Abstracts Experimental Studies; Animal Tumors

ABSTRACTS EXPERIMENTAL STUDIES; ANIMAL TUMORS

Studies on the Artificial Production of Tumors by Chemical Substances, K. MuT~. Gann 29: 132-151, 1935. A review of the literature dealing with the artificial production of tumors. The author recognizes three periods. The first started with the failure of Hanau in 1889 to produce tumors in rats by tar and ended in 1915 with the epoch-making experiments of Yamagiwa and Ichikawa, who produced cancerous growths in rabbits’ ears after the repeated application of coal-tar. Beside this substance the following chemicals have been employed by numerous investigators in attempting to produce tumors in animals : xylolparaffin, scharlach R, sudan 111, indophenol, dimethylaminoazobenzol, amidoazobenzol, amido-azotoluol, a-naphthylamin, toluidin, glycerine, oleic acid, palmitic acid, indol, skatol, turpentine, and crude paraffin oil. The second period from 1915 to 1931 covers the experimental production of cancer in various animals by tar and tar products having unknown chemical formulae. During this period about 700 papers were written on this subject. The third period, from 1932 to the present, includes the brilliant work of Kennaway, Cook, and others on the fractionation of tar and subsequent preparation of a highly carcinogenic substance, 1 : 2 : 5 : 6 dibenzanthracene, Sasaki’s experimental production of hepatoma in animals by o-amido-azotoluol, and the very recent work of Kennaway and Cook on the conversion of deoxycholic acid of bile into a carcinogenic agent, methylcholanthrene. K. SUGIURA

Further Studies on the Production of Dibenzanthracene Tumors in Pure Strain and Stock Mice, H. B. ANDERVONT. Public Health Reports 50: 1211-1217, 1935. The subcutaneous injection of mice with 1 : 2 : 5 : 6-dibenzanthracene in lard induced sarcomas that were transplantable to members of the strain of pure-bred mice in which the growths originated. Sarcomas could be elicited by a single injection of 0.8 mg. of dibenzanthracene, but repeated injections gave a higher percentage of tumors. A strain (CBA) that developed very few spontaneous mammary carcinomas was extremely susceptible to dibenzanthracene, though the tumors developed later than in strains with a high incidence of breast cancer. WM. H. WOGLOM

Experimental Studies on the Transplantability of Hepatoma Produced by Means of Ortho-amidoazotoluol 1 : 3 : 4, T. IIKUBO. Experimentelle Studien uber die Transplantabilitat des mittelst o-Amidoazotoluols erzeugten Hepatoms, Gann 29: 79-87, 1935. The author reports successful subcutaneous transplantation of hepatoma produced in rats some seven to ten months after feeding with o-amidoazotoluol and p-amidoazobenzol, or by feeding o-amidoazotoluol alone. One of the two subcutaneous transplants was carried successfully for five generations. The subcutaneous transplantations gave positive results in 35 out of 66 inoculated animals. The transplantability seemed to increase from generation to generation, so that at the fifth generation 12 out of 14 rats gave positive growths. On the other hand, in the first generation, a growth was found in only one out of 6 rats. The histologic picture of the subcutaneous and intraperitoneal tumors was identical with that of the original. The article is illustrated by photographs and photomicrographs. K. SUUIURA [These interesting results give definite evidence of the malignant nature of the liver tumor artificially produced by an organic compound, but also show that the phenanthreric 659 660 ABSTRACTS nucleus is not an essential part of a carcinogenic substance, though the work of Kenn- away, Cook, and their collaborators has proved that a large number of compounds containing this group are highly effective producers of cancer. Similarly, Morton and Clapp (Science 82: 134, 1935. Abst. in Am. J. Cancer 25: 415, 1935) have shown that symmetrical triphenylbenzene and tetraphenylmethane are feebly carcinogenic. Yo- shida’s original paper on the production of hepatoma by o-amidoazotoluol was printed in the Proceedings of the Imperial Academy of Japan 8: 464, 1932. For abstracts of other papers by Yoshida see Am. J. Cancer 19: 97, 1933; 22: 137, 1934; 24: 676, 1935. The original article gives details as to the feeding. One gram of o-amidoazotoluol is dissolved in 20 C.C. of warm olive oil and, after cooling, a volume of olive oil is added to make 20 gm. This solution is then thoroughly mixed with rice so that 1 gm. of rice contains 1 mg. of o-amidoazotoluol. An animal will consume daily about 5 to 10 gm. At the same time some fresh green food is given. Since the azotoluol is toxic to many of the rats, the experiment must be conducted with a large number of animals. After about two months of this feeding the liver cells show fatty atrophy in the center of the lobules with proliferation at the periphery. After five to eight months marked adenomatous proliferation is seen, and in those animals which survive after nine months a typical carcinoma of the liver develops. The statement by Fischer-Wasels that he has been unable to repeat Yoshida’s work is nullified by the fact that he does not mention the substance he used (Verhandl. d. deutsch. path. Gesellsch. 28: 66, 1935).-E~.]

Production of Tumors by Organs from Tumor Animals, FERDINANDBLUMENTHAL. Ueber die blastomatosen Eigenschaften von Organen von Tumortieren, Bull. schweiz. Vereinig. f. Krebsbekampf. 1 : 62-66, 1933. The author reviews the experiments of the past few years on the transfer of propagable new growths by means of blood or other organs from their bearers, and decides that the successful outcome is not due to the presence of metastatic tumor cells. One of the principal reasons for his belief is the statement that even embryos from a tumor-bearing mother will transmit the neoplasm, for the passage of tumor cells through the placental barrier is hardly conceivable. All this suggests the presence of a diffusible etiological agent of some sort, and if the findings may be applied to man, it would appear that malignant disease is not entirely eradicated by excision of the neoplasm. The agent still remains at large, and all possible measures (radiation, diet, endocrine treatment) must be directed against it even though the growth itself may seem to have been successfully removed. [There is no intimation in this paper that some investigators have failed to transmit tumors by ihjecting the organs of their bearers.] WM. H. WOQLOM

Cellular Allergy and Carcinogenesis, 0. REUTERWALL.tfber cellulare Allergie und Krebsgenese, Ztschr. f. Krebsforsch. 42: 117-139, 1935. With allergy as a basis, a working hypothesis can be constructed that neglects neither carcinogenic agent nor predisposition. Two experimental methods are available for inquiry into the significance of allergic irritation for neoplasia. The carcinogenic activity of recognized allergic agents can be tested, and the allergic properties of known carcinogenic substances investigated. Both have been employed in the experiments which this paper describes. In respect to the former, repeated injection of serum or egg albumen into the rabbit’s ear was found to induce proliferative changes but nothing resembling malignant growth. As for the latter, the lesions following the injection of tar or 1 : 2 : 5 : 6- dibenzanthracene are discussed, and emphasis is laid on the long period that elapses between introduction of the carcinogenic agent and the appearance of the malignant transformation. The allergic irritation and its immediate consequences would thus seem to be but the first link in a long chain of events. The nature of the subsequent links cannot yet be explained; there are many possibilities-physical or chemical alterations in the cell, irreparable damage to its division mechanism, somatic mutation, perhaps a virus that becomes operative when the resistance of the cell has been broken down, or, most promising of all for investigation, surface changes. EXPERIMENTAL STUDIES ; ANIMAL TUMORS 661

Seven photomicrographs and two photographs of gross specimens illustrate this paper. WM. H. WOQLOM

Origin of the Inflammatory Epithelial Proliferation in the Experiments of B. Fischer, M. A. ZACHARJEWSKAJA. Uber die Genese der entzundlichen Epithelwucherungen im Versuch von B. Fischer, Ztschr. f. Krebsforsch. 42: 209-221, 1935. The injection of scharlach R and other substances into the rabbit’s ear, as practised by B. Fischer-Wasels and others, gives rise to an epithelial hyperplasia that is morpho- logically suggestive of carcinoma. Two explanations for this reaction have sprung up. One, espoused by Fischer-Wasels himself, ascribes it directly to specific chemical stimulation by the exogenous agent. Other investigators, however, while accepting this hypothesis in a general way, believe that mechanical or circulatory factors are required in addition. The second explanation suggests that the epithelial hyperplasia is but secondary to inflammatory or circulatory changes in the underlying connective tissue, the exogenous factor thus having significance only in so far as it excites these lesions. As a result of his own experiments the author comes to the following conclusions: Two types of epithelial proliferation follow the injection of scharlach R into the rabbit’s ear. In the first, growth begins in the hair follicles, and the epithelium retains its differentiation. In the second type, which has its inception in the first, differentiation is lost. Both varieties reach their acme where there are advanced inflammatory changes in the connective tissue, and the second type, indeed, appears only where epithelium showing the first type of growth has penetrated as far as the subjacent inflammatory cellular infiltration. Epithelial proliferation ceases as soon as this infiltrate has been replaced by fibrous tissue. Thus epithelial overgrowth is not due directly to the chemical nature of the material injected, but to the inflammatory reaction elicited in the connective tissue by the presence of this irritant. WM. H. WOQLOM

Lead Therapy in Cancer and the Effect of Certain Colloidal Metals upon the Growth of Transplantable Rat Tumors, STEFANv. PASTINSZKYAND BERTAOTTENSTEIN. Uber die Bleitherapie des Krebses und den Einfluss einiger kolloider Metalle auf das Wachstum experimenteller Rattenimpftumoren, Ztschr. f. Krebsforsch. 42: 245-250, 1935. After briefly reviewing experimental lead therapy, the authors describe their work with the Ehrlich-Putnoky tumor, which is stated to be the Ehrlich mouse carcinoma growing in rats. A colloidal preparation of lead and titanium produced grave anemia and stimulated tumor growth when administered in large doses, but was without any effect whatsoever in smaller amounts. When the preparation had been injected directly into the neoplasm, lead could easily be demonstrated in it by histochemical methods, but only traces were discoverable when the agent had been subcutaneously introduced, and ashed material did not suggest any specific affinity of the tumor cell for lead. Colloidal titanic acid had a slight inhibiting effect, which could be reinforced by colloidal copper. Colloidal tellurium, though it tended to produce necrosis, did not cause the disappearance of tumors. WM. H. WOQLOM

