, usually with cyst formation; glial tissue was not found within these growths but at the periphery; the same pseudoxanthomatous cells were usually found as in the eye lesions. Similar tumors were found in some cases in the cerebellum and spinal cord as well as in the cerebrum. In the author’s case, the patient’s father had died with von Hippel’s disease, and a brother was also affected. Autopsy showed the typical pathological picture of angiomatosis retinae and a tumor at the base of the brain and in the cervical section of the spinal cord. The growth in the brain and the upper part of the spinal cord was an angioma containing many of the pseudoxanthoma cells typical of such growths associated with angiomatosis retinae, while the lower part of the spinal cord growth was a gliosis with cavity formation, the lesion typical of syringomyelia. The author notes that this is the eighth case of angiomatosis retinae with lesions of the central nervous system that has come to autopsy, and the second case in which there were associated lesions of syringomyelia. Case of Malignant Nevus Treated by Physical Means during the Past Three Years, E. OPPERTAND E. HARTMANN.Sur un cas de naevome malin de la conjonctive trait6 depuis trois an8 par les agents physiques, Bull. SOC.d’opht. NO. 1: 8-11, 1932. The author presents a case of histologically proved malignant nevus in the inner canthus of the right eye. Diathermy proved inefficacious, and, despite the THE EYE

contraindications to radium therapy in growths of this type, it was used as an adjunct to electrocoagulation. A needle of 1 millicurie was implanted in May 1930 after electrocoagulation of the caruncle. In October 1930 there was a recurrence. By February 1931 the recurrent growth was quite large, despite electrocoagulation. At that time six needles of 1 millicurie were used, and in November 1931 the mass had apparently disappeared. In January 1932, however, there was a recurrence in the upper lid. H. RIVERO

Value of Roentgen-ray Examination in Diseases of the Orbit, W. HOFFMANN. Der Wert der Rontgenuntersuchung bei Erkrankungen der Augenhohle, Ztschr. f. Augenheilk. 75: 243-256, 1931. The author notes that roentgen-ray examination has long been recognized as of value in the diagnosis of conditions involving the bony wall of the orbit, but only modern refinements of technic have made roentgen rays of value in lesions of the soft parts of the orbit. He reports 7 cases in which roentgen-ray examination gave definite data on the site and extent of the lesion, not obtainable by other means. Syndrome of Tumor at the Apex of the Orbit, J. ROLLET. Syndrome de l’apex orbitaire d’origine n60plasiqueJ Lyon m6d. 147: 468-470, 1931. Rollet reports a case which is of interest because of the symptoms arising from pressure at the apex of the orbit, due to a tumor. There were exophthalmos and optic atrophy of the left eye, and in the right, choked disc. The patient had been operated upon for carcinoma of the breast and showed evidence of bone metastases. At autopsy a metastatic tumor of the skull was found on the left side. The optic nerve on the left side was entirely surrounded and compressed by the tumor in the region of the optic canal. The optic atrophy on this side was due directly to the compression, and is a typical symptom of tumors involving the apex of the orbit. The optic nerve on the right side was edematous, but it was not surrounded by tumor tissue, and the author is unable to explain the edema.

Melanotic Carcinoma of the Eyeball and Orbit Originating in the Pigmented Epithelium, G. BIETTI. Ueber ein vom Pigmentepithel ausgehendes Melano- karzinom des Bulbus und der Orbita, Klin. Monatsbl. f. Augenheilk. 87: 459-486, 1931. The author notes that the pigmented epithelium of the iris, as well as that of the ciliary body and of the retina, shows a tendency to proliferation, which is usually benign. Proliferation of the pigmented epithelium also occurs in sarcoma of the choroid or glioma of the retina. The case described occurred in a man sixty- three years of age. Symptoms of irritation in the left eye had been noted five years previously, followed by considerable loss of vision. Over a year before the patient came under the author’s observation there were swelling and hemorrhage in the eye and complete loss of vision. A diagnosis of perforating sarcoma of the choroid was made. Removal of the eye with exenteration of the orbit was done, The patient died some months later with liver metastases. Histologic examination showed a malignant pigmented epithelial tumor-hence properly described as a melanocarcinoma-that had originated in the ,pigmented epithelium of the retina and the ciliary body.

Primary Adenocarcinoma of the Orbit, AMADEO NATALE. Adenocarcinoma primitivo de orbita, Rev. de especialid. 6: 954-961, 1931. Also in Arch. de oftal. de Buenos Aires 6: 635, 1931. A man of forty-six years was operated upon for a primary tumor of the left orbit, which proved on histologic study to be an adenocarcinoma, instead of a 514 ABSTRACTS fibroma or fibrosarcoma, as had been expected. The author believes that the tumor may have originated primarily from embryonic epithelial remnants within the orbital cavity, with subsequent carcinomatous degeneration. Operation was followed by roentgen therapy. Several photographs and two poorly reproduced photomicrographs illustrate the paper.

Sarcoma of the Orbit and the Maxillary Sinus, MONTHUSAND FAVORY.Sarcome de l’orbite et du sinus maxillaire, Rev. d’oto-neuro-opht. 9: 541-542, 1931. The authors report a case in a woman fifty-two years of age, in which the chief symptom was an increasing exophthalmos of the left eye, with a slight diplopia and strabismus. Palpation showed a tumor of the lower border of the left orbit; x-rays showed an area of increased density in the maxillary sinus on the left side; nasal examination showed nasal polyps in the region of the middle turbinate. On histologic examination, sarcoma cells were found in some portions of these growths. The diagnosis was sarcoma of the maxillary sinus invading the orbit and also the nasal fossa. It is interesting to note that there was no pain in this case and no involvement of the optic nerve. The authors question whether the best treatment in such a case would be a radical and mutilating operation or radiotherapy. In the discussion radical operation followed by radiotherapy was recommended.

Obsemations on the Treatment of Orbital Osteoma, with Report of a Case, N. PATTERSONAND H. CAIRNS. Brit. J. Ophthal. 15: 458-467, 1931. Besides its effects upon the eyeball and its nerves, an orbital osteoma may go on to involve the ethmoidal sinuses, project through the floor of the anterior fossa, and become adherent to and finally penetrate the dura. It may then give rise to such serious complications as cerebrospinal rhinorrhea, intracerebral aerocele, and meningitis. Small osteomata of the orbit are of importance, therefore, directly as a cause of proptosis and indirectly a8 a source of danger from intracranial complications as they enlarge. These lesions may come to the hands of the ophthalmologist, the aural surgeon, or the neurological surgeon, and the method of surgical approach is an important one. For small osteomas which on x-ray study are shown not to have penetrated the floor of the anterior fossa, the orbital approach is probably desirable. An illustrative case is given. When x-rays show an intracranial extension, there can be no question but that a transfrontal intracranial operation is indicated. It is regrettable that a disease such as this should lie, through divisions and specialization of modern medicine, on the border line of three specialties. The only way to correct this state of affairs is to insist on the closest cooperation and to make combined studies. EDWINM. DEERY

Two Cases of Exenteration of the Orbit with Skin Grafts, DANIELB. KIRBY. Arch. Ophth. 6: 309, 1931. Two brief case presentations before the Section of Ophthalmology of the New York Academy of Medicine, one of an epithelioma of the orbit, the other of a melanosarcoma. Removal of Tumors of the Muscle Conus of the Eye, M. BOURGUET.Sur l’ablation des tumeurs du c8ne musculaire de l’oeil, Bull. et m6m. SOC.d. chir. de Paris 23: 532-535, 1931. The author notes that it is unnecessary to perform an operation an the external walls of the bony orbit to remove tumors enclosed in the space of which the eye muscles form the walls. The chief symptom of such tumors is the exophthalmos due to the pressure of the growing tumor. In the author’s operation on these THE THYROID GLAND 515 tumors, after dissection of the conjunctiva and the skin at the border of the orbit, access to the space behind the eyeball is obtained by passing a long speculum between the tendon of the external rectus and that of the inferior rectus. The adipose tissue sac is drawn aside by a nasal forceps with the tip covered with cotton. The tumor is separated carefully from this sac, and dissected out, when encapsulated, until the pedicle ia reached. It is then grasped in a snare and removed in the same way as the tonsils in the snare operation. Operative results with this method have been excellent.

Case of Malignant Rhabdomyoma of the External Rectus Muscle in an Old Man, ANGELO VITTADINI. Un caso di rabdomioma maligno del muscolo retto esterno in un vecchio, Boll. d’ocul. 11 : 200-206, 1932. At the age of sixty-six a man had what was presumed to be a pterygium removed from the cornea of the right eye. One year later the lesion recurred and grew rapidly. It was now apparent that the lesion was a malignant tumor, and enucleation was done. A rhabdomyoma arising from the external rectus muscle was found. One year after operation there was a recurrence. Under radium treatment (details not given) the local tumor regressed quickly, but death followed a year later from presumptive liver metastases. An autopsy was not obtained. Two photomicrographs and a short bibliography are included. C. D. HAAGENSEN

THE THYROID GLAND Prognosis and Treatment of Malignant Goitre, R. S. DINSMORE,Western J. Surg., Obst. & Gynec. 39: 828-838, 1931. The histories of thirteen patients are summarized, including instances of lymphosarcoma, fibrosarcoma, papillary adenocarcinoma, and malignant adenoma. These four groups represent only 12 per cent of the malignant tumors of the thyroid gland. The remaining 88 per cent offer a prognosis which is much more encouraging than is generally supposed. Papillary carcinomata treated by combined surgery and x-ray gave 50 per cent three-year cures, and malignant adenoma 25.8 per cent three-year cures. WILLIAMJ. HOFFMAN

Carcinoma of Thyroid Arising in Discrete Adenomata, FRANKH. LAHEY. Surg. Clin. North America 12: 795-803, 1932. Lahey states that practically all carcinomata beginning in the thyroid gland arise in previously existing benign adenomata. Unfortunately it is possible in most instances to make a diagnosis of carcinomatous change in a previously benign adenoma of the thyroid only when the lesion has penetrated the capsule of the adenoma and invaded the adjacent structures, at which stage it is hopeless from the point of view of operative cure. Graham has shown that careful search of adenomata will frequently demonstrate areas where thyroid tissue has ruptured through the intima of the vessel and is growing within the lumen. Not every patient in whom vessel ingrowth is found will show carcinoma and distant metastases; in fact, but few of them will. A careful search, however, in those specimens of supposedly benign adenomata which have recurred with characteristic malignant features will rarely fail to reveal areas in which vascular ingrowth can be demonstrated. An unusually firm, discrete adenoma of the thyroid is suggestive of malignancy. Also, when a discrete adenoma, previously freely movable, becomes fixed or loses its discreteness of outline, a malignant growth should be suspected. A sudden 516 ABSTRAOTS paralysis or weakening of action of one vocal cord in a patient who has previously had a thyroid adenoma may also be indicative of malignant changes. There are two types of thyroid adenoma: the multiple colloid adenomatous goiter and the fetal or embryonal adenoma. This latter type resembles the adenofibroma of the female breast, and in it arise 96 per cent of all cancers of the thyroid. The author believes that all single discrete adenomata should be removed. If they are found to be malignant, x-ray therapy should be instituted. Four cases are reported to illustrate these ideas. W. S. MACCOMB

THE THYMUS GLAND

Case of Carcinoma of the Thymus, J. J. COLLINS.Radiology 18: 1148-1149,1932. A report of a case of carcinoma of the thymus in a negro male, twenty-eight years of age. Symptoms of sore throat, toothache, fever and general malaise had been present for five weeks before admission to the hospital. Later edema of face and neck was noted, followed shortly by dyspnea and still later by dysphagia. A clinical diagnosis of cellulitis of the neck with sinus thrombosis was made. Radio- graphic examination revealed a large, dense mass, 11 cm. in width, in the upper mediastinal area. In view of the history and the course of the illness, it was thought that the condition was mediastinal abscess rather than tumor. Autopsy revealed a large mass filling the upper mediastinum. Microscopic examination showed an undifferentiated-cell carcinoma. Metastases were found in the pleura, liver, and mesenteric nodes. W. S. MACCOMB

Case of Malignant Thymoma, B. R. NISBET. Brit. M. J. 2: 403, 1932. A case of malignant thymoma occurring in a two-and-a-half-year-old male child is reported. A severe attack of dyspnea led to a diagnosis of laryngeal diphtheria and treatment was instituted including the use of serum. Apparent improvement resulted, but two weeks later the child died. Tracheotomy had been performed but was not successful in relieving the severe laryngeal spasms and resulting cyanosis. Post mortem a large tumor of the thymus'was found. The left lung was collapsed; the spleen was enlarged. Metastases had occurred to the mediastinal and deep cervical nodes and to the kidneys. Unfortunately a report of the microscopic examination of this specimen is not given. W. s. MACCOMB

THE BREAST

Pre-Neoplastic Reaction of Regional Lymph Glands during the Development of Mammary Carcinoma, B. AUSTONI. Sulle reazioni preneoplastiche delle linfoghiandole regionali durante lo sviluppo del carcinoma mammario, Tumori 6: 31-58, 1932. In 27 cases of breast carcinoma Austoni studied the histology of the lymph glands with particular care. In 17 cases metastases were present. In the remaining 10 cases the nodes showed marked endothelial hyperplasia, which Austoni regarded as indicative of the absorption of toxic products from the adjacent cancer. This hyperplasia had no particular morphologic features distinguishing it from other types of adenitis. Six photomicrographs and an extensive bibliography are included. C. D. HAAGENSEN THE BREAST 517

Relationship between Fibrosis Cystica, Benign Tumors, and Carcinoma of the Breast, W. JUNGE.Uber die Beziehungen zwischen der Fibrosis Cystica, den gutartigen Tumoren und dem Karzinom der Brustdriise, Beitr. z. path. Anat. u. z. allge. Path. 88: 595-650, 1932. Sixty-seven breasts examined at the pathologic institute of the University of Rostock in the year 1930 afforded the material for this detailed study of the relationship between fibrosis cystica, benign tumors, and mammary carcinoma. HOWARDC. TAYLOR,JR.

Condition of the Milk Ducts in Breast Cancer, W. SCHOLZ.Ueber das Verhalten der Milchgiinge im Mammacarcinom, Frankfurt. Ztschr. f. Path. 43: 102- 113, 1932. On the basis of examinations of 47 specimens from women ranging in age from thirty-two to seventy-five years, Scholz concludes that retention of secretion in the milk ducts may provide an external chemical irritative factor predisposing to the development of cancer. In 35 per cent of his specimens, the ducts in the cancer area showed non-cancerous obliteration with dilatation and stasis, while in the non-cancerous areas this picture was much less common. He holds, therefore, that a mastitis obliterans is a factor in carcinogenesis. In the appendix, fallopian tubes, prostate, seminal vesicles, and testicles, investigation shows that obliteration of the duct lumina is of inflammatory origin, and that it can occur only after loss of the epithelium. The obliterative process in the milk ducts is entirely different from senile atrophy, in which the epithelium remains, although altered. Furthermore, old age cannot be the decisive factor in the process, since the condition is found in comparatively early life. In reality, non-inflammatory senile obliteration of the milk ducts is a rare condition. Detailed descriptions of the microscopic findings are given, with illustrations; also a bibliography of German references. M. E. MORBE

Dermal Edema in Mammary Carcinoma, E. A. VOTTA. El edema d6rmico en el carcinoma de mama, Prensa med. argent. 18: 662-669, 1931. The author calls attention to the presence of edema of the dermis, which may occur not only with an ulcerated carcinoma, but with a deep nodule of secreting carcinoma of the breast. One case history is discussed.

Resent Status of Surgical Treatment of Epitheliomata of the Breast, A. TAIL- HEFER. fitat actuel du traitement chirurgical des 6pith6liomas du sein, Paris m6d. 22: 244-249, 1932. Statistics of the Halsted and Willy Meyer operation are assembled to show that while the five-year cures average from 30 to 40 per cent for all cases and 70 per cent for cases without axillary metastases, these results suffer greatly when the period of observation is lengthened. Since visceral and bony metastases cannot be combatted, improvement in results can be expected only by eliminating local, cutaneous, and axillary recurrences by an operative technic that takes into account the main avenues of lymphatic permeation: subcutaneous, internal, external and retromammary chains. The author favors the Danis technic (Bull. Acad. Roy. de m6d. de Belgique 8: 47-71, 1928) for all cases except those where operation is contraindicated, as in acute cancer of young women, atrophic scirrhus in the aged, widespread local cancer, or cases with distant metastases. The incision should always be at least 5 cm. outside the tumor, should remove the skin of the base of the axilla, and should be widely undermined; closure should be a secondary consideration, with skin grafting if necessary. Axillary dissection 518 ABSTRACTS is perfected by incision towards the midpoint of the clavicle, by working from above, downward and outward, with sacrifice of the nerve to the latissimus dorsi as well as both pectoral muscles. Important nodes are removed by approaching the serratus magnus and the rectus sheath. Electrocoagulation of the perforating intercostal vessels and lymphatics is recommended. The results are too recent to be reported; but the author hopes for further improvement by the combination of surgery and radiotherapy. NELSONB. SACKETT Association of Surgery and Irradiation in the Treatment of Cancer of the Breast, J. PI~RQUINAND G. RICHARD. L’association de la chirurgie et des radiations dans le traitement du cancer du sein, Paris m6d. 22: 250-258, 1932. In evaluating results of treatment the authors review the prognostic factors due to age, histologic malignancy and radiosensitivity. The results of four lines of treatment are given. 1. Prophylactic postoperative roentgen radiation, using repeated moderate doses, almost doubles the percentage of three, five, and ten-year cures obtained by surgery alone. Statistics are still unavailable from the use of the radium pack. 2. Roentgen irradiation in the course of or instead of operation has not yet given very encouraging results. The authors would limit it to cases in which there is a local or general contraindication to surgery. 3. Preoperative irradiation does not increase the frequency of metastases and does not impair healing if the dosage is correct and the interval is at least two weeks before operation. Only scanty statistics of preoperative treatment and surgery are available. 4. Preoperative and postoperative radiation has given 50 per cent of five- year cures in operable (Groups I and 11) cases compared with 25 per cent by surgery alone. Further improvement has been obtained by a combination of preoperative and postoperative radiation with electrosurgery and electrocoagulation of the entire operative wound area. NELSONB. SACKETT

Carcinoma of Breast: Radical Amputation with Cautery, J. T. MASONAND J. W. BAKER. Surg. Clin. North Amer. 11: 1079-1083, 1931. In treating carcinoma of the breast the authors follow Percy and Scott in radical amputation and axillary dissection with the actual cautery, using white heat for skin incision, undermining and removal of the breast, and dull red heat for the axillary dissection. Preoperative sodium amytal and light chloroform anesthesia are used. All patients receive postoperative x-ray therapy before leaving the hospital. Primary union occurs in two to three weeks. One case is reported. The patient was able to return to her work as a stenographer in four weeks. No follow-up is given. NELSONB. SACKETT

Surgery and the Healing Process in Irradiated Areas, with Special Reference to Mammary Carcinoma, 0. JUNQLINQ.Ober das Operieren und die Wund- heilung im rontgenvorbestrahlten Gebiet, mit besonderer Berticksichtigung des Mammakarzinoms, Strahlentherapie 44: 125-130, 1932. The practice of irradiating mammary carcinomas before radical operation has not found favor in Germany, although in Sweden it has been tried with marked success. Jungling here reports his experience with 52 cases in which preoperative irradiation was given. He exposed the tumors through two or three portals, giving each field four or five doses of 380 T each, irradiating only one or two fields per day. The radical operation followed three to six weeks later. Following this, the operated area was treated with radium. After the x-radiation the skin of the exposed area becomes dry and heavily pigmented. Some tumors disap- THE BREAST 519 peared almost completely, though nests of malignant cells still remained, while others regressed to a lesser degree. The gland also decreased in size. Fat and connective tissue became firmer and dryer. The operation is thereby rendered somewhat more difficult, but not enough so to embarrass the surgeon. Healing is normal. Preoperative irradiation is in no way contraindicated. CHARLESPACKARD

Management of Breast Cancer, A. SOILAND.J. A. M. A. 98: 786-788, 1932. The author describes the treatment of breast cancer by implantation of radium needles containing from 1 to 2 mg. of salt; 75 to 100 mg. of radium is usually required for complete radiation of the breast and likely areas of metastasis. The needles are left in position for seven to ten days. Over 3,000 cases have been treated since 1901 with encouraging results; but no statistics are given. The high cost of such treatment is a drawback. NELSONB. SACKETT

Histologic Stages of Regression in an Irradiated Breast Cancer, M. JOLY.fitapes histologiques de regression d'un cancer du sein irradi6, Bull. et m6m. SOC.de radiol. m6d. de France 20: 116-119, 1932. This important contribution gives the histologic changes found by successive biopsies of an epithelioma in a woman aged forty-four years, who refused operation but submitted to several large doses of x-radiation. The well known appearances in the tissues are accurately described. The patient died about a year after treatment, following the apparent cure of skin nodules and vertebral metastases by radiation. The author concludes that the survival of cancer cells after such an intense irradiation points to its ineffectiveness or actual harmful influence; and now spreads the treatment over one or two months. NELSONB. SACKETT

Results of Treatment of Mammary Carcinoma, FRANKE. ADAIR. Ann. Surg. 95: 410-424, 1932. A report is made of the five-year results of the treatment of 199 cases of primary operable carcinoma of the breast during the decade from January 1, 1916, to January 1, 1926. These cases do not represent all of the operable cases handled in these years, for in many instances biopsy was avoided to prevent a possible dissemination of the disease and these slightly uncertain cases have been excluded. Of the total number, 23 were treated by surgery alone, and of these only 10 per cent were living at the end of five years. There were 37 treated by radiation methods alone: 4 died of intercurrent disease; 12 (36.3 per cent) are living; 4 are living with disease present and 24.2 per cent are living without evidence of disease. Of the 137 cases treated by surgery combined with radiation, 52 (40.6 per cent) have lived over five years; all but three of these (38.2 per cent) have no evidence of disease. The fact that 36.3 per cent of cases treated by radiation only are alive is an encouraging finding and offers a hopeful method of treating the many cases in which there is some complicating disease contraindicating a major operation. The fact that four of the living cases treated by radiation had disease present is not a serious drawback, since in these cases the cancer appears to have been inacti- vated. Adair stresses the fibrosing effect of radiation on the " cancer bed '' and the resulting permanent imprisonment of the cancer cells. He reports in detail the histories of three women in whom cancer cells were found within fibrotic masses treated by radiation over six years before. The subsequent course of these cases has not indicated that these cells are dangerous, as a rule. HOWARDC. TAYLOR,JR. 520 ABSTRACITS

Interesting Form of Cancer of the Breast: Degenerated Adenoma, A. SCHWARTZ. Une forme intbressante de cancer du sein. L’ad6nome dbg6n6r6, Paris m6d. 22: 323-324, 1932. The author reports an instance of carcinoma of the breast, small discrete and attached to the skin, and discusses the fibro-adenomas in which malignancy may be present, even though the tumor seems encapsulated and circumscribed. He cautions against a categorical diagnosis of benign tumor and advises frozen section diagnosis at operation. NELSONB. SACKETT Carcinoma of the Breast and Multiple Bone Lesions, C. PALIOS.Gpithblioma du sein et lbsions osseuses multiples, Rev. de chir. 50: 546-551, 1931. A woman of sixty-five entered the clinic for a pathological fracture of the femur, giving a history of a small hard tumor of the left breast of some twenty years’ duration. Five to six years before, it had enlarged, become stony hard, protruded through the skin, and discharged a few drops of blood from a small crater. Limitation of function of the right arm, generalized pains, and spinal symptoms had supervened eighteen months before admission. Histologic study of the amputated breast revealed a carcinoma. Skiagrams are included to show multiple fractures and rarefaction of the skeleton involving both femora, pubes, ilia, ribs, humeral heads, clavicles, and scapulae. The skull and lumbodorsal vertebrae were spared. NELSONB. SACKETT Comedo Adenocarcinoma of the Breast, F. C. HILL. Northwest Med. 30: 502- 503, 1931. A girl nineteen years of age complained of a lump in the right breast, located deep in the region above the areola. It was 2 cm. in diameter and mobile. Under the diagnosis of fibroadenoma or mastitis, operation revealed an invasive tumor occupying a large part of the upper hemisphere. Photomicrographs show gland- like structures and ducts with thickened walls lined by several layers of chromo- philic cells, many of which are round and tend to the undifferentiated type. The lumen is packed with exfoliated cells and often shows small cystic dilatations. A. C. Broders classified the sections as of grade I malignancy. The patient was well eight months after operation, and a good prognosis was indicated by the absence of axillary involvement. The comedo type of adenocarcinoma is rare, as is breast cancer under the age of twenty years (one in 2083 cases at the Mayo Clinic, See Harrington, S. W.: J. A. M. A. 92: 208, 1929). NELSONB. SACKETT Multiple Liver Metastases from a Fjrimary Breast Cancer (Right) by Way of the Retrograde Lymphatics, L. MINUCCIDEL ROSBO. Metastasi multiple a1 fegato da carcinoma mammario (d) primitivo per via linfatica retrograda, Minerva med. 23: 250-255, 1932. In a woman aged forty-two, dying with advanced carcinoma of the right breast, autopsy showed that neither the axillary nor supraclavicular nodes were involved. The lymphatics and nodes along the right internal mammary artery showed carcinoma, however. The right lobe of the liver contained a large metastatic tumor, and there were other smaller nodules in the left lobe. The lungs showed no gross [abstractor’s italics] evidence of involvement. On the basis of this evidence the author concludes that the path of metastasis was by permeation of the lymphatics through the intercostal spaces to the nodes along the internal mammary, and thence retrograde through diaphragmatic nodes to the liver. [M. B. Schmidt (Die Verbreitungswege der Carcinome, Jena, 1906) showed long ago that gross inspection of the lung is not sufficient to rule out cancer emboli. These are often microscopic and quiescent.] C. D. HAAGENSEN THE BREAST 521

Arborescent Proliferating Adenofibroma of the Breast, P. MOURE.L’adho- fibrome arborescent et proliferant du sein, Bull. et m6m. SOC.nat. de chir. 58: 269-278, 1932. The author calls attention to a group of histologically benign adenofibromata which develop by continuity, the normal gland tissue not being invaded but merely pushed aside by the arborescent prolongations which on cross-section give the gross appearance of disseminate islands of cancer tissue. In his first patient, aged thirty-four years, local excision was followed by a recurrence under the scar in three years. At a second operation a non-encapsulated mass with irregular prolongations was removed, with dissection of one arborization down onto the intercostal space. The patient has remained well seven years after the second operation. A second patient, a thirty-year-old woman, presented a tumor with a fairly smooth, rounded superficial surface easily separable from the surrounding breast, but with numerous branching prolongations into the deeper parts of the breast, requiring extensive resection. Histologic examination revealed a branching pericanalicular adenofibroma with the usual young connective-tissue elements and milk ducts lined by single or double layered cuboidal cells with no sign of malignancy. The author concludes that some cases classified as recurrent adenofibrosarcoma may have been recurrences of an incompletely removed arborescing fibroma, and recommends wide excision into normal breast tissue as superior to enucleation. NELSONB. SACKETT Bilateral Lymphoblastoma of the Breasts, G. PA~QUALINO.Linfoblastoma bilat- erale delle mammelle, Tumori 18: 172-192, 1932. A woman aged thirty-four, in the ninth month of hei eighth pregnancy, noted a swelling of the left breast. After delivery, which was normal, no milk formed in this breast and the axillary nodes enlarged. Twenty days post partum the right breast became swollen and the corresponding axillary nodes soon became palpable. Both breasts enlarged rapidly and attained a great size. A biopsy from one showed lymphoblastoma. The patient died two months after the first signs of disease had appeared. A good clinical photograph and one photomicrograph are included. C. D. HAAGENSEN

Paget’s Disease of the Nipple Associated with DitIuse Carcinomatosis of the Chest-Wall, H. W. BARBER. Brit. J. Derm. & Syph. 44: 214-218, 1932. A report of a single case of Paget’s disease of the nipple with extensive carcinoma of both breasts. Erosion was present for eighteen months. NELBON B. SACKETT

Paget’s Disease of the Nipple, R. PICODUNI AND E. R. GAVINAALVARADO. Enfermedad de Paget del mamel6n, Rev. med. latino-am. 18: 1778-1784, 1931. The authors describe a case of Paget’s disease of the nipple in a woman of forty-five years, who sought advice for chronic eczema of the right nipple, of insidious onset and sixteen years’ intermittent duration. On account of gradual induration and retraction of the nipple and hardening of the breast, the woman feared a mammary cancer. A biopsy specimen showed cellular elements with the typical characteristics of Paget cells. The authors believe that in the majority of cases, though not invariably, Paget’s disease is due to invasion of the skin by a mammary cancer. Treatment should always be surgical in their opinion, as deep lying cancers may exist which cannot be recognized. Reference is made to the work of Simard (Bull. de 1’Assoc. franp. p. 1’6tude du cancer 19: 50, 1930), who 522 ABSTRACTS showed, by total and serial sections of the organ, a mode of propagation not mentioned by either Borst or Ribbert, i.e. by the milk ducts and lymph channels.

INTRATHORACIC TUMORS: LUNGS AND MEDIASTINUM

Incidence of Bronchial and Lung Cancer in 1925-1931, ERWINDISSMANN. Uber die Hiiufigkeit des Bronchial- und Lungenkrebses in den Jahren 1925-1931, Ztschr. f. Krebsforsch. 36: 563-571, 1932. This report comes from the Pathological Institute of the German University in Prague. Among 7,855 autopsies in the period 1925-1931 there were found 80 bronchial and lung cancers, constituting 1.02 per cent of all autopsies and 10.85 per cent of all carcinomas, an increase over the period 1920-24. The sixth decade was the age of greatest incidence. Bronchial carcinoma is now four times as frequent in men as in women; up to 1924 it was only twice as frequent. In a large number of those succumbing to lung cancer there was a history of work connected with a dust or smoke hazard.