Effect of Preventive Radiotherapy on the Growth of Malignant Tumors and Metastases, B. GRYNKRAUT.De la radioth6rapie preventive experimentale contre l’accroisse- ment des tumeurs malignes et des mbtastases, Bull. et m6m. SOC.de radio]. m6d. de France 22: 105-109, 1934. The author reports the results of experiments on rats inoculated with Jensen sarcoma. He found, as has long been known, that heavy irradiation of the animals prior to the implantation of the tumor did not prevent the latter from growing, though the volume of the tumor was less, after a given period, in the irradiated animals. Re- gional lymph node metastases were found frequently in the irradiated animals but not in the controls (none went over three weeks). There are no illustrations. A short bibliography is appended. C. R. MULLINS 662 ABSTRACTS

The So-called (( Gas Treatment of Malignant Tumors )' by B. Fischer-Wasels, M. TANAKAAND K. MUTO. Nachprufung der sog. 'I Gasbehandlung der bosartigen Geschwulste " von B. Fischer-Wasels, Gann 29: 88-100, 1935. The authors investigated the statement of B. Fischer-Wasels that when animals bearing malignant tumors were placed in a chamber containing a mixture of carhon dioxide and oxygen there resulted marked inhibition of tumor growth due to the excessive accumulation of oxygen and resultant tissue acidosis (Frankfurt. Ztschr. f. Path. 39: 48, 1930). Tumor-bearing animals were allowed to remain in a gas chamber containing a mixture of 5 per cent carbon dioxide and 95 per cent oxygen for three hours daily except Sundays. At the same time injections of various preparations were carried out, partly intravenously and partly subcutaneously. The Kato rabbit sarcoma and Bashford mouse carcinoma were used. The gas treatment was found to be valueless. K. SUGIURA

An Artificial Fever of 111.4' F. as a Means of Destroying Cancer in the Animal Body, GEORGEWALKER. Am. J. Cancer 25: 301-304, 1935. The temperature of rats bearing the Walker carcinoma 256 was raised to 111.4' F. by putting the animals into an incubator running at 104' F., or between the plates of a high-frequency apparatus, and maintained at this 'point for twenty minutes. None of' the animals survived more than ten hours, but that the treatment had had some dele- terious effect on their tumors was suggested by the poor growth or total failure of these neoplasms when transplanted into other rats. It was found eventually that the maxi- mum temperature which a rat will stand is 109' F. This was maintained for thirty minutes on alternate days for four treatments, but in none of the experiments was any effect noted on the growth of the tumor. The artificial fever from the thermostat seemed to be less harmful to the rats than that produced by the high-frequency apparatus, for none of this group lived the required twenty minutes after their temperature had reached 111.4' F. [There is no intimation given by the author that this experiment has already been done by several investigators.] WM. H. WOGLOM

Hemorrhagic Necrosis and Regression of Sarcoma 180, GREGORYSHWARTZMAN. Science 82: 201, 1935. Bacterial substances capable of eliciting local skin reactivity to bacterial filtrates in rabbits produce, upon intravenous injection, hemorrhagic necrosis and regression of transplantable tumors in guinea-pigs, mice, and rats. However, there is a high death rate in animals thus treated. In an effort to reduce their toxicity, B. typhosus culture filtrates were mixed with an antiserum. The best results were obtained when 300 B. typhosus reacting units were combined with 200 neutralizing units of antityphoid horse serum. Of 27 mice bearing sarcoma 180 and treated intravenously with this mixture, 5 died from two to twenty days after injection. Prompt hemorrhagic necrosis took place in 23 mice and complete regression of tumors with healing in 21 or 78 per cent. This tumor regresses in but 1.3 per cent of healthy untreated animals. [However, care must be taken in interpreting experiments of this type, where the animal is subjected to treatment with highly toxic materials, for while the total of regressions in many thousands of animals may average only 1.3 per cent, in small groups of 100 or 200 it may amount to from 7 to 12 per cent, and in series of 24 animals to as much afi 50 per cent. These figures are obtained in the course of routine inoculation, without any form of treatment. Therefore, it will be necessary for the author to do as he suggests, and extensively control this experiment upon spontaneous growths in animals. Only if the method proves effective on such primary tumors should it be testcd on neoplasms of the human subject.] WM. 11. W0GIA)M EXPERIMENTAL STUDIES ; ANIMAL TUMORS 66.3

Chemical Composition of the Nucleic Acids of Malignant Tissue, G. KLEINAND J. BECK. Die chemische Zusammensetzung der Nucleinsauren nialigner Gewebe, Ztschr. f. Krebsforsch. 42: 163-177, 1935. The nucleic acid isolated from various malignant neoplasms of man and the lower animals was similar to that obtained from normal tissues. WM. 11. WOGLOM

Normal Development of the Mammary Glands of Virgin Female Mice of Ten Strains Varying in Susceptibility to Spontaneous Neoplasms, W. U. GARDNERAND L. C. STRONG.Am. J. Cancer 25: 282-290, 1935. The mammary glands of ten strains of mice, differing in susceptibility to spontaneous neoplasms and inbred for from 14 to 44 generations, were examined at intervals of six to eight days from the 25th to the 100th day of life. In each of two strains, one strain resistant (I,) and one susceptible (A) to spontaneous neoplasms, four mice were found deficient in one or both of the glands of the third or lower thoracic pair. One or more of the glands of the third thoracic pair of variable numbers of mice from all of the tumor- susceptible strains, and from two of the tumor-resistant strains, either developed at a retarded rate or remained rudimentary. No other morphological variations were observed in the animals of the different strains during the interval studied that might be associated with tumor susceptibility. Cyclic hypertrophy and regression of the mammary glands were observed during the estrous cycle. During estrus and early post-estrus, the mammary ducts were slightly distended, and in the younger mice the bulbous terminations of the ducts were more numerous and distended. The glands increased in size until the mice reached sixty to seventy days of age, at which time they had reached their full virginal development. This study indicated that no structural factor in the development of the mammary glands in virgin female mice was associated with the intrinsic hereditary predisposition to mammary carcinoma in mice.

Estrous Cycles of Mice during Growth of Spontaneous Mammary Tumors and the Effects of Ovarian Follicular and Anterior Pituitary Hormones, EDGARALLEN, A. W. DIDDLE,L. C. STRONG,T. H. BURFORDAND W. U. GARDNER.Am. J. Cancer 25: 291-300, 1935. The estrous cycle was investigated in 59 mice of four strains inbred with regard to the early appearance of spontaneous mammary carcinoma or adenoma. With advanced growth of the neoplasm the estrous cycles became infrequent, long periods of diestrus occurred, and the genital organs came to be almost as atrophic as those of ovariectomized animals. After long periods of diestrus the accessory genital organs could be stimulated repeatedly to normal estrous cycles by injection of theelin or the implantation of two or three pituitaries from gonadectomiaed mice. Several successive treatments with either theelin or anterior pituitary, or with combinations of both, have been tried. There is a time in the degenerative phase of the ovary when pituitary treatment is no longer effective. Minimal doses of theelin produce positive vaginal reactions in such animals. These results indicate that the acyclic condition in tumor mice probably involves primarily the gonadotropic function of the pituitary. The paper closes with a good bibliography. WM. H. .WOOLOM

Further Data on the Existence of Extra-chromosomal Influence on the Incidence of Mammary Tumors in Mice, W. S. MURRAYAND C. C. LITTLE. Science 82: 228-230, 1935. So striking was the difference between reciprocal crosses in two strains of mice, one with a high incidence of mammary cancer and one in which no such growths have been found (Science 78: 465, 1933. Abst. in. Am. J. Cancer 21: 668, 1934), that it seemed desirable to study back-cross generations. Though most of the animals are still alive, the preliminary results are sufficiently interesting to justify publication. 664 ABSTRACTS

In the four types of back-cross studied, the incidence of mammary tumors was found to depend primarily upon the direct transmission of extrachromosomal influences, a result which completely confirms the earlier experiments with FI and FOmice. WM. H. WOQLOM

Time-intensity Factor in relation to the Genetic Effects of Radiation, H. D. GRIFFITH AND K. G. ZIMMER. Brit. J. Radiol. 8: 4@47, 1935. A knowledge of the time-intensity relation is of practical importance to the clinician; it may also throw light on the mechanism by which radiations affect living cells. The authors present a full summary in tabular form, of the results of studies involving the time factor on normal and malignant tissues, on tissue cultures, eggs and seeds, and on various small plant and animal forms. In a majority of cases, a decrease in intensity of the incident beam is followed by a decrease in the magnitude of the response. A striking exception is seen in the rate at which mutations in Drosophila are produced; here the dose in roentgens determines the mutation rate, regardless of the intensity. Even very weak doses, if applied for a long enough time, are effective. Whether this is true for man also is an important question which should be further investigated. CHARLESPACKARD On the Alteration in the Sensitivity of Cells towards Radiation Produced by Cold and by Anaerobiosis, J. C. MOTTRAM.Brit. J. Radiol. 8: 32-39, 1935. Beans are more sensitive to gamma and to x-rays when they are irradiated at 0" C. than at higher temperatures, If cooled either before or after exposure at normal temperature, their sensitivity is not changed. Exposed in an atmosphere of nitrogen, they are less sensitive than in air. [The small number of individuals-3 to 7 pairs in 5 tests- and the high variability of this material render these conclusions doubtful.] CHARLESPACKARD

THE CANCER CELL; TISSUE CULTURE STUDIES Variations in the Chondriomes of Transplantable Tumors and Those of Man, E. GRYN- FELTT AND P. MAURY. Les variations du chondriome dans les cellules des tumeurs malignes humaines et exp&imentales, Arch. SOC.d. sc. m6d. et biol. de Montpellier 16: 15-18, 1935. The authors distinguish three different phases in the evolution of the cancer cell and assert that each is associated with characteristic alterations in the mitochondria. 1. Tupicnl CtlEs: Here the cells retain the differentiation and most of the functional activity of the mother tissue. It is evident that the mitochondria will hardly depart from the normal standard in either shape or distribution. 2. Atypical Cd.u: The essential characteristic of atypical cells is a lack of differentiation, and their fundamental physiological property an augmented power of proliferation. The mitochondria are uniformly scattered throughout the entire cell body. Sometimes they are arranged in chains or, no doubt in consequence of fission, assume the form of a diplococcus or a dumb-bell. 3. Dege?ieriilir~gCells: When this stage is reached, the mitochondria are already degenerating, sinco their destruction precedes that of the nucleus, as in the case of the non-malignant cell. The tumors employed in this investigation were the Flexner-Jobling rat carcinotna and mammary and uterine cancer8 from the human subject. WM. H. WOQLOM

Atypical and Pathological Multiplication of Cells Approached through Studies on Crown Gall, A. J. RIKERAND T. 0. BERQE. Am. J. Cancer 25: 310-357, 1935. Among the conclusions drawn by the authors of this extensive survey are the following: ['Tumor strands " and '' secondary tumors " occurred only after inoculation at the top of plants with a number of internodes condensed in the apical buds, and apparently THE CANCER CELL; TISSUE CULTURE STUDIES 665 by elongation of the internodes. ‘I Secondary tumors ” did not always repeat the structure of the primary. A number of cytological phenomena appeared to be the result rather than the cause of the pathological condition. None of the reactions produced by various chemical substances was as vigorous as that set up by crown gall bacteria. The evidence for antibody production in plants needs confirmation. No proof exists that a bacteriophage or a virus is the cause of cell stimulation in crown gall. There is nothing to show that crown gall bacteria elicit tumors in warm-blooded animals, though they may perhaps do so in cold-blooded ones or in insects. Seven pages of bibliography complete the paper. WM. H. WOGLOM Tissue Culture: Its Application to Radiological Research, F. G. SPEAR. Brit. J. Radiol. 8: 6S86; 280-297, 1935. A review of the achievements of experimental radiology which have been made possible by the tissue culture method. The advantages of this method are that the cultures are free from outside influences, that is, the effects are localized in the cells actually irradiated, and that the responses of the cells can be observed from the time of exposure until the end of the experiment. The data thus obtained are valuable as a guide for experimentation which it may be desired to make under the complicated conditions of growth in the living animal. The results show that radiations act directly on cells, the first effect being a change in the rate of mitosis. The rate of growth of the culture is a less sensitive criterion. When small doses are repeated after an appropriate interval, the effect is greater than that of a single large dose [as has long been known from the work of Regaud]. Prolonged irradiation affects cell metabolism, inhibiting the utilization of sugars. The ultimate effect of radiation depends on the power of recovery in the cells. This differs greatly in different tissues. Experiments with chick embryos show that the effects in vivo are similar to those obtained in, vitro, but the response varies according to the presence or absence of a blood supply. When this is normal, recovery is favored; if the vessels are injured by the radiation a generalized destruction follows, due to the interference with the blood supply. The irradiation of tissues shows a variability in the power of cellular recovery and there is some evidence of a selective action of radiation and of a differential action as well. An extensive bibliography is appended. CHARLESPACKARD Effect of Short Waves on Cell Growth in vitro, A. E. ROFFO,JR. Relation entre les ondes klectriques et la multiplication cellulaire dans les cultures de tissus I‘ in vitro,” Arch. d’6lectric. mkd. 42: 466-475, 1934. Waves from 0.58 to 6.75 meters in length inhibit the growth of a rat sarcoma in vitro, but not that of embryo chick heart. The fundamental exerts a more intense action than its harmonibs. WM. H. WOULOM Photosensitivity of Chick-Embryo Cells Growing in Media Containing Certain Carcino- genic Substances, MARGARETREED LEWIS. Am. J. Cancer 25: 305-309, 1935. When certain carcinogenic hydrocarbons, as, for example, 1 : 2 : 5 : 6-dibenzanthracene, 1 : 2-benzpyrene, or methylcholanthrene, were added to cultures of chick embryo, the cells developed photosensitivity to the electric light used for their observation. Their condition seemed to correspond in the first stages to that induced by some of the influences, such as ether and ammonia, heat, or distilled water, that bring about a more fluid condition in cytoplasm, and the change was often accompanied by an inhibition of cell division with subsequent mitotic anomalies duplicating many of the types seen in malignant growth. WM. H. WOGLOM Do Normal Cells Change to Cancer Cells Under Hormonal Influence? P. JAISOHN. West Virginia M. J. 30: 414-415, 1934. It is suggested that ‘I through some hormonal influence, if the potassium and calcium balance of the blood should become upset, there may result a high concentration 666 ABSTRACTS of potassium in the body fluids. The chemically active potassium then would set free hydrogen ions from the cell contents with which it comes in contact, including the sterols in the cells, The dehydrogenated molecules of sterols will be transformed into something like the carcinogenic element in tar.” GRAYH. TWOMBLY

TERRESTRIAL AND MITOGENETIC RAYS AND CANCER

Do Injurious Terrestrial Rays Exist? WALTERFRIEDRICH. Gibt es schadliche Erd- strahlen? Deutsche med. Wchnschr. 61 : 83-84, 1935. During the past few years the statement that terrestrial rays cause disease, and cancer in particular, has aroused a great deal of concern among the people of Germany. Radiation that is sufficiently intense to exert a biological action (e.g., x-rays) is in most cases artificially produced, whereas that which occurs in nature is far too weak to cause any damage to living organisms. Even in the vicinity of powerful sending stations, where the electrical and magnetic fields are infinitely stronger than any of natural occurrence could possibly be, no anomalies of flora or fauna and no disturbance of health in the inhabitants have been observed. By terrestrial rays the dowser means rays demonstrable by the divining rod. lJsually he confesses to entire ignorance of their nature and refers the whole problem to the physicist, though a few operators describe them as very short electrical waves with a length of from a few centimeters to a millimeter. The methods of proof, however, arc not those of the trained physicist and accounts of the simplest physical properties (e.g., absorption) are often vague in the extreme. A few dowsers, who lay claim to some training in physics, try to surround their fantastic conceptions with a cloak of mathe- matics, but without even comprehending the order of magnitude of the forces with which they deal. The chief proof for the presence of terrestrial rays is said to be a feeling of discomfort, or the occurrence of actual illness, and adherents of the divining-rod offer a multitude of instances which they try to support by statistical methods. Examination of their figures, however, shows a total lack of conformity with the requirements demanded in biological investigations. Rut the darkest chapter of all is that concerning the so-called protective devices. These, from the standpoint of the physicist, are merely silly, for the principle on which they are constructed, if indeed there is any principle at all, is so variable that, were one type of apparatus to work, another could not possibly be effective. None of the various appliances has stood the tests to which they have been subjected by properly qualified physicists, and as a result of governmental investigation their sale has been discontinued in Switzerland. Most dowsers simply exploit the gullibility of the public for their own advantage, but a few are honest and sincere. The scientist ought to cooperate with this latter group and try to penetrate the riddle of the dowser and the terrestrial ray, WM. H. WOGLOM

Can Cancer be Elicited by Terrestrial Rays? H. BEITZKE. Konnen durch Erdstrahlcn Krebse ereeugt werden? Wien. klin. Wchnschr. 48: 959-961, 1935. It has been suggested that cancer is caused by the terrestrial rays said to be demonstrable with a divining rod above all good subterranean conductors of electricity such as water courses [see editorial in Am. J. Cancer 15: 299, 19311. A map of these underground streams has even been published for a town with a high cancer mortality, whereby all the patients are shown to have lived over subterranean water. The wonder is, however, according to Beiteke, that the mortality was not even higher, for whole rows of streets lay above underground water courses. It has been pointed out, too, that so many and so frequently intersecting streams within such a small area as is represented by the map would be a geological impossibility. Furthermore, even though weak electrical currents do no doubt flow through the earth, we who live in an electrical age are constantly TERRESTRIAL AND ‘MITOCENETIC RAYS AND CANCER 667 exposed to all sorts of electromagnetic and electrostatic fields several thousandfold stronger than those of the earth currents, yet there is no sign that even these are harmful in the slightest degree, much less that they cause malignant disease. As a lucrative business has sprung up in devices that are said to protect against terrestrial rays, it would be well to have the question settled once and for all. This can be done by keeping animals that are predisposed to cancer over an underground stream and controlling the experiment with others kept at a site free from terrestrial rays. In a room on the first floor of the author’s laboratory, a room which a well known dowser said lay over a subterranean stream, a small colony of male and female mice was accordingly established, while another group from the same source was maintained as controls in a remote part of the building where the divining rod showed no water. In the meantime, Vl&sand de Coulon published the statement that more spontaneous tumors arose in mice kept in grounded cages than in insulated ones /see Absts. in Am. J. Cancer 19: 417, 856, 857, 19331. The incidence in the fofmer case was 3.8 per cent, in the latter 0.3 per cent. As a confirmation of this observation would strengthen the possibility that terrestrial rays can produce cancer, the author repeated his experiment with a second series of animals. After eleven months the sole product was one carcinoma in a female of the control group in the first series-that is to say, in a mouse that had not been exposed to terrestrial rays. The experiments were hampered by epidemics and there remained only 250 survivors in all when they were terminated, two and a half years from the establishment of the first series and thirteen months from the time when the second series was set aside in grounded or insulated cages. The experiment gave no support for the idea that terrestrial rays cause cancer, or for the statement of V1i.s and de Coulon. Though the number of mice available to the author was relatively small, seven or eight cancers should have developed in the grounded mice were the contention of Vl&sand de Coulon correct. It is suggested that differences in the soil may explain the discrepancy and Beitzke announces his intention of doing the experiment over again, closing with the wish that it might be repeated by others as well and in as many different localities as possible. [The reliability of the divining rod has been thoroughly investigated by Gerlach (Naturwissenschaften 20: 883, 1932. Abst. in Am. J. Cancer 17: 483, 1933), who dis- missed the pretensions of its advocates as impudent charlatanism.] WM. H. WOGLOM