Primary Carcinoma of the Bronchus, PORTERP. VINSON. Minnesota Med. 15: 15-17, 1932. In the last five years there have been far more cases of primary bronchogenic carcinoma reported than ever before. The increasing use of the bronchoscope in the study of pulmonary disease has added much to our knowledge of the early manifestations of this disease. Vinson has reviewed 71 cases of malignant disease of the lung observed from May 1925 to January 1931, in which diagnosis was made by microscopic study of a biopsy specimen obtained by means of the bronchoscope; 57 of the patients were men and 14 were women. The incidence was greatest in the sixth decade. In only two instances was there a history of tuberculosis. Less than half the patients were smokers, and only a few smoked to excess. Eight gave a family history of carcinoma. Symptoms of carcinoma of the bronchus may simulate those associated with any pulmonary disease. In this series there were 5 patients who gave no history of cough. One patient had no pulmonary symptoms but presented himself for examination because of weakness, loss of weight, and pain in the legs. Sixty of the patients had had sputum, frequently purulent in character, associated with the cough. Bloody sputum had been present in 43 cases. Dyspnea was present in 49 of the 71 cases. Pain was the most disturbing symptom, and was noted by 47 patients; 62 complained of loss of weight. Symptoms and signs of associated pulmonary infection were present in 38 cases. Pleural effusion was found in 6 instances. Metastasis was definite in 10 cases and questionable in one. It was found most frequently in the cervical lymph nodes but was observed in the orbital cavity in two cases and in bones in three. The recurrent laryngeal nerve was involved in 4 instances. Roentgenographic examination of the chest revealed evidence of a lesion of the lung in 69 cases. In 32 cases the lesion observed was thought to be inflammatory. In 70 of these cases the diagnosis of malignant disease was made on bronchoscopic examination. Frequently it has been found impossible to obtain a positive biopsy because of the fact that the tumor itself was in an inaccessible portion of the bronchus. Sometimes tissue removed from an apparently clinically malignant lesion is found to be inflammatory. This condition has been noted especially in cases of unsuspected foreign body of intrapulmonary or extrapulmonary origin. INTRATHORACIC TUMORS : LUNGS AND MEDIASTINUM 523

Tissue removed at bronchoscopic examination was examined and classified as follows :

Squamous carcinoma...... 40 cases GradeIV ...... 27 GradeIII...... 12 Grade 11...... 1 Adenocarcinoma...... 26 cases Grade IV ...... 11 GradeIII...... 12 GradeII...... 1 Grade I ...... 2 Although the prognosis in primary malignant disease of the bronchus is regarded as hopeless, radiation therapy should always be used. Forty-two patients of this series were so treated. Ten patients were living and considered their condition improved for an average of fifteen months after a diagnosis had been made. At present the author believes that operative treatment of malignant growth of the bronchus is rarely justifiable. W. S. MACCOMB

Primary Carcinoma of the Lung, with Report of a Case Treated by Operation, C. I. ALLENAND F. J. SMITH.Surg. Gynec. and Obst. 55: 151-161, 1932. Weller in 1913, writing of primary bronchial carcinoma of the lung (Arch. Int. Med. 11: 314,1913), suggested that the following requirements be fulfilled; namely, that (1) an autopsy shall have been performed, (2) the carcinomatous nature of the condition shall have been verified microscopically, and (3) there shall be no reasonable suspicion that the lesion is not a primary one. At that time Weller collected 90 cases of primary bronchogenic carcinoma which met these requirements and discarded others previously reported as lacking sufficient data. The use of the bronchoscope and of the radiograph were urged in order to establish an earlier diagnosis. It would seem that there is a definite increase in the incidence of bronchogenic carcinoma, not to be accounted for solely by increased diagnostic acumen and an increasing interest in the disease. This is best demonstrated by Simpson’s report from the London Hospital, which, comparing tumors found to autopsies performed, shows a percentage increase from 0.51 in 1907 to 2.05 in 1925. In comparing primary carcinoma of the lung to total malignant growths observed, a percentage increase was found from 1.0 in 1907 to 3.7 in 1925. Histogenetically there may be three types of lung carcinoma: (1) those arising from the bronchial epithelium, (2) those arising from the bronchial mucous glands, and (3) those arising from the alveoli. The polymorphism of the tumor cells often renders a histogenetic diagnosis impossible. Many writers have found an association of primary bronchogenic carcinoma with tuberculosis, and believe the latter to be a predisposing factor. That there is a causal relation between influenza and lung carcinoma has not been proved. From the reports of bronchogenic carcinoma arising in workers in the Schneeberg mines in Saxony, there would seem to be a direct relationship of the irritation of dust and the chemical effect of the ingredients of the ore to the origin of bronchogenic carcinoma. Because of a constantly changing clinical picture, no symptom complex can be laid down as pathognomonic. Cough, pain, sputum (at times blood-tinged), and dyspnea are the most common symptoms due to the primary local pathology. Less frequently and later appear cyanosis, dysphagia, stertor, and pleural effusion. 524 ABSTRACTS

Weller has stated that tumors composed largely of columnar or of undifferentiated cells metastasire widely and early, while the cornifying squamous-cell type spreads chiefly by local extension, with late metastases to the regional lymph nodes. Metastases from lung carcinoma arise most frequently in lymph nodes, but may also occur in bone, liver, lungs and pleura. The diagnosis of primary bronchogenic carcinoma is often not made until in the late stages of the disease. This is largely due to the latent course and to complicating conditions such as atelectasis and bronchiectasis, caused by obstruction of a bronchus. The use of the bronchoscope is strongly urged, and exploratory thoracotomy may be justified in+those instances in which a diagnosis of intrathoracic pathology cannot be otherwise established. The radical operation for bronchogenic carcinoma, as pointed out by Graham, offers scant hope of cure at present, because of the advanced stage at which the diagnosis is usually made. Better results have been reported by some authors from the use of radium and deep x-ray therapy. Others are of the opinion that this type of treatment has been of no value. The authors’ patient was apparently cured fourteen months after operation. W. S. MACCOMB Primary Carcinoma of the Lung, WILLISF. MANQES. Am. J. Roentgenology 27: 858-869, 1932. In patients suffering from primary carcinoma of the lung, the symptoms have usually been present for some time before roentgenoscopic study is instituted. This may be due to the fact that the family physician does not consider the possibility of carcinoma as the diagnosis. ‘‘ Early diagnosis should be made if the possibility of bronchial neoplasms is considered and careful studies are made. The early symptoms are usually those of bronchial irritation and the early signs those of bronchial obstruction.” Jackson has divided malignant growths of the lung into three classes: (1) growths primarily endobronchial; (2) growths primarily peribronchial or parenchymal; (3) peribronchial growths seen after the endobronchial intrusion of the growth. The first class is subject to positive diagnosis if in a bronchus or branch which can be seen through the bronchoscope. In the second class the tumor can often be felt with the bronchoscope. Jackson has used the terms “fixity,” “ rigidity ” and l1 deformity ” of the bronchial wall, and believes they are sufficiently characteristic features to justify a tentative diagnosis of malignancy. In the third class, when the lesion intrudes sufficiently, tissue can at times be obtained bronchoscopically . Manges reports a series of 36 cases accompanied by exceptionally good roentgenographic studies demonstrating various diagnostic points. In his analysis he found that in 8 instances the lesion occurred in the right upper lobe, in 5 in the right middle lobe, in 8 in the right lower lobe, and in 9 in the left lower lobe. Most of these involved the root struotures, of which 9 were on the left side and 15 on the right side. The outline was sharp in 23 cases and irregular in 13. Twenty-six showed some evidence of displacement of the heart and other mediastinal structures toward the site of the lesion. Three showed evidence of displacement away from the lesion, and 7 cases showed practically no displacement. Metastases were evident in 6 cases; no metastases in 30. There were other lesions in 4 cases, as lung abscess, bronchiectasis or lues. There was bronchoscopic evidence of new growth in 29 cases but in a number of these the tissue removed was either insufficient for positive diagnosis or the records were indefinite. The diagnosis was confirmed by surgical biopsy in 3 instances and post mortem in 5. Twenty-one of these cases received roentgen-ray treatment; the remaining 15 did not. Practically all the treated cases showed at least temporary clinical evidence of improvement. One patient is living and well for seven years, except INTRATHORACIC TUMORS : LUNGS AND MEDIASTINUM 525 for a permanent bronchiectasis; another for six years. Another, treated elsewhere, is well nearly eight years, and a number have been symptom free for more than one year. w. s. MAcCoMn Diagnosis of Tumors of the Lungs, R. EPSTEIN. Zur Diagnose der Lungenge- schwiilste, Roentgenpraxis 3: 1057-1062, 1931. Although in many cases the clinical signs and symptoms are suggestive of primary or secondary carcinoma of the lung, the correct diagnosis is usually only made after accurate interpretation of roentgenograms. Therapeutic results may be bettered as the diagnoses in these conditions are made earlier in the course of the disease. This article is illustrated with roentgenograms of selected cases. BENJAMINR. SHORE

Seven Cases of Primary Malignant Tumor of the Lungs, A. VERSTRAETEN.A propos de sept cas de tumeur maligne primitive du poumon, Scalpel 84: 1358- 1361, 1931. The author reports 7 cases of primary malignant tumor of the lung, with full clinical details.

Clinical Study of Eight Cases of Primary Cancer of the Lung, LE FEVREDE ARRIC, R. MARTENS,C. BOSQUETAND R. VERHOOGEN.Etude clinique de huit cas de cancer primitif du poumon, Scalpel 84: 1313-1331, 1931. The authors report in detail 8 cases of primary cancer of the lung among a total of 6,054 hospital admissions. There was only one female patient in this series. The x-ray findings were not typical, except in one case. In 6 cases the tumor was an epithelioma (spinocellular or basal-cell) of bronchial origin; in one case a sarcoma, and in one, an endothelioma. Chondromas of the Lung, PIETROVERGA. I condromi del polmone, Pathologica 24: 1-22, 1932. In going over the pathology museum of the University of Perugia, Verga found two cases of chondroma of the lung. He himself autopsied a third case of this type of tumor. Briefly, the findings in the three cases were as follows: 1. In a man aged seventy-one, dying of bronchopneumonia and carcinoma of the bladder, a large chondroma lying beneath the visceral pleura was found. 2. In a mafi of sixty-eight, gelatinous nodules were found scattered diffusely throughout both lungs. Histologically the neoplasm was a myxochondro-osteosarcoma. 3. A patient aged seventy-one died of cerebral hemorrhage. In the upper lobe of the right lung was a nodular, hard tumor which shelled-out easily from the parenchyma. It was made up of cartilage, fat, tubules lined with cylindrical epithelium, and smooth muscle fibers. Verga includes a critical review of the 58 cases which have previously been reported, an exhaustive bibliography, and fourteen photographs of the gross and microscopic specimens. C. D. HAAGENSEN

Primary Sarcoma of the Lung and Metastatic Mediastinal Sarcoma, G. HERRN- HEISER. Primares Lungensarkom und metastatisches Mediastinalsarkom, Med. Klin. 28: 1128-1131 and 1166-1168, 1932. Herrnheiser discusses the roentgen diagnosis and therapy of primary sarcoma of the lung and metastatic sarcoma of the mediastinum and reports a case of each. M. E. MORSE 24 526 ABSTRACTS

Mediastinal Compression by Sarcoma, GON~LEZSU~REZ. Sindrome de com- presi6n del mediastino por sarcoma encefaloide, Arch. d. med. cir. y espec. 35: 478-480, 1932. This is a fuller report of a case previously presented by the author (see abstract in Am. J. Cancer 17: 234, 1933).

Large Congenital Air Cyst of the Lung in a Child, V. CREMER. Volumineux kyste gazeux congenital du poumon chez un enfant, Bull. et m6m. SOC.de radiol. mdd. 20: 203-205, 1932. Large Broncho-pulmonary Cyst in a Child of Fifteen, R. DEBR~AND E. BLINDER. Volumineux kyste bronchopulmonaire chez un enfant de quinze am, Bull. et mdm. SOC.mdd. d. hap. Paris 56: 818-823, 1932. These two articles describe the same case, illustrated by x-ray photographs- The patient had had a sudden onset of cyanosis, dyspnea, and chest pain following two attacks of pneumonia at the age of three and measles at the age of six. A diagnosis of pneumothorax wa8 made. The symptoms gradually passed off and, when examined at fifteen, the boy’s only complaint was mild dyspnea on exertion. The x-ray showed the right chest practically clear, the mediastinurn, trachea and heart displaced to the left, in the upper right chest some apparently normal lung parenchyma, and no signs of compressed lung. The diagnosis of congenital air cyst was made on the radiographic appearance. JEANNETTEMUNRO

Malignant Tumor of the Mediastinum, FLOYDS. KIDD. Med. Bull. Vet. Admin. 9: 190-193, 1932. A detailed report of a mediastinal tumor occurring in a man forty-one years of age. The final diagnosis was not made until post-mortem examination, at which time a tumor mass was found occupying the entire superior mediastinum. [It is not stated whether or not this tumor arose from the thymus; neither is a report given on the microscopical examination.] W. S. MACCOMB

THE ABDOMINAL WALL

Desmoids and Sarcomas of the Abdominal Wall, Z. W. MANKIN. Desmoide und Sarkome der Bauchwandung, Arch. f. klin. Chir. 169: 688-711, 1932. Mankin has collected from the literature 629 cases of neoplasms of the anterior abdominal wall, and adds 17 cases of his own. Included in the 629 cases are 423 fibromas, 155 fibrosarcomas, 4 myosarcomas, 2 angiosarcomas, 43 unclassified sarcomas, and 2 myxomas. All but 7 of these growths were situated on the anterior aspect of the abdominal wall, and the majority of these were below the umbilicus. The patients included 544 women and 85 men. Ninety per cent of the women were parous and in 62 per cent there seemed to be a definite relationship between pregnancy and the origin or acceleration of growth of the neoplasm. Firm, encapsulated, benign connective-tissue desmoids made up the largest group in this series. The majority were about the size of a hen’s egg and were observed in the lower portion of the anterior abdominal wall. The symptoms were indefinite in character and depended upon the size and position of the growth. Radical surgical removal is the recognized form of therapy, as radiotherapy has been found unsatisfactory. Local recurrences are common and may be observed in from 30 to 40 per cent of the cases. Myxomas are rare tumors which are apparently derived from embryologic elements of the umbilical cord. Mankin gives the history of a patient with one of these tumors and includes a photomicrograph to illustrate the histologic characteristics. THE DIGESTIVE TRACT 527

Of the 49 true sarcomas, 42 were situated on the anterior and 7 upon the lateral aspects of the abdominal wall. In contrast to the desmoids, the majority of these were observed in men and were of unusual malignancy. In the histories of these patients it was usually possible to separate an early period of slow growth from the later and rapidly malignant period. Trauma seemed to play a definite etiological r81e in the two cases of sarcoma observed by Mankin. One apparently followed an intramuscular injection, while in the other acceleration of growth seemed to follow iodoform injections and incomplete surgical removal of a supposedly benign tumor. A good bibliography is appended. BENJAMINR. SHORE Endometrioma of the Umbilicus, REXWALDBROWN. Surg. Clin. North America 11: 931-932, 1931. A thirty-six-year-old woman had a bluish umbilical nodule which became swollen before and during menstruation. The tumor was excised, and a right oijphorec- tomy was done for a “ chocolate ” cyst. The author favors Sampson’s genetic theory that the endometrium escapes by a retrograde flow from the uterus through the tubes at the menses. GEORQET. PACK

THE DIGESTIVE TRACT

Myomas of the Esophagus, PIETROBEZZA. I miomi dell’esofago, Pathologica 24: 71-84, 1932. Bezza collected reports of 28 cases of leiomyoma and 3 cases of rhabdomyoma of the esophagus. To these he added descriptions of 5 cases of leiomyoma which were encountered at autopsy. None of these 5 patients had had any clinical signs of disturbed esophageal function. They had died as the result of pneumonia, prostatic hypertrophy, cirrhosis, peritonitis, and fracture of the spine, respectively. Four were men and one a woman. Their ages varied between fifty-five and seventy-three. In three of the cases the tumor developed from the muscle layers normally existing in the esophagus; once from the longitudinal layer, once from the circular layer, and once from the muscularis mucosae. In the two remaining cases the tumor appeared to arise within the submucosa, but no connection with the muscular coats could be traced. Nine photographs and a comprehensive bibliography are included. C. D. HAAQENSEN Radiologic Diagnosis of Pedunculated Tumors of the Esophagus, J. PALUQYAY. Rontgendiagnose gestielter Speiserohrengeschwulste, Rontgenpraxis 4: 761- 770, 1932. Palugyay reports the seventh case of a pedunculated tumor of the esophagus in which the correct diagnosis was made by radiologic methods. His patient was a man fifty-five years of age who was admitted to the hospital because of dysphagia and loss of weight. Roentgenograms demonstrated an elongated dilated area about 5 cm. long in the cervical portion of the esophagus. By the use of a small amount of barium and swallowed air as contrast media, a tumor covered with irregular folds of mucosa could be demonstrated in this area. The diagnosis of pedunculated tumor of the esophagus was made on these findings. A growth measuring 8 x 5 x 2.5 cm., composed mostly of smooth muscle, was removed at operation. The patient died of hemorrhage and sepsis. The article is well illustrated with roentgenograms and photographs of the gross specimen. BENJAMINR. SHORE 528 ABSTRAUTS

Gastrographic Method in the Diagnosis of Carcinoma of the Stomach, Gastro- Intestinal Ulcers, and Cholecystitis, N. ONODERA,S. KANEGAE,M. MATUFUSI, AND T. HAM. Ueber die gastrographische Methode der Diagnose von Magen- krebs, Magen-Darm-Geschwur und Cholecystitis, Ztschr. f. klin. Med. 118: 354-373, 1931. The authors describe their method of recording the hunger contractions of the stomach and the curves which they have found characteristic of various diseases. An air-filled rubber balloon is swallowed and the contractions are recorded on a kymograph. The curves typical of carcinoma of the stomach show accentuated contractions coming slowly and at irregular intervals and never ending in the tetanic contractures observed in the normal stomach. Similar curves have been observed in a case of sarcoma of the stomach and also in gastric syphilis. Injec- tions of paraffin with 30 to 50 per cent of mercury in the stomach wall of normal rabbits give curves similar to those observed in human gastric carcinomas. The authors believe that this method of diagnosis is reliable, easy to use, inexpensive, and is valuable in early cases in whatever portion of the stomach the tumor is situated. Other curves have been found which are more or less characteristic of gastric ulcers and of cholecystitis. A detailed description of the apparatus used is given, and the various types of curves are well illustrated. BENJAMINR. SHORE

Peritonitis Following Operations for Gastric Carcinomas and Ulcers and Duodenal Ulcers. A Discussion of the Causes of Death after Operation, Especially Peritonitis, R. FRIEDRICHAND H. WEBER. Die Infektion des Peritoneums bei Magenoperationen wegen Carcinom, Ulcus ventriculi und Ulcus duodeni. Gleichzeitig eine Uebersicht ueber die postoperativen Todesurachen, insbe- sondere der Peritonitis, Arch. f. klin. Chir. 171: 673-691, 1932. The primary surgical mortality following resection of the stomach for carcinoma continues to be high in spite of refined operative technic and the reduction of fatal pulmonary complications by the use of local anesthetics. This is due largely to the fact that more advanced and difficult cases are being operated upon with increasing experience of surgeons. Peritonitis due to contamination at the time of operation continues to be the commonest fatal complication of gastric resection. The operative mortality of gastric resection for carcinoma reported by the authors is 25.1 per cent, two thirds of the deaths being due to peritonitis. Peritonitis following gastro-enterostomy or resection of the stomach for ulcer is relatively uncommon. In 171 cases of gastric resection for ulcers there were only 6 deaths from generalized peritonitis. Cultures of the peritoneal cavity in the region of the suture line in 7 cases of gastric and 10 cases of duodenal ulcers operated upon were either sterile or showed relatively non-pathogenic organisms, while in two thirds of the cases of carcinoma of the stomach pathogenic organisms of the colon or streptococcus groups were identified. This qualitative and quantitative difference in the bacterial content of gastric ulcers and carcinomas is believed to account for the marked variation in the incidence of general peritonitis following resection. BENJAMINR. SHORE

Myoma of the Stomach, N. B. SCHTSCHUPACK.Vrachebnoje Delo Nos. 5 and 6, pp. 282-283, 1932. A submucous leiomyoma of the lesser curvature of the stomach is described, in a twenty-eight-year-old female, diagnosed preoperatively on the basis of clinical and roentgen ray findings. The importance of early diagnosis and the possibility of malignant change in these tumors are stressed. The occurrence of leiomyomata is to be borne in mind when examining stomach cases. MAURICELENZ THE DIGESTIVE TRACT 529

Further Observations on a Case of Pedunculated Tumor of the Stomach, Diag- nosed Radiologically and Confirmed by Operation, ALBERTOANZILOTTI. Ulteriori osservadoni su di un caso di tumore peduncolato dello stomaco radiologicamente diagnosticato e operatoriamente controllato, Radiol. med. 19: 717-18, 1932. This case, first reported in 1930, showed on radiologic examination a 6lling defect which at times was found in the pyloric antrum, at other times in the duodenum. The diagnosis at the time was gastric polyp with a long pedicle, allowing passage of the polyp into the duodenum. The patient refused operation then, but returned later because of severe gastric symptoms and hemorrhage. Operation confirmed the radiologic diagnosis. A gastric polyp on a long pedicle was found in the second section of the duodenum. The author illustrateswith an x-ray photograph. JEANNETTEMUNRO Invagination of Gastric Polyps into the Duodenum, E. SAUPE. Die Invagination von Magenpolypen in das Duodenum, Roentgenpraxis 4: 694-698, 1932. The author reports two cases of invagination of gastric polyps through the pylorus into the duodenum. In the first case this occurred during the roentgen examination of the gastro-intestinal tract, and caused symptoms simulating an acute perforation of the stomach. Both patients were operated upon with satisfactory results. The correct preoperative diagnosis was made in one case and in the other re-examination of the films in the light of the operative findings showed the prolapsed polyp. The article is illustrated with roentgenograms. BENJAMINR. SHORE Intussusception in Adults, G. A. MOORE. New England J. M. 207: 395-398, 1932. From all available statistics a fair estimate would be that about 5 to 10 per cent of all intussusceptions occur in adults. In children usually no cause for the intussusception can be demonstrated, while in adults a tumor or some abnormality of the intestine such as Meckel’s diverticulum is usually responsible. The former condition is the more frequent. Kassemeyer (Deutsche Ztschr. f. Chir. 118: 205-264,1912), among 199 cases of intussusception resulting from tumors, found 85 of malignant origin and 114 benign. Of the malignant tumors in Kassemeyer’s series 48 were carcinoma and 26 were sarcoma. In the benign group 60 were polypi and 20 lipomas. Forty- two were caused by Meckel’s diverticulum. Kassemeyer found 92 cases involving the small intestine alone as compared with 192 in which the large intestine was involved. In most adult cases of intussusception the symptoms extend over weeks, months, and even years. Constipation of the most severe type is often observed in chronic cases, as are recurring attacks of colicky abdominal pain. Vomiting is an uncommon early symptom. Blood in the stools in adult intussusception from any cause is of rare occurrence. X-ray examination of the intestinal tract is of the greatest value as an aid in diagnosis. The ideal method of removal of the tumor is by enterotomy and local excision, if possible in a one stage procedure. However, if the condition of the patient does not warrant this, removal in two stages is to be recommended. Moore has reported two cases of intussusception in the adult. The first occurred in a man seventy-five years of age. At operation an intussusception was found in the ileum, due to a tumor the size of an English walnut. Microscopic examination of this tumor showed it to be an adenocarcinoma, primary in the ileum. Recovery was uneventful. The second case occurred in a woman sixty- five years of age. Here also an intussusception was found in the ileum, but in this instance was due to a lipoma. This patient developed a postoperative pneumonia and died. W. S. MACCOMB ABSTRACTS

Chronic Inflammation of the Mesentery in a Case of Recurring Invagination of the Ileum Due to a Small Sedunculated Tumor, L. GALIFI. Mesenterite cronica in un caso di invaginazione recidivante dell’ ileo per tumoretto peduncolato, Radiol. med. 19: 565-571, 1932. A case ip reported in which a small, apparently benign tumor in the lumen of the terminal ileum caused repeated attacks of severe pain due to invaginalion. It is discussed from the point of view of radiologic diagnosis. Mesenteritis and stenosis of the small intestine were diagnosed from the plates. The article is illustrated by x-ray photographs. JEANNETTEMUNRO

Cancer of the Colon and of the Rectum. Personal Experiences from 1892 to 1932, JOSEPHCOLT BLOODGOOD. Ann. Surg. 95: 590-619, 1932. Bloodgood discusses in a general manner his experiences in the treatment of carcinoma of the entire colon and rectum over a period of forty years. Most important in the prognosis in all of these cases is the extent of the local disease at the time of operation. Bloodgood believes that much more valuable time is lost by patients themselves not seeking medical treatment soon enough than by pro- crastination on the part of physicians. As early diagnosis of gastro-intestinal tumors is becoming more common, more benign and easily eradicated growths are being seen. It is also interesting that as the number of cases of cancer of the colon subjected to operation in the very earliest stages increases, and the number of those who live five or more years also increases, more patients return after three to five years with cancer in some other part of the colon. Decompression of the colon by means of appendicostomy is recommended as a preliminary procedure before all radical operations on the large intestine. Radi- cal removal of all growths, either for purposes of a cure or palliation, with the corresponding lymph nodes is recommended: Primary suture at the time of resection is considered safe and is preferred to the more time-consuming Mikulicz type of procedure. Preliminary irradiation is suggested for those cases where the cancer involves the anus in patients who are old and bad operative risks, especially if large amounts of radium and an experienced radiotherapeutist are available. The article is illustrated with case reports, photographs of gross specimens, roentgenograms, and photomicrographs. BENJAMINR. SHORE

Malignant Adenomata of the Colon. E. J. KILFOY. Am. J. Surg. 13: 283-290, 1931. Kilfoy reviews some of the literature on malignant adenomata of the colon and reports a case illustrating the ineffectiveness of incomplete surgery and roentgen therapy. A Mikulicz resection of 10 cm. of sigmoid had been done for multiple polyps and adenocarcinoma of the sigmoid. After three years and five courses of roentgen therapy, autopsy showed carcinoma in the colostomy stoma, the wound, and in some remaining polyps of those scattered throughout the left colon. Metastases were also present. JOHNFALLON Tumor of Sigmoid Flexure or the Adnexa, P. G. PLENZ.Flexur- oder Adnex- tumor? Ztschr. f. Geburtsh. u. Gyniik. 102: 137-142, 1932. Reference is made to the already considerable number of reported cases in which colonic growths have been mistaken for tumors of the adnexa, the author adding one case of his own. HOWARDC. TAYLOR,JR. Pseudomyxoma of the Appendix, IVANGORI MORENO. Pseudomixoma del apbndice, Arch. argent. de enferm. d. apar. dig. 7: 53-128, 1931. In this extensive article Moreno gives a general survey of the clinical and anatomical facts on pseudomyxoma of the appendix, stressing the desirability of THE BILIARY TRACT 53 1

distinguishing between the pseudomyxoma caused by hyperplasia of the glands and the connective tissue of the appendix and that form where there is a real cystadenoma of the mucosa. Both forms may lead to a pseudomyxoma of the peritoneum. Most of the cases of pseudomyxoma belong to the first group. Pseudomyxoma of the peritoneum is caused by the mucus produced by the appendix. It may enter the abdominal cavity through a perforation caused by necrosis of the appendicular wall, or by means of the lymphatic vessels. The peritoneum reacts by formation of a highly vascular granulation tissue and sub- serous infiltration. The mucus sometimes carries tumor cells, which may give rise to secondary new-growths in the peritoneum. Appendiceal pseudomyxoma, which generally is benign and chronic, practically always attacks persons past thirty years and is more frequent in men. Three periods may be distinguished in its development, namely an initial period, which may last for years, in which no symptoms are found or only those of an acute or chronic appendicitis; a second period in which the first definite symptoms occur, and a third period in which the peritoneum is affected. In the second period the patient may complain about pain. Palpation will reveal a tumor in the right iliac fossa. When a patient shows a tumor in the ceco-appendicular region, elastic or pasty in consistency, irregular in form but sharply bounded and not painful even upon pressure, the existence of a pseudomyxoma is very probable. Moreno discusses extensively the differential diagnosis and prognosis in separate sections. Cysts of the ovary may also lead to a pseudomyxoma of the peritoneum, but with the formation of much larger amounts of mucin. In most cases ascites and cachexia complicate the clinical picture. The writer describes in detail a case of pseudomyxoma of the appendix in a sixty-two-year-old man. The tumor consisted of a number of cystic cavities filled with mucus and lined with epithelium. It apparently was a multiple cystic adenoma. The description of the tumor is clarified by one schematic figure, three photographs, and six photomicrographs. Three x-ray pictures show the satisfactory function of the intestine after the operation. A bibliography of more than 250 references concludes the text. JOHANNESP. M. VOGELAAR

Concerning Cysts of the Appendix, C. DAMBRINAND L. DAMBRIN. Sur lea kystes de l’appendice, Toulouse m6d. 32: 695-700, 1931. The authors removed a cystic appendix or mucocele 11 cm. long and 3 cm. wide from a thirty-five-year-old woman. It contained a gelatinous liquid. The cyst was easily palpated through the abdominal wall, and simulated either a carcinoma of the appendix or an ileocecal carcinoma. It developed probably as a chronic inflammatory retention cyst with later sterilization of the cystic contents. GEORGET. PACK