Some Phases of the Mitogenetic Ray Phenomenon, ALEXANDERHOLLAENDER AND WALTERD. CLAUS. J. Optic. Soc. America 25: 270-286, 1935. Mitogenetic rays are said to be ultraviolet light of 1900-2500 A. with an intensity of 10-1000 quanta/cm*/ sec. It was thought at first that they were of biological significance only, the result, and partly the cause, of cell division, and it was because of this assumed stimulating influence on mitosis that they received their original name. Now, however, many investigators believe that they are connected with practically all chemical reac.- tions. On account of the shortness of their wavelength, the rays have been called oligoluminescence; ” other writers employ the terms ‘I Gurwitsch rays,” or M-rays.” Although more than 500 papers and several books have appeared on the subject, a number of investigators doubt the very existence of these rays, at least in the form reported, and the present authors believe that reliable methods for their detection have not yet been fully established. The biological and physical procedures usually employed should be carefully scrutinized for accuracy, and methods developed which can be used as a routine technic, for the problem is potentially too important to rest on the prejudices created by irresponsible publications like many of those that now adulterate the literature. Definite evidence for the existence of the rays must be gathered before their significance can be discussed. The paper is illushrated by five diagrams and a chart, and is accompanied by an extensive bibliography. WM. H. WOGLOM 668 ABSTRACTS

CLINICAL AND LABORATORY OBSERVATIONS

Trauma and Malignant Tumors, L. C. KNOX. Am. J. Surg. 26: 66-73, 1934. In a comprehensive review of the subject in 1929 (Arch. Path. 7: 274, 1929), Knox was led to the conclusion that no causative relation between a single trauma and tumor formation had ever been completely established and that the award of compensation for this reason alone was therefore unjustifiable. She believes that no valid evidence has since been offered to warrant a change in that opinion. While the clinician shows a tendency to accept the patient’s theory of the development of a tumor following a blow or other injury, and the general trend of thought has been influenced, perhaps uncon- sciously, by the increasing number of verdicts returned in favor of the injured person, the observations of the laboratory worker and pathologist are in general opposed to any cause-and-effect relationship. In the first place, all attempts to produce tumors in animals by, physical tissue injury have failed, though other such agents active in man are usually equally effective in animals. Again the possibility that trauma may merely serve to call attention to a tumor already present but previously unrecognized is borne out by the comparatively frequent discovery of undiagnosed cancer at autopsy. Sta- tistics furthermore fail to indicate any increase in cancer following war injuries or the increased number of industrial and motor accidents in recent years as compared with the general population. A distinction must be made between the effect of a single mechanical injury and the long-continued irritation which may result from an injury which has been the origin of some scar, ulcer, or inflammatory lesion upon which a tumor later develops. Here however, a lapse of a period of years between the beginning of the irritation process and the appearance of the neoplasm is probably always a necessary condition. The relationship of trauma to brain tumors, tumors of the eye, the leukemias, chordoma, melanorna, and bone tumors are taken up in detail, various authorities being quoted and several illustrative cases cited from the literature. A bibliography is appended.

Epithelioma Developing on a Traumatic Scar of Accidental Origin, E. DELANNOYAND J. DRIESSENS. Epith6lioma cutan6 dBvelopp6 sur une cicatrice traumaticlue d’origine accidentelle, Ann. d. m6d. lbg. 14: 828-832, 1934. The authors give a short discussion of cancers developing in scars and report the case of a thirty-six-year-old man who suffered severe trauma to the leg at the age of nine years, with intermittent ulceration since that time, recently increasing in extent. ’ Amputation was done and the patient was apparently well three years later. Patho- logically the lesion was an epidermal type of carcinoma, with invasion of the surrounding muscles. There are no illustrations. A short bibliography is appended. C. R, MULLINB

Early Post-traumatic Epithelioma, DUVOIRAND A. ABECASSIS. Epith6lionia mal- pighien post-traumatique pr6coce, Ann. d. m6d. 1Bg. 14: 833-836, 1934. The authors discuss the possible relationship of trauma to cancer and mention pertinent case reports. Their own patient was a forty-four-year-old man who was found to have an epithelioma of the dorsum of the hand four months after an injury with a metal tool. The lesion was excised but no follow-up is given. A photomicrograph of the tumor is presented, and there is a short bibliography. C. R. MULLINS

Case of Acute Traumatic Cancer, LEMAITRE,NUYTTEN AND R. DANCOURT.Un cas de cancer aigu traumatique, Echo m6d. du nord 2: 61-62, 1934. A fifty-eight-year-old man suffered trauma to the wrist. Within a few days the wound began to enlarge and when he was seen two months later a lesion 6 om. in diameter was present. Biopsy showed it to be a squamous-cell carcinoma. It healed following treatment, 86 mg. radium, but the follow-up was brief. There are no illustrations and no references. C. R. MULLINS CLINICAL AND LABORATORY OBSERVATIONS 669

Chondroma and Traumatism, DUVOIRAND L. POLLET.Chondrome et traumatisme, Ann. d. m6d. 16g. 14: 837-840, 1934. A forty-three-year-old man presented a lesion of the upper humerus which was interpreted roentgenographically as a chondroma. There had been trauma to the arm two years and thirty-two years before, and this was thought to be an etiological factor. No biopsy was done and no follow-up is given. An x-ray photograph is shown. C. R. MULLINS

Osteochondroma and Trauma, A. MINNE AND M. MARCHAND-ALPHANT.OstBo- chondrome et traumatisme, Ann. d. m6d. 16g. 15: 559-565, 1935. In the discussion of the relationship of trauma to osteochondroma, the authors cite two cases. The first is that of a thirty-three-year-old man who was seen three months after having suffered severe trauma to the thigh. There was a bony spur on the femur just below the great trochanter. This was removed and the microscopic diagnosis was osteochondroma. [Cartilage is present in many osteomas.] The second patient was a twenty-one-year-old man who suffered a dislocation of the elbow, which was reduced. About one month later there was thickening of the tissues in the anterior region of the elbow and x-rays showed a shadow of increased density here. This was interpreted as osteochondroma [though in the x-ray reproduction it resembles myositis ossificans]. Beside roentgenograms, a microscopic section from the first case is reproduced. There is no bibliography. C. R. MULLINS

Chordoma, a Traumatic Tumor, A. PEYRONAND J. M~LISSINOS.Chordome. Tumeur traumatique, Ann. d. m6d. 16g. 15: 478-488, 1935. The authors discuss the nature of ‘‘ chordoma ” from the anatomical, pathological, and clinical points of view, with emphasis upon sacrococcygeal tumors. It is believed that trauma plays a definite r81e in the etiology, case reports being cited to support this view. About 25 per cent of the cases reviewed gave a definite history of trauma as the exciting cause. There is a moderately extensive review of the literature with a bibliography. C. R. MULLINS

Occupational Cancer, LUIGI CAROZZI.Le cancer professionnel, Arch. d’6lectric. m6d. 42: 85-93; 118-142; 155-160, 1934. In a review of industrial cancer the author states that it has the following attributes: 1. It is rarely unheralded, being almost always preceded by constitutional changes (toxemia) or by precancerous lesions. 2. It most often affects the skin and frequently appears at an age when cancer at this site is still uncommon. More rarely the lungs, urinary bladder, or bones are involved. 3. When the tumors are multiple, as they often are, they may develop either con- comitantly or in rapid succession. 4. The growths are somewhat more often carcinomas than sarcomas. 5. Several factors are often concerned, and it is not always possible to separate that causing the preliminary irritation from that which gives the final impetus (e.g., endocrine imbalance). The author believes that in extremely rare instances a single trauma may result in a malignant growth of the skin; as for the bones and internal organs, the evidence is uncertain at best. The time intervening between injury and neoplasm he states may vary from three weeks to a year for sarcoma, six weeks to a year for carcinoma, one to ten months for glioma, and from three weeks to two years for other varieties of tumor. This period is often shorter in the case of open wounds or burns, particularly where a carcinogenic agent such as hot tar is concerned. After this general discussion the author reviews the recent literature on cancer of the lungs among the miners of Joachimstal and Schneeberg, of the bladder in aniline dye workers, on sarcoma of the bones in those who apply luminous paint to watch-dials, G70 ABSTRACTS

and on cancer of the skin in those unduly exposed to sunlight, x-rays, arsenic, mineral oils, tar, soot, etc. WM. I€. WOGLOM

Silicosis and Malignant Disease, J. H. I~BLE.JIancet 2: 982-983, 1934. That the relationship between silicosis and cancer is more than coiricidcntal is shown, according to Ilible, by the finding of 3 cases of malignancy in 14 autopsies performed upon patients dying from the former disease. A fourth patient was found to have inyeloid leukemia, Two of the malignant lesions were found in the lungs and in one of these there was a second and entirely unrelated growth in the sigmoid colon. In the third case there was a small tumor in the liver similar in structure to a bile-duct carcinoma. A second tumor was also found in this case, an early carcinoma of the prostate, histologically unlike the first lesion. No illustrations are included. It is suggested that the soluble silica may act as a carcinogenic agent. In a letter to the editor W. Sampson Handley (Lancet. 2: 1128, 1934) discusses Dible's paper and suggests that instead of the silica itself causing the malignant growth, the lymphatic obstruction caused thereby is the responsible factor. [All of which is just as probable as that silica is a carcinogenic agent.] THEODORES. RAIFORD

Relationship between Carcinoma and Tuberculosis in Man, GERTRUDHEDDAEUB. Uber die Beeiehungen ewischen Carcinom und Tuberkulose beim Menschen, Ztschr. f. Krebsforsch. 42: 140-162, 1935 Florid tuberculosis and extensive carcinoma are rarely associated. Latent tuberculosis is frequently activated by the presence of a carcinoma. Tuberculosis, when it stimulates the reticulo-endothelial system, has an inhibiting effect on carcinoma. This stimulation is like that of other protein bodies-that is to say, non-specific. An extensive bibliography is appended. WM. H. WOGLOM