THE BILIARY TRACT Roentgen Delineation of Liver Tumors by Means of Hepatosplenography, E. MARTINAND S. KADRNKA.Zur Frage der roentgenologischen Darstellung von Lebertumoren durch Hepatosplenographie, Schweiz. med. Wchnschr. 62: 807-810, 1932. The authors report the delineation of metastatic hypernephroma nodules in the liver by roentgenograms taken after the intravenous injection of thorotrast. This drug is used in 5 per cent solution and is given intravenously in gradually increasing doses at one to two days interval until a total of 0.75 cubic centimeters per kilo of body weight has been given. Roentgenograms of the liver and spleen are made twenty-four hours after the last injection. This fractional method of ABSTRAOTS administering thorotrast allows a patient’s tolerance to be raised to a point where a sufficient quantity of the drug can be introduced to produce shadows in the roentgenogram without causing toxic symptoms. BENJAMINR. SHORE Some Generally Unknown Facts of Clinical Importance about Primary Liver Carcinoma, C. BONNE. Eenige weinig bekende feiten van klinische beteekenis omtrent het primaire levercarcinoom, Geneesk. tijdschr. v. Nederl. Indie 72 : 389-392, 1932. Primary carcinoma of the liver is much more frequent in the tropics than in the temperate zones and for this reason may be called a tropical disease. Frequently the function of the liver is not greatly disturbed, even with extensive pathological changes of its structure. The patient may continue his regular work until a few days before his death. This occurs with primary liver-cell carcinomas, the cells of which may function like normal liver cells. It is not known whether primary liver carcinoma has a greater tendency to develop in small or in large cirrhotic livers. It has been found in livers of 1150, 1100,1075,995,915,725, and even 620 grams. Hemorrhage is sometimes so acute that the patient may die from loss of blood into the abdominal cavity. This may occur even in cases where the tumor is very small. It is not known whether primary cancer of the liver is as frequent in white persons and Indo-Europeans as it is in natives of the Dutch Indies, and in the Chinese. Metastasis takes place to the lungs and sometimes to the bones. A spontaneous fracture may be the first symptom of the disease. JOHANNESP. M. VOGELAAR

Numerous Metastases to the Scalp from a Carcinoma of the ‘‘ Porta Hepatis,” GABRIELEDAL Pozzo. Numerose metastasi di carcinoma della porta del fegato esclusivamente localizzate nel cuoio capelluto, Cancro 3 : 80-84, 1932. Carcinoma metastases in the scalp were discovered in the course of a routine physical examination of a man aged sixty, about to have a hernia repaired. The primary source was not discovered until autopsy. A large mass of carcinoma with a central necrotic area was found to occupy the site of the gallbladder, which could no longer be identified. Largely on the basis of the histologic findings, a final diagnosis of primary carcinoma of the liver arising in the bile ducts was made. C. D. HAAQENSEN

Solitary Congenital Adenoma of the Liver, PIETROBUCOLOSSI. L’adenoma solitario congenito del fegato, Arch. ital. di chir. 31: 441-480, 1932. The author reports a case of a thirty-four-year-old woman who noticed a gradually enlarging tumor of the abdomen. There were no other symptoms. At operation a pedunculated tumor the size of a large orange, and attached to the liver, was removed. The patient was well one year later. The tumor was covered by peritoneum and a well defined capsule. The microscopic picture showed atypical liver cells, arranged in imperfect lobules and in some cases full of biliary pigment. The author gives a comprehensive bibliography, a historical sketch, and a review of the literature. He includes drawings and photomicrographs. JEANNETTEMUNRO

Pathological Anatomy of Cysts of the Liver, M. BLUMAND W. MULLER. Ein Beitrag zur Klinik und pathologischen Anatomie der Cystenleber, Deutsches Arch. f. klin. Med. 173: 206-211, 1932. Blurn and Muller report the case of an eighty-two-year-old man in whom a large cystic liver had been observed over a period of twenty-five years. Although THE BKIARY TRACT 533

liver function tests could not be done, there was no history of any disturbance of function. Autopsy showed a cystic liver weighing 16.kg. and measuring 120 cm. at its greatest circumference. The cysts contained thick chocolate-colored fluid, rich in cholesterin but lacking bile pigments. Histologic examination showed the cysts to be lined with a single layer of cuboidal epithelium resting on a dense connective-tissue framework. Of especial interest was the marked proliferation of the bile ducts in the intervening liver tissue and the great increase in the fibrous tissue trabeculae. The article is illustrated with a photograph of the gross specimen and photomicrographs. BENJAMINR. SHORE Contribution to the Study of Ciliated Cysts of the Liver, PIETROBEZZA. Con- tributo all0 studio delle cisti ad epitelio cigliato del fegato, Arch. ital. di anat. e istol. pat. 2: 1367-1380, 1931. At autopsy of a woman aged thirty-nine, dying of tuberculosis, the author found a small smooth-walled cyst projecting slightly from the surface of the liver. It was lined with cylindrical ciliated epithelium. The wall contained a few smooth muscle fibers. The author concludes that it originated from a congenitally displaced portion of the bile-duct system. The accompanying photomicrographs do not show the cilia satisfactorily. C. D. HAAGENSEN

Carcinoma of the Hepatic Ducts, G. MILLESAND J. D. KOUCKY.Ann. Surg. 95: 468-470, 1932. Thirty-six cases of primary carcinoma.of the hepatic duct have been previously recorded. Death from biliary obstruction usually forestalls metastases. The patient whose lesion is described here was a male fifty-three years of age. The tumor was an adenocarcinoma 1.5 cm. in diameter, apparently located half way between liver and cystic duct. There were no metastases. Ten weeks after the onset of symptoms, the duct was dilated, curetted, and closed over a catheter. Autopsy, four days later, showed miliary liver abscesses. The ducts contained " white bile," showing that suppression of function continued four days after relief of obstruction. The Kupfer cells contained bile, emphasizing the dissocia- tion of the excretion and formation of bile, in so far as the liver is concerned. The gallbladder and common duct were dilated and their muscular coats atrophic, suggesting that distention alone is not sufficient stimulus to contraction but that chemical bile is needed. JOHNFALLON

Cancer of the Hepatic Duct, GUILLERMOBosco. El chncer del canal hephtico, Rev. m6d. latino-Am. 17: 390-397, 1931. Bosco stresses the fact that it is impossible to make the diagnosis of cancer of the hepatic ducts with any degree of certainty. This is due to the inaccessibility of the tumor, its failure to cause pressure symptoms, the absence of metastases in liver and other organs, and the relatively good general condition of the patient. The icterus which appears in an early stage of the disease is caused partly by the tumor and partly by the spasm of the duct. The same symptoms may be found in cancer of the head of the pancreas, tumor of the ampulla of Vater, chronic pancreatitis, adhesive periduodenitis, gallstone in the ductus choledochus, and hydatid cyst of the lobulus quadratus. The writer reports a case of cancer of the hepatic duct in a forty-four-year-old man. Fifteen days after the first symptoms of fever and vomiting he was deeply jaundiced. The liver was enlarged and somewhat painful upon pressure. The spleen was slightly increased in size. The blood showed a myeloid reaction (myelocytes, metamyelocytes, promyelocytes). At operation a small hard tumor was found in the hilus of the liver, enclosing the hepatic duct and its main branches. 534 ABSTRACTS

Autopsy revealed complete obstruction of the hepatic duct by a primary tumor of the size of an olive. Two figures illustrate the lesions. JOHANNESP. M. VOGELAAR Diagnosis of Papilloma of the Gallbladder by Cholecystography, HANSW. HEFKE. Die Diagnose von Papillomen der Gallenblase mittels Cholezystographie, Rontgenpraxis 3: 871-873, 1931. A case is reported of papilloma of the gallbladder in a young woman of twenty years diagnosed by cholecystography and substantiated by operation. The only clinical symptoms had been two attacks, three months apart, of sudden pain in the right upper abdomen radiating only to the back, accompanied by vomiting of material containing bile. There was no icterus, coloring of stools, chills, or fever. Clinical examination was negative. Repeated roentgen examinations revealed a round shadow about the center of the gallbladder, not shifting its position. Operation proved this to be due to a papilloma. Differentially it is important to remember that papilloma always remains in the same position, while stones change. Papilloma is usually in the central portion of the gallbladder while calculi prefer the fundus. A tangential picture will usually demonstrate a connection between the shadow and the wall in the case of papilloma.

Giant Gallbladder with Stone and New Growth, F. GALLARTMON~S. Colecisto gigante calculoso y neoplhsico, Arch. Argent. de enferm. d. apar. digest. 7: 35-41, 1931. This is a report of an enormous cyst of the gallbladder in a woman fifty-seven years of age. In the upper part of its wall an extensive new growth had developed, invading the stomach and the pancreas. Part of the cyst wall was adherent to the transverse colon. The cyst, which contained a large stone, could not be removed entirely. The patient died three days after the operation from anuria. The new growth was diagnosed as a carcinoma of the gallbladder. Three text figures are given. JOHANNESP. M. VOGELAAR

THE PANCREAS

Case of Diabetes Mellitus and Fatty Diarrhoea due to Carcinoma of the Pancreas, T. VANORDEN URMY, C. M. JONESAND J. C. WOOD. Am. J. Med. Sci. 182: 662-675, 1931. In a patient with symptoms of chronic pancreatitis of five years' duration icterus developed, necessitating a cholecystogastrostomy for relief of biliary obstruction. The patient survived this operation for four years, although the pancreas contained a large colloid adenocarcinoma. Mild diabetes mellitus developed during the last eighteen months. The emaciation and general debility were combated by a very high carbohydrate diet and insulin. Pain was persistent, and eventually hemorrhage and infection led to the death of the patient. The authors were unable to demonstrate that diabetes produced by encroachment of tumor tissue in the pancreas differed clinically, or in any other way except degree of severity, from the so-called " true '' diabetes mellitus. GEORGET. PACK Cystic Carcinoma of the Pancreas with Atypical Insular Proliferation, C. PAN~.

.s Carcinoma cistico del pancreas con contemporanea proliferazione atipica insulare, Tumori 5: 516-541, 1931. A man of forty-six died after an illness of several months during which he progressively lost weight and finally developed an abdominal tumor. Autopsy showed a large pancreatic tumor with metastases to regional nodes. Histologically the tumor was a tubular adenocarcinoma. In some portions it contained many THE SPLEEN 535

small cysts formed by the dilatation of tubules. Scattered throughout the tumor were nodules made up of cells which closely resembled those of the islands of Langerhans. The author discusses the histogenesis of the tumor at great length. He believes that it originated from undifferentiated cells of the excretory ducts. These gave rise both to the island cells and to the cells making up the tubules. The paper is well illustrated, and an exhaustive bibliography is included. C. D. HAAGENSEN

Acquired Syphilis of the Pancreas and Cancer, J. LERICHE. Le pancreas dans la syphilis acquise et les cancers, Concours m6d. 53: 2264-2270, 1931. The pancreas is said to be very vulnerable to acquired syphilis. Diffuse syphilitic pancreatitis, syphilitic cirrhosis of the pancreas, and pancreatic gum- mata are the three common types of involvement. All provoke serious disturbances in the glycogenic-glycolytic function, as well as interference with external pancreatic secretions. These metabolic disorders caused by pancreatic syphilis are said to predispose to the development of carcinoma not only in the pancreas but throughout the body. On this account, syphilitic patients in general are thought to be more likely than others to acquire cancer. GEORGET. PACK

MESENTERIC TUMORS

Case of Cystic Lymphangioma in a Fourteen Months Old Infant, J. WOLF. Polska gal. lek. 10: 874, 1931. At operation on a child of fourteen months a large cyst originating between the leaves of the mesentery of the upper jejunum was enucleated. The histologic diagnosis was cystic lymphangioma. In spite of the enormous size of tumor, no signs of intestinal obstruction were noticed, and the child made a perfect recovery. J. NARAT

Fibrosarcoma of the Mesentery, J. BEROARECHE.Fibrosarcoma del mesenterio. Arch. de med. cir. y espec. 34: 1017-1021, 1931. The author reports a case of fibrosarcoma of the mesentery which was proved histologically. It is of interest chiefly because of the rare incidence of mesenteric tumors. Schmid (Arch. f. Gynak. 118: 490, 1923) reported 277 mesenteric and retroperitoneal tumors, 77 of which were true mesenteric growths. The biology of these tumors is difficult to determine. Many benign tumors, such as lipomas and myxomas, develop rapidly and may recur even after an apparently thorough extirpation. The statement of Schmid that half of the mesenteric and retroperitoneal tumors, though operable, should be considered malignant is justified. Metastases from mesenteric tumors are rare, but recurrences are frequent. Some authors believe in the prophylactic use of x-ray following operation, others consider it useless. H. RIVERO

THE SPLEEN

Primary Sarcoma with Abscesses of the Spleen, ALEJANDROJ. PAVLOVSKYAND CARLOSPILLADO MATHEU. Sarcoma primitivo abscedado del bazo, Bol. y trab. SOC. de cir., Buenos Aires 15: 1106-1117, 1931. Also in Prensa med. argent. 18: 1269-1270, 1932. The writers report a case of primary sarcoma of the spleen in a thirty-six-year- old man. At operation an abscess was found immediately under the peritoneum, 536 ABSTRACTS and 2 liters of sterile pus, containing some blood, were removed. Four months later, during a second operation, a large tumor of the spleen containing many abscesses was found. The patient died about two months after this. Autopsy revealed that the diaphragm and the lower part of the left lung had been invaded by the new growth. The tumor showed many thrombi and necrotic regions containing lymphocytes. This case is important, not only because primary sarcomas of the spleen are very rare, but also because of the abscesses. Primary sarcoma of the spleen is characterized by a considerable enlargement of the organ with a tendency to form adhesions with the neighboring organs. The latter are invaded by the tumor tissue after invasion of the capsule. Metas- tases are found chiefly in the lung, stomach, and liver. One x-ray picture, six photomicrographs, and a short bibliography complete the article. JOHANNE~P. M. VOGELAAR

Bone Changes in Hemangiosarcoma of the Spleen, P. DEL BUONO. Alterazioni dello scheletro nell’emo-angiosarcoma della milza, Radiol. med. 16: 609-630, 1932. A woman of fifty-two who had suffered pain in the left hypochondrium and back for a year showed an enlarged and tender spleen. X-rays of the skeleton showed rounded zones of increased transparency in the bones of the skull, lacunar areas of decalcification in the spine and ribs, atrophy of the vertebrae, and decalci- fied areas in the pelvis. The long bones were normal. Splenectomy was done. Pathological examination showed a variety of tumor tissue infiltrating and replac- ing the normal splenic tissue. The pathological diagnosis was spindle-cell sarcoma associated with a hemangio-endothelioma. The author discusses the radiologic differentiation from other conditions giving splenic tumor and destructive bone changes. He feels the picture here is dis- tinctive, permitting an accurate diagnosis before pathological examination of the spleen. The article is illustrated by photomicrographs and roentgenograms. JEANNETTEMUNRO

Case of Reticulo-endothelioma of the Spleen, J. SABRAZ~SAND R. DUP~RI~.Un cas de r6ticulo-endoth6liome de la rate, Gas. hebd. d. sc. m6d. de Bordeaux 52: 679-683, 1931. The authors report a case of splenomegaly in a boy of three years. The enlargement had been observed since an accident in which there had been considerable compression in the region of the spleen. There was no enlargement of the liver. Material obtained by puncture of the spleen showed numerous reticulo- endothelial cells; also large macrophage cells. The spleen was excised. Macro- scopically the appearance suggested a sarcoma, and histological examination led to a diagnosis of reticulo-endothelial sarcoma arising in the reticulo-endothelial tissue of the spleen. The growth showed a syncytial reticular structure with numerous fragile capillaries. The authors consider that the term splenoma can be applied to tumors of this type.

Splenoma, J. MONTPELLIER.La spMnome, Gal. hebd. d. sc. m6d. de Bordeaux, 52: 674-679, 1931. The author describes a case observed in a native of Algeria, fifty years of age, who died of sarcoma of the maxillary sinus with metastasis. At autopsy the spleen showed no evidence of metastases; on microscopic examination, however, a peculiar nodule was found in the upper pole, which consisted chiefly of fibrous connective tissue. This connective tissue showed few cells in the center of the nodule, but at the periphery there were numerous cells. In the meshes of this THE FEMALE GENITAL TRACT 537

connective-tissue network were masses containing elements characteristic of the splenic tissue-splenocytes, lymphocytes and reticular cells, the latter in a state of hyperplasia and fibroblastic transformation-also numerous red cells and extra- cellular hemosiderin. This does not appear to the author to show the characteristics of true tumor formation, but rather a sclerotic hyperplasia of the reticulum of the spleen, probably a form of inflammatory reaction.

THE FEMALE GENITAL TRACT R81e of Radiotherapy in Cancer of the Female Genital Tract, W. WEIBEL. Die Rolle der Strahlentherapie bei den Genitalkrebsen des Weibes, Wien. klin. Wchnschr. 45: 6-8, 1932. The effectiveness of the treatment of uterine cancer in radium institutes bids fair to rob gynecological clinics of teaching material of great importance. The only means of rectifying this is to provide such hospitals in the teaching centers with ample radium and x-ray apparatus. In the university clinic of Prague, cervical cancer was treated by irradiation exclusively in 46 per cent of the cases in 1931 as against 35 per cent in 1929 and 1930, due doubtless to the recent acquisition of 300 mg. of radium. The Stock- holm methods are followed and postoperative x-ray therapy is always given. In corpus cancer 34 of 43 cases were operated upon and irradiated afterwards. The operative mortality was 3 per cent. Of 36 cases of primary vaginal carcinoma, in the last three years, 3 were treated by radical surgery and 33 by irradiation. Of 16 vulvar carcinomata, 12 were treated by surgery and postoperative radiation. Ovarian cancer is usually inoperable when seen. Of 49 cases 36 were treated by operation and irradiation, 5 by irradiation alone, and 8 were beyond treatment. Of the 36 operations, 9 were merely exploratory, and in 11 others only removal of the primary tumor was possible. The question of dosage in roentgen treatment is still unsettled there being some return to the old method of small doses repeated over a long time. One case of inoperable papillary psammocarcinoma (biopsy from peritoneal metastasis) was irradiated over seven years, and recently when the tumor became noticeably enlarged, was operated upon. A papillary cystadenoma without histologic evidence of malignancy was removed. This may correspond to Vogt’s three cases (Strahlentherapie 32: 640, 1929). The author concludes that roentgen therapy offers considerable hope even in inoperable ovarian cases. NELSONB. SACKETT

Tumors Incident to and Complicating Pregnancy and Labor, A. MATHIEUAND A. HOLMAN.Northwest med. 30: 529-532, 1931. Of 2150 pregnant women, 115 were found to have 131 tumors of the pelvic organs: 65 fibroids, 21 ovarian cysts, 20 vaginal cysts, 15 cervical polyps, and 10 miscellaneous tumors, including 2 rectal polyps and 3 cysts of the cervix. One of the latter, in a forty-three-year-old primipara with a large baby in breech presentation, was of such size as to block offthe upper vagina and obliterate the external 0s. After cesarean section hysterectomy was necessitated by severe hemorrhage due to placenta accreta, confirmed histologically. While 9 of the cervical polyps caused no symptoms, the others caused bleeding and were removed with the cautery. The authors agree with the popular tendency toward removal of ovarian cysts when diagnosed, and away from routine laparotomy for fibroids. In 8 of the latter, cesarean section was required, in 3 of them for other indications primarily. Nine abortions and one abruptio placentae were attributed to fibroids. NELSONB. SACKETT 538 ABSTRACTS

Diagnosis of the Extent of the Lesion in Cancer of the Uterus, P. CHASTENETDE GERY AND SIMONELABORDE. Le diagnostic de 1’6tendue des lesions dans le cancer de l’uterus, Bull. de 1’ Assoc. franp. p. 1’6tude du cancer 21: 163-169, 1932. Two cases of uterine carcinoma are described to illustrate the difficulty of judging the extent of disease. (1) In a woman of fifty-seven years the cervix was small, firm, and without external evidence of disease. The corpus was moderately enlarged, soft, and movable. Hysterectomy was performed and when the abdomen was opened, omentum, a loop of ileum, and the ileocecal junction were found to be adherent to the uterus and involved by the disease. Despite the extensive resections which were done, the patient recovered from the operation. (2) In a woman of forty-three the cervix was slightly irregular, and showed a small vegetation, which proved to be carcinoma. In the course of operation the cervix was torn. Study of the resected specimen showed that this friability was due to the fact that the tumor involved the entire thickness of the wall of the cervix, the disease being far more extensive than clinical examination had suggested. C. D. HAAGENSEN

Double Carcinoma of the Uterus with Disseminated Endometriosis of the Myo- metrium, F. FERRERO.Doppio carcinoma in utero con endometriosi dis- seminata nel miometro, Cancro 3: 27-30, 1932. In a woman of forty-nine with menorrhagia and an enlarged uterus the author was unable to examine the cervix because of narrowing of the vagina. He therefore did a hysterectomy. The patient died of peritonitis. The uterus showed squamous carcinoma of the cervix and adenocarcinoma of the corpus. There were foci of endometrium and well developed chocolate cysts scattered throughout the myometrium. C. D. HAAGENSEN

Double Carcinoma of the Uterus, G. VILLATA. Carcinomi duplici dell’utero, Cancro 3: 3146, 1932. Among 480 cases of cancer of the uterus examined at the Cancer Institute of Turin there were seventeen in which more than one type of epithelium was found. Villata gives brief descriptions of these cases. The majority of the diagnoses were made from curettings sent in for diagnosis. In four cases the author believes he was dealing with two separate and distinct tumors-adenocarcinoma and squamous carcinoma. One of these cases is that reported by Ferrero, abstracted above. The other thirteen cases were examples of squamous metaplasia in adenocarcinoma. Six good photomicrographs and a short bibliography are included. C. D. HAAGENSEN Syphilis and Cancer of the Uterine Cervix, A. TOURAINE.Syphilis et cancer du col de l’uterus, Paris m6d. 22: 207-210, 1932. This paper enumerates from the French and German literature those points of evidence in favor of the etiological relationship of syphilis to cervical cancer. A syphilitic history in the cancer patient, her husband, parents, and children has been reported in one-half to two-thirds of the cases. A table is given to show that, while the high proportion of cervical cancer deaths in young women (55 per cent between twenty and forty years) contrasts with the low proportion (1.7 per cent) of general cancer deaths in the same age-group, it does correspond with the high proportion (33 per cent) of general cancer deaths among syphilitics. Similarly, between twenty and sixty years, 95 per cent of cervical cancer deaths occur, cor- THE FEMALE GENITAL TRACT 539 responding with 85.8 per cent of general cancer deaths in syphilitics, but contrast- ing with only 21.7 per cent of general cancer deaths among the population of Paris. A positive Wassermann reaction has been obtained in 67 per cent of cases of cervical cancer. Numerous authors have found epithelioma developing on tertiary ulcers, and the author has no doubt that secondary and other tertiary lesions-arteritis, sclerosis, and syphilitic endometritis-are important con- tributing factors in the origin of cancer. In particular he traces the relationship between syphilis, leukoplakia, and epithelioma. He studied 29 cases of leukoplakia, finding that syphilis was present clinically in 19 or 66 per cent, while twelve (41 per cent) terminated in epithelioma. While similar relationships have not been sought in squamous cancers of the canal, it is believed that syphilis may play an important part in the hyperplasia and metaplasia preceding the cancer. Touraine concludes that syphilis plays a very important rale in the genesis of cervical cancer, probably through intermediary local specific lesions such as leukoplakia, ulcerated gumma, chronic metritis, and hyperplasia or metaplasia of the mucous membrane. NELSONB. SACKETT Retrograde Metastases in Cancer of the Cervix, S. MEYER. MBtastases r6tro- grades dans le cancer du col, Rev. franc. de gyn6c. et obst. 26: 638-844, 1931. After mentioning several previous contributors to the subject of the cutaneous metastases from cancer of the cervix, Meyer reports an interesting new case. A woman of thirty-eight years was operated upon in 1928 for an early cancer of the cervix, the procedure being a simple total hysterectomy because of the coexistence of an extensive inflammation of the adnexa and parametria. Three months later there was no sign of cancer, but x-ray treatments were given. Two years later the patient returned with two small vaginal nodules and two small subpubic skin ulcerations. In spite of treatment, a gradual extension of the neoplasm occurred over the skin of the abdomen, groin, and thigh. A blocking of the normal lymphatic drainage through the previous pelvic inflammation is regarded as a possible explanation of these retrograde metastases. HOWARDC. TAYLOR,JR.

Treatment of Cancer of the Body of the Uterus, C. BBCLBRE. Traitement du cancer du corps de l’ut6rus, Paris m6d. 22: 259-266, 1932. The great divergence in the reported late results of radiotherapy in cancers of the corpus uteri-e.g. in France 17 per cent cures, in Stockholm 60 per cent-is due less to technic than to variation in the criteria for diagnosis and grouping of the cases. For curettings permit diagnosis based only on cell structure, whereas early malignancy is indicated chiefly by variations in tissue architecture as shown only by sections including the whole depth of the mucosa. Also some series include cervical canal and isthmus cancers, squamous or transitional in type, while others include only cylindrical-cell growths. The author proceeds to outline the diagnosis and the results of surgical and radiation treatment as applied to adenocarcinoma of the corpus from the isthmus to the fundus. Figures of Muret, QuBnu, and BBcl&re are averaged, indicating that not over 60 per cent of cases of metrorrhagia after the menopause, 12 per cent during the menopause, and 2 per cent before the age of forty, are proved histologically to be due to cancer of the body. The author therefore pleads for biopsy in every case of metrorrhagia and points out the value of the irregular, hazy, or lacunar lipiodol shadow not only in determining the presence of an intra-uterine lesion but in directing the diagnostic curet to its exact site. The reported dangers of biopsy and hysterectomy are outweighed by these advantages. World statistics agree that total hysterectomy gives 40 to 60 per cent of five- year cures and carries 7 to 10 per cent operative mortality. The latter may be 540 ABSTRACTS reduced 4 to 5 per cent by subtotal or even vaginal hysterectomy in aged or obese subjects. The cure rate is not sensibly lowered provided hysterographic and clinical findings indicate a growth limited to the upper part of the organ. Irradiation gives five-year cures in the various European and American clinics which are consistently 10 to 20 per cent in the inoperable group, but which vary in the operable group from 15 per cent at the Curie Foundation to 60 per cent at Stockholm, 65 per cent at Memorial Hospital, and 66 per cent at Munich. Com- bined surgery and irradiation has not thus far improved the results judging from reports of 53 per cent cures at Memorial Hospital and 13 per cent at the Mayo Clinic. Doubtless difficulties in diagnosis, classification (inclusion or exclusion of malignant papillary adenoma), and lack of agreement as to operability, radiosensitivity, dosage, and technic of irradiation explain these wide discrepancies. For the present, therefore, BBcl&re recommends radiotherapy for inoperable corpus cancers and those where there is a medical or technical contraindication to surgery; and for metrorrhagia due to benign and to doubtfully malignant conditions. Total hysterectomy is still preferred in all other operable adenocarcinomata of the corpus. A bibliography is added. NELSONB. SACKETT Permanent Cure of Beginning Corpus Carcinoma by Curettage, FLAISCHLEN:Zur Dauerheilung des beginnenden Korpuskarzinoms durch Abrasio, Ztschr. f. Geburtsh. u. Gyniik. 102: 211-221, 1932. The first patient described in this report, a single woman thirty-nine years old, was curetted in 1909 for menorrhagia. Much tissue was removed, which was diagnosed histologically as adenoma malignum evertens, with transformation into carcinoma. The patient’s periods returned normally after the operation and the menopause occurred at the age of forty-nine. Thirteen years after the operation a papillary cyst with malignant degeneration was removed from the left ovary. Twenty years after the first operation, however, the patient died of spinal metastases secondary to a growth of a lymph node invaded by what Flaischlen regards as cancer secondary to the ovarian but unrelated to the uterine tumor. The second patient was curetted and received a series of four x-ray treatments in 1922, and is now well, almost ten years later. Flaischlen does not consider the radiation of significance in the outcome of this case. HOWARDC. TAYLOR,JR. Indications for Surgery in Cancer of the Cervix, J. LANOS. Les indications chirurgicales dans le cancer du col de l’ut6rus, Bull. et m6m. SOC. m6d. de Paris, pp. 188-194, March 11, 1932. Using Regaud’s figures (10 per cent early, 36 per cent class 11, 44 per cent inoperable, and 10 per cent far advanced), the author concedes the superiority of radium in cases at the limits of operability and in certain fungating growths of the portio. In operable cases-where radioresistant forms cannot always be determined even histologically, where inflammatory reactions follow radium insertion, where radium treatment permits no examination of the parametrial tissues and glands and likewise no direct attack on these extensions-surgery is preferable, except in those persons with extreme obesity or medical contraindications, and should carry the reasonable mortality of 5 to 6 per cent. This implies good technical skill, minimizing of shock by spinal anesthesia, and of infection by drainage. ,which the author recommends by both abdominal and vaginal routes in every case. NELSONB. SACKETT

Vaginal Hysterectomy, ITALOBARCAROLI. L’isterectomia vaginale, Clin. chir. 35: 78-111, 1932. Barcaroli believes that vaginal hysterectomy still has a place in the treatment of tumors of the uterus. During the last seven years he had done the operation 98 THE FEMALE QENITAL TRACT 54 1 times without a single operative death. In 42 cases the operation was done for fibromyoma. The author points out that radiation is ineffective for submucous fibroids, and this is the type which is most frequently encountered in women near the menopause-the group of cases for which radiation had promised most. Seventeen cases of carcinoma of the cervix and two of carcinoma of the corpus were operated upon. The cases are too recent to permit of estimation of the percentage of cures obtained. Barcaroli is of the opinion, however, that early cases of cervical carcinoma should be treated with radical operation rather than by radium. C. D. HAAQENSEN

Vaginal Approach in the Surgery of Cancer of the Cervix, R. MICHEL-B~CHETAND MAURICELUZUY. De l’utilitb de la voie vaginale dans la chirurgie du cancer du col utbrin, Montpellier mBd. 75: 248-260, 1932. Nine cases are reported of cancer of the cervix of the uterus treated by radium and vaginal hysterectomy without operative mortality and without recurrence after three to five years. The vaginal hysterectomy for cancer has been regarded as less to be recommended than the abdominal operation of Wertheim because of the alleged greater completeness of the latter. The difference in the extent of the two operations is not very great, however, and the high mortality from the Wer- theim procedure should lead to the restriction of its use to cases in which the risk is especially justified, in particular in women of good physical condition with limited invasion of the parametria. HOWARDC. TAYLOR,JR. History of Abdominal Hysterectomy for Cancer of the Cervix of the Uterus, M. F. JAYLE.Historique de 1’hystBrectomie abdominale pour cancer du col de l’utBrus, Rev. franc. de gyn6c. et d’obst. 27: 53-69, 1932. This article is essentially an attack on the use of the term Wertheim operation for the various types of radical hysterectomy for cancer of the cervix. In the first place the term is rarely accurately applied, since few operators employ the exact technic of Wertheim, which requires the following: (1) extirpation of the iliac, hypogastric and pelvic glands; (2) removal of almost all of the vagina; (3) very extensive dissection of the ureters. In the second place Wertheim has no priority in the discovery of the main principles of the operation. Langenbeck performed a hysterectomy for cancer in 1825. Freund successfully removed the uterus for cervical cancer in 1878 and in his later work developed the idea of removal of the parametria and iliac glands. It is to him if to any one man that the operation should be attributed. The principles of the operation later called the Wertheim, extended hysterectomy with removal of the glands, had already been laid down in America by Ries, Clark, and Kelly before Wertheim’s first work appeared. Jayle concludes by proposing to the French Society of Gynecology that the term Wertheim operation he discarded and the procedure be described instead as extended abdominal hysterectomy, with or without the excision of certain groups of lymph nodes. HOWARDC. TAYLOR,JR.

Results of Radical Hysterectomy in Cancer of the Uterine Cervix, VILLARDAND R. LABRY. RBsultats de 1’hystBrectomie Blargie dans le cancer du col utBrin, Lyon chir. 28: 736-744, 1931. Using their hysterectomy technic previously described (Lyon chir. 27: 210, 445, 1930) so as to minimize peritoneal soiling, the authors have 70 cases to report since 1923. The primary mortality was 5 cases, or 7.14 per cent, as follows: 2 from embolism, one each from bronchopneumonia, hyperthyroid toxemia, and erysipelatous infection of a hypodermic puncture of the thigh. Non-fatal sequelae were phlebitis, 2 cases of pulmonary infarct, 2 cases of ureteral fistula, and anuria due to ureteral compression necessitating an ureterostomy. Late results are 542 ABSTRACTS absolute and concern only cases histologically confirmed. For 50 cases thus controlled and traced, the five-year successes are 10 out of 19, or 52.6 per cent; for three years 22 out of 38, or 57.89 per cent; for over one year, 43 out of 50, or 86 per cent. Nineteen cases recurred: 5 in the first year, 9 in the second, 4 in the third year, and one after five years. Distant metastases were observed twice: once to the viscera and once to the bony system. Postoperative prognosis could not be made from the gross lesions encountered or from the difficulty of removal, nor were the histologic findings of great prognostic value. About one fourth of the cases presented removable cancerous lymph nodes which had been for the most part overlooked clinically. Of three serious cases receiving preoperative radium treatment, two survived more than six years. Postoperative radium therapy to local vaginal recurrences likewise gave excellent results. The above results are far from ideal, but indicate that surgery still has a place in the treatment of operable cases, which unfortunately still means only one out of five at the Charit6 Hospital. Contraindications may be grouped as (1) anatomical, including fixation of the parametrial tissues, rectal, vesical and cul-de-sac extensions, and distant metastases; (2) medical, including lesions of cardiovascular and pulmonary systems, and (3) relative, as old age and excesfiive obesity. Large vegetating growths filling the vaginal vaults are no contraindication, as they have a better prognosis than the infiltrating or retracting forms. Hysterectomy out- ranks irradiation in providing direct exploration and attack of the cancerous extensions and in avoiding the dangers due to general absorption of irradiated neoplastic tissue. The happy results of combined radium and operative treatment indicate further application of this method, but never with the idea of rendering an inoperable case operable. NELSONB. SACKETT

Cancer of the Cervix and Radical Hysterectomy: Discussion of Statistics, B~OUIN: Cancer du col et hystbrectomie Blargie: Discussion de statistique, Bull. et m6m. SOC. nat. de chir. 58: 6-7, 1932. The author admits the value of the League of Nations criteria in cancer mortality reports but defends his own practice of leaving untraced cases out of consideration in figuring his percentage of cures. While the latter would be unfairly lowered by considering the large proportion of untraced clinic cases as dead from cancer, the same does not apply to his private cases, only four of which are untraced. Counting these latter as dead from cancer, he reports 55 cases with 2 operative deaths (3.63 per cent) and 21 living and well (38.18 per cent) five or more years after operation. NELSONB. SACKETT

Radiotherapy of Carcinoma of the Uterine Body, FRIEDRICHVOLTZ. Die Strah- lenbehandlung des Korpuskarzinoms, Strahlentherapie 44: 250-256, 1932. Voltz reviews the data from his extensive series of cases of carcinomata of the uterine corpus and points out the advantages of combined radium and x-ray treatment. All cases reported as cured have been symptom-free for at least five years. Of those treated between 1913 and 1921, 41 per cent are cured. The record is still better for the years 1921 to 1926, when 62 per cent cures are reported. The average of all is 46 per cent. The improved results are due to the development of technical methods, including possibly the procedure of first irradiating the hypophysis. Voltz believes that the combination of radium and x-rays is better than either one alone. His figures show that for radium alone the cures average 28 per cent; for the combined method, 59 per cent. He has tried x-rays alone in only three cases. The figures for absolute cures compare favorably with the results of surgery (43 per cent according to Heymann). When the cases are grouped according to age, it appears that of patients between forty-one and fifty- THE FEMALE GENITAL TRACT 543

five years, 62 per cent are cured, while between fifty-six and eighty years, only thirty-three per cent are cured. CHARLESPACKARD

Radium in Cancer of the Uterine Cervix, FOVEAUDE COURMELLES.Le radium contre le cancer du col utbrin, Bull. et m6m. SOC. m6d de Paris, pp. 226-228, March 26, 1932. Having used radium for twenty-eight years, the author has among his longest traced cases some ten and fifteen-year cures. He still uses radium salt in silver tubes wrapped in cotton and packed against the 08 with cotton. The dose varies from 20 to 100 mg. for ten to sixty hours. No perforations or burns have occurred. NELSONB. SACEETT

New Body Cavity X-ray Tube for Irradiating Uterine Tumors, W. SCHAEFERAND E. WITTE. Uber eine neue Korperhohlenrontgenrohre zur Bestrahlung von Uterustumoren, Strahlentherapie, 44: 283-292, 1932. The authors describe a small x-ray tube similar in form to a cathode ray tube. Electrons from a hot filament pass down a thin-walled metal tube which serves as the anode. This is water-cooled. The target at the extreme end is a nickel block which is the source of x-rays and also a filter to stop the cathode rays. The dimensions of the emergent beam are controlled by a cap of brass and lead with suitable apertures. The tube operates at 100 kv. and 4 ma., but higher voltages are possible. A copper filter cuts out the softest rays. When this is set at different angles, the energy distribution of the beam is somewhat modified. When treating a patient, a speculum is first introduced into the vagina; the tube is then inserted inside it and held at the proper place. A special cap over the end of the tube allows the rays to emerge from the side, if this is desired. The advantage of such a method is that the skin is spared and the energy is applied directly to the diseased tissue. In practice the tumor receives the very large dose of 4500 r at a depth of 1 cm. The clinical results thus far have been encouraging, but it is too soon to state the final value of this method. CHARLESPACKARD

Carcinoma of the Uterus Complicated by Tubal Gestation, S. E. TRACEY.Trans. Am. Assoc. Obst. Gynec. and Abdom. Surg. 44: 136-140, 1931. While the literature reveals rare cases of ectopic pregnancy associated with cervical cancer, the author failed to find a single reference to its association with carcinoma of the corpus. He reports the case of a woman who had four full-term deliveries and who, seven years after the birth of the fourth child, was operated on for a left tuba1 gestation. When seen three and one-half years later, she complained of irregular spotting instead of the normal menstrual period and an attack of acute abdominal pain. As pelvic examination revealed only tenderness on the right side, a curettage was performed and large amounts of tissue were obtained, which was found to be adenocarcinoma. At operation, free blood was found in the abdomen; the right tube was enlarged and contained a small fetus. The cancer was located just above the internal 08, which may explain its failure to prevent conception. NELSONB. SACKETT

Epithelioma of the Cervix, P. CAMPUZANOCACHO. Epitelioma cervical, Arch. de med. cir. y espec. 35: 312-315, 1932. The author reports a single case of transitional-cell epithelioma of the cervix with parametrial involvement, treated with x-ray and radium. He states that the most radiosensitive cancers of the cervix are the stratified squamous types, followed by the transitional types, which, when the degree of involvement is slight, should be treated surgically and by physical means. The technic of treatment is discussed. H. RIVERO 544 ABSTRACTS

Cancer of the Cervical Stump: Its Prophylaxis, A. H. MOLFINOAND RAULBOERO. Chncer del mufiofi del cuello uterino. Su profilaxis, Sernana mCd. 1: 1680- 1682, 1932. A case is reported of a carcinoma of the cervix developing after a subtotal hysterectomy for fibroids. Despite radiation, the patient died one year later. It is agreed among various surgeons that 1 per cent of cervices may become cancerous after subtotal hysterectomy for other causes. It has therefore been advocated that all hysterectomies should be total, possibly in disregard of the fact that this means an increase of at least 2 per cent in mortality. The author advocates as prophylactic measures the electrocoagulation of the cervix and subtotal vaginal hysterectomy. No details are given. H. RIVERO Sarcoma of the Uterus with a Report of Five Cases, S. W. LEE. Chinese M. J. 46: 175-183, 1932. Clinical reports are given of five patients with sarcoma of the uterus, two of which arose from fibromyomata. NELSONB. SACKETT Endometriosis, WILLIAMH. GOODWIN.Southern M. J. 25: 325-332, 1932. After a preliminary review of the theories of endometriosis, Goodwin reports seven cases, representing relatively extensive examples of the disease. He recommends that, although the gross appearance of the implantation is fairly characteristic, quick microscopic sections be studied before the exact operative procedure is decided upon. In one of his cases an adenocarcinoma of the corpus was known to exist, and it was only by close inspection and immediate histologic study that it could be determined that the implantations in the ovaries and on the pelvic peritoneum were due to endometriosis and did not represent hopeless metastases. In a second case, also, there was a close resemblance to a hopeless pelvic carcinoma, Surgical exploration is to be recommended in these doubtful cases. Treatment by x-ray may result in improvement and lead to the incorrect conclusion that a pelvic carcinosis has been cured by this means. HOWARDC. TAYLOR,JR.

Endometrial Cysts, CHARLESEHA. J. Med. 12: 418-422, 1931. This is a short review of the etiological concepts of endometriosis, the symptoms, diagnosis, pathology, and prognosis, and a plea for radical surgical removal wherever possible. Two cases of laparotomy and removal of chocolate cysts are reported, one for the relief of metrorrhagia and pain, the other for abdominal pain, dysmenorrhea, and sterility. NELSONB. SACKETT

Chorio-epithelioma of the Uterus, ARTHURH. CURTIS. Surg. Gynec. & Obst. 54: 861-864, 1932. A vivid clinical description and complete pathologic findings at autopsy are given for a case of chorio-epithelioma of the uterus. The patient, a nulliparous woman of twenty-eight years, came under observation for expectoration of blood. This appeared after a period of eighteen months of perfect health and followed upon the removal by curettage of tissue having grossly and microscopically the appearance of an hydatidiform mole. Physical examination of the patient disclosed a paralysis of the external rectus muscle of the right eye, a soft subcutaneous nodule near the sternal end of the right clavicle, a slightly enlarged, softened uterus, giving a strongly positive Hegar’s sign, and dullness and rCtles over the entire chest. Death ensued shortly, of pulmmary hemorrhage. Necropsy revealed metastatic lesions in the right broad ligament, pelvic veins, kidneys, liver, pleura, lungs, and brain. An excellent colored plate accompanies the article. HOWARDC. TAYLOR,JR. THE FEMALE GENITAL TRACT 545

Behavior and Clinical Significance of Prolan Excretion with Destructive Hydatidi- form Mole and with Chorionepithelioma Malignum after Radiation Treatment, D. GOSTIMIROVI~.Das Verhalten und die klinische Bedeutung der Prolanaus- scheidung bei destruierender Blasenmole und bei Chorionepithelioma malignum nach Strahlenbehandlung, Munchen. med. Wchnschr. 79: 629-630, 1932. The value of radiation in the treatment of chorionepithelioma has been demonstrated by the 11 cases reported by Wintz, 8 patients having remained well over periods from two to thirteen years. The high excretion of anterior pituitary sex hormone in cases of this disease has also been demonstrated, and the value of the test in following the course of the disease and detecting early recurrence after surgical treatment is recognized. No previous report exists, however, on the behavior of the hormone excretion when only radiation treatment is employed. The three cases upon which this study is based are as follows: 1. A woman of twenty-four years with chorionepithelioma malignum uteri treated by intrauterine applications of mesothorium and x-rays is now well three years after her first treatment. 2. A woman of forty-five whose curettings resulted in a diagnosis of hydatidiform mole with great suspicion of malignancy was also treated by x-rays and mesothorium. She is now well two and a half years after treatment. 3. A woman of thirty years with uterine chorionepithelioma and vaginal metastasis was treated by x-rays to the pelvis, bitemporal radiation of the hypophysis, and uterine and vaginal applications of mesothorium. She is without evidence of disease three months after treatment. Comparison of the behavior of the prolan excretion after radiation and surgery reveal certain differences. After operation, in cases that are cured the hypophyseal sex hormone disappears in two to three weeks. After radiation the second and third phases of the Aschheim-Zondek reaction disappear, whereas the primary reaction persists for a much longerqperiod. The persistence of reaction I is not to be interpreted as indicative of an unfavorable result, since it is probably the result of the roentgen castration or an expression of a distant radiation effect. A temporary excretion of even the luteinizing factor, Prolan B, is occasionally observed after roentgen castration. Unless repeated, this finding, also, is not to be taken as absolutely indicative of a recurrence. HOWARDC. TAYLOR,JR.

Value of the Pregnancy Reaction of Zondek and Aschheim in Diagnosis and Prognosis of Chorion Epithelioma, F. J. BROWNE. Proc. Roy. SOC. Med. 24: 1628-1632, 1931. A thirty-seven-year-old woman with a history of three confinements came to the clinic for continuous vaginal bleeding and vomiting for two months and a half. The urine contained much albumin. The blood pressure was 218/112, and there was edema of both legs. The uterus was much enlarged, but contained no x-ray evidence of a fetus. Twelve days after curettage for mole, the Aschheim-Zondek reactions I1 and I11 were negative. A second curettage for bleeding was performed a month after the first; the curettings contained nothing suggestive of malignancy, and no Aschheim-Zondek test was done. Two months later the patient was readmitted for hemorrhage and the Aschheim-Zondek test I1 was found positive. Panhysterectomy revealed a uterus of normal size, but bilateral enlarged ovaries with multiple lutein cysts. The Aschheim-Zondek test eight days later gave only a positive reaction I (maturing follicles) even when the urine was concentrated thirty times. The test has remained negative up to seven months after hysterectomy. The uterus contained a tumor 2 cm. in diameter just under the mucosa, merging into a larger, less deeply blood-stained area extending to the parametrium. The latter was found microscopically to contain a narrow outer zone free of tumor cells, which had otherwise invaded the entire wall of the uterus. The bulk of the 546 ABSTRACTS malignant chorionic epithelium lay in spaces in the uterine wall. Histologically the prognosis did not seem good, but the follow-up examinations and Aschheim- Zondek tests so far indicate a good result. The author abstracts an analogous case report by Ehrhardt (Zentralbl. f. Gynec. 54: 1538, 1930), which brings out the value of quantitative estimations of the hormone in the urine. In Erhardt’s case the urine contained 90,000 mouse units per liter, or ten times the normal pregnancy content. Curettings and post- mortem examination were both negative for chorionepithelioma of the uterus; the primary tumor was found in the right tube, with metastases in the left ovary, both kidneys, liver, spleen, lungs, and brain. NELSONB. SACKETT

Treatment of Chorionepithelioma, H. EYMER. Zur Behandlung des Chorion- epithelioma, Strahlentherapie 44: 241-249, 1932. The author reviews the literature on the treatment of this rare disease, of which 1000 cases have been reported in the last forty years. Since surgical treatment, consisting in removal of the uterus, has not been very successful, radiotherapy alone or following operation is advised, though the number of cases cured by radiation is small. Eymer describes in some detail 9 cases treated at the Heidel- berg clinic. In 6 cases the uterus was removed and cures resulted, though one has been followed for only a year. One of the remaining 3 patients who was given an overdose of x-ray in 1914, together with radium therapy, died. Another was operated upon and given x-ray treatment for pulmonary metastages. Death ensued from brain metastases. The third, treated with mesothorium, thorium-x implantations, and x-rays, is still alive after one year with a negative Aschheim- Zondek reaction. In spite of this poor record, the author believes that radiotherapy is valuable, especially since one-fourth of the cases are inoperable. CHARLESPACKARD

Uterine Fibromas and Arterial Hypertension, C. A. CASTANO.Los fibromas uterinos y la hipertension arterial, Prensa med. argent. 19: 29-32, 1932. Castano states that he was the first to note the association of hypertension and myomas of the uterus. Since 1923 he has observed 305 patients with myoma. Sixty-five per cent of these had hypertension. Because 52.9 per cent had a positive Wassermann reaction and 60.7 per cent had clinical evidence of aortic disease, Castano believes that hereditary syphilis is the cause of myoma and hypertension. C. D. HAAGENSEN The Ovary and Endometrium in Patients with Myoma, PAULHAGGSTROM. Ovarium und Endometrium bei Myomkranken, Ztschr. f. Geburtsh. u. Gyniik. 102: 36-104, 1932. The endometria and the ovaries of 56 patients of various ages from thirty-two to sixty-nine suffering from uterine myoma have been studied in great detail, and the data carefully compared with the observations of a multitude of previous writers who have devoted their attention to the subject. The upper limit for size of the normal ovary has been taken as 8 grams. On this basis it was found from this material of 105 ovaries-55 right and 50 left- that 28 women, or exactly half, had ovaries of normal weight. Of the remainder, 11 patients had one overweight ovary; in 17 both were large. The follicles which were present in a single large central section from each ovary were counted and, as was to be expected, great variations were found, dependent chiefly upon the age of the patient. Atretic follicles occurred in moderate numbers but were less in evidence than the large and numerous corpora albicantia. The corpora lutea in these patients did not show, as previous investigators have claimed, any special gross or microscopic appearance. THE FEMALE GENITAL TRACT 547

The ovaries of 36 of the 56 patients showed some form of hemorrhage, in the graafian follicles, corpora lutea, lutein cysts, or the ovarian parenchyma. The so-called small cystic degeneration was a frequent finding, although Haggstrom admits the difficulty of deciding which cases to place in this category. The condition was present in 30 patients; in 6 cases only one ovary was involved. Other pathologic changes were also noted, various other types of cystic structure and surface fibromata as well as signs of former inflammation. In 17 cases the ovarian vessels were slightly or not at all hyalinized, while in 39 the hyalinization was extensive. The endometrium was examined in 54 cases. In 23 cases the mucosa was quite normal, in 21 atrophic; in 4 there were small hemorrhages between the glands, in 4 cases true hypertrophy, and in one case each, tuberculosis and adenometritis. There was no change that could be called specific for myomas. The presence or absence of irregular bleeding and the history of sterility were analyzed in relation to various factors, but seemed to depend chiefly upon the position or size of the myoma. [The exhaustive historical review which introduces this paper shows clearly what a fertile field for theorizing has been this one of the pathology of the ovary in association with or as a cause of myoma of the uterus. Haggstrom’s own data are presented almost without comment and, since no theory is being served, im- press one with their accuracy. The completeness of his anatomical study and the extensive bibliography make the paper a valuable work of reference.) HOWARDC. TAYLOR,JR.

Uterine Fibroma or Pregnancy, DELBET. Fibrome ut6rin ou grossesse, Rev. g6n. de din. et de th6rap. 46: 85-87, 1932. The author reviews the various forms and evolution of myomata, presenting the case of a young woman with multiple fibroids and amenorrhea of two months’ duration. Although fibroids may augment menstrual flow, they do not cause its suppression. Hence pregnancy must be assumed in spite of the lack of confirma- tory signs, and the Aschheim-Zondek test be performed. NELSONB. SACKETT

Roentgenologic Demonstration of Uterine Myomas and a Case of Myoma of the Uterus Complicated by Pregnancy, K. KOSTER. Der rontgenologische Nach- weis von Myomen des Uterus an Hand eines Falles von Uterusmyom, mit Graviditat kompliziert, Rontgenpraxis 4: 730-739, 1932. The author reports the case of a thirty-eight-year-old woman whose pregnancy was complicated by two large myomata in the fundus, and one in the cervical region of the uterus. The latter was of such a size and position as tb obstruct the normal birth canal. Calcified fibromyomata of the uterus can be demonstrated in the ordinary roentgenogram, while the induction of a pelvic pneumoperitoneum or the introduction of an opaque medium into the uterus and tubes may lead to the correct radiologic diagnosis of uncalcified tumors. The article is illustrated with roentgenograms. BENJAMINR. SHORE

Intraperitoneal Hemorrhage from a Fibromyoma of the Uterus, EZIOPOLACCO. Emorragia intraperitoneale da fibromioja dell’utero, Gior. med. d. alto adige 4: 193-199, 1932. A woman of forty-nine with a history of menorrhagia and metrorrhagia and increase in size of the abdomen had several attacks of vertigo associated with severe abdominal pain. She was seen in the hospital in shock, with a rigid, tender abdomen. An immense, tender myoma was felt by vaginal examination. Opera- tion revealed a large amount of blood in the abdominal cavity and a myomatous uterus with a ruptured varicose vein upon its surface. A good recovery was made 548 ABSTRACTS following subtotal hysterectomy. The author reviews similar cases in the literature. JEANNETTEMUNRO

Physiotherapy of Uterine Fibromata, CH. GUILBERT. Le traitement physio- thbrapique des fibromes utbrins, Bull. et m6m. SOC. m6d. de Paris, pp. 220- 226, March 26, 1932. While physiotherapy will be contraindicated in 50 per cent of cases of uterine fibromata cases because of the youth of the patients, pregnancy, pressure symptoms, adnexal inflammation, pedunculated, calcified or gangrenous growths and those developing after the menopause, the author recommends it in the remainder. He reports on 192 patients with 87 per cent of successes after one treatment, 8 per cent after a second treatment, and 7 cases (or 4 per cent) operated upon because of suspected malignancy. He uses a large field, 9 x 24 cm., 0.5 mm. copper and 2.0 mm. aluminum filters, 30 cm. distance, 2 hours’ exposure front and back with the addition of two lateral 10 x 10 fields only in the very obese. The dose varies from 450 to 550 r; and there has been no case of skin damage nor any clinical or operative evidence of adhesions or malignant changes attributable to the radiation. NELSONB. SACKETT

Radiation Treatment of Myomata, J. B. PORCHOWNIK,J. B.: Uber Roentgen- behandlung der Myome, Roentgenpraxis 4: 721-727, 1932. Between the years 1918 and 1932 Porchownik treated 700 cases of myomata of the uterus with x-rays. Three per cent of these patients were under thirty-five years of age, 47 per cent from thirty-five to forty-five, and 50 per cent from forty- five to fifty-five. The tumors were about the size of a three months’ pregnancy in 65 per cent of the cases, of a four months’ pregnancy in 23 per cent, and in 12 per cent the growths reached to the umbilicus. Complete disappearance of the myomata was obtained in 47 per cent of the cases, and in 50 per cent shrinkage to one half or one third the original size was obtained after radiation. Three patients in whom the results were unsatisfactory were later proved by operation to have carcinoma of the ovary, uterine sarcoma, and carcinoma of the uterine body. The author considers the radiation of myomata to be contraindicated in very young patients, during pregnancy, in the presence of other true tumors of the pelvic organs, when a suspicion of necrosis or infection of the myoma exists, and in all cases in which the diagnosis of benign uterine myoma is in doubt. BENJAMINR. SHORE

Radium Treafment for Myoma and Metropathia Haemorrhagica, R. T. J. JASCHKE. Die Radiumbehandlung der Myome und Metropathia haemorrhagica, Strahlen- therapie, 44: 235-240, 1932. Radium is preferable to x-rays in cases of myoma of the uterus and of metrorrhagia, since it affects chiefly the mucous membranes without injuring muscle tissue. The uterus shrinks, the membranes becoming atrophic, but regenerate later. The value of radium lies in its prompt checking of the hemorrhage; but it cannot affect a large tumor to any extent. In practice, Jaschke uses radium only on women of forty-six years or older; younger women are treated by radium only if operation is not advisable. Since 1918 he has treated 96 cases of myoma. There were two deaths from causes not directly related to the primary disease. Of 228 cases of metrorrhagia, 13 showed carcinomatous epithelial growth. All have recovered perfectly. Two tubes are used, totalling 50 mg. of element enclosed in 1.5 mm. of brass and a hard rubber sheath. The usual dose is 1800 milligram hours. A biopsy is always done. Cases showing tumors of the submucosa should not be given this type ol treatment. CHARLESPACKARD THE FEMALE QENITAL TUUT 549

Technic and Indications for the Hydromineral Treatment of Uterine Fibroids, DAVID. La technique et les indications du traitement hydromineral des fibromes utbrins, Arch. SOC. d. sci. m6d. et biol. de Montpellier 12: 583-598, 1931. Hydrotherapy in the treatment of uterine fibroids,. particularly by means of baths of concentrated sodium chloride, is discussed in this paper. Particular reference is made to the effect of hydrotherapy on uterine bleeding, the liberation of adhesions, and possibly the actual resolution of the fibroid itself. The details of the treatment are described and the types of fibroid for which it should be given are noted. HOWARDC. TAYLOR,JR.

Lymphocystic Fibroma of the Uterus (" Fibroma lymphangiocysticum "-Robert Meyer), L. MOTILOFF. Uber das lymphocystische Fibrom des Uterus (,, Fibroma lymphangiocysticum "-Robert Meyer), Arch. f. Gynak. 148: 674-697, 1932. Two cases are presented of a rare uterine tumor, the lymphocystic fibroma, about which there has been a great deal of misunderstanding. The original error may have been based upon the erroneous misconstruction placed upon a statement of Virchow, by which the lymphangiectatic changes were accepted as the measure of malignancy. The belief that these tumors were all malignant was perpetuated by a study of Muller, in which he incorrectly included a true sarcoma and explained the absence of endothelium as due to poor fixation. A step forward was made by Reuter, who correctly described a tumor of this type as benign but regarded it as of mesenchymal origin and attempted to prove the cavities to be the results of degeneration. Robert Meyer considered the lymph cysts as the characteristic feature of the tumor group and therefore ascribed the origin of the tumors to a defective combination of tissues rather than to the development of mesenchymal cell rests. In the cases collected by Meyer there was a great variation in the degree in which histologic signs of malignancy were manifested. He therefore regarded the group of tumors as sarcomatoid, with the possibility of some of its members being actively malignant. In particular, however, the invasive characteristics of the tissue are not so striking as in sarcoma of other types. Two new examples of this tumor are reported by Motiloff. In the first case the form of the tumor was maintained by a delicate reticulum with cells that were, as a rule, short and of spindle type, although oval and polygonal forms occurred. The characteristic lymph vessel changes were very marked, the tumor tissue distorting the lymphatics into numerous irregular clefts and forming polypoid growths extending into the dilated regions. The periphery of the tumor was indistinct and tumor cells were found spreading irregularly through the surrounding muscle fibers. The features of the second case were similar, though less charac- teristically developed. Hemorrhagic necroses were found frequently, especially in the first case. In both cases giant cells with dense chromatin were numerous. Previously reported cases have had a favorable course, neither metastasis nor recurrence having been observed. Motiloff, however, is guarded in the prognosis which he offers, a cautiousness which appears justified, for in an appended note it is reported that the first patient had developed a large abdominal tumor which proved to be a polymorphic cell sarcoma. HOWARDC. TAYLOR,JR.