Leukemic Reactions in Carcinoma, L. M. KUGELMEIBIZ.Leukamoide Reaktionen bei C'arcinoni, Folia haemat. 53: 370-381, 1935. The fact that a blood picture resembling that of leukemia may appear in persons with advanced carcinoma has long been known, but it is important that the blood be studied from the differential diagnostic standpoint by modern methods and that the rather infrequent cases be described. The author adds two examples to our records. The first patient, a man of sixty-nine, had a history of one month's pain in the sacrum and back with sharp shooting pains in the left thorax. Blood examination showed 24,400 leukocytes, and the differential count was 64 per cent polynuclear neutrophils, 15 per cent lymphocytes, 11 per cent monocytes, 4 per cent eosinophils, 1 per cent irritation forms, and a few myelocytes. The red cell count showed a marked secondary anemia. The patient was too ill for a gastro-intestinal series or other radiological investigation and died nine days after admission. The final count showed erythrocytes 2,460,000; hemoglobin 52 per cent; leukocytes 21,600, with the appearance of myeloblasts 1 per cent, promyelocytes 2 per cent, myelocytes 6 per cent; plasma cells 3 per cent. The correct diagnosis was not made until autopsy, when a carcinoma of the lesser curvature of the stomach with metastases in the lumbar vertebrae was found. The second patient was a woman, forty-nine years old, who in contrast to the other patient had for many years had symptoms of gastric disturbance. In 1932 fluoroscopic examination did not show an ulcer of the stomach. In 1933 the gallbladder was removed because (if a large stone. Nine weeks after this operation the patient had severe pain in the knee- and ankle-joints, later extending to the shoulder and hip. She then began to lose weight very rapidly, and for this reason she was admitted. Death occurred in about a month, with a diagnosis of probable bone metastases of unknown source. The blood picture, on admission, showed red cells 4,560,000; hemoglobin 25 per cent: white cells 9,200, with very few abnormal forms. Three weeks later the leukocytes had increased to 15,000, myelocytes and myeloblasts had appeared, while the anemia had increased. Hemorrhages began to occur in the retina. The last blood study showed myeloblasts 2 per cent; promyelocytes 1 per cent; myelocytes 11 per cent. Autopsy revealed an unexpected scirrhous carcinoma of the lesser curvature with metastases in the regional lymph nodes, liver, pleura, vertebrae, and the long bones. CLINICAL AND LABORATORY OBSERVATIONS 671

Kugelmeier was able to collect from the literature only 31 cases [obviously an incomplete survey]. Most of the patients he found to be over fifty, the majority had carcinoma, only 9 of the 31 having sarcoma. The greater number had carcinomata of the digestive tract, but there were 3 cases of carcinoma of the breast, 2 of carcinoma of the gallbladder, 2 of carcinoma of the uterus, and one each of carcinoma of the prostate, lung, and penis.. The explanation of the changes in the blood is not simple. An earlier view held that it was due to local irritation or mechanical conditions setting up a com- pensatory hyperplasia of the marrow, which was displaced by central metastases. Autopsy observations of some of the patients, however, showed that the same blood changes could be found in those having very little metastatic involvement; hence this explanation had to be abandoned. A few of the cases collected had no bone metastases that could be discovered by the most careful post-mortem investigation. Another suggestion is that the tumor possesses toxic powers resembling those which are seen in the infectious diseases, but the answer to this is that extensive metastases may exist in the bones without the slightest change in the circulating leukocytes. It may be granted that the site of the tumor, the rapidity of its breakdown, and other unknown factors may be concerned in the picture, but certainly no satisfactory scientific explanation is at present available. The question of a coincident carcinomatosis and a leukemia has received some support from recent investigations on leukemia in mice which suggest that in these animals at least the disease is a malignant growth, but the number of reported cases in man of true leukemia combined with malignancy is only four, and also it is obvious that there are many persons with advanced carcinoma whose blood is not carefully examined shortly before death and in whom, in all probability, at one period or another, this leukemia-like change may exist unrecognized. Similar changes in the blood are also observed in other conditions, as, for instance, benzol poisoning and reactions after the use of typhoid vaccine, and it has been suggested that radiologists suffer frequently from myelogenous leukemia. It is obvious that the whole subject of leukemoid states needs further study. An excellent bibliography is appended.

Contribution to the Study of Reports of Intra-abdominal Tumors and Tumors of the Small Intestine, J. JALET. Contribution b 1’6tude des rapports des tumeurs intra- abdominales et de l’intestin gr&le, Bull. et m6m. Soc. de radiol. m6d. de‘France 22: 203-205, 1934. In considering the question of rare abdominal tumors, the author reports the case of a fifty-year-old man with a blood picture of lymphoid leukemia (1,000,000 white blood cells per cubic millimeter and 99 per cent lymphocytes). A large mid-abdominal mass was present, and since the x-rays showed no lesion in the gastro-intestinal tract, this mass was thought to consist of enlarged lymph nodes. Some improvement followed radiotherapy, but the patient soon succumbed. There are no illustrations and no bibliography is included. C. R. MULLINS

Some Rare Tumors in Infants, VIGNARD. Quelques tumeurs rares chez l’enfant, Avenir m6d. 32: 115-118, 1935. From an experience of twenty-five years the author recounts some of the unusual tumors that he has seen in children, including a large hydronephrotic kidney, weighing 2.5 kg., in a child nine years of age; two examples of large cysts of the kidney; two large ovarian tumors (one a dermoid in a child four years of age) ; a large hemangioma of the back which recurred after operation and was finally fatal; and a malignant tumor of the parotid in a twelve-year-old boy, with recurrence and final death from metastases. There are five photographs of the gross lesions. No bibliography is given. C. R. MULLINS

Sacrococcygeal Teratoma, It. STRAETMANS.TBratome sacro-coccygien, Bruxelles-m6d. 15: 527-528, 1935. The author describes a sacrococcygeal embryoma 15 cm. in diameter in a six-and-a- half month male fetus. It was remarkable not only for its size but also for the great variety of tissues it contained. WM. H. WOGLOM 672 ABSTRACTS

Pseudo-aneurysmal Tumor of the Hand, P. CH. FABREAND P. DAMBRIN.Tumeur pseudo-an6vrysmale de la main, Ann. d’anat. path. 12: 380-383, 1935. The authors report a tumor of the hand, mistaken for a cirsoid aneurysm, which proved at autopsy to be a metastasis from a carcinoma “ with clear cells and of trabecular or papillary structure,” involving the left kidney. The growth on the hand is called an (I atypical carcinoma.” A nodule extirpated from the parotid region. during life was described as a “ ganglion invaded by an atypical carcinoma of undetermined origin.” [No diagnosis is offered other than that quoted, but the illustration of the renal tumor strongly suggests hypernephroma.] WM. H. WOQLOM

A Case of Reticulo-endothelioma [Angioma or Endothelioma] of the Gluteal Region, CH. LENORMANTAND P. MOULONGUET.Sur un cas de r6ticulo-endoth6liome de la r6gion fessiAre, Ann. d’anat. path. 12: 425-428, 1935. The authors report a tumor of the gluteal region in a woman twenty-seven years of age, of unknown duration, and about 15 cm. in diameter. At operation it appeared to be encapsulated and was easily removed. The growth consisted of lobules containing a large vessel at the center and surrounded by rather dense connective tissue. Its cells were fusiform, with large nuclei, prominent nucleoli, and indistinct boundaries. Innumerable small vascular channels were to be seen, some lined by these proliferating cells, others by elements resembling normal vascular endothelium. A small amount of collagen was present in the form of fine fibrils lying among the tumor cells or encircling some of the capillaries. Certain areas were rather suggestive of malignancy, though when the patient was examined one year after operation there had been, so far, no recurrence. The neoplasm had evidently originated in vascular endothelium, and might be included among the proliferating angiomas. Two photomicrographs are included. WM. H. WOQLOM

Case of Hemolymphangioma of the Axillary Space, J. MINNEAND R. LOORIUS.Un cas d’h6molymphangiome du creux axillaire, Echo m6d. du nord 2: 611-612, 1934. Recausk of the rarity of cystic lymphangioma of the axillary region, the authors report the case of a seven-year-old child who had such a lesion with a recent history of growth. It was completely excised and diagnosed pathologically as cystic lymphangioma. Reference is made to similar cases in the literature. C. R. MULLINS

. Prognosis in Cancer, with Especial Reference to Visible Neoplasms, E. N. KIME. Arch. Phys. Therapy 16: 282-284, 1935. The author discusses the prognosis of cancer at large, but adds nothing of particular interest to the information already existing on the subject. THEODORES. RAIFORD

Grading of Malignancy in Terms of the Cytomorphology of the Mood, 0. C. GRUNER. Canadian M. A. J. 31: 623-626, 1934. While it is true that there is no specific change in the blood-cell formula in patients with carcinomas and sarcomas, it does not follow that a hematological study of the blood provides no help in the diagnosis of cancer. The characteristics which the author feels speak strongly for the presence of cancer are the following: (1) a strong ‘‘ phlegmasic ” reaction and double refractile granules and flakes of the fresh blood when viewed with crossed Nicol prisms; (2) the abundance of monocytes, especially of the endothelioid type in stained specimens; (3) the presence of intracellular bodies in these monocytes; , (4) great diminution of the trachychromatic lymphocytes; (5) only moderate leukocytosis, the non-segmented nucleates being 25 per cent of the neutrophiles, or over; (6) unusually thick nuclei in the neutrophiles, with bizarre contours and dark granules; (7) either a well marked hypochromic anemia and changes of size and shape, or hardly any abnormality of the red cells. Characters which almost certainly rule out cancer are: (1) absence of the changes in the fresh blood noted above; (2) a monocyte count of over 3 or even 4 per cent: (3) normal red cells without obvious abnormality of the white CLINICAL AND LABORATORY OBSERVATIONS 673 cell formula; (4) a neutrophilia of well over 80 per cent with leukocytosis and no abnormal monocytes; and (5) a high absolute and relative count for small lymphocytes. It must be remembered that the blood simply reflects interferences with the functional capacity of the organs and that neoplasms themselves all behave in different ways and may be relatively quiescent ” or ‘( active ” from the point of view of the blood. BENJAMINR. SHORE