Extramucosal Cholesterin Cysts of the Uterine Tube; Origin and Treatment of These Cysts, J. HERTZAND A. HOLLANDER.Kystes cholesteriniques extra- muqueux de la trompe uterine; origine et traitement de ces kystes, Rev. frang. de gyn6c. et d'obst. 27: 139-145, 1932. Cystic structures the size of a cherry or a cherry stone, having a sebaceous or dermoid appearance, have been encountered in the walls of the fallopian tube 550 ABSTRAUTS in four women operated upon for entirely different conditions. These four patients, aged twenty-seven, forty-seven, seventeen, and twenty were being treated, respectively, for sterility, cysts of the ovary, adnexal tuberculosis, and uterine atresia. Study of these cysts histologically resulted in the conclusion that the majority were the result of a small subperitoneal hemorrhage associated with endometriosis, which had become encysted and transformed into an amorphous substance containing cholesterin. In the case associated with tuberculosis the cyst is regarded as probably representing a partially healed tuberculous lesion. These cysts are easily enucleated, and they should be so treated unless associated lesions require a more extensive excision of tissue. HOWARDc. TAYLOR,JR. Management of Advanced Carcinoma of the Ovary, PAULPETIT-DUTAILLIS. Conduite tenue dans un cas d’6pith6liome des ovaires, aux limites de I’op6ra- bilit6, Rev. g6n. de clin. et de th6rap. 46: 178-182, 1932. Using a single case to illustrate his points, Petit-Dutaillis discusses the treatment of ovarian cancer of moderate advancement. In his rather informal dis- sertation he considers the advisability of a preliminary trial by radiation, preoperative pharmacologic and psychic measures, the use of postoperative x-ray if the pathologic structure indicates a sensitive tumor, and finally the employment of magnesium chloride, splenic extracts, and certain vaccines. HOWARDC. TAYLOR,JR. Follicular and Cylindromatous Ovarian Carcinoma, E. BRANDSTRUP.Carcinoma ovarii folliculloides et cylindromatosum, Hospitalstid. 75: Forenig. f. Gynaek. og Obst. Forhandl. 38-42, 1932. The case reported occurred in a woman of sixty-five years. She had borne seven children, had a normal menstrual history, and had passed the menopause fifteen years before admission. Seven years before admission she had suffered a slight vaginal hemorrhage, for which curettage was done. This condition recurred three years later, and curettage was repeated. Microscopic examination revealed an endometritis. No tumor was palpable at this time. Fifteen years after the menopause hemorrhage again, appeared, persisting for five weeks approximating in amount that of normal periods. Diagnostic curettage was performed, followed by roentgen-ray treatment. Microscopic examination revealed a follicular and cylindromatous carcinoma of the ovary, a granulosa-cell tumor. These tumors are encapsulated, varying in size from a cherry to that of a man’s head. They occur at any age, but especially in older women. The cells resemble granulosa cells of the ovarian follicles, with a tendency to concentric, follicle-like formation about a cavity. Meyer was able to collect 42 cases of this rare tumor. Double salpingo-oophorectomy was done in the present case. Hemorrhage is rare in ovarian carcinoma. The hormone test showed that an abnormal amount of folliculin was excreted; this excess excretion persisted for two months after operation due possibly to metastases. Unusual Case of Granulosa-cell Tumors of the Ovaries, with Metastases to the Bones, C. H. SOLTMANN.Uber einen ungewohnlichen Fall von Granulosazell- gewiichs des Eierstockes mit Knochenmetastasen, Virchow’s Arch. f. path. Anat. 284: 466-473, 1932. Soltmann describes a case of granulosa-cell carcinoma of the ovaries in a forty- three-year-old patient with metastases to the first and second sacral vertebrae. The tumors of the ovaries were removed surgically, but the patient died of para- lytic ileus ten days later. Histologic examination of the primary tumors and metastatic nodules in the vertebrae showed identical structure. Throughout the THE FEMALE GENITAL TRACT 551 growths there were nests of epithelial cells which had the characteristics of primary ovarian follicles. This is the first granulosa-cell carcinoma of the ovaries which is known to have metastasized. There are no illustrations. BENJAMINR. SHORE Folliculoma of the Ovary of the Type of Kahlden, I. ABRAHAMER.Uber ein Follikulom des Ovariums vom Typus Kahlden, Centralbl. f. allge. Path. u. path. Anat. 53: 310-312, 1932. Brief reference is made to the theories of origin of the granulosa-cell tumors, and a single new case is reported. The patient was a twenty-four-year-old woman, complaining of irregular bleeding of two years’ duration and of drawing pains in the lower abdomen. At operation there was found an anteflexed uterus, normal right adnexa, and a plum-sized tumor of the left ovary, which was removed. This tumor was soft, with smooth exterior and a yellow cut surface. Microscopic examination showed cystic structures with a single-layered cuboidal epithelium; between these were islands of cells, arranged in palisade formation about vacuoles, with the nuclei in a basal position. The tumor was regarded as benign. HOWARDC. TAYLOR,JR.

The Brenner Tumor of the Ovary, a Peculiar Type of Neoplasm and Its Position among the Growths of the Ovary, ROBERTMEYER. Der Tumor ovarii Brenner, eine besondere Art von Geschwulst und ihre Stellung unter den Gesch- wulsten des Eierstocks, Zentralbl. f. Gyniik. 56: 770-782, 1932. This is essentially the same material as that published in Arch. f. Gyniik. 148: 541, 1932, though with somewhat less detail. See Am. J. Cancer 16: 1457, 1932. HOWARDC. TAYLOR,JR.

Teratoma of the Ovary with Chorionepithelioma-likeMetastases as the Cause of Precocious Puberty with a Positive Pregnancy Reaction, H. FASOLD.Ein Teratom des Ovars mit chorionepitheliomiihnlichen Metastasen als Ursache einer Pubertas praecox mit positiver Schwangerschaftsreaktion, Ztschr. f. Kinderheilk. 51: 519-526, 1931. A year and a half before her admission to the clinic, when she was six and a half years of age, this patient began to have vaginal bleeding at intervals of three weeks. Upon admission, it was noted that she was of unusual height for her age, that the breasts were partly developed, and hair was present about the external genitalia. Further. examination disclosed a tumor the size of a small orange to the right of the uterus, metastatic nodules under the skin of the anterior chest wall, neck, and forehead, and a shadow in the chest suggestive of a metastasis there also. Tissue obtained by the removal of one of the metastatic nodules showed a tumor composed of large, polymorphic cells, suggestive in places of sarcoma. Certain areas offered similarities to chorionepithelioma and, since the Aschheim- Zondek reaction was found to be positive, it is believed that the premature puberty resulted from hormones produced by the primary teratoma of the ovary with its chorionepithelioma-like metastases. Brief discussion is given of the causes of pubertas praecox and the relation of chorionepithelioma to gynecomastia. [No photomicrograph of the tissue is reproduced and no report made of the amount of anterior pituitary hormone that was being excreted]. HOWARDC. TAYLOR,JR. Fibroma of the Ovary, ALEXANDERG. GABRIELIANZ.Am. J. Obst. & Gynec. 23: 449-450, 1932. An unusual complication of a fibroma of the ovary is reported as occurring in a seventy-year-old woman. At operation following an attack of acute abdominal 552 ABSTRAUTS pain and enlargement, there was found a tumor mass, 12 x 9 x 6 cm. in diameter, attached to the left ovary by a long twisted pedicle. HOWARDC. TAYLOR,JR.

Papillary Tumors of the Ovary, G. A. BAKSCHT. Vrach. delo. No. 3 and 4: 171- 172, 1932. Also uber pseudomaligne und scheinbar inoperable papillare Ovarialtumoren. Zentralbl. f. Gynlik. 56: 1996-2000, 1932. A report of two cases of benign papillary cystadenoma of the ovary which had been diagnosed, on laparotomy, as inoperable papillary adenocarcinoma. On the basis of these two cases, and a short review of the literature, the author emphasizes differential diagnostic points between these tumors and papillary adenocarcinomata of the ovary on the one hand, and tuberculosis of the adnexa on the other. He believes that in the adenocarcinomata, laparotomy is frequently followed by aggravation of the local and general condition of the patient, whereas this procedure frequently improves the condition in patients with peritoneal tuberculosis. Neither of these changes occurs in benign papillary cystadenoma of the ovary. The only treatment worth while in his opinion is radical surgical removal of the primary focus and of the metastases, even in the presence of ascites and numerous peritoneal extensions. Postoperative irradiation is considered useless, as it is not followed by regression of peritoneal metastases. MAURICELENZ

Anatomic-pathologic, Clinical, and Therapeutic Considerations regarding a Large Cystoma of the Ovary, Twisted on Its Pedicle, and Showing Beginning Necrosis and Endocystic Hemorrhage, M. POLTRONIERI.Considerazioni anatomo- patologiche, cliniche e terapeutiche su di un grosso cistoma ovarico, torto sul peduncolo, in via di necrosi e con emorragie endocistiche Clin. ostet. 34: 80-86, 1932. The author did an emergency laparotomy on a woman aged thirty-one with a large ovarian cyst with a twisted pedicle. Because of the presence of pus in the pouch of Douglas, and numerous adhesions between the sac and the colon, he did not attempt resection, but merely marsupialized the cyst and inserted a Mikulicz drain. The woman recovered. C. D. HAAGENSEN

Another Case of Sarcoma of the Ovary in a Young Girl, S. MEYER. Autre cas de sarcome de l’ovaire chez une jeune fille, Strasbourg m6d. 91 : 437-438, 1931. A twenty-four-year-old girl who had never menstruated sought aid for crises of abdominal pain, cramps, and vomiting. Lobulated hard tumors occupied the pelvis, extending to the umbilicus, with ascites. Laparotomy revealed a very large papillary tumor of the right ovary. Microscopic study showed this to be an alveolar sarcoma. There were no peritoneal metastases. NELSONB. SACKETT

Intra-abdominal Hemorrhage from Ruptured Corpus Luteum Cysts, P. W. GREELEY. Illinois M. J. 61: 44-46, 1932. The author reviews the subject of bleeding from ruptured corpora lutea and reports two cases diagnosed as acute appendicitis, in which operation revealed a normal appendix, a large effusion of blood in the abdomen, and active bleeding from a torn ovarian cyst lined by normal corpus luteum tissue. [The abstractor has reported 26 cases of ovarian hemorrhage indicating that not only corpus luteum but simple hemorrhagic cysts, endometrial cysts, graafian follicles, dermoids, and malignant cysts may occasionally rupture and give the signs of discrete or massive intraperitoneal hemorrhage. See Am. J. Obst. and Gynec. 23: 849, 1932.1 NELSONB. SACKETT THE FEMALE GENITAL TRACT 553

Case of Spontaneous Rupture of a Suppurative Dermoid Cyst of the Ovary into the Vagina, A. SPIREA. Sur un cas de rupture spontanbe dens le vagin d’un kyste dermoide suppure de l’ovaire. Arch. SOC. d. sci. m6d. et biol. de Mont- pellier 13: 28-31, 1932. Contrary to the title of this article, the drainage of pus, and later, of fat and hairs, seems to have followed exploratory puncture of the culdesac and subsequent enlargement and tube drainage of the opening. A year later the tumor of the right ovary had disappeared entirely, while the drainage through the ‘‘ fistula ” became clean and very scant. The author gives a bibliography of cases of dermoids rupturing into the peritoneum, bladder, rectum, and uterine cavity. NELSONB. SACKETT

The Presence of Epithelium in Blood Cysts of a Transplanted Ovary, E. S. J. KING. Surg. Gynec. & Obst. 54: 635-639, 1932. An observation of the development of blood cysts in a transplanted ovary is taken as evidence against the theory of Sampson that such cysts arise from the implantation of material derived from the uterus. The patient, an unmarried female of twenty-one years, with a previous history of gonorrhea, was first treated by a left salpingo-oophorectomy and appendectomy. On account of continuation of symptoms, a second operation was performed four months later and a right salpingo-oophorectomy was carried out by the electrothermic method. The ovary, which contained a typical corpus luteum, was regarded as normal and was engrafted in the right rectus abdominis muscle. The menses continued as before, but about a year later the site of the graft became painful and swollen with each recurring period, so that after three more months the engrafted ovary was removed. The specimen measured 2 by $ by 3 inch and contained numerous cysts, the largest two being filled by a chocolate-like material. Microscopic examination showed a little ovarian tissue about the blood cysts, which were surrounded by the structures characteristic of retrogressing atretic follicles. Where the cyst walls were mainly fibrous, there was an epithelial lining, flattened for the most part, but in a few places cuboidal or columnar. The possibility of uterine material being transplanted with the graft, or of implants being already present in the ovary at the time of the graft, is considered as a most unlikely explanation for the origin of the cysts. The cysts are instead to be regarded as atretic follicles or luted cysts into which bleeding has occurred. The bleeding, King regards as related to the hemorrhage occurring at menstruation, with the corpus luteum and the epithelial development as a functional differentiation of cells, depending on the pressure of blood in the cysts. [King’s attack upon the “ series of circumstantial observations ” which now support the implantation theory of endometriosis seems justified, but his apparent proof that certain blood cysts of the ovary are not of endometrial origin does not exclude the possibility that many may be.] HOWARDC. TAYLOR,JR.

Case of Giant Ovarian Cyst, FRANCESCOBENSO. Su di un caso di cisti ovarica gigante, Policlinico, sez. prat. 39: 15-18, 1932. Benso removed an ovarian cyst weighing 29.2 kilograms from a woman aged fifty-four. C. D. HAAGENSEN

Colossal Right Ovarian Cyst, V. TRAVAN.Colossale cisti ovarica destra, Clin. ostet. 34: 78-80, 1932. From a woman aged sixty-six the author removed an ovarian cyst containing 40 liters of fluid. C. D. HAAGENSEN 554 ABSTRACTS

Atypical Leiomyoma of the Vagina, L. RIGOLETTI. Leiomioma relativamente atipico della vagina, Cancro 3: 70-73, 1932. A nodular, movable tumor was enucleated from the wall of the vagina of a woman aged thirty-five. It proved to be a leiomyoma. It was atypical in that it contained numerous multinucleated muscle cells. The author believes that it originated from a remnant of Gartner’s duct. One photomicrograph and a short bibliography are included. C. D. HAAGENSEN

Basal Cell Carcinoma of the Vulva, LOUIEN. CLAIBORNAND HUBERTB. HOL- SINQER. Surg. Gynec. & Obst. 54: 830-838, 1932. According to the authors of this paper, basal-cell carcinoma of the vulva is extremely rare, having been reported in only two instances prior to the case observed by them. Their patient was a white woman, aged sixty-nine years. For the previous thirty-four years, since the birth of her last child, she had experienced an itching sensation on the left side of the vulva and for six years had observed a small growth. Examination disclosed, on the midportion of the inner aspect of the left labium majus, an irregular elliptical area, 3 by 2.5 cm. in diameter, slightly indurated, with superficial areas of ulceration. This area was excised under local anesthesia. Microscopic sections showed strands and clusters of small spindle and polygonal epithelial cells extending into the subcutaneous tissue from the surface of the ulcerated areas. Some of the large cell masses contained cystic spaces. The structure was considered to merit the diagnosis of basal-cell carcinoma. Treatment of such a lesion in the vulva should, as elsewhere, be relatively conservative. HOWARDC. TAYLOR,JR.

GENITO-URINARY TRACT

Malignant Tumors of the Kidney in Infancy and Childhood, C. G. MIXTER. Ann. Surg. 96: 1017-1027, 1932. This article is based on a study of 41 instances of renal neoplasms encountered among 22,000 surgical admissions during the past twenty-one years at the Chil- dren’s Hospital in Boston. The author feels that these tumors should probably all be grouped as “ embryomas,” because of the many features of gross similarity, in spite of wide variations in microscopic structure. He discusses the clinical picture in childhood, the differential diagnosis, and stresses the value of exploratory operation in all cases except those definitely demonstrating metastases or extension, He considers the transperitoneal approach the procedure of choice and uses avertin and ether anesthesia. X-ray treatment is rarely of benefit. The statistical data from the study of the 41 cases is given. The operative mortality from the whole group of nephrectomies (28 of the 41 cases) was 21.4 per cent. All surviving cases belong among the 30 cases definitely classed as embryomas. Four children have lived three years or longer without recurrence, a salvage rate of 18.2 per cent for the nephrectomized patients. JEANNETTEMUNRO Malignant Tumors of the Kidney in Childhood, L. AUROUSSEAU.Les tumeurs malignes du rein chez lea enfants, Gar. m6d. d. France pp. 354-357, May 15, 1932. The author reports seven cases of malignant tumors of the kidney in children of five years or younger. Three of the children are still alive two or more years after operation. The article includes a discussion of the incidence of malignant tumors of the kidney in childhood, their pathological anatomy, clinical course, and treatment. The author stresses the gravity of prognosis in all cases, the need of follow-up in operative cases, and the use of heavy doses of x-rays postoperatively. JEANNETTEMUNRO GENITO-UBINARY TRACT 555

Carcinoma of the Kidney Pelvis, A. BONNARD.Epitheliome du bassinet, J. m6d. de Bordeaux, 109: 307-308, 1932. Presentation of the pathologic specimen removed at operation. Examination revealed a papillary carcinoma of the kidney pelvis. WILLIAMJ. HOFFMAN

Multiple Invasive Fibromata of the Kidney, SILVIOCOLOMBINO. Fibromi mul- tipli, invadenti del rene, Cancro 3: 63-69, 1932. A man of forty-one had a large, firm tumor in the right kidney region, which produced no symptoms. A pyelogram showed deformity of the calyces on this side. The kidney was removed. A lobulated fibroma had replaced the lower pole. A photograph of the gross specimen is included. C. D. HAAGENSEN Nephro-uretero-cystectomy for Widespread Papillomatosis, JOHN EVERIDGE, Proc. Roy. SOC.Med. 25: 538-539, 1932. The title of the present article is misleading. The right kidney, ureter, and a portion of the right wall of the bladder were removed, but no complete cystectomy was done. The patient, a man of thirty-one, had been operated upon for perforating gastric ulcer, at which time the renal tumor was discovered. On subsequent nephrectomy the ureter and kidney pelvis were found to be crowded with papil- lomata. Cystoscopy carried out at intervals after operation failed to reveal any recurrence. The general condition of the patient has remained excellent. ' R. S. FERGUSON

Cancer of the Rectum and Bladder, JUANJOS~ GAZZOLO AND GERONIMOVAQUI~. Cancer de recto y vejiga, Rev. m6d. latino-am. 17: 222-230, 1931. A case report of extensive carcinoma of the rectum and the bladder in a sixty- year-old man. Cystoscopic investigation revealed a large tumor in the left side of the bladder. The rectal tumor, as seen with the proctoscope, showed a large ulcerating cauliflower surface. Biopsy revealed an adenocarcinoma. The primary treatment, given in 3 sittings, consisted in electrocoagulation of the tumor in the bladder. One month later a total abdominoperineal extirpation of the Miles type was performed. The rectum, the cellular tissue of the pelvis, that of the ischio-rectal fossae, the levatores ani, and the lymph nodes were removed. The treatment of the bladder was continued every two to three months in order to remove recurrences. The patient was still in an excellent condition two and a half years after operation. Four pictures elucidate the text. JOHANNESP. M. VOQELAAR

Present Methods of Treating Tumors of the Urinary Bladder, ARTHURJACOBS. Glasgow M. J. 36: 57-68, 1932. Jacobs' study is based on a series of 56 cases treated within the past four years, including 24 benign epithelial tumors of the bladder. The author deplores the delay in diagnosis. In the patients having simple papillomas hematuria had existed on an average of thirteen months prior to cystoscopic examination. In those suffering from malignant tumors an average of seven months elapsed between the onset of hematuria and cystoscopic diagnosis. The 24 benign tumors, with one exception, were treated by diathermy, with satisfactory results: 20 through the cystoscope; 3 by cystotomy and diathermy. There was no operative mortality in this group. In one case excision was done. Of the 32 malignant tumors, 7 were treated by excision, 9 by irradiation, 11 by diathermy, and 5 received no treatment. The lowest operative mortality in the malignant group was attained in those treated by partial cystectomy : there were two deaths in this group within six months of operation. Five patients are 556 ABSTRACTS described as free of recurrence as from one to four years. One of these, however, proved to have a simple connective-tissue tumor and in another there had been a " recurrence in previous situation (dome)," four months prior to the report, requiring a second partial cystectomy. Of the nine patients treated by radium, 4 died postoperatively; 2 within a year; 3 patients were living four, ten, and fourteen months, but in the last of these symptoms had returned. Of the 10 patients treated by diathermy and traced, only 2 were living-four and forty months respectively. The longest period of survival among those dying was twenty months. The author believes that the risk of total cystectomy is too great to warrant its general use in the treatment of carcinoma of the bladder. The recent advances in palliative surgery, resection of the presacral nerve, and cordotomy, are briefly discussed. R. S. FERGUSON Malignant Myxomatous Rhabdomyoma of the Bladder, SILVIOCOLOMBINO. Rabdomioma mixomatoso malign0 della vescica, Cancro 3 : 47-50, 1932. A boy aged seventeen suffered from acute urinary retention. Cystoscopy showed a small nodular tumor of the bladder neck. At suprapubic cystotomy the tumor was removed as completely as possible and its base coagulated. It was a myxomatous rhabdomyoma. Four months later the bladder was filled with tumor tissue. Colombino attempted transplantation of the ureters, with the result that the tumor fungated through the wound in the left loin. As the report was written, the patient was in extremis. C. D. HAAGENSEN Cancer of the Urinary Meatus, LUISA QUADRAS-BORDES.CAncer de meato urinario, Ars. med. Barcelona 7: 357-358, 1931. A report of a rapidly growing tumor of the urethra in a thirty-four-year-old woman, which within five months attained the size of a walnut. The tumor was removed successfully and x-ray treatment applied through a field including the inguinal and femoral lymph nodes. A total dose of 3500 r., divided over a period of eighteen days, was given. Radium therapy was applied also (29 millicuries over a period of five days). The patient was apparently well when examined four and a half months after the operation. There was no swelling of the inguinal'nodes. For prophylactic reasons radium was again applied (12 millicuries). Microscopical investigation of the tumor showed it to be a basal-cell epithelioma. Two gross photographs are given. JOHANNESP. M. VOGELAAR

THE NERVOUS SYSTEM

Diagnosis and Treatment of Tumors of the Brain. (Review of the Symposium at the First International Neurological Congress), F. C. GRANT. Arch. Neurol. and Psychiat. 27: 1447-1468, 1932. This is one of the numerous reports appearing in the literature, of the symposium on Brain Tumors at the Neurological Congress at Berne, Aug. 31-Sept. 4, 1931. See Am. J. Cancer 16: 456, 1932. Apparent Effects of Cerebral Tumors on Auditory Acuity, L. J. LAWSON. Arch. Otolaryng. 15: 583-591, 1932. It is well known that reduction of hearing may be caused by lesions in any way affecting the auditory pathway from the sensory end-organ to the cortex. The THE NERVOUS SYSTEM 557

majority of observers believe that brain tumors in general do not cause a reduction in hearing. A case is described in which a large left cerebral tumor (glioblastoma multiforme) had apparently been associated with a progressive bilateral reduction in hearing. EDWINM. DEERY

Localization of Intracranial Tumors by the BMny Method, R. J. HUNTER. Arch. Neurol. and Psychiat. 28: 226-234, 1932. Presentation of cases to illustrate the localizing value of the B&r&nytest in patients with intracranial tumors. The varying responses obtained, and their significance are discussed. EDWINM. DEERY

Clinical and Recent Roentgenographic Methods in Diagnosis of Nervous System Pathology, L. BARRAQUERFERR~~. La clinica y 10s modernos medios radio- grhficos de exploraci6n en neuropatologia, Ars m6d. Barcelona 7 : 337-349, 1931. A short discussion of well known roentgenologic signs of central nervous system pathology. Nothing new is brought forth. EDWINM. DEERY

Craniography, Encephalography, Ventriculography, ANTONIOSUBIRANA. Cranio- grafia, encefalografia, ventriculografia, Arch. d. neurobiol. 11 : 617-671, 1931. This article gives an introductory orientation in the field of craniography, encephalography, and ventriculography. Part of it deals' with the changes in the normal x-ray picture caused by tumors and diseases related to tumor growth. Twenty-nine roentgenograms with short descriptions of the cases and an extensive list of articles form a useful addition to the text. JOHANNESP. M. VOGELAAR

Dilferential Diagnosis of Lesions in and Adjacent to the Sella Turcica, C. H. FRAZIER.Am. J. Surg. 16: 199-222, 1932. Intrasellar adenomas may produce outstanding endocrine symptoms and no visual disturbances, or they may cause marked visual loss but no endocrine disturbances. Others evoke both neighborhood and endocrine symptoms. The majority of such tumors show a perfectly characteristic sella turcica. Suprasellar adenoma usually differs from the former lesion only in that the sella turcica shows normal outlines. Adenocarcinoma, while less common, at first produces a clinical syndrome similar to the intrasellar adenoma. Adamantinoma may cause very variable visual field defects. Dwarfism, somnolence, adiposity, regressive sex characteristics, femininity and polyuria are the more common clinical states found. Teratoma may occur in the chiasmal region and, depending upon the exact position, cause signs and symptoms similar to other sellar region tumors. Ganglioneuromas rarely arise in this region, probably coming from the tuber cinereum. Suprasellar arachnitis may cause a chiasmal syndrome and cannot be definitely recognized without operation. Suprasellar jibroblastoma occurs in adults who give a long history and show normal roentgenograms. There is a variable visual field loss, usually more marked in one eye. Primary optic atrophy is present. EDWINM. DEERY

Incorrect Diagnoses in Cases of Brain Tumors. Symptomatology of Brain Tumors in Elderly Persons, B. BADT. Fehldiagnosen bei Hirntumor. Beitrag zur Symptomatologie des Hirntumors im hoheren Lebensalter, Deutsche med. Wchnschr. 58: 893-895, 1932. A necropsy study of brains from some two thousand chronic cases over a'period of ten years in the State Hufeland Hospital, Berlin. Fifteen brain tumors are 25 558 ABSTRACTS

described which had been incorrectly diagnosed during the lifetime of the patient. General remarks upon neurological symptomatology follow. EDWINM. DEERY Removal of Brain Tumors by Unipolar Electrocoagulation, C. VINCENT,M. DAVID AND P. PUECH.Sur l’ablation des tumeurs du cerveau par l’electro-coagulation unipolaire, Rev. neurol. 1: 843-866, 1932. Presentation of a series of representative case histories of patients with intracranial tumors, in which tumor removal was greatly facilitated by the use of the electrocautery. [Unipolar electrocoagulation consists simply in bringing the negative pole nearer the positive, in contrast to the generally used method of a negative plate placed under the patient’s back.] EDWINM. DEERY

Presentation of Patients Operated on by a New Method in Neurosurgery of Using the High-frequency Current, TH. DE MARTELAND J. GUILLAUME. Presentation de malades operes par un nouveau procede d’utilisation des courants ii haute frequence en neuro-chirurgie, Rev. neurol. 1: 657-676, 1932. General remarks on neuro-surgery with a few illustrative case histories. The writers use the Heitz-Boyer electrocautery. EDWINM. DEERY Some Statistics on Intracranial Tumors, M. P. NIKITIN. Einige statistische Daten hinsichtlich der Hirntumoren, Deutsche Ztschr. f. Nervenh. 124: 275-278,1932. General clinical statistical study of 103 verified brain tumors, reflecting the generally known facts. Histopathology is not considered in any detail. EDWINM. DEERY Some Features of Glioblastoma Multiforme, E. M. DEERY. Bull. Neurol. Inst. of N. Y. 2: 157-193, 1932. A histopathological study of the blood vessel changes found in glioblastoma multiforme (spongioblastoma multiforme). The “ reactive overgrowth ” affects only the lining endothelium of some vessels; in others the vascular adventitia is hyperplastic. In other vessels a combination of the two forms may occur. Since the writer finds identical changes in other gliomas, tumors from other parts of the body, and in certain inflammatory conditions, such as hematomas, it is held that the blood vessel changes associated with glioblastoma multiforme are in no way specific, nor do they form a safe criterion for the pathological diagnosis. EDWINM. DEERY Multiple Tumors of the Nervous System, H. L. STEWART.Arch. Neurol. I% Psychiat. 28: 132-139, July 1932. A case report, with necropsy findings, of a patient with multiple tumors. An encapsulated tumor attached to the sheath of the right sciatic nerve proved to be a perineural fibroma. A second tumor was found lying between dura and arachnoid over the right cerebral motor cortex. It showed the histologic structure of a very cellular meningioma in which were many mitotic figures. Within the pons was a tumor of fibroblastic cells which, however, had produced no collagen, elastic tissue, or silver-positive fibrils. To account for its fibroblastic origin there would have to have been an inclusion of the leptomeninx in the brain stem. A tumor of the pituitary region showed certain characteristics of the meningothelioma and others similar to the angioblastic type of growth. Two other small tumors [not described histologically but presumably of mesoblastic origin] were found attached respectively to the motor oculi nerve and the third right cervical nerve. It is believed that all these tumors originated from the same embryologic tissue. EDWINM. DEERY THE NERVOUS SYSTEM 559

Cases of Cerebral Tumor, with Ventriculography, SCHRODER.Tilfaelde af tumores cerebri, Hospitalstid. 75 : Neurologisk Selsk. Forhandl. 22-29, Aug. 4, 1932. The author describes five cases in which ventriculography was used as an aid in diagnosis. In the first case the cerebral pressure symptoms, dilatation of the sella turcica, metabolic symptoms, and homonymous hemianopia with rather pale discs suggested pituitary tumor. Ventriculography, however, showed no internal hydrocephalus but displacement from one side to another of the ventricular system. Operation revealed a cystic tumor. The second patient had suffered for some years from epileptiform spasms of the left arm and facial region, of the jacksonian type. There was also an abducens paresis of the left eye and choked disc of a few diopters. The Wassermann reaction was positive. Operation over the motor area revealed a large arachnoid cyst with compression of the underlying cerebral tissue. For the seven years after operation the patient has had no spasmodic attacks. Both of these cases, diagnosed as brain tumor, proved at operation not to be so. In a third case obesity and hemianopia, together with a dilated seUa turcica, pointed to pituitary tumor but ventriculography revealed a tumor of the left side, most probably of the frontal lobe. Instead, therefore, of making the incision on the right side, as for pituitary tumor, the trephining was done on the left side. Nothing was found except marked pressure, and further exploration was avoided. The fourth patient suffered from headaches, weakness, slight dementia, and convulsive seizures, suggesting a displacing process localized to the motor region of the right side. Ventriculography showed medium internal hydrocephalus; filling of the left lateral ventricle slightly greater than that of right side. Autopsy revealed hemorrhage in the frontal lobe. The fifth patient was admitted for observation, apparently suffering from encephalitis, in a torpid and dull condition and quite disorientated. Neurologic examination revealed no definite symptoms of medullary disease. The patient’s dulness suggested a cerebral affection, and a diagnosis of probable cranial metastases was given. Roentgen examination of the stomach showed symptoms pointing to gastric cancer in the prepyloric region. Roentgenograms of the brain were normal. Ventriculogaphy showed moderate symmetrical hydrocephalus but no findings justifying the assumption of tumor in the hemispheres. Autopsy revealed a tumor in the right angle. In summarizing the advantages of ventriculography, the author emphasizes its value in confirming diagnosis in cases involving indications for vital operations, in rendering avoidance of operation possible in certain cases, and finally in refine- ment of diagnosis by revealing new symptom constellations hitherto unsuspected.