Eosinophilia in Malignant Disease (A Case of Perirenal Reticulosarcama with Large Numbers of Eosinophils in the Blood and in the Tumor), J. PAVIOT,M. LEVRAT AND A. GUICHARD.L’Bosinophilie sanguine des tumeurs malignes (a propos d’un cas de rBticulosarcome p&i-r6nal avec Bosinophilie sanguine et tumorale), Ann. d’anat. path. 12: 113-130, 1935. A fifty-six-year-old man had a mass in the left hypochondrium resembling somewhat an enlarged spleen. His blood, on the two occasions when it ?as examined, contained 85,870 and 97,000 white cells, of which 46.2 per cent were polymorphonuclear eosinophils and 28 per cent young eosinophile cells with one or two nuclei. At autopsy, thirteen days after admission to the hospital, a retroperitoneal tumor 15 cm. in diameter was found involving the left kidney. Microscopic examination showed that it was unquestionably of connective-tissue origin, though of complex structure. Some portions, composed of syncytial strands crowded with clear, oval nuclei, resembled an embryonal reticulosarcoma. Others were composed of individual cells with long processes anastomosing among themselves or with those of neighboring elements to form a network whose interstices contained some erythrocytes and numerous other free cells, among which the eosinophil predominated. Still other fields represented angiosarcoma with irregular cavities of very variable size, lined by neoplastic cell8 which often assumed an endothelial character. The connective tissue was loose in some areas, more dense in others, and mature strands separated the angiomatous and reticular constituents, shading off insensibly into the latter. In the less differentiated parts of the growth, and especially in the reticular portions, there were areas of hematopoietic tissue containing myeloid cells, but never eosinophile myelocytes. Adult lymphocytes and plasmocytes were scattered throughout the tumor. The most interesting feature of this neoplasm was its extraordinary richness in eosinophile cells, of which there was a complete series: normal polymorphonuclear eosinophils, polymorphonuclears with but a few oxyphile granules, free monocytes with eosinophile granules, and finally cells resembling reticulo-endothelium, endothelial cells, and fibroblasts, all provided with oxyphile granules. There was thus a complete line from the fixed cell to the free, from the reticulo-endothelial element to the adult polymorphonuclear eosinophil. An occasional plasmocyte with oxyphile granulations and Russell bodies was encountered. The authors review the literature on eosinophilia in malignant disease and discuss the significance of the eosinophils in this sarcoma, but come to no definite decision. They are inclined to accept origin in the neoplasm itself by an eosinophilic transformation of connective-tissue cells, with subsequent escape into the blood stream. WM. H. WOQLOM

Carcino-sarcoma. A Study of the Microscopic Anatomy and Meaning of a Peculiar Cancer, W. F. HARVEYAND T. D. HAMILTON,Edinburgh M. J. 42: 337-378, 1935. After reviewing the opinions of various investigators on the nature of the spindle- shaped cells in the tumor widely known as carcinosarcoma, the authors present six cases of their own from the human subject and close with the following conclusions: There does occur a tumor containing both carcinoma and sarcoma, which may appropriately be called carcinosarcoma. The sarcomatous element is secondary to the carcinoma, and perhaps represents an exaggeration of the vigorous fibroblastic reaction sometimes seen in carcinoma. Tumors containing aggregations of spindle-shaped epithelial cells are easily mis- 674 ABSTRACTS

taken for carcinosarcoma. These may be called spurious carcinosarcoma, or carcinoma sarcomatoides. WM. H. WOGLOM

Benign Epithelial Invasion, W. BOYD. Canadian M. A. J. 31: 273-275, 1934. Invasion of the deeper tissues by surface epithelium, while a hall-mark of malignant disease, may also occur in benign conditions. This is commonly seen in the uterus, gallbladder, fallopian tube, and stomach. In the last three organs it is usually associated with chronic inflammatory changes. Several photomicrographs illustrate the article. [Ignorance of these facts, which have long been known, leads not infrequently, especially in the uterine cervix, to utterly unnecessary operative procedures.] BENJAMINR. SHOILE

DIAGNOSIS AND TREATMENT

Why Late Diagnosis in Malignancy? An Analysis of Two Hundred Late Diagnoses, E. 2:. SHEI’LEY.Canadian M. A. J. 31: 406-408, 1934. Two hundred consecutive patients with malignant disease who presented themselves with evidence of the diagnosis being made late in the course of the disease were studied in order to determine what factors caused this delay. The most important single factor was the patient’s ignorance concerning the disease. Other causes were procrastination, fear, absence of pain, misdirection by family and friends, and financial impediment. From this study it is readily seen that a combination of undesirable factors, to no small degree preventable, accounts for the inevitable terminal disaster. BENJAMINR. SHORE

Rble of the Pathologist in the Diagnosis of Cancer, W. 1,. ROBINEON.Canadian M. A. J. 31: 298-301, 1934.

When I‘ the rdle of the pathologist ” and not “ the rdle of the laboratory ” in the diagnosis of cancer is considered, the human element, the pathologist, is recognized. In these days of delicate instruments of scientific exactitude, and serological reactions of almost unbelievable accuracy, one is prone to rely unduly upon things mechanical and chemical and to forget the humanism in things scientific and religious. We are still dependent for the diagnosing of pathologic material upon the human element. The pathologist recognizes very early is his career that there is no standard picture of cancer that can be taken as a guide. In probably 90 per cent of the cases there is no difficulty. This percentage, however, is growing less and less and, vice versa, the problem is growing greater and greater. Without a doubt this is due to the increased interest manifested by the laity and medical profession in the ferreting out of suspicious lumps with which the human body seems to be so frequently afflicted. Inadequate amounts of tumor tissue sent in for examiiiation, poor preservation or an insufficient accompanying history, keep the percentage of obscure cases unnecessarily large. Even when those due to these causes are eliminated, we still have a definite percentage to worry about, and here the greatest personal skill and most exacting technic must be brought into play. BENJAMINR. SHORE Further Experiences with the Fuchs Reaction (2nd Communication), V. KAFKA,JR. Weitere Erfahrungen mit der Fuchsschen Reaktion (I1 Mitteilung), Ztschr. f. Krebsforsch. 42: 241-244, 1935. The author reports 447 tests carried out on 282 patients by the original Fuchs method or two of its modifications. In a general way the result was correct in 92.9 per cent. Considering only those 82 cases of carcinoma or other malignant tumor where the diagnosis had been liistologically confirmed, the correct results came to 89.1 per cent. In the second half of this series, however, 92.8 per cent was achieved. Thus the proportion of successes rose as the reaction became more and more perfected. Of 29 tests in 26 control cases, 88.4 per cent were right. A false reaction was ~b- tained in 3 patients with gastric ulcer (though in 11 previously tested the result had been correct) and in 2 with cirrhosis of the liver. WM. H. WOGLOM DIAGNOSIS AND TREATMENT 675

Place of Radiation Therapy, H. M. MORAN. New Zealand M. J. 33: 341-353, 1934. In the following group of tumors, irradiation treatment has no just claim to dominion: (1) malignant melanomas; (2) osteogenic sarcomas; (3) carcinoma of the stomach, pancreas, gallbladder, liver, adult kidney, and adrenals; (4) the glionias, meningionias, neurofihromas, vascular tumors of the brain, and tumors of the pouch of Rathke; (5) mixed-cell tumors of the testis; (6) sarcomas of the uterus. In the following group irradiation is justifiable if surgical excision has been tried and has failed or been found impracticable, and also as a routine if the association of irradiation and surgery is believed capable of enhancing the results obtained from operation alone: (1) cancer of the breast; (2) cancer of the buccopharyngeal region, the larynx, and the esophagus; (3) cancer of the salivary glands; (4) inoperable adenocarcinomas of the ampulla of the rectum; (5) carcinomas of the bladder and prostate; (6) adenocarcinomas of the uterus; (7) malignant diseases of the ovary; (8) Graves' disease: (9) secondary malignant deposits in lymph nodes: (10) some inflammatory conditions; (11) certain neuralgic and neurotic conditions. In a third list are enumerated those new growths and other non- malignant conditions in which irradiation can justly claim a most important part in treatment: (1) the basal-cell type of carcinoma of the skin; (2) squamous-cell carcinomas of the skin, including the lips and penis; (3) carcinoma of the tongue; (4) squamous carcinomas of the cervix uteri; (5) Ewing's tumor of bone; (6) lymphosarcomas; (7) seminomas of the testis; (8) pituitary adenomas of the brain; (9) fibromyomas of the uterus; (10) metropathia hemorrhagica; (1 1) certain blood diseases. BENJAMINR. SHORE An Adhesive Applicator for Radium Therapy, A. S. JOHNSTONE.Brit. J. Radiol. 8: 298-305, 1935. For the method of radium application described by the author a piece of adhesive plaster (elastoplast) is applied to the surface lesion; layers of adhesive felt and plaster are then added successively until the desired thickness is obtained. Small radium tubes or radon seeds are then arranged appropriately on another piece of adhesive plaster, which is applied to the mould. The applicator conforms readily to irregular surfaces, is light, easily made, and inexpensive. [If zinc oxide is present in the adhesive material, as it usually is in the United States, it may give rise to soft radiations which, with the irritating action of the plaster itself, may serve to increase the skin reaction.] CHARLESPACKARD Glycosuria Following X-Ray Therapy: A Case of Lymphadenoma, J. CARSLAW.Glas- gow Med. J. 122: 145-148, 1934. The author reports the case of an eighteen-year-old boy with Hodgkin's disease in whom glycosuria appeared following 123 deep x-ray treatments, 37 of which were over the abdomen. This was accompanied by a good deal of constitutional disturbance and a fever of 100" to 102" F. The urine was clear nineteen days after the sugar was first noticed and showed only occasional traces of sugar thereafter. This is a unique case in the author's rather wide experience in the x-ray treatment of leukemia and lymphogranulomatosis. He has no doubt that damage to the pancreas by the irradiation was the cause of the glycosuria. BENJAMINR. SHORE Value of Magnesium Chloride as an Aid in the Treatment of Cancer, a Preliminary Report, R. H. CRAIG. Canadian M. A. J. 31: 531-533, 1934. The author reports the case of a forty-three-year-old man with an extensive carcinoma of the larynx, in whom marked local improvement was obtained by the subcutaneous administration of magnesium chloride and the local application to the pharynx of a spray of magnesium chloride and pepsin. The exact amount of the drug administered is not stated. BENJAMINR. SHORE

Prophylaxis of Cancer in Women, S. DELLE CHIAJE. La prophylaxie dans la lutte contre le cancer chez la femme, Bruxelles-m6d. 15: 350-355, 1935. The author describes the program of a Neapolitan institute devoted to the control of cancer in women. WM. H. WOGLOM 676 ABSTRACTS

The Little Things in Which’Cancer May Develop and the Importance of Discovering Them Early so that Cancer May He Prevented or Easily Cured, J. C. BLOODGOOD. New Orleans M. & S. J. 85: 884-892, 1933. A plea for the early diagnosis and treatment of cancer, calling especially for attention to lesions of the skin, breast, oral cavity, and cervix, and to unexplained symptoms referable to the bones and digestive tract.