Case of Cerebral Tumor, F. CLAYTON.Lancet 1: 835, 1932. A single clinical case report of a patient who suddenly developed signs of an intracranial tumor. He improved following a right subtemporal decompression and radium therapy. [Histologically unverified.] EDWINM. DEERY

Case of Cerebral Tumor, C. V. GRIFFITASAND T. S. LYNAGH. J. Royal Nav. M. Ser. 17: 209-211, 1931. Although cholesteatomas are of common occurrence in aural conditions, an intracranial tumor of this nature is rare. A case report with necropsy findings is given. The cholesteatoma was found “ lying in the third ventricle close under the roof and completely filling the cavity.” EDWINM. DEERY 560 ABSTRAUTS

Cerebral Tumor Operated Upon, WINTHER. Tumor cerebri (opereret), Hospital- stid. 75: Neurologisk Selsk. Forhandl. 15-17, July 28, Aug. 4, 1932. A single case report of a large meningioma successfully removed from the right temporal lobe of a woman forty-two years of age. Ventriculography was of great aid in diagnosis. Pathological details are not given. Cerebral Tumor with Perforation of the Skull (Meningeal Endothelioma), J. NORDENTOFT.Tumor cerebri med gennembrud af kraniet (endothelioma meningum), Hospitalstid. 75: 863-870, 1932. A woman of forty-eight years suffered an injury to her head from a fall some years before admission, The wound extended from below the left eye to the left temple. There was no loss of consciousness and no convulsions. Six months before admission the patient noticed anesthesia and paresthesis in her feet, especially the left, which finally extended to the hands. For the last few months she had been unable to walk and could not move her feet. Memory and vision were somewhat reduced. Three months before admission she complained of headache localized to the left parietal region, and noticed a soft spot in her skull at this point. Re- cently she had suffered from persistent nausea. Her psyche was normal. Oph- thalmoscopic examination was negative, and there were no symptoms of cranial nerve involvement. An irregular defect was found in the skull in the left parietal tuber measuring 4x23 cm., in which could be felt a soft area over which the skin was normal. A similar area was discovered at the vertex, a little to the left of the median line. This lesion was 5 cm. long and 23 cm. wide, with soft tissue protruding. Between the two defects was a bony bridge 1 to 13 cm. wide. It had invaded the superficial part of the brain, with metastases to the regional lymph glands. A meningioma was suspected and roentgen therapy instituted. The tumor disappeared and the defects in the cranium filled up with fibrous tissue, but with no new formation of bone, while the paresthesias subsided. Cure has persisted for five years. No microscopic examination of the tumor is reported. Fibroblastoma Deep within the Substance of the Left Cerebral Hemisphere, without Demonstrable Meningeal Origin, D. PETIT-DUTAILLISAND I. BER- TRAND. Fibroblastome profond, intracerbbrsl de l’hemisphere gauche, sans connexions meningees decelables, Rev. neurol. 2: 96-100, 1932. A typical “ fibro-endothelioma ” occurring within the brain substance and showing no meningeal attachment is rare, and a case is reported in detail. The writers consider an origin from the dura or leptomeninges as unlikely nor do they believe this tumor could have arisen from the choroid plexus. They do not mention the real possibility of this fibroblastic tumor having arisen from an intracerebral blood vessel. EDWINM. DEERY Multiple Cerebral Gliomas, Simple Decompression, M. B. Coxos. Gliomes multiples de I’encCphale, trepanation simple, Rev. neurol. 2 : 91-96, 1932. Necropsy showed a “ glioma ” of the left hemisphere and a second “ glioma ” of the third ventricle. EDWINM. DEERY Report of a Case of Psychic Equivalents Associated with Tumor of the Brain, H. W. WOLTMANAND C. M. LEARMONTH.Proc. Staff Meet. Mayo Clinic 7: 121-123, 1932. A man of twenty-nine years complained of attacks of amnesia. In the absence of localising neurological signs he was subjected to encephalography. The enceph- alograms demonstrated a filling defect of the right lateral ventricle. At operation THE NERVOUS SYSTEM 561

a large cystic tumor (histology not discussed) of the right temporal lobe was radically removed. The only sequel to the operation was a quadrantic visual field defect. EDWINM. DEERY

Large Meningeal Tumor (Meningoblastoma) Compressing the Left Cerebral Hemisphere, BONNAMOURAND DUPLAN. Volumineuse tumeur m6ning6e (m6ningoblastome) comprimant l’h6misphbe cer6bral gauche, Lyon m6d. 145: 429-432, 1932. A patient developed partial right hemiplegia with aphasia in the course of a few days, and died three days later. Necropsy revealed a large growth markedly compressing the temporal lobe. EDWINM. DEERY

Anatomico-pathological Studies on a Case of So-called Calcified Angioma of the Meninges, Shown by X-rays, K. H. KRABBE. Recherche8 anatomopatho- logiques sur un cas de soi-disant angiome calcifi6 des meninges d6mentr6 par la radiolographie, Rev. neurol. 1 : 1394-1397, 1932. A case report, with necropsy findings, of a patient with a calcified angioma. From this case and others the writer believes there is usually associated an adjacent area of congenital brain hypoplasia. Such patients very often show a vascular nevus on the skin of the face. The above case differs from the cases of “ epi- lepsy with cerebral calcification ” described in the literature in that in the present instance there was found parenchymal calcification quite independent of the abnormal blood vessels. EDWINM. DEERY

Meningiomas of the Sella Turcica, E. MARXAND H. J. BOEV~.Meningiomes de la selle turcique, Arch. d’opht. 49: 417-426, 1932. A single clinical case report of a patient with a suprasellar meningioma. Vision improved after operation. The general remarks that follow reflect the commonly known facts. EDWINM. DEERY

Case of Meningioma of the Sella Turcica, C. VINCENTAND H. BERDET. A propos d’un cas de meningiome du tuberculum sellae, Rev. neurol. 2: 82-85, 1932. Single clinical case report of a patient, who, at operation) proved to have a meningeal fibroblastoma, apparently arising from the inner extremity of the wing of the sphenoid bone. EDWINM. DEERY

Angio-reticulo-glioma of the Cerebellum, L. CORNIL,J. OLMERAND J. ALLIEZ. Angior6ticulogliome du cervelet, Rev. neurol. 1 : 938-942) 1932. Case report of a tumor of the cerebellum, with necropsy findings. Three distinct types of formation could be recognized histologically: a cavernous angioma type of growth, reticulo-capillary areas, and finally a group of cells designated as para-epithelial cells [neuro-ectodermal origin]. EDWINM. DEERY

Large Tumor of the Fourth Ventricle, H. THOMAS,TH. DE MARTELAND J. GUIL LAUME. Volumineuse tumeur du 4” ventricule, Rev. neurol. 1 : 653-657, 1932. A clinical case report of a child who at operation proved to have an astrocytpma of the cerebellar vermis. EDWINM. DEERY

Tumor in the Posterior Cranial Fossa. E. SORENSEN. Tumor i bageste Hjaerne- grube, Hospitalstid. 75: Neurologisk Selsk. Forhandl. 14-15, July 28, 1932. A boy of six years had become ill three months earlier with headache, vomiting and strabismus. A few weeks later disturbance in gait was noted. Neurologic 562 ABSTRACTS examination revealed peripheral facial paresis on the right side, bilateral ptosis, corneal anesthesia, and paresis of the right masseter, as well as deafness in the right ear. Ophthalmoscopy showed choked disc on both sides, with beginning atrophy. Also there was a slight left hemiplegia with a positive Babinski sign. There was oculomotor paresis on the right side. The patient thus had an inferior crossed hemiplegia apparently caused by a tumor of the posterior cranial fossa. There is a possible question as to whether the tumor is intrapontine, approaching the surface and giving rise to meningeal irritation, or extracerebral, as at the cerebello- pontine angle. In favor of the first theory is the marked oculomotor paresis; in favor of the latter theory is the disproportionate involvement of the cranial nerves as compared to the pyramidal tract symptoms.

Cystic Tumor of the Hypophysis, R. D. RAWSON.Tumor quistico de la hipofisis, Rev. de especialid. 6: 669, 1931. A clinical case report with operative findings. The patient was operated upon, and some 20 C.C. of dark fluid were aspirated from a chiasmal region cyst. EDWINM. DEERY

Infundibular Syndrome in Endocranial Tumors, ARMANDOMORRA. Sindrome infundibolare da tumore endocranico, Terapia 22: 12-16, 1932. A man of thirty-two suffered from severe left frontal headache. An extra- ordinary appetite for sweets developed, and finally attacks of vomiting and polyuria. On examination bilateral choked discs, diplopia, nystagmus, weakness of the right hand, and accentuation of the reflexes on the right side were found. A left temporal decompression was done, no attempt being made to remove the pituitary tumor which was assumed to be present. The author claims that injections of pituitary extract produced a temporary remission of symptoms. At the time of the report, however, the patient was much worse. C. D. HAAGENSEN

Tumor of the Hypophyseal Region Successfully Treated by X-rays, WORMS, FRIBOURG-BLANCAND GAUTHIER. Tumeur de la region hypophysaire traitbe avec SUCC~Spar la radiotherapie, Rev. neurol. 1 : 634-637, 1932. A single clinical case report of an adult male who presented the usual signs and symptoms of a pituitary adenoma (probably a chromophobe adenoma). Roent- gen therapy was used and there followed a marked subjective improvement, as well as a progressive enlargement of the fields of vision. EDWINM. DEERY

Cerebrospinal Rhinorrhea With Cyst of the Pituitary Body, C. SMITHAND L. WALTER. Arch. Otolaryng. 14: 610-614, 1931. A single clinical case report of an adult man with cerebrospinal rhinorrhea. Roentgenograms of the skull showed changes in the sella turcica characteristic of a pituitary tumor. A transfrontal operation disclosed a " cystic tumor 'I of the pituitary. It is believed that erosion of the sellar floor, with a discharge of fluid into the nose by way of the sphenoid air cells, was the mechanism of the rhinorrhea. EDWINM. DEERY

Oligoglioma of the Rolandic Region. G. GUILLAIN,D. PETIT-DUTAILLIS,I. BERTRANDAND J. LEREBOULLET.Oligodendrogliome de la region rolandique, Rev. neurol. 1: 977-985, 1932. Clinical case report of a female of thirty-five years, who proved to have an oligoglioma. The duration of symptoms had been eight years. Definite calcification was not demonstrable in the roentgenograms of the skull. There follows a description of the tumor with photomicrographs. As others have also noted, THE NERVOUS SYSTEM 563 this tumor shows an abundance of cells representing transition stages between spongioblasts, oligodendrocytes, and astrocytes. EDWINM. DEERY Treatment of Medullary Surgical Conditions, M. BALADO. Tratamiento de las afecciones medulares quirurgicas, Semana m6d. 1 : 682-689, 1932. This is a general discussion of tumors of the spinal cord and of the vertebral canal, without new material.

Rapid Spinal Compression by a Primitive Type of Meningeal Sarcoma, J. LEVI VALENSI,I. BERTRAND,MASQUIN AND RONDEPIERRE.Compression mBdul- laire A Bvolution rapide par sarcome primitif des m6ninges1 Rev. neurol. 1: 952-955, 1932. A man in good health suddenly showed spinal cord compression signs, and within two months a complete flaccid paraplegia. A necropsy revealed an extensive sarcoma arising from the inner surface of the dura. EDWINM. DEERY

Juxtamedullary Cervical Cord Tumor in a Child of Nine Years, WEILL-HALL& PETIT-DUTAILLISAND C. VOGT. Un cas de tumeur cervicale juxtam6dullaire (fibrogliome) chez une enfant de 9 ans, Rev. neurol. 1: 985-988, 1932.

Clinical case report of a patient who proved to have a fibrogliome l1 [perineural fibroblastoma] in the region of the seventh cervical segment. EDWINM. DEERY

Neurofibromatosis, ROBERTKIENBBCK AND HUGOROSLER. Neurofibromatose, Fortschr. a. d. Geb. d. Rontgenstrahlen, Erganzungsband 42, 1932. pp. 52. The authors present a general review of neurofibromas and ganglioneuromas, and discuss in particular their roentgenographic manifestations. A brief survey of the bone changes seen with these tumors is presented, and the previously reported cases are classified according to the bone affected. The authors have no personal observations of changes of this sort. The bulk of the monograph is devoted to the roentgen characteristics of nerve tumors in the thorax. In addition to the 37 cases of neurofibroma and the 19 cases of ganglioneuroma in this location which they were able to collect, the authors describe 11 cases which they personally observed. One case was proved by autopsy, four were proved by operation, and in six the diagnosis rested on clinical data only. In the operated group all the patients recovered from the operation. Three of these tumors were neurofibromas. One of the three patients died of a psychosis one year after operation, one was well twenty months after operation, and the third patient had a recurrence after one year. A fourth patient operated upon had a ganglioneuroma and was well twelve years later. In three of the four proved cases, and in all six of the presumptive cases of intrathoracic neurofibroma, there was also generalized neurofibromatosis of the skin. These cases are illustrated by many excellent roentgenographs. Because of the original data presented, and the comprehensive bibliographic study which it includes, this monograph should be read by all those interested in the subject of neurofibromatosis. C. D. HAAQENSEN Atypical Case of von Recklinghausen’s Disease, E. SORENSEN. Acta Psychiat. et Neurol. 7: 647-658, 1932. A single clinical case report of a patient known to have multiple peripheral neurofibromas, and suspected of having intracranial lesions as well. A brief discussion of the histopathology of von Recklinghausen’s disease is included. EDWINM. DEERY 564 ABSTRAOTS

Operative Treatment of Acoustic Neuromas and Results, C. F. LIST. Die operative Behandlung der Acusticusneurinome und ihre Ergebnisse, Arch. f. klin. Chir. 171: 282-325, 1932. Clinical and surgical facts in regard to the treatment of neuromas of the eighth cranial nerve. Some 176 cases are the subject of the report. The paper reficcts the generally accepted facts in regard to surgical treatment. EDWINM. DEERY

Malignant Neurofibroma of the Scalp, A. VERBRUGGHENAND A. w. ADSON. Arch. Neurol. and Psychiat. 28: 167-171, 1932. A clinical case report of a congenital tumor of the scalp behind the right ear. Because of a rapid increase in size, it was radically removed. The tumor proved to consist for the most part of characteristic neurofibroma, but in some areas malignant changes were found. EDWINM. DEERY

Neuroma of Mixed Nerves, TH. DE MARTELAND J. GUILLAUME.Neurinorrie des nerfs mixtes, Rev. neurol. 1: 884-889, 1932. Neuroma developing from a mixed nerve is rare. A clinical case report is given of a patient who, at operation, proved to have such a tumor in the right cerebello- pontine angle, but not arising from the acoustic nerve. “ It probably arose from the sheath of Schwann of a mixed nerve.” EDWINM. DEERY

Recurrent Mixed Cell Sarcoma of the Sciatic Nerve, A. F. HOBBS. Austrsliun and New Zealand J. Surg. 1: 430-435, 1932. A single case report of a woman of forty-one years who, eighteen months after the apparently complete removal of a “ spindle-cell sarcoma ” arising from the left sciatic nerve, died with clinical signs of an intracranial tumor. Necropsy revealed metastatic nodules in the brain and lung. The association of such tumors with von Recklinghausen’s disease is mentioned. Emphasis is laid on the serious prognosis of cases of neurofibromas of the deeper nerve trunks. EDWINM. DEERY

Complex Tumor of the Abdominal Sympathetic, LODOVICOMENCARELLI. Su un complesso tumore del simpatico addominale, Pathologica 24: 454-460, 1932. This is a pathological report of a tumor accidentally discovered during an autopsy on a child who died of poisoning. The tumor lay between the left kidney and the suprarenal and was connected to the hilum of the kidney. Its fibrous capsule was infiltrated by tumor cells and surrounded a small nodule of aberrant suprarenal cortex cells. The tumor proper contained fibers which appeared to be of glial nature and sympathetic cells of all stages from embryonal types to adult ganglion cells. The article contains a long bibliography and is illustrated by a photograph and photomicrographs. JEANNETTEMUNRO

THE BONES AND JOINTS; TENDON SHEATHS Biopsies in Tumors of the Bones, HEINZBAUMECKER. Probeexzision aus Knoch- entumoren, Zentralbl. f. Chir. 59: 1049-1050, 1932. Baumecker advocates the taking of biopsy specimens for the purpose of diagnosis of tumors of the bones. He believes that such a procedure is without harm to the patient. BENJAMINR. SHORE THE BONES AND JOINTS: TENDON SHEATHS 565

Evaluation of Biopsies in Tumors of the Bones, F. J. LANG. Zur Bewertung der Probeexzision bei Knochengeschwiilsten, Zentralbl. f. Chir. 59: 1618-1621, 1932. Lang reports the case of a fifteen-year-old boy with pain, tenderness, and loss of function in the region of the right shoulder which followed an injury received several months previously. Roentgenograms showed an area of destruction about the size of a walnut in the outer portion of the head of the right humerus. A diagnosis of round-cell sarcoma was made from the histologic examination of several small biopsy specimens. As consent for a radical resection could not be obtained, the growth was removed as completely as possible by curettage. Micro- scopic examination of these larger portions of tissue showed not only the areas of round-cells on which the original diagnosis of sarcoma had been made, but also more fibrous areas containing large numbers of multinucleated giant cells. Still other portions showed new osseous and osteoid tissue. The lesion must be considered as benign and belonging to the group of localized osteitis fibrosa, although no follow-up report is given. The author stresses the fact that as large portions of tissue as possible should be taken from the periphery of a growth for diagnostic purposes, and that great care should be exercised in evaluating the microscopic appearances of a small portion of any tumor. The article is illustrated with a roentgenogram and three photomicrographs showing the three types of tissue observed in this one growth. BENJAMINR. SHORE

Giant-cell Tumors, J. GOSSELIN. Tumeurs h myeloplaxes, Bull. m6d. de Quebec, 32: 275-276, 1931. Thd giant-cell tumors, formerly classed as sarcoma, are now considered to be hemorrhagic osseous dystrophies with numerous myeloplaxes in a connective- tissue stroma. They are very radiosensitive and best treated by deep roentgen- ray therapy. In the illustrative case recalcification of the lesion and almost complete reconstruction of bone resulted from such treatment.

Treatment of Single Giant-cell Tumors, R. HUMMEL. Die Behandlung der solitaren Riesenzellengeschwiilste, Rontgenpraxis 4: 545-564, 1932. Twelve patients with solitary giant-cell tumors of the bones were treated at the university clinic in Frankfurt a. M. from 1920 to 1927. Two of these were treated surgically and received postoperative radiation. In one of these cases the cal- varium was the site of the tumor, and in spite of the radiation, multiple tumors have appeared in other regions of the body. In the second case the tumor was located in the femur, and the patient remained well after six years. In ten patients the treatment consisted entirely of radiation. Satisfactory results were obtained in all but one of these. In this patient the tumor had probably undergone malignant degeneration before radiotherapy was begun. In one other case amputation of the arm was necessary five years after radiation was begun. Histories of these patients are given in abstract form, and numerous roentgenograms illustrate the article. BENJAMINR. SHORE

Metastatic Skeletal Tumors, R. WEINGARTEN.Zur Klinik der metastatischen Knochengeschwiilste, Zentralbl. f. inn. Med. 53: 739-742, 1932. Weingarten reports the case of a woman twenty-nine years of age who complained of indefinite gastric symptoms and pains in the pelvis and sacral vertebrae. Roentgenograms of the gastro-intestinal tract, pelvis, and vertebral column 566 ABSTRACTS

showed no pathological changes. The patient died after a short illness, and an autopsy disclosed a small infiltrating carcinoma of the stomach with osteoplastic metastases in the entire vertebral column. Carcinomas of the prostate and breast metastasize most frequently to the bones. The primary growth was present in these organs in 13 of 17 cases of metastatic bone tumors tabulated by Weingarten. BENJAMINR. SHORE

Cystic Tumors of the Pelvic Region, BRANDTAND F. KLAGES. Cystische Tumoren der Beckengegend, Arch. f. klin. Chir. 171: 186-195, 1932. Two patients presented themselves with almost identical clinical signs and symptoms of tumors growing both inside and outside of the pelvis. One, a man twenty-two years of age, showed a rounded, non-tender, tense tumor deep in the musculature of the right buttock. This mass was aspirated and 200 C.C. of brownish-yellow fluid was removed. After injection with lipiodol, roentgenograms demonstrated a communicating cavity inside the pelvis, about the size of a hen’s egg. At operation a partially cystic, yellowish-brown tumor was removed in pieces, although complete removal, especially of that portion within the pelvis, was impossible. The patient made a good recovery and has remained well without evidence of recurrence for sixteen months after operation. Microscopic examination of the tumor showed it to be fairly well encapsulated by thick fibrous tissue, with numerous trabeculae of the same tissue extending into the growth. The tumor itself was composed of nests of large xanthoma cells, cholesterin crystals, and foreign-body giant cells. The picture was typical of a giant-cell xanthoma of the kind most often seen along the tendon sheaths of the fingers and toes. Photomicrographs illustrate plainly the histologic characteristics. No similar case of such a tumor arising in the gluteal or pelvic region could be found in the literature. The second patient, a man twenty-two years of age, also showed a deeply situated tumor in the right buttock. At operation this was found to be a typical ganglion arising in the connective tissue in the region of the hip joint. BENJAMINR. SHORE

Carcinomatous Caries of the Pelvic Bones, ST. SIMON.Die Caries carcinomatosa der Beckenknochen, Rontgenpraxis 4: 538-541, 1932. St. Simon reports extensive carcinomatous caries of the pelvis in one patient with a squamous-cell epithelioma of the cervix uteri and in another following an operation for carcinoma of the body of the uterus. Such metastases are considered rare, as bony involvement could be demonstrated in only fourteen of 780 cases of carcinoma of the vagina, cervix, and fundus of the uterus studied. Five of these were found at autopsy, while the remaining nine were diagnosed by roentgenograms. BENJAMINR. SHORE

DBuse Carcinoma of the Bones of the Cranium, G. ZoRRAqufN. Epitelioma difuse de 10s huesos del orado, Semana m6d. 1: 1293-1302, 1932. The author reports a frontoparietal tumor in a young acrobat who broke bottles with his head. The Wassermann reaction was negative, and a roentgenogram of the skull showed the bone changes seen in diffuse neoplasias of the long bones. Specific treatment did not affect the growth nor prevent the failure of vision. Headache became severe and constant, with nausea, vomiting, and increasing loss of sight. Following excision of the tumor the headache disappeared and vision returned. The tumor was a basal-cell carcinoma. No primary source could be found. H. RIVERO T.HE BONES AND JOINTS: TENDON SHEATHS 567

Squamous-cell Epithelioma Arising in the Wall of an Old Fistula over an Osteo- myelitic Cavity, D. YAMAGUCHI.Uber einen Fall von Kankroid, welches an der Wand einer alten mit Fistel versehenen osteomyelitischen Knochenhohle entstand, Gann 26: 253, 1932. A man of forty-two years had had an acute osteomyelitis of the left femur twenty-five years before. The fistula remained open and continually discharged thin pus. At operation the bone cavity was found filled with a cauliflower-like growth, infiltrating the osseous tissue. Histological examination revealed a typical squamous-cell epithelioma with pearls. K. SUGIURA

Osteogenic Sarcoma in a Child of Three Years, A. L. CRAIG. J. Bone & Joint Surg. 14: 707-711, 1932. An Hawaiian girl of thirty months had pain and tenderness over the tibia1 tuberosity and slight fever. X-ray showed a destructive process of the upper end of the tibia, which was curetted. Cultures were negative. Six months later anemia and cachexia had developed and a fungating, profusely bleeding mass occupied the anterior aspect of the tibia. Biopsy showed an osteogenic sarcoma. Following radium treatment the mass decreased in size and healed. A year later the child had gained ten pounds, and x-rays of the chest and long bones were negative. Photographs illustrate the article. JEANNETTEMUNRO

Primary Sarcoma of a Vertebra, F. DI BELLA. Sarcoma vertebrale primitivo, Radiol. med. 19: 410-415, 1932. This is a clinical account illustrated with a photograph and x-ray photographs. An eleven-year-old girl, five months after an injury to the lower back, began to complain of pain and soreness in the right lumbar region. A steadily growing tumor appeared at the site of the pain. X-ray showed partial rarefaction of the third lumbar vertebra and a partially calcified paravertebral tumor. Diagnostic puncture yielded cells of spindle-cell sarcoma. With intensive x-ray treatment the pain disappeared, but the mass did not regress. Four months later cachexia had developed, pain had recurred, and the tumor had increased in size. Roent- genograms showed rarefaction of the entire third lumbar vertebra with destruction of the posterior portion. The intervertebral discs were normal. The author gives a review of the literature and discusses differential diagnosis. JEANNETTEMUNRO

Sarcoma of the Skull in Breast-fed Baby, J. R. MENDILAHARZUAND F. ARANCIBIA. Sarcoma del crane0 en el lactante, Semana m6d. 1: 1262-1264, 1932. The author describes a seventeen-months-old boy who died with a tumor diagnosed from biopsy as a small round-cell sarcoma. Autopsy revealed a tumor occupying most of the cranial wall. There was a metastasis in the left kidney. H. RIVERO

1. Mistaken Diagnosis of Sarcoma in Osteomyelitis. 2. Case of Unusually Large Bone Tumor, 0. SPITZENBERGER.1. Fehldiagnose eines Sarkoms bei Osteo- myelitis. 2. Ein Fall eines besonders grossen benignen Knochentumors, Fortschr. a. d. Geb. d. Rontgenstrahlen 45: 488490, 1932. The first patient presented by Spitzenberger before the Wiener Gesellschaft fur Rontgenkunde in February 1932 was a man forty-seven years of age with an osteomyelitis of the ilium. The clinical history and the highly destructive, non- sclerosing character of the lesion, as demonstrated by roentgenograms, led to the diagnosis of a malignant bone tumor. The patient died of sepsis, and autopsy showed no evidences of a neoplasm. The second patient was a man sixty-six years 568 ABSTRACTS of age with a hard bony tumor about 12 cm. in diameter in the left elbow region. The tumor was first noticed following an accident twenty-f our years previously and had gradually increased in size during the intervening period. The radiologic diagnosis of osteochoudroma was made, and this was verified at autopsy at a later date. There are no illustrations. BENJAMINR. SHORE

Osteogenetic Pulmonary Metastases from Osteosarcoma of the Femur, L. M. ASTI. Metastasi polmonari osteogenetiche da osteosarcoma del femore, Radiol. med. 19: 416-424, 1932. A boy of sixteen who had had a leg amputated for osteosarcoma of the femur complained some months later of pain in the shoulder. The x-ray which is reproduced showed calcified shadows in the lung parenchyma. The boy died with a clinical picture of bronchopneumonia. At autopsy the lung showed nodules of true osseous tissue, some with well formed lacunae. The author discusses the radiologic differentiation of such metastases, considering especially calcified pulmonary lymph nodes, chondromas, primayy ossified tumors such as dermoids and teratomas, and pleural calcification. JEANNETTEMUNRO

An Osteochondroma of the Astragalus, FRITZERLER. Uber ein Osteochondrom an der Talusrolle, Zentralbl. f. Chir. 59: 1360-1364, 1932. A man thirty-four years of age had received an injury ten years previously, although disability at that time was not great. Eight years later he began to have attacks of pain in the right foot. This pain increased in severity and caused interference with locomotion. At the time of admission to the hospital there was considerable deformity of the right foot and ankle, and x-rays showed a destructive lesion involving the entire astragalus. A biopsy by the puncture method yielded only serosanguineous fluid, and a histologic diagnosis could not be made. The clinical diagnosis of tuberculosis was made and a plaster cast was applied. Roent- genograms seven months later showed further destruction, characteristic of a new growth. Microscopic examination of a surgically obtained biopsy specimen led to the diagnosis of osteochondroma. The article is illustrated with roentgenograms and a drawing of the tumor, but there are no photomicrographs and no follow-up report is included. BENJAMINR. SHORE Malignant Changes in a Case of Generalized Osteitis Fibrosa with Parathyroid Tumors,A. LEE. Generalisierte Ostitis fibrosa cystica mit maligner Entartung und Epithelkoerperchentumoren, Rbntgenpraxis 4: 740-744, 1932. The author reports a case of generalized osteitis fibrosa in a forty-two-year-old man, with the appearance of sarcoma in one of the areas in the right tibia. This diagnosis was made from a biopsy specimen and was confirmed at autopsy. Examination of the neck showed a tumor of the left lower parathyroid gland, 10 cm. long and 2 cm. wide, and a second, somewhat smaller tumor on the right side. Microscopically they had the structure of normal parathyroid glands. Details of the calcium and phosphorhs metabolism are not given. The article is illustrated with roentgenograms and a drawing of the organs of the neck to show the parathyroid tumors, but there are no photomicrographs. BENJAMINR. SHORE Osteitis Deformans of Paget, G. SCHMORL.Uber Ostitis deformans Paget, Virchow’s Arch. f. path. Anat. 283: 694-751, 1932. During a period of thirty-seven years Schmorl studied the skeletons of 190 patients with proved Paget’s disease of the bones. Only those are included in which definite histologic bony changes could be demonstrated. The occurrence of definite mosaic-like structures in preparations stained with hematoxylin is charac- THE BONES AND JOINTS : TENDON SHEATHS 569 teristic of this disease, and depends upon the fact that production and destruction of bone are taking place at the same time. From 1926 to 1930 inclusive, Schmorl studied 138 cases of Paget’s disease in detail. There were 80 men and 58 women, and together they represented an incidence of 3 per cent in 4614 autopsies on patients over forty years of age. True osteitis deformans was not observed in any patient under forty years of age, and it is believed that those cases which have been reported, especially in children, were probably based upon incorrect interpretations of roentgenograms. The following table shows the order of frequency of involvement of the various portions of the skeleton in this series. Sacrum ......

...... 39 (28.370) ...... 18 (13.2%)

...... 10 ( 0.2YG)

Osteitis deformans must be considered as a local bone disease, although it may occur in several portions of the same skeleton. In Schmorl’s experience lesions of a single bone are more common than is multiple involvement of the skeleton. In general it may be said that portions of the skeleton doing the most mechanical work show the changes of osteitis deformans most frequently. They are observed in the lumbar vertebrae twice as often as in the thoracic and three times as often as in the cervical segments. While the ribs are rarely involved, the changes, when seen, are almost always in the sternal end, where the stress of torsion accompanying respiration is greatest. Pulsation of the brain, tension of the neck muscles, and the movements accompanying mastication are offered as etiologic factors in the development of Paget’s disease in the skull. The author describes in detail the various portions of individual bones which may be affected and the frequency with which they are involved. One interesting photograph of the base of a skull shows tremendous thickening due to Paget’s disease of the left half, while the right appears normal. These changes are gradual and overlap the midline. The histologic characteristics of osteitis deformans, from the earliest to the most advanced stages, are described in detail. Excellent photomicrographs illustrate all of the lesions. Of unusual interest and clarity are those showing the earliest forms of the disease, i.e. absorption with accumulation of giant cells in the Haversian canals, and the characteristic mosaics. The last portion of the article differentiates clearly between osteitis deformans of Paget and generalized osteitis fibrosa of von Recklinghausen. Included is a detailed discussion of the histologic changes of the two diseases and of the etiologic rale of hyperparathyroidism in generalized osteitis fibrosa. Schmorl has never seen a tumor of a parathyroid gland in a proved case of Paget’s disease. BENJAMINR. SHORE

A Case of Paget’s Osteitis Deformans, R. KIENBOCKAND M. SEREGHY.Ein Fall von Ostitis deformans Paget, Rontgenpraxis 4: 698-703, 1932. The authors report a case of Paget’s disease in a man sixty-four years of age. He had the typical bony changes in various parts of the skeleton and a compression fracture of a lumbar vertebra which caused a spastic paraplegia. Death was due to a gastric hemorrhage. The article is illustrated with roentgenograms. BENJAMINR. SHORE 570 ABSTRACTS

Paget’s Disease of the Bones in a Woman with a Large, Calcified Fibromyoma, M. SANTORO.Alterazioni pagetiche della scheletro di una malata portatrice di grosso fibromioma calcificato, Radiol. med. 19: 712-717, 1932. A woman of fifty-six, examined radiologically for a supposed injury of the hip, was found to have a large calcified mass in the pelvis and changes typical of Paget’s disease in the pelvis, tibiae, fibulae, and skull. The author discusses the possibility of an identical factor, such as arteriosclerosis or arteritis, being concerned in the bone changes and the calcification of the fibromyoma. He discusses differential diagnosis from the radiologic point of view. The article includes x-ray photographs. JEANNETTEMUNRO Vascular Tumors of the Tendon Sheaths, S. PRINCIGALLI.Contributo alla conoscenza dei tumors vascolari della guaine tendinbe, Chir. d. org. d. movi- mento 17: 128-132, 1932. The author gives a resume of the frequency, position, and type of tumors found in connection with the tendons and tendon sheaths, and reports two cases. A girl of fourteen had had slight pain about the malleolus for four years. Examina- tion revealed a slowly growing tumor. At operation a hemangioma was found attached to the peroneal tendon. A woman of fifty-six had similar symptoms referred to the base of the ring finger. A lympho-endothelioma was found attached to the flexor tendon. The article includes photomicrographs. JEANNETTEMUNRO Xanthomatous Giant-cell Granulomas of the Tendon Sheaths, W. SPRENOER. Zur Kenntnis der xanthomatosen Riesenzellgranulome der Sehnenscheiden, Arch. f. klin. Chir. 169: 683-687, 1932. Sprenger reports the case of a man fifty-six years of age with a typical xanthomatous giant-cell tumor of the tendon sheaths in the region of the right ankle. The tumor had apparently arisen four years previously when the patient injured his ankle in jumping. It had gradually increased in size and caused some disability because of pain. It wa8 about 5 cm. in diameter, and was situated on the outer side of the ankle, just medial to the external malleolus. Microscopic examination of the excised tumor showed the giant and foam cells and cholesterin crystals typical of these lesions. Besides this, there was considerable hemosiderin deposited throughout the growth. The author believes that this, together with the definite history of injury, is suggestive of an inflammatory rather than a neoplastic origin. The article is well illustrated by a photograph of the gross specimen and photomicrographs. BENJAMINR. SHORE Synovial Osteochondromatosis, RICAWOTRUCCO. Osteocondromatosis sinovial, Semana m6d. 1: 882-906; 976-988; 1045-1053; 1099-1110; 1193-1199, and 1265-1274, 1932. Osteochondromatosis is due to an abnormal tendency of articular synovia, serous bursae, and tendon sheaths to form osteocartilaginous bodies. This condition has been known by a variety of names-multiple osteocartilaginous bodies, joint mice, arthrophytes, chondromms of the articular capsule, synovial chondromas, and synovial osteochondromatosis. The lesion is seen more frequently in men (75 per cent of cases) than in women. Osteochondromatosis must be distinguished from other affections that may give rise to free bodies in the joints, such as synovitis with rice bodies, osteochondritis with nodules produced by inflammatory changes, and the trophic lesions of arthritis deformans. The author presents three cases accompanied by photographs, radiologic studies, and histologic records. Free bodies in the joints are classified as follows: THE LYMPHATIC SYSTEM 571

(a) Mobile bodies arising from the articular capsule and the subsynovial tissues; extrasynovial bodies. (b) Bodies from the articular cartilage. (c) Osteocartilaginous sequestra due to a dissecting osteochondritis, tuberculosis, or any other unknown cause. (d) Synovial derivatives or osteochondromas. An exact definition is difficult, but in general osteochondromatosis has been assumed to be an articular disease characterized by the presence of numerous cartilaginous or osteocartilaginous bodies in joints where the articular surfaces are not diseased or, in some cases, show only slight arthritis deformans. In certain examples the disease extends to the periarticular bursae; in others it is present only in the tendinous sheaths. It is generally monoarticular, progresses silently, and is troublesome only in its later stages. In 50 per cent there is a history of trauma, Historically, Ambroise Par6 was the first to remove a free body from a joint. Four theories have been suggested to explain the origin of the condition: the traumatic, infectious, embryonal, and neoplastic. It is not improbable that two or more conditions may underlie the disease. From a pathological standpoint, the disease apparently originates in the articular capsule and synovial membrane. As a rule, the joint linings are congested and hard in certain areas, from which hang bodies of different sizes. The number of bodies found varies from a few up to a thousand or more. The articulations occasionally seem to be obliterated; the bodies penetrate all recesses; the joint is swollen; movement is limited or absent, and pain is present. The arthrophytes are of all sizes, free or hanging by pedicles. Structurally they are formed of concentric layers of tissue, externally fibrous and somewhat thin, medially cartilaginous, and internally osseous. They may arise from any part of the synovia and may begin as chondromas or osteomas, as hyaline fibrous or calcified cartilage, or may be made up of combinations of any of these. Bone develops directly from connective tissue or from cartilage. Once formed, the bodies increase in volume. It is probable that in such an environment the cartilage may proliferate. These nodules differ in their origin from other free bodies found in arthritic, tabetic, and traumatic joints. Once free, there is a change of the cartilage to fibrous tissue, and a moderate necrosis of the bony element. Occasionally the bodies become attached again by a broad base. The differential diagnosis is based upon the slow evolution, the considerable number of foreign bodies, augmentation of their volume and that of the joint, limitation of movement, pain of lightning-like nature, x-ray demonstration of bodies that are festooned and mushroom-like, and finally the general good health of the patient. From the point of view of prognosis the condition is considered as a benign neoplasia. In the literature there is only one case reported in which an osteosarcoma developed, and in that instance there may have been an association of the two conditions. It is evident that the fewer the masses, the easier complete extirpation. Re- currences are occasionally met with even after removal. H. RIVERO

THE LYMPHATIC SYSTEM: LY MPHOSARCOMA, THE LEUKEMIAS, HODGKIN’S DISEASE Contribution to the Knowledge of Endothelial Tumors of the Lymph Glands, G. F. DE GAETANI.Contributo alla conoscenza dei tumori endoteliali delle ghiandole linfatiche, Pathologica 24: 104-110, 1932. Three cases are described, in each of which the author made a diagnosis from a node removed from the neck, of “ endothelioma, primary in lymphatic tissue.” 572 ABSTRACTS

[On the basis of both the clinical history and the photomicrographs, many observers would classify these cases as anaplastic carcinoma or lympho-epithelioma originating from the epithelium of the oropharynx. The term " endothelioma " is a poor one.] C. D. HAAGENSEN Lymph Node Tumors in the Groin, FROMMOLT.Lymphdriisentumoren' in der Leistenbeuge, Ztschr. f. Geburtsh. u. Gynak. 102: 210-211, 1932. Brief report is made of a case in which enlargement of the nodes of the groin without blood changes was found in a woman of sixty-three years. Nodes were later discovered in other regions, so that the condition was definitely a general but aleukemic lymph node disease. HOWARDC. TAYLOR,JR. Surgical Cure of Lymphosarcoma, G. GARRY. Operative Dauerheilung eines Lymphosarkoms, Arch. f. klin. Chir. 170: 790-793, 1932. Lymphosarcomas of different portions of the body vary considerably in malignancy, those of the peripheral lymph nodes, such as those in the neck, axilla, and inguinal regions, showing a high degree of malignancy, while those of the tonsils, pharynx, stomach, intestines, and spleen are relatively benign. A man twenty-three years of age was admitted to the hospital with a huge tumor in the left axilla, of eight months' duration. It was firm, fixed, and pain- less. Roentgenograms of the chest showed no evidence of metastatic tumor. Microscopic examination of the biopsy specimen led to the diagnosis of lymphogranuloma. A radical operation was performed, the left breast, pectoralis major and minor muscles, and , axillary contents being removed in one mass. Microscopic examination of the bumor showed large masses of round cells slightly larger than lymphocytes, with marked infiltration of the capsule. A diagnosis of lymphosarcoma of the axillary lymph nodes was made. Postoperative radiotherapy was advised but refused by the patient. It is now five years since the operation, and the patient is in good health without any signs of residual tumor. The article is well illustrated with photomicrographs. BENJAMINR. SHORE

Radium Therapy of a Sarcoma of the Right Inguinal Glands with Bone and Lung Metastases, ANGELOSANTORO. Radiumterapia in un caso di sarcoma delle ghiandole inguinali di destra, con metastasi ossee e polmonari, Policlinico (sez. prat.) 39: 291-294, 1932. A lymphosarcoma of the right groin was excised, and recurred promptly. It continued to grow despite roentgen treatments (details not given). When treated with surface application of radium it promptly disappeared. Four months later metastases to the femur and lungs were discovered. These also cleared up under radium treatment. Six months later the patient was still well. A number of clinical photographs are included. C. D. HAAGENSEN

Malignant Lymphogranulomatosis, a Borderline Disease, WEISSMANN-NETTER. La lymphogranulomatose maligne, maladie frontihre, Semaine des h8p. de Paris 8: 80-88, 1932. The author presents clinical, anatomical and experimental arguments in favor of the inflammatory and the neoplastic theories of Hodgkin's disease, adding epidemiological arguments in favor of the inflammatory theory. He also discusses at length the arguments for and against the theory of a tuberculous origin. He believes that lymphogranuloma is on the borderline between inflammation and the neoplastic process. The epidemiological arguments are of interest, in particular the instances recorded in the literature of positive inoculation of Hodgkin's disease in the human subject. L. F. CRAVER THE LYMPHATIU SYSTEM 573

Hodgkin’s Disease, E. L. JENKINSON.Radiology 19: 41-49, 1932. Jenkinson emphasizes the occurrence of gross bone lesions of Hodgkin’s disease. He states that, as in carcinoma, the bone changes are of two types, “ osteoblastic ” and osteoclastic. He finds that a differential diagnosis from the x-ray findings alone is impossible. He recalls no instance in which Hodgkin’s disease has attacked or passed through a joint. Two cases are reported showing bone involvement. In one, autopsy confirmed the diagnosis of lymphogranuloma of the proximal third of the femur. In the other case there was increased density of the bones of the pelvis, attributed by the author to cod-liver oil and calcium, and definite changes in one ischium, both scle’rosis and destruction. Marked improvement in the bone followed x-ray treatment, pain was relieved, and the patient was better able to walk. The author states that the vertebrae, ribs, bones of the pelvis, and the proximal third of the femur are the common sites of Hodgkin’s lesions. He feels that well directed local irradiation is superior to generalized treatment, L. F. CRAVER

Severe Symptoms of Lymphograndomatosis, MERKLEN. Les souffrances dans la lymphogranulomatose, MBdecine 13: 209-213, 1932. This is a discussion of what symptoms of HodgkinLs disease may cause actual suffering on the part of the patient. The main symptoms discussed are (1) those due to mediastinal pressure, (2) pruritus, (3) pain. The discussion of pain leads to a consideration of involvement of the spine and spinal canal, with a mention of paraplegia. L. F. CRAVER

Spinal Cord Complications in Lymphogranuloma .and Lymphosarcoma, GOOR- MAGHTIGH. Les complications nerveusea medullaires du lymphogranulome et du lymphosarcome, Bull. Aced. roy. de m6d. de Belgique 12: 116-156, 1932. Goormaghtigh presents an excellent review and discussion of disturbances of the spinal cord caused by Hodgkin’s disease and lymphosarcoma. From the literature he has collected and briefly summarized cases classified as follows: I. Lymphogranuloma. A. Cases with mixed symptoms (visceral and nervous). 1. Without vertebral lesions (19 cases). 2. With vertebral lesions (15 cases, to which is added a case of his own). 3. Cases with toxic or ischemic lesions of the cord (4 cases). B. Cases with purely nervous symptoms (4 cases). 11. Lymphosarcoma (7 cases, to which is added one case, observed by the author’s colleague, DeStella). No one has demonstrated a primary lymphogranuloma of the epidural space or meninges, such involvement being always secondary. Goormaghtigh states that radiologists are unanimously of the opinion that the bone does not react to lymphogranuloma to produce increased bone density, but mentions as very exceptional an example in which there was an exostosis of the vertebra causing nerve pressure. [Diffuse osteoplastic changes are found fairly frequently in Hodgkin’s disease.] In general, the development of symptoms of spinal cord lesions in lymphosarcoma and lymphogranuloma is relatively slow. Exceptionally it may be very rapid, as in a case of Lemerre and Augier with luxation of the atlas. Remarkable periods of remission may occur. Four cases are cited in which violent physical effort was followed by fulminating symptoms of involvement of the cord. Puzzling cases are those presenting only central nervous symptoms, with nothing to indicate the existence of Hodgkin’s disease. Such cases have been 574 ABSTRACTS operated on under a diagnosis of primary tumor of the spinal canal. Goormagh- tigh urges watchfulness for such signs as the following: a polycyclic prevertebral shadow, rarefaction of vertebrae, eosinophilia, history of pruritus, mediastinal enlargement, changes in contour of the esophagus, and Homer’s syndrome. Therapy of these lesions consists of irradiation, with or without arsenic. Although the results are not permanent, great relief is often obtained. What is true of Hodgkin’s disease applies also to lymphosarcoma, and when either of these diseases affects the cord, it behaves like a true malignant tumor. The bibliography contains 50 references. L. F. CRAVER

Blood in Hodgkin’s Disease, with Special Reference to Eosinophilia, W. G. SEARS. Guy’s Hosp. Rep. 82: 40-54, 1932. Sears reports a case of Hodgkin’s disease in a man aged forty. Because of enlargement of the spleen and the leukocytosis of from 62,000 to 76,440, with eosinophilia varying between 51 and 59.8 per cent, the diagnosis first considered was eosinophilic leukemia. Biopsy of one of the enlarged inguinal lymph nodes established the diagnosis of Hodgkin’s disease, and that diagnosis was verified at autopsy. The eosinophiles were almost entirely of mature form, and on only one occasion were a few myelocytes seen. The marrow showed large numbers of eosinophile myelocytes. Sears reviews blood changes occurring in Hodgkin’s disease, as reported by Bunting, Fabian, Falconer and others, and includes a table of 13 cases besides his own, showing a remarkable degree of eosinophilia. Only one other case, that of S. G. Stewart (Arch. Int. Med. 44: 772, 1929) had a leukocytosis (100,000) and an eosinophilia (72-90 per cent) exceeding that of Sears’ case. Sears discusses the clinical occurrence of eosinophilia, and concludes that it seems likely that there is some unknown common factor causing the over-production of eosinophiles in the bone marrow. A summary is given of the blood counts of the 35 patients who received treatment for Hodgkin’s disease in the x-ray department at Guy’s Hospital from 1926 to 1931. Sears’ analysis shows that a slight and progressive anemia occurred. The total white cell and differential counts were within normal limits, any tendency to variation from the normal being a moderate leukocytosis, with a slight lymphocytic decrease. In 8 instances the eosinophiles were between 4 and 7 per cent. Sears concludes that a blood count in Hodgkin’s disease is of little positive value in diagnosis. L. F. CRAVER

Primary Pleuropulmonary Types of Hodgkin’s Disease, J. BERNARD.Les formes pleuropulmonaires primitives de la maladie de Hodgkin, Prat. m6d. franp. 13; 286-301, 1932. Bernard gives a discussion of the clinical features and differential diagnosis of Hodgkin’s disease appearing first in pleura or lung. Nothing essentially new is presented. The author comments on a divergence of view as to which type of pulmonary involvement in Hodgkin’s disease is more common; the disseminated nodular type or the circumscribed form. He states that the nodular disseminated type is more common in secondary involvement of the lung in cases of generalized Hodgkin’s disease, but that the primary pulmonary form of Hodgkin’s disease is more commonly circumsoribed, resembling a chronic or subacute pneumonitis. L. F. CRAVER

Hodgkin’s Disease of the Lung, S. J. HARTFALL.Guy’s Hosp. Rep. 82: 55-74, 1932. Hartfall reports in detail 4 cases of Hodgkin’s disease of the lung, with post- mortem and histological notes. In all his cases the involvement of the lung was THE LYMPHATIC SYSTEM 575 secondary. He states that the mode of advance of the disease in the lung by true infiltration, lymphatic permeation, and the occurrence of metastasis strongly sup- ports the view of Hodgkin’s disease a8 a neoplastic process. The following classification of the gross pathology of pulmonary Hodgkin’s disease is given. 1. Root infiltration from a mediastinal glandular mass. 2. Massive intrapulmonary Hodgkin’s disease. 3. Diffuse fibrous infiltration (which proves to be Hodgkin’s disease microscopically). 4. Discrete or nodular disseminated Hodgkin’s disease. L. F. CRAVER

Gastro-intestinal Forms of Malignant Lymphogranuloma, P. CH~NEAND J. VANIER. Les formes gastro-intestinales de la lymphogranulomatose maligne, Gaz. d. h8p. 105: 497-500, 1932. Ch6ne claims to have published, with Ramond, the first French observation of malignant lymphogranuloma of the stomach. The same case is again reported in the present article. A man of fifty-eight years began to have symptoms in 1925 suggesting gastric ulcer. In 1927 a gmtro-enterostomy was done, the operation revealing scarring and adhesions of the pyloric region. Eight months later a pylorectomy was done (no pathological report is given). The patient died in January 1930, with symptoms d a gastric neoplasm. Autopsy showed a deep ulcer on the lesser curvature 3 or 4 cm. from the pyloric amputation. The surrounding lymph nodes were enlarged up to the size of a pigeon’s egg. Histologic examination showed the features of Hodgkin’s disease, with Sternberg cells even within the lumina of some of the disorganized gastric glands. The authors cite briefly a number of cases culled from the literature, showing involvement of stomach or intestine by Hodgkin’s disease. The bibliography includes 35 references. L. F. CRAVER

Two Cases of Lymphogranulomatosis Maligna, D. C. HAREAND E. H. LEPPER (with Commentary by F. PARKESWEBER). Lancet 1: 334-337, 1932. The first of the two cases reported was one of Hodgkin’s disease in a woman of thirty-one, who had, also, extensive bilateral pulmonary tuberculosis. The main interest in this case lies in the involvement of the periosteum of the lower cervical and upper dorsal vertebrae by Hodgkin’s disease, with extension through the intervertebral foramina and the growth of lymphogranulomatous tissue on the external surface of the dura. The spinal cord was edematous but firm. Pains and paresthesias in the upper extremities and weakness and muscular wasting of the arms and hands led Parkes Weber to make the diagnosis, during the patient’s life, of periosteal involvement of the vertebrae. The second case, in a woman of forty-eight, is of interest because of extensive involvement of the stomach wall, with perforation, lesions of the intestine, infiltration of the liver along the great vessels, and also because of the atypical histological picturemainly lymphocytic with much fibrosis-rendering difficult a distinction from lymphosarcoma. Parkes Weber suggests that the term lymphosarcomatosis includes two diseases: (1) the lymphosarcomatosis of Kundrat and Naegeli, and (2) a variety of lymphogranulomatosis. L. F. GRAVER

Pyopneumothorax in Hodgkin’s Disease, A. J. HALLAND R. V. DAWBARN, Lancet 1: 183-185, 1932. The diagnosis of Hodgkin’s disease was not suspected at any time during the course of illness of the patient, a woman twenty-three years old. The clinical 576 ~STRACTS features were those of streptococcal pyopneumothorax, with terminal acute peritonitis. The patient gave a history of pain in the lower back, weakness, and fever of several months’ duration, but nothing was found during her life to account for these initial symptoms. Autopsy revealed extensive Hodgkin’s disease of the abdominal and thoracic lymph nodes, infiltration of the bronchial mucosa of the right lung by typical Hodgkin’s disease, a nodule of Hodgkin’s granuloma in the lower lobe of the right lung, and a large mass and several smaller nodules of lymphogranuloma in the liver. No obvious perforation of the pleura was found to account for the pneumothorax, and it was demonstrated that the abscess found in the lower part of the upper lobe was not due to breaking down of lymphogranulomatous tissue. The authors account for the abscess on the basis of secondary infection in an atelectatic area, caused by lymphogranulomatous obstruction of the bronchi. L. F. CRAVER

Case of Lymphogranulomatosis Treated for Ten Years, P. HESSAND H. SCHLECHT. Ein Fall von Lymphogranulomatose mit zehnjahriger Behandlungsdauer, Rtintgenpraxis 4: 186-189, 1932. The authors report a case of Hodgkin’s disease beginning in August 1921 in a man aged twenty-nine. The disease originally involved cervical, axillary, and mediastinal lymph nodes, and the chest film showed a mass in the right upper pulmonary field. From early in 1922 to June 1929 seven series of X-ray treatments were given, with definite palliation each time. Late in 1929 symptoms of compression myelitis of the lower cervical cord developed. Although there was no evidence of involvement of the cervical vertebrae, iodipin injection of the spinal canal suboccipitally showed a complete block at the level of the 7th cervical vertebra. Two x-ray treatments of this area with 50 per cent of an erythema dose resulted in definite alleviation of the symptoms. The same symptoms recurred in October 1930, and were partly relieved by a third treatment with x-rays. Death occurred in April 1931, nine years and eight,months after onset of the disease. L. F. CRAVER

Hodgkin’s Disease without Lymphadenopathy, T. P. SEARSAND W. C. BLACK. Colorado Med. 29: 208-210, 1932. A woman twenty-five years old complained of weakness, dyspnea, pallor, fever, and cough of gradual development, but no satisfactory diagnosis could be made. There was cachexia, with extreme leukopenia, and blood cultures were repeatedly negative. There was no palpable lymphadenopathy nor splenic enlargement. Even the gross findings at autopsy failed to show the primary cause of death, and the diagnosis remained unknown until microscopic study was made of the thymus, spleen, and bone marrow, revealing Hodgkin’s disease. L. F. CRAVER Hodgkin’s Disease without Involvement of Superflcial Glands, W. L. DEMBROW. Med. Bull. Vet. Admin. 8: 85-87, 1932. Under this title the author describes a case in a man thirty-one years old who presented a mediastinal tumor, with symptoms of nervousness, weakness, cough, and pruritus. Five months later he died. No biopsy or autopsy was done. L. F. CRdVER

Hodgkin’s Disease with an Enormous Tumor, MILIANAND BAUSEAN.Maladie de Hodgkin ii tumeur Bnorme, Bull. SOC.franc. dermat. et syph. 39: 381-384, 1932. The authors report the occurrence of a left supraclavicular tumor, 28 x 25 x 15 cm., in a case of Hodgkin’s disease. The patient was a man aged thirty-seven THE LYMPHATIC SYSTEM 577 years, who had first shown evidences of this disease three years previously. Two years previously he had received x-ray treatment over a period of five months. No biopsy was made from the tumor, but an axillary node showed Hodgkin’s disease. L. F. CRAVER

Difierential Diagnosis of Lymphogranulomatosis and Tuberculosis, E. MOLLER. Zur Differentialdiagnose von Lymphogranulomatose und Tuberkulose, Ront- genpraxis 4: 432433, 1932. A boy twelve years of age, who had been under observation in a clinic for tuberculosis for three years, developed marked bilateral cervical and left axillary lymphadenopathy. The chest film showed a tumor-like shadow of enlarged nodes at each hilus, which finding, together with the absence of periadenitis about the superficial nodes, suggested the possibility of Hodgkin’s disease. However, the chest film also showed streaking and mottling in the lateral mid-lung field, suggesting that the whole process was tuberculous. Microscopic examination of two nodes removed from the axilla showed caseous tuberculosis, and no evidence of Hodgkin’s disease. L. F. CRAVER

Case of Malignant Lymphogranuloma Associated with Miliary Tuberculosis, LAEDERICHAND H. MAMOU.Sur un cas de lymphogranulomatose maligne et de tuberculose granulique associ6es, Bull. et m6m. SOC. m6d. d. hap. de Paris 48: 751-760, 1932. The authors present a report of a case of Hodgkin’s disease beginning as a mediastinal mass, with later development of typical symptoms of generalization, marked especially by skin lesions and gastro-intestinal symptoms suggesting tabetic gastric crises and dysentery. The blood showed marked leukocytosis (33,000) and polynucleosis (90 per cent). There was no eosinophilia. The autopsy was of interest: first, because of the widespread lesions of miliary tuberculosis intimately mixed with granulomatous lesions; second, because wherever the organs had been directly exposed to x-rays the granulomatous lesions could not be identified as Hodgkin’s disease, while in viscera such as the liver and kidneys, which had escaped direct irradiation, typical Hodgkin’s granuloma was found. L. F. CRAVER

Froehlich’s Syndrome, Diabetes Insipidus and Bitemporal Hemianopsia Resulting from Malignant Lymphogranuloma of the Hypophysis, S. D’AMORE. Sindrome di Froehlich, diabete insipid0 ed emianopsia bitemporale da linfogranuloma maligno ipofisario, Gazz. d. osp. 53: 579-585, 1932. A man of thirty gave a history of four months of intractable itching two years previous, then great increase in frequency and quantity of urination, gain of weight about the abdomen and neck, temporary sexual stimulation followed by impotence, fever, and occasional frontal headaches. Physical examination showed a typical Froehlich’s syndrome and enlargement of the peripheral lymph nodes. There was inability to concentrate the urine. The blood was normal except for a low white count. X-ray showed deformity of the sella turcica and the anterior and posterior clinoid processes. There was bitemporal hemianopsia. A biopsy of a lymph node gave the picture of malignant lymphogranuloma. The author briefly reviews the causes of Froehlich’s syndrome in other than tumor cases, finding the reported cases of lymphogranuloma of the hypophysis extremely few. He discusses the theories of adiposogenital dystrophy and of diabetes insipidus and the nature of malignant lymphogranuloma, questioning any connection with tuberculosis. JEANNETTEMUNRO 578 ABSTRACTS

Atypical Hodgkin’s Disease, A. CHAND. Lancet 1: 1094, 1932. Chand’s patient, a man of forty, had a generalized, almost symmetrical lymph node enlargement, moderate enlargement of the spleen and liver, widespread edema, and pronounced anemia. While the blood picture was that of myeloid leukemia, an excised node was reported by two pathologists as showing atypical Hodgkin’s disease. The patient was still under observation at the time of the report. L. F. CRAVER

Present Status of the Study and Treatment of Leucemia, R. ISAACS,J. Lab. and Clin. Med. 17: 1006-1009, 1932. Isaacs summarizes selected points bearing on the etiology, symptoms, types, and treatment of leukemia, giving 22 references. He emphasizes his belief that the effect of radiation on myelocytes, metamyelocytes, young polymorphonuclear leukocytes, and medium-sized and small lymphocytes is to stimulate them to pass rapidly through the remaining stages of their normal life process and to die of senility. The action of radiation on primitive myeloblasts, lymphoblasts or monocytoblasts is quite different, in that it stimulates them to rapid division and reproduction, and thus makes the disease process worse instead of better. Large lymphocytes and cells of the monocyte group are but little affected by therapeutic doses of x-rays. Blood transfusion alleviates some symptoms, especially when there is marked anemia, and may be followed by a temporary decrease of the white cell count. Iron and whole liver, Isaacs believes, are of value in chronic lymphatic leukemia. L. F. CRAVER