THE SKIN Case of Multiple Primary Squanlous-celled Carcinomata of the Skin in a Young Man, with Spontaneous Healing, J. F. SMITH. Brit. J. Dermat. & Syph. 46: 267-272, 1934. Self-healing Primary Squamous Carcinoma of the Skin, J. S. DUNNAND J. F. SMITH. Ibid. 46: 519-523, 1934. A short abstract of the first of these reports has already appeared (Am. J. Cancer 23: 147, 1935). In view of the publication of a second case, however, it has seemed advisable to repeat the first with some further details. The patient was a twenty-three-year-old miner. Seven years earlier reddish, macular spots had appeared on his legs. These enlarged and ultimately healed, leaving pitted scars. The disease had been continuous to the time of the report. At this time a large number of lesions were present, in various stages, over practically the entire body. These begin as minute, reddish papules resembling an early acne lesion, with a horny plug in the center. As they enlarge the centers ulcerate. Later the ulcer heals and the edges flatten out, leaving deep pitted scars. Microscopically the lesion is a downgrowth of epithelium, often with the formation of pearls. These epithelial plugs, however, do not show any tendency for the peripheral cells to spread through the surrounding connective tissue as is the case with true epitheliomata. The only attempt at therapy was the administration of two erythema doses of x-ray to one lesion, which had no effect, and the production of a cure in a small, early lesion by exposure to radium of unspecified amount and time. The second report concerned a forty-two-year-old man who presented himself with a lesion measuring 3.5 by 3 cm. in the skin of the right thigh. It was dull red in color and had a smooth, shining surface. In the center was a depressed area 1 cm. in diameter, which was dotted with irregular brownish hyperkeratotic points. The margin of this central area was undermined but there was nowhere any ulceration. The plaque was firm, elastic, freely movable, and neither painful nor tender. The inguinal lymph nodes on both sides were just palpable. The duration of the lesion was five weeks. The tumor was excised and histologic study of sections cut from the periphery to the center of the growth showed an actively growing squamous epithelioma in the outer margins with a gradual regression towards the center until only a superficial layer of stratified squamous epithelium remained. This formed the lining to a large crypt which contained squamous dbbris. On a continuous tracing of the whole process from without inwards, it became quite clear that this central area had once been the site of the same active epithelial invasion as was present at the periphery. This the authors interpret as the beginning of a spontaneous cure. One of the unusual features in this case was the size which the tumor had attained in five weeks of growth. [The duration as obtained from the patient, who apparently was not very clear on the subject, and the histological type of the neoplasm suggest a much longer period.] Rapidity of growth is usually associated with early involvement of the regional lymph nodes but this was absent in the present case. It is not impossible that some of the cases of primary epithelioma which are diagnosed clinically, excised, studied histologically, and cured permanently, are examples of the condition which has here been described and that, had they been left to develop naturally, they would have gone through the series of changes which end in a spontaneous cure. In the discussion the authors agree that the growth may not have been a true epithelioma. The article is illustrated with a photograph of the excised specimen and photomicrographs. THE SKIN 677

[It would seem questionable whether the term carcinoma should be used for such growths. They resemble very closely the keratotic downgrowths produced in the rabbit’s ear by the injection of scharlach R. These, as is well known, completely imitate epitheliomas, except that they heal spontaneously when the irritation ceases and never form metastases. Thus it is possible to produce the morphological appearance of an epithelioma without the cells developing those invasive capacities which are characteristic of true malignancy.] BENJAMINR. SHORE

Epithelioma on Lupus. Treatment by Irradiation, J. NUYTTENAND L. LEMAITRE. L’BpithBlioma sur lupus. Son traitement par les radiations, Echo m6d. du nord 2: 835-862, 1934. The authors discuss the pathogenesis, histologic forms, evolution, treatment, and prognosis of epitheliomas which develop in lupus lesions. They believe that the treatment of lupus by x-ray predisposes to malignancy, though this point of view is not generally accepted. Of their patients, 50 per cent had had radiation therapy previously. Lesions of this nature grow rapidly and invade neighboring bone quickly, but seldom metastasize to the nodes. In treatment, radium is preferred, either as needles or as a pack. If radium therapy cannot be carried out, x-rays are used. Reports of 22 cases are presented, !>f which only fifteen, mostly squamous, were proved by biopsy. Ten of the 22 patients were regarded as cured, 4 having passed the five-year period. Nine patients had involvement of the bone locally or metastases to the regional lymph nodes. Photographs of many of the gross lesions are presented, together with a fairly extensive bibliography. C. R. MULLINS

On the Dysontogenetic Origin of Basal-Cell Carcinoma, JOSEPHMCFARLAND, EMMETT F. CICCONEAND JOSEPHGELEHRTER. Am. J. Cancer 25: 273-281, 1935. A number of basal-cell carcinomas were plotted upon diagrams of the face in order that their distribution might be studied with reference to their origin through defective concrescence of the embryonal facial fissures, as suggested by Glasunow. The distribution, which was found to conform with that of other supposed dysontogenetic lesions (sequestration dermoids, mixed tumors), is entirely different from that of the more common squamous-cell carcinoma. Thus Glasunow’s suggestion is supported. WM. H. WOGLOM

Roentgen Therapy of Cutaneous and Mucocutaneous Epitheliomas, A. HAYEM. Roent- genth6rapie des Bpith6liomas cutan6s et cutan6o-muqueux, Echo m6d. du nord 2: 2940, 1934. For cancers involving the skin and mucocutaneous orifices the author usually em- ploys three seances of x-ray therapy, at two-day intervals, the total dose being about 4500 r. Thirty-two cases are reported involving all part,s of the body, but mostly the face. In only a few was biopsy done. Local cure was obtained in all but one case. Most of the patients were followed for only a short time. Two had known metastases in the regional nodes later. There are no illustrations and no references. C. R. MULLINS

Nevocarcinoma, E. GAUMOND.Naevo-carcinome, Bull. SOC.m6d. d. h6p. Universitaires de Qukbec, pp. 185-189, June 1934. The term nevocarcinoma designates those pigmented lesions of a malignant nature which usually develop from a pre-existing mole. In some few instances, however, there is no pre-existing lesion, as in the following case. A fifty-six-year-old woman had suffered from an ulceration of the heel for one year, trauma being an initial factor. Pathologically the lesion was a malignant melanoma. Local healing followed electrocoagulation and irradiation. No follow-up is given. Another case is mentioned in which rapid metastasis occurred. The possible r61e of trauma is considered. There are no illustrations. A short bibliography is appended. C. R. MULLINS 678 ABSTRACTS

THE BREAST

Diagnosis and Treatment of Doubtful Mammary Tumors, M. C. TODAND li. K. DAW- SON. Lancet 2: 1041-1045, 1934. Among the mammary lesions which may give rise to difficulty in diagnosis the authors find the following groups: (1) benign tumors: (2) chronic infections; (3) cystic changes; (4) early carcinoma; (5) acute carcinoma; (6) pregnancy and lactation tumors; (7) fat necrosis. Of the benign tumors, fibro-adenomas are the most conimon. When solitary, such tumors are not difficult to diagnose; when multiple and diffuse, especially in older patients, they may be associated with cyst formation or with undetected malignancy and may constitute a greater diagnostic problem. This form of tumor usually yields to conservative treatment, and shows no more tendency to malignant change than any other portion of the glandular tissue of the normal breast. If malignancy does develop, it is in the form of a sarcoma and its detection is relatively simple. A second type of benign tumor is the papilloma. This is regarded as an epithelial hyperplasia and the outcome is uncertain. The formation of large blue dome cysts is an indication of regression, but with this exception papillomata are to be looked upon with suspicion. The hard, fixed tumor not infrequently formed by chronic mastitis may be clinically similar to carcinoma. The axillary nodes are usually enlarged, though softer than in the presence of carcinoma. Malignancy may also be simulated by chronic tuherculous or syphilitic infection. Cystic changes in breasts may give rise to considerable uncertainty in diagnosis, especially since they are apt to appear at an age when carcinoma is to be suspected in all doubtful lesions. Again whether a single cystic mass or the diffuse, lumpy breast be clinically evident, one cannot definitely rule out the coexistence of a malignant tumor. Unfortunately the usual clinical signs associated with mammary cancer are significant of extensive malignant spread, and the early malignant lesion, whether developing in a pre-existing benign tumor or normal breast tissue, may give little or no evidence of its presence. Among the types of early cancer are early malignant change in a benign papilloma, early duct cancer, a very small cancer in a breast otherwise normal to palpation, early carcinoma associated with cystic change, and finally malignant tumors of the skin with secondary invasion of the underlying breast tissue. One of the rare forms of malignant growth is the so-called acute carcinoma which simulates infection. It is usually a diffuse carcinomatosis and extremely difficult to detect before treatment. However a careful history may eliminate other possibilities, especially if malignancy is borne in mind. Infection in the breast is rare aside from that connected with pregnancy and lactation. Treatment of these doubtful tumors is practically always surgical. Local ezcision suffices for fibro-adenoma in a young patient and possibly for some of the chronic infections. Obviously if the excised tissue proves malignant on histological examination, radical mastectomy should be carried out at once. Simple mastectomy is advisable in all cases when there is doubt as to the existence of malignancy except in the case of acute carcinoma and lactation tumors, where surgery should be limited to biopsy by electric cautery. With simple mastectomy, malignancy can be detected in the great majority of instances, if present, thus allowing the surgeon to proceed immediately with radical removal. If the nature of the lesion cannot be determined, there still remains the choice of completion of the radical operation, a two-stage procedure (waiting for the pathological report), and irradiation without further surgery. The authors have found the two-stage procedure adequate in many cases and feel that, if the second stage is not delayed too long, there is little to be feared from the dissemination of malignant cells in the few instances in which this procedure is called for. Radical mastcctomg is obviously indicated where there is reasonable assurance that the lesion is malignant. Collected statistics have shown that the highest survival rates are found where this is done at an early stage, hence no patient should be denied this advantage. Irradiation should be reserved for those cases in which the diagnosis of malignancy is ascertained, but the choice between surgery and irradiation is one which must be made for the individual case. There are six illustrations and a short bibliography. THEODORES. RAIFORD THE BREAST 679