Metabolism of Leucocytes from Normal and Leukemic Blood, L. J. SOFFERAND M. M. WINTROBE. J. Clin. Investigation, 11 : 661-676, 1932. Soffer and Wintrobe studied the oxygen consumption and aerobic and anaerobic glycolysis in vitro of leukocytes in a series of cases of leukocytosis and acute and chronic myeloid and lymphatic leukemia. They found that the oxygen consumption and the glycolytic activity were inversely proportional to the concentration of the white cells in the blood. Allowing for the influence of concentration, no differences could be found in the metabolism of mature and immature leukocytes, nor in a comparison of leukocytes of normal blood with those from leukemic blood. The amount of oxygen consumed rapidly decreased, the longer the duration of the experiment, the maximum consumption per unit of time being reached during the first ten minutes. The granulocytes had a somewhat greater oxygen consumption than the lymphocytes, and about twice the glycolytic power of the latter. The number of red blood cells in the sample did not appear to influence the oxygen consumption of the leukocytes. The metabolism of granulocytes under aerobic and .anaerobic conditions resembled that of malignant tissues, while the metabolism of the lymphocytes was similar to that of normal adult tissues. L. F. CRAVER

Relation of the Sympathetic Nervous System and Generalized Lymphoid Hyper- plasia to the Pathogenesis of Exophthalmic Goiter and Chronic Lymphatic Leukemia, H. B. FRIEDQOOD.Am. J. Med. Sc. 183: 841-849, 1932. In a second article (for the first see Am. J. M. Sc. 183: 515529,1932. Abst. in Am. J. Cancer 16: 1232, 1932) Friedgood makes further comparisons between the symptomatology and pathology of Graves’ disease and chronic lymphatic leukemia. He stresses the concept of the thymico-lymphatic constitution in patients who have exophthalmic goiter. As noted in his former article, Lugol’s solution amelio- rates the symptoms of both diseases in a strikingly similar fashion, while it does THE LYMPHATIC SYSTEM 579 not relieve true hyperthyroidism induced by ingestion of thyroid. The author interprets the foregoing facts as an indication that the symptoms and signs of Graves’ disease and chronic lymphatic leukemia are primarily independent of thyroid dysfunction, but rather dependent on disturbances of the sympathetic nervous system and the lymphatic system. The effect of iodin is probably related to the pathologic physiology of the sympathetic nervous system. L. F. CRAVER

Results of Roentgen Irradiation in Chronic Leukemia, J. ARENDTAND W. GLOOR. Resultate der Rontgenbestrahlung bei chronischen Leukamien, Strahlenthera- pie 44: 715-738, 1932. The authors review briefly the prevailing views as to the pathogenesis and appropriate treatment of the chronic leukemias. If chronic leukemia is a neoplastic process, then the commonly used fractionated treatment would seem inappropriate, and massive dosage should be employed. In view of the disagree ment on theoretical grounds as to the nature of the leukemic process, only experience can decide which is the better method of treatment, and it is therefore important to collect as nearly as possible all cases of this disease, in order to assess critically its response to therapeutic measures. Of the three agents of choice in the treatment of chronic leukemia, arsenic, x-rays, and radium, the authors have had no experience with the last named, and their article consists of a presentation of arguments and statistics in favor of the combined use of intensive arsenic and fractionated x-ray therapy. The action of karyoclastic poisons has been shown to be not unlike that of short-wave rays, consisting of pyknosis, karyolysis, and necrobiosis. Among such poisons are anilin, isamine blue, trypaflavin, lead, thallium, and arsenic. The mode of action of radium, short-wave x-rays, and these poisons is qualitatively very similar, perhaps essentially alike. The differences in their actions are more quantitative. Cases become refractory to irradiation or to arsenic. Ray-resistant cases very often respond to arsenic, or, according to Saragen, to extracts of nodes. The authors’ cases have frequently been treated first with arsenic. Their special indications for x-ray therapy are: (1) failure to respond to arsenic, (2) symptoms or complications referable to the enlarged spleen, liver, or nodes. They discuss the various methods that may be used in irradiating, for example, the spleen; varying from a maximum single dose as used by Rosenthal, through single fractional doses, repeated fractional doses, the saturation dose method, prolonged fractional dose method, to intermittent x-ray treatment of the entire body and prolonged continuous irradiation of the spleen by radium. Their own cases have been treated with single fractional or divided fractional doses of x-rays, mostly with the following factors: 170 kilovolts, 3 milliamperes, 0.5 mm. copper or zinc filter. For myeloid leukemia they employed in the beginning a single fractional dose, averaging about 240 T to the spleen, with two or three skin portals, depending on the size of the spleen. This treatment was repeated when indicated. In some instances the enlarged liver, and less often the bones, were also irradiated. For lymphatic leukemia the palpable masses of nodes, as well as the spleen, were irradiated. If the case showed an exacerbation which no longer responded to irradiation, or if the patient became continuously worse in spite of irradiation, the dose of x-rays was not increased but a period of treatment with arsenic was instituted, after which the case was often found to be again re- sponsive to irradiation. In the course of time the single fractional dose was reduced to 60 to 120 r, at least in the myeloid form of chronic leukemia. The authors regard the division of the splenic area into many small portals as super- fluous. In the lymphatic form of chronic leukemia irradiation of the lymph node groups may safely be begun with doses of 240 to 300 r. 580 ABSTRAOTS

The authors state that in their opinion it is not yet decided whether the irradiation of the whole body is the method of choice for chronic leukemia. It seems valuable for one reason, that is, that cases refractory to local irradiation may still respond to total irradiation, since so much pathologic tissue that has never been irradiated is reached by this method. They report one case of their own treated by a dose of only 3 r anteriorly and posteriorly to the entire body, at a distance of 180 cm. This case had previously been treated ineffectively by arsenic and repeated x-ray irradiation of the spleen and lymph nodes. Following the total irradiation there was a marked shrinkage of the huge spleen, a steady drop in the white cells, and a real improvement in the patient’s condition. The effect, however, was only temporary, and a relapse soon occurred, with death five month later of thrombosis and embolism. In view of the frequently observed infiltrations in the kidneys of leukemic subjects, and the consequent danger of retention of uric acid, Nemenow proposed preliminary irradiation of the kidneys. The authors suggest that possibly diathermy of the kidneys during the period of irradiation might increase the volume of circulation through those organs, and thus increase the elimination of urinary excretory substances. Arsenic therapy was carried out mainly as follows: 1. Parented injections of arsenous acid, beginning with 1 mg. daily, increasing daily by 1 mg. until 15 mg. a day is given; continuing this dose, according to the case, for six to ten days; then decreasing the dose until 1 mg. a day is again given. 2. Oral administration of Arsylen Roche, 1 to 2 tablets, three times a day, or arsacetin 0.05 gm. three to five times a day. Arsacetin produced skin lesions less often than the other forms. The authors report their results on 39 cases of chronic myeloid leukemia and 26 cases of chronic lymphatic leukemia. They present a curve showing the duration of life in their cases of chronic myeloid leukemia, superimposed on the curves of Minot’s 68 trertted and 52 untreated cases, and Hoffman and Craver’s 82 treated cases. Comparison of these curves shows that their cases ran the most favorable course; the average duration of life being over four years, and the curve showing a more gradual drop, indicating relatively larger percentages of patients living over four years. They attribute their superior results to the individually selected, combined roentgen and arsenic therapy. Citing 7 cases of chronic myeloid leukemia and a case of chronic lymphatic leukemia, the authors reach the following conclusions. A judicious combination of arsenic and roentgen therapy can bring about actual improvement in the results. No generally applicable plan of therapy can be formulated. In myeloid leukemia the clinical picture and the response to irradiation permit division of the disease into three stages. In the first stage arsenic therapy is the method of choice, and should include both oral and parenteral administration. Changing from one preparation of arsenic to another is often necessary, and an increase of dosage up to 15 to 20 mg. of arsenous acid should be the goal. Roentgen therapy may also be used in this stage, best in the form of single fractional doses. In the second stage, characterized by a certain degree of ray-resistance, combined arsenic and roentgen therapy is usually effectual, although, because of more frequently appearing general disturbances, the dose of arsenic can not be made as large as in Stage 1. Roentgen therapy in Stage 2 is best used in the form of repeated fractional doses. The authors have had insufficient experience with prolonged fractional x-ray treatment or with irradiation of the entire body to permit them to form any conclusions as to the value of those methods. The third stage is characterized by a fundamental impairment of the function of the bone marrow, with progressive depression of the hematopoietic apparatus, together with myeloid proliferation, and is accompanied by showers of myeloblasts. In this stage, roentgen irradiation is rather dangerous. However, even here very cautious irradiation by prolonged THE LYMPHATIC SYSTEM 58 1

fractional dosage may sometimes show better results than single or repeated fractional treatments, the latter forms of administration often aggravating the myelosis, that is, bringing about an increase of myeloblasts. In this stage arsenic, supported by blood transfusions, is the method of choice. The transfusions favorably influence the hemorrhagic diathesis and help to remove the burden from the damaged erythropoietic system. In chronic lymphatic leukemia, in which these different stages cannot be distinguished, a certain degree of ray-resistance may appear later than in chronic myeloid leukemia. From the beginning, the authors think, combined arsenic and roentgen therapy is the most appropriate measure. The superficially located lymph nodes are readily accessible to x-rays. The method of repeated fractional doses has proved effective. The authors’ curve for duration of life in chronic lymphatic leukemia shows a large proportion of deaths in the first year of the illness. This finding they attribute to the fact that in neglected or unrecognized cases of leukemia, complications, which are always most serious, first called attention to the presence of leukemia. They state that with appropriate treatment and continued medical attention, the prognosis in chronic lymphatic leukemia is much better than in chronic myeloid leukemia. Heliotherapy, especially recommended by Naegeli, is useful only a8 an adjunct. In no cme has heliotherapy alone, without arsenic or x-rays, brought about a reduction in leukocytes. L. F. CRAVER Lymphomatosis of the Iris in Leukemia, H. WEVE. Lymphomatosis iridis bei Leukamie, Arch. f. Augenh. 105: 710-720, 1932. Weve’s patient was a female child two years old, whose history indicated the onset of the leukemic process presumably at the age of five months. The child wa8 pale and thin, with a right cervical adenopathy. The left eye presented the picture of an iridocyclitis with hypopyon, thought possibly to be tuberculous. A smear of the turbid fluid from the anterior chamber showed discrete cells resembling large lymphocytes. Since the condition was not responding satisfactorily to treatment, iridectomy was done the portion of iris removed showing a structure resembling lymphoma. The patient became febrile, and lost weight, and the spleen became palpable. The blood count showed 128,500 white blood cells with 89 per cent of cells of the myelocyte series. Soon afterward the child died. Only the eye was available for post-mortem examination. It showed leukemic infiltration about the corneal scar, along the major vessels traversing the sclera, in the iris, the ciliary body, and the choroid. L. F. CRAVER

Clinical Case of Acute Leukemia, F. CUBERO. Caso clinico. Leucemia aguda. Ecos espan. d. dermat. y sif. 7: 67-74, 1931. A twenty-year-old man had multiple brown tumors of varying size on the head, soft, movable, and not tender. The tonsils and the throat showed large ulcerating tumors. Multiple faint blue spots could be seen on the body. The right lower arm showed three small tumors, and there were five tumors on the anterior side of the right lower leg. A few small lymph nodes could be felt in the neck, but none in either axilla. Those of the inguinal region were enlarged. One of the tumors on the left leg was removed for biopsy. Microscopically an infiltration of lymphocytes was present in the skin. The diagnosis was multiple hemorrhagic sarcomatosis (Kaposi). Four photographs show the tumors as they were about two to three weeks after the patient had entered the hospital. The tumors continued to grow, and the spots on the body developed into tumors. The inguinal lymph nodes greatly increased in size. The tumors in the throat also became larger. Finally the tumors of the skin and scalp began to 582 ABSTRAOTS grow softer and give off a sanguineous fluid. The spleen was not enlarged. After a short period of apparent regression, the patient died. The final diagnosis was aleukemic lymphatic leukemia. The blood showed 4,720,000 erythrocytes and 7,600 leukocytes. Among the latter were 45 per cent lymphocytes, 6 per cent large mononuclear cells and transition forms, 45 per cent neutrophilic and 4 per cent eosinophilic granulocytes. Nothing is said concerning treatment. JOHANNESP. M. VOGELAAR

Acute Lymphatic Leukaemia With Facial Diplegia and Double Abducens Palsy, A. HOWELLAND J. GOUCH. LANCET1: 723-724, 1932. This was evidently a case of acute lymphatic leukemia. It occurred in a boy eleven years of age and ran a total course of nine weeks. One blood count showed 480,000 white blood cells and 93 per cent of lymphocytes. Following 4700 milligram hours of radium over the spleen there was a drop in leukocytes but no other favorable change. Autopsy showed extensive typical leukemic infiltration of the organs. A tumor-like mass was found in the region of the thymus. In the right frontal lobe of the brain was a brown area 3 mm. in diameter, found to be made up of a mass of lymphocytes intermingled with blood pigment. Throughout the cerebrum and basal ganglia were several small areas of perivascular lymphocytic infiltration. In the pons were two very small lymphomas, one in the region of the main nucleus of the trapezium. In addition there was recent thrombosis of a vessel running through the right facial nucleus. The nerve cells of the sixth and seventh nuclei on both sides showed chromatolysis, shrinkage of cell bodies, and margination of the cell nuclei. Serial sections through the intracranial portions of the sixth and seventh nerves showed commencing degeneration of nerve fibers, with a very slight degree of leukemic infiltration of the nerve sheaths. L. F. CRAVER

Case of Acute Eosinophilic Leukaemia, G. R. MCCOWENAND H. B. PARKER. J. Royal Naval Med. Serv. 18: 131-133, 1932. A shipwright aged forty-five, survived only thirteen days after the onset of symptoms. The spleen was not palpable for the first nine days. Leukocytosis steadily increased from 20,000 to 154,000. Terminally the eosinophile polynuclear cells comprised 49 per cent, and the eosinophile myelocytes, 29.5 per cent of the white cells. The autopsy findings were rather incomplete because of post-mortem decomposition. Panton, clinical pathologist of the London Hospital, in commenting on this case, believes it desirable to label it acute eosinophilic leukemia, chiefly on the basis of the blood picture. The authors feel that they did not entirely exclude acute trichinosis. L. F. CRAVER

Case of Acute Myeloblastic Leukaemia, H. BARBER. Guy’s Hosp. Reports 82: 75-80, 1932. Barber reports a case of acute myeloblastic leukemia occurring in a man aged forty-three years. The acute symptoms terminated in death in three weeks. [It is of interest to note that a history was obtained of the appearance of ecchymoses and of prolonged bleeding following extraction of some teeth one year previously. This history suggests that the patient may have had leukemia then. If so, the terminal illness must be regarded clinically as an exacerbation of a chronic leukemia. Yet, the autopsy findings were those of acute leukemia, there being very little evidence of myeloidiaation of the liver and spleen. The kidneys showed the most marked local infiltration.] L. F. CRAVER THE LYMPHATIC SYSTEM 583

Acute Myelosis, F. LASCH. Ein Beitrag zur Frage der akuten Myelose, Med. Klin. 28: 754-755, 1932. Lasch reports the case of a woman sixty-five years of age who died with acute myeloblastic leukemia which was associated with an osteomyelitis of the mandible and chronic sepsis. The blood culture was at all times sterile. Autopsy showed the typical macroscopic and microscopic picture of a true myeloid leukemia. The author believes that the osteomyelitis and sepsis may either have been the cause of the leukemia or merely an accompanying condition. BENJAMINR. SHORE

Malaria and Myeloid Leukemia, C. AUBERTIN. Paludisme et IeucEmie myelolde, Bull. et m6m. SOC.m6d. d. h6p. de Paris 48: 435-438, 1932. Two cases are cited of myeloid leukemia developing in soldiers who served in Salonika in 1917. In one case leukemia had been diagnosed six years, in the other fourteen years, after the patient acquired malaria. Aubertin, who stated in 1906 that he believed malaria to be a predisposing cause of myeloid leukemia, is still of that opinion. While admitting that leukemia is a rare sequel of malaria, he maintains that malaria is a relatively frequent antecedent in cases of myeloid leukemia. He finds no such frequency of a malarial history in the lymphoid form of leukemia or in the (‘lymphomatoses.” He suggests a systematic search in malarial spleens for myeloid lesions, and in the blood of anemic malarial subjects with large spleens, for myelocytosis. He states that, although such a reaction in the blood has been noted by Rieux, it must be acknowledged that anatomical and hematological evidences of transitions between malaria and myeloid leukemia are almost unknown. L. F. CRAVER

Leukemia Masked as Hyperthyroidism, 0. J. MENARD. Surg. Clin. North Amer. 12: 835-838, 1932. .Menard presents two cases of myeloid leukemia with signs and symptoms of hyperthyroidism. Case I at first showed nothing clinically to suggest leukemia, and it was only after repeated blood counts that the diagnosis was made. It is interesting that even before the onset of the symptoms suggesting hyperthyroidism this patient had diabetes. In the second case the signs, including bilateral but unequal exophthalmos, were suggestive of hyperthyroidism, but minute retinal hemorrhages suggested a blood dyscrasia. Menard justly urges that any patient with an elevated metabolism with no definite cause have repeated blood counts, as the first indication of a relapse in leukemia may be a rise in the basal rate. L. F. CRAVER

Splenectomy in Myeloid Leukemia, J. KUHLE. Milzexstirpation bei myeloischer Leukiimie, Deutsche Ztschr. f. Chir. 235: 674-676, 1932. Kuhle removed the spleen from a female patient fifty-four years of age, in an aleukemic stage of myeloid leukemia. The spleen extended beyond the midline and down to the pelvis and showed perisplenitic adhesions to the stomach, colon, and diaphragm. Eleven days after splenectomy the patient received a blood transfusion of 600 C.C. The author states that on admission the patient seemed to be threatened with an early death, but that, following the operation, a remission occurred, lasting several months. However, at the time of his report the white cells had increased to 35,000, and the differential count showed a typical myeloid leukemia, L. F. CRAVER 584 ABSTRAOTS

Chronic Leukemic Reticulo-endothelioses, C. BOHNEAND L. HUISMANS. Bei- triige zur Kenntnis der chronischen leukiimischen Reticuloendotheliosen, Virchows Arch. f. path. Anat. 283: 575-592, 1932. Along with a discussion of views as to the origin of the monocyte of the blood, the question of monocytic leukemia and the monocytoses, aleukemic reticulosis, and metabolic reticulo-endotheliosis (Gaucher, Niemann-Pick and Schuller- Christian), the authors report a case which they conclude is one of subleukemic reticulosis. A woman fifty years old had noticed, two years before, a slowly developing enlargement of the left tonsil. It finally caused pressure symptoms and dysphagia. Biopsy showed lympho-epithelioma. Irradiation of the tonsillar tumor caused it to disappear completely in ten days. Lymph nodes of the cervical and inguinal regions became enlarged. The blood showed an increase of monocytes up to 15 per cent. A few weeks later the patient was found to have marked enlargement of the spleen and liver, and a pronounced general lymphadenopathy. The blood then showed marked anemia, extreme lymphopenia, and a monocytosis of 27 per cent. Following irradiation of the spleen, the percentage of monocytes fell to 3, rising terminally to 25 per cent. The total duration of the illness was two and a half years; the acute stage following roentgen treatment lasted three months. Autopsy showed a marked enlargement of the spleen and lymph nodes, less marked enlargement of the liver, a grayish red marrow of the femurs, pronounced anemia and cachexia, and widespread inflammatory foci in the right upper lobe of the lung. Microscopically there was a pronounced uniform proliferation of reticulum cells in spleen, lymph nodes, and bone marrow. Lymphatic tissue in these organs was completely suppressed. In the periportal connective tissue of the liver, in the interstitial tissue of the pancreas, and in the kidneys, reticulum- cell hyperplasia could be demonstrated. Only in the bone marrow could transformation of reticulum cells to free monocytes be shown. L. F. CRAVER

PUBLIC HEALTH, STATISTICS, EDUCATION Present Cancer Problems, G. V. HULTOREN.Aktuella kancerfragor, Svenska liik. 29: 49-63, 1932. A short resume of the most pertinent questions discussed in the sixty lectures of the 41st International Postgraduate Course in Vienna in 1932. The subjects include serology, chemistry, tests for cancer, heredity, and clinical problems. Some 50 prominent specialists contributed to these lectures. Official Report of the Committee for the Control of Cancer. Die Organisation der Krebsbekiimpfung (Offizieller Bericht), Zentralbl. f. Chir. 59 : 1066-1068, 1932. The German committee for the control of cancer composed of representatives of the State and of the medical profession met in Berlin on January 30, 1932. The early diagnosis and treatment of cancer and the grave responsibilities of the medical profession in this regard were discussed. It was felt that complete centralization of cancer patients in special hospitals was, at the present time, not feasible in Germany, and that these patients could be cared for adequately in the various hospitals and university clinics already in existence. The same attitude was expressed in regard to the construction of new institutions for the radiation treatment of cancer patients. Funds to insure the proper examination and treatment of cancer patients are essential in any program, and in Germany the start in this direction has been made in Baden. It was suggested by Professors Dietrich and Stauder that cancer statistics could be greatly improved by making PTJBLTC HEALTH, STA’MSTICS, EDUCATION 585 this disease a reportable one. Until this is compulsory, voluntary reporting of the disease by physicians was suggested. BENJAMINR. SHORE Remarks Concerning the Purpose of Cancer Hospitals, ALEX.FRAENKEL. Zeit- gemasse Bemerkungen Iiber die Bestimmung von Krebsspitalern, Wien. klin. Wchnschr. 45: 8-9, 1932. Fraenkel makes the occasion of the opening of the new government cancer hospital in Vienna an opportunity for a discussion of the purpose of cancer hospitals in general. He believes that a cancer hospital in a city such as Vienna should work in close accord with all the other hospitals of the city, and should accept for treatment not only the early but all the apparently far advanced cases which have been discharged as hopeless from other hospitals. A great deal in the way of palliation can be accomplished for some of these advanced cases. Such clinical material should be utilized by a cancer hospital for the purpose of trying out new forms of therapy. A cancer hospital should merit being called an “ Institute for Experimentation in Cancer Therapy.” The new Vienna Cancer Hospital has one hundred beds and is equipped with every modern facility for the treatment of cancer, including five grams of radium. C. D. HAAGENSEN Results of Cancer Control in Westphalia and Conclusions Drawn Therefrom, P. ESCH. uber die bisherigen Ergebnisse der Krebsbekampfung in Westfalen und einige Schlussfolgerungen daraus, Deutsche med. Wchnschr. 58: 1077- 1078, 1932. This study was based on the records of 17 hospitals in the province of West- phalia. In 1930 these institutions received 881 cancer cases; in 1931, 1074, an increase of 21.3 per cent. This increase consisted mostly of inoperable cases, these having risen to 31.6 per cent, while the increase in operable cases was only 2.7 per cent. In the case of uterine carcinoma the increase of operable cases in 1931 was only 1.5 per cent while that of inoperable was 41.5 per cent. During the second half of the year 1931 there was a decrease of hospital cases of uterine cancer, which is attributed to the financial depression rather than considered as a real decrease. The cost of treatment should be reduced to meet this emergency.

Hospitalization of Cancer in Massachusetts, G. H. BIGELOWAND H. L. LOMBARD. New England J. M. 206: 607-609, 1932. The result of the campaign carried on in Massachusetts by the combined efforts of the state medical society, the American Society for the Control of Cancer, and the Massachusetts Department of Health has been that more patients are demanding hospitalization, service such as has not before been offered is being given, and both patients and physicians are recognizing cancer earlier. The present study is based on three-year averages, 1923-25 and 1928-30, covering 75 hospitals, including, in the latter period, the Pondville Hospital for cancer. The 11.9 per cent decrease in the number of operations for cancer patients in hospitals and 16.5 per cent decrease for those who died in hospitals following operation is attributed to a greater selectivity of surgical cases by surgeons. All cases receiving both radiation and operation have been classified as operative cases. The greatest increase in the use of radiation has been in breast cancer, with cancer of the buccal cavity second. There has been a decrease in radiation of skin cancer. Radiation is used most frequently in cancer of the female genital organs and of the buccal cavity. The study shows that individuals with cancer are more ready to enter hospitals for treatment than formerly, and that surgeons are handling these cases in a more approved manner. 586 ABSTRAOTS

True Statistics of Cancer Mortality, KARL FREUDENBERG.Die wirklichen Zahlen der Krebssterblichkeit, Deutsche med. Wchnschr. 58: 1171-1173, 1932. The author claims that although there is no decrease in cancer incidence (as shown by a study of the figures for the Prussian provinces) there is certainly no increase so far as these do not depend upon a shifting of the age levels. Such an increase is apparent and not real since in previous years a large number of cancer cases were not recognized, death in the death certificates being ascribed to old age. The decrease in such vague diagnoses parallels the increasing percentage of physicians to population and advances in diagnosis.

Mortality from Malignant Tumors in Charkov, U. S. S. R., A. M. MERKOWAND E. I. PLATSCHEWSKY.Zur Sterblichkeit infolge bosartiger Neubildungen in Charkow (U. S. S. R.), Virchow’s Arch. f. path. Anat. 282: 158-171, 1931. A review of the reports of the pathological sections of the hospitals of Charkov for 1901-1929 shows that deaths from malignant tumors constituted 6.5 per cent of all deaths, and 7.2 per cent of all deaths for fifteen years of age and over; deaths from carcinoma constituted 5.54 per cent of all deaths; from sarcoma and other malignant growths 1.03 per cent (for ages fifteen years and over, 6.1 per cent and 1.1 per cent respectively). In the period of 1901 to 1929 there was a slight increase in the percentage of malignant tumors correctly diagnosed during life; there was a still greater increase in the percentage of incorrect diagnoses of malignant growths that were not sustained by the autopsy findings, indicating that physicians are paying more attention to the possibility of malignancy. The malignant growths found at autopsy exceeded those diagnosed during life by 13.9 per cent. The average age of those dying from carcinoma in Charkov was 51.1 years for males and 51.4 years for females, with the largest percentage of deaths between the ages of forty-five and fifty-four years. For sarcoma, the average age at death was forty-one years for males and forty years for females, with the highest percentage of deaths between the ages of thirty-five and forty-four years. There was no evidence of any increasing tendency for death from carcinoma to occur at an earlier age. The average age of death from carcinoma, however, is lower in Charkov than in western Europe. Statistical Report of the Diagnostic Service (Autopsy and Biopsy) for the Year 1931, B. DE VECCHIAND C. PANA. Rendiconto statistico del servizio diag- nostico necroscopico e istologico per l’anno 1931, Boll. d. lega ital. per la lotta contro il cancro 6: 26-30, 1932. The age and sex distribution of the different forms of tumors diagnosed at the Institute of Pathology of the University of Florence during 1931 are given. C. D. HAAGENSEN Cancer Statistics, &I. N~GAYO.Gann 26: 286, 1932. Nagayo gives his last report on a statistical study of cancer among Japanese. The results are tabulated in 13 tables. K. SUGIURA

Cervical Cancer. Its 1926-1929 Incidence in Five New York State Cities. Its Prevention, Its Future, GLENNA. WOOD. New York State J. M. 32: 265- 271, 1932. A study was made of the statistics for cervical cancer in Buffalo, Rochester, Syracuse, Albany, and Yonkers, over the years 1926-1929. On the basis of this study the author inclines to place the responsibility of the future of cervical cancer on the physician. Proper care of post-partum lesions of the cervix will reduce PUBLIC HEALTH, STATISTICB, EDUCATIOX 587 cancer incidence, and such care depends upon the physician, who must realize that not only immediate treatment of lesions post-partum is important, but also re- examination and later treatment if necessary.

Responsibility of the Practitioner in Menopausal Bleeding, JAMESE. KING. New York State J. Med. 32: 385-390, 1932. A plea is made for a more careful scrutiny into the cause of menopausal bleeding by the physician and for the education of women as to the importance of insisting upon a positive diagnosis. In abnormal bleeding at or near the menopause biopsy of cervical tissue or examination of material removed by curettage will in certain cases afford a positive diagnosis. X-ray treatment should never be employed until carcinoma has been excluded.

In Reference to Cancer Mortality in the Insane, L. LAURSEN.I anledning af cancerdodeligneden hos Sindssyge, Ugesk. f. laeger. 94: 238-239, 1932. A discussion of recent papers on cancer in the insane, containing suggestions as to the possible errors in such statistics.

Birch Rods, ‘‘ Cancer Arteries,” etc., CARLVON KLINCKOWSTR~M.Wiinschel- rute, “ Krebsadern ” und Ahnliches, Med. Welt, 6: 1148-1149, 1932. Comments on quack procedures and apparatus.

Parasitic Propaganda, R. LE BRET. Les propagandes parasites, Lutte contre le cancer 10: 18-22, 1932. The propaganda on the part of the French Anti-Cancer League to remove the stigma attached to cancer and make it a subject which can be discussed openly and sanely has been so successful that various commercial enterprizes have seized upon the market value of its ‘‘ respectability.” The wine interests have carried on a campaign to drink more wine, on the theory that drinking wine prevents cancer. Their claim is based on the coincidence that the vineyard regions of France have a lower cancer death rate. Le Bret points out that the death rate from cancer is really dependent upon the facilities for medical care. Where well trained physicians are available and attend all deaths the cancer rate is high; it is low in those communities where physicians are scarce and where many death certificates are signed without the cause of death being known. The vineyard regions of France are the very ones in which the percentage of death certificates signed “cause of death unknown” is highest. C. D. HAAGENSEN

Recent Work on Cancer at the University of Louvain, G. ODIO DE GRANDA. Trabajos recientes sobre cancer de la Universidad de Lovaina, Bol. de la Liga contra el cancer 7: 129-142, 1932. A short history of the University of Louvain opens this paper. The author then gives a long resume of the work of Maisin and his colleagues on the production and treatment of cancer. Thls portion is not entirely free from errors.