Interstitial Radium Treatment of Carcinoma of the Breast: Description of a Radical Technique, R. G. HUTCHISON.Brit. J. Surg. 22: 465-474, 1935. Using Keynes’ technic (Brit. J. Surg. 19: 415, 1932. Abst. in Am. J. Cancer 16: abst. p. 1102, 1932) Hutchison, working in the Holt Radium Institute in Manchester, England, has evolved a method which is now brought forward with the claim that it is a radical, i.e., radiologically complete, implantation of radium in breast cancer. A detailed description of the implantation of the radium needles is included, with drawings and roentgenograms showing the needles in place in the breast, axilla, supraclavicular area, and mediastinum. The main features are: (1) the irradiation of a large volume of tissue in continuity; (2) the application of the allied principles of peripheralization of radium foci and of cross-fire irradiation; (3) a new approach to the problem of mediastinal lymphatic area involvement; (4) a new approach to the irradiation of the upper axilla so that an unbroken volume of radiation extends from the breast to the supraclavicular area; (5) extended irradiation of the supraclavicular zone. During 1931 and 1932, 53 cases of carcinoma of the breast were radically treated with radium implantation. During this period the policy was consistently adopted of referring all apparently operable cases for surgery, and of treating earlier cases only if there were definite surgical contraindications. Of the 53 patients treated, 17 or 32.1 per cent were alive at the time of the report, more than one year and under two years.. These results are gratifying when the material is considered. With the exception of 5 cases, all belonged to the late inoperable group. BENJAMINR. SHORE

Tumors of the Breast, JOHNF. ERDMANN.South. Surg. 3: 277-289, 1934. The material appeared, also, in Medical Record 140: 583, 1934 (Abst. in Am. J. Cancer 24: 439, 1935).

Carcinoma of the Breast in a Male Pellagrin, W. A. ELLISON. Med. Bull. Vet. Admin. 12: 74-75, 1935. A case of mammary carcinoma in a white male is reported. Although a mass had been present for twenty years, enlargement with ulceration had begun only three years before the patient’s initial examination. The recent clinical evidence of malignancy was thought to be due to the presence of pellagra; in other words, the presence of a severe nutritional disease was believed to have caused the benign tumor to undergo malignant change. [This idea does not conform with the results of experimental studies of the subject.] THEODORES. RAIFORD

THE EYE

Melanoma of the Choroid: the Prognostic Significance of Argyrophil Fibers, G. R. CALLENDERAND HELENORCAMPBELL WILDER. Am. J. Cancer 25: 251-258, 1935. One hundred and twenty cases of melanoma of the choroid studied by the Division of Ophthalmology at the Army Medical Museum form the basis of this report. No metastases occurred when all areas of the primary tumor contained argyrophil fibers, but metastasis took place in 36 per cent of the cases in which some areas had no fibers and in 57 per cent of those with fibers only in the stroma of the primary growth. The results are more striking among the patients followed for five years or longer. No deaths are recorded for the first group, 68 per cent for the second, and 100 per cent for the third. Classification according to fiber content thus affords an aid in prognosis, a decrease in fiber production indicating an increase in malignancy. The paper is illustrated by 12 photomicrographs. WM. H. WOGLOM

Hemangioma of the Conjunctiva, S. SANYAL.Calcutta M. J. 28: 172-175, 1933. Of the ocular angiomas, those belonging to the conjunctiva proper are rare. During the past sixty-six years only 33 such cases have appeared in the literature. The author reports the case of a twenty-six-year-old man with multiple conjunctival angiomas of the 680 ABSTRACTS right eye which had been present since birth but which had begun to grow only during the past six months. The large lesion was 6 mm. in diameter and involved the cornea for a distance of 3 mm. The lesions were scraped off the cornea and the whole mass of tumor with the underlying conjunctiva was excised. The base was cauterized with phenol and sutured. There had been no recurrence one year after operation. Hih- tologic study showed the lesions to be angiomas. One colored drawing is included. BENJAMINR. SHOltE

Report of an Unusual Case of Orbital Tumour, W. H. Gow. Brit. J. Ophth. 18: 520- 524, 1934. The author reports the case of an eighteen-year-old girl with a large tumor of the left orbit of five years’ duration. The excised specimen was cystic, measured 21 cm. in circumference, and contained 90 C.C. of thick brownish fluid. The wall of the cyst was fairly uniform in thickness in the posterior half but anteriorly it was thickened considerably with the remnants of the eyeball, the thickened cornea and conjunctiva, and parts of the lids. Histologic study showed the lining to be squamous epithelium. The diagnosis of epithelial or dermoid cyst was made. While cysts of this type are often found in the region of the eye, the interest in this case liea, first, in the fact that it must have arisen posteriorly to the eye ball, and secondly, in the size to which it had grown, causing a complete flattening of the eye ball. No similar case could be found in the literature. The article is illustrated with photographs of the patient before and after operation, and photomicrographs, some of which are in color. BENJAMINR. SHORE

THE ORAL CAVITY AND UPPER ’ RESPIRATORY TRACT Use of the Diathermy Knife in Malignant Disease of the Mouth, Nose and Pharynx, N. PATTERSON.Lancet 2: 633-636, 694-698, 1934. The author reports on 109 cases of malignant disease treated by diathermy or endothermy before 1929, that is, more than five years before the time of reporting. The sites were the tonsils, soft palate and faucial pillars (51 cases); tongue and floor of the mouth (31); hard palate, upper alveolus and maxillary antrum (8); buccal mucosa of cheek (6) ; lower alveolus (3) ; nose, postnasal space and posterior oropharyngeal wall (10). Of the tonsil group cases, 40 were squamous-cell carcinomas and one an endothelioma; the remaining 10 tumors were not histologically examined, mostly because the tumors were destroyed by diathermy in the earlier years before routine use of biopsy. Of the 51 patients, 12 lived free from recurrence for over five years (this number included 3 cases in which no biopsy was made). Of 31 patients with lingual .cancer, 8 survived for over five years. In 15 of the tongue cases the lymph nodes were invaded, and none of these patients survived for five years. Of the 3 patients with cancer of the lower alveolus, one lived over five years and died without recurrence. For carcinoma of the mucosa of the cheek diathermy is generally unsatisfactory and may be expected to give good results only in cases where the disease has not penetrated deeply. Two patients treated by local application of diathermy only died within two years, but without local recurrence. Four patients operated upon with the aid of the endothermy knife were living without recurrence over five years after treatment. Carcinoma of the hard palate and maxillary antrum is also treated by a combination of ordinary surgical methods and diathermy. Of the author’s 8 patients, one of whom had a melanotic carcinoma, 2 lived more than five years. Five of the 10 patients with malignant tumors of the nose, postnasal space, and posterior pharyngeal wall lived over five years, but 2 of these subsequently died of recurrence. The author concludes his paper with a discussion of the treatment of the cervical nodes. In the presence of definite cervical metastasis a block dissection of the neck THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 68 1 should be done unless contraindicated by the extent of the involvement or the condition of the patient. The endothermy knife was found to be unsatisfactory for neck dis- sections. A bibliography is appended.

Treatment of Cancer of the Mouth by Surface and Interstitial Irradiation, G. E. PFAHLER. Radiology 23: 472-475, 1934. The author begins the treatment of cancer of the mouth with external irradiation with the radium pack or x-rays, followed almost immediately by local surface application of radium inside the mouth, using radium element filtered through 2 mm. of platinum and 1 to 3 mm. of rubber. Interstitial applications are made with iridio-platinum needles having a wall thickness of 0.5 or 0.6 mm. and containing 1, 2, or 3 mg. of radium element. The Rmall quantity needles are usually left in place about five days. Occa- sionally 10 mg. radium needles having a wall thickness of 0.4 mm. of monel metal are used where short exposures (four hours) are desired. Radium packs are made up with Columbia paste or felt pads or sponge rubber. A distance of 4 to 6 cm. is used. The 10 mg. radium units are encased in 1 mm. of gold and 1 mm. of platinum and are so distributed as to give about 1 mg. per square centimeter. Usually 150 mg. are applied to the affected side and 100 mg. to the other side, the packs being left in place twenty-four hours. The treatment is repeated two or three times a week until 30,000 to 50,000 mg. hr. have been given. When necessary, such treatments are supplemented by 200 kv. roentgen irradiation, using 2 mm. copper filtration. . Small carcinomata of the lip are usually excised, with subsequent x-ray treatment of the regional nodes. Large lesions are irradiated with interstitial and surface applications of radium. For cases of carcinoma of the lip treated prior to Jan. 1, 1929, the following figures are given.

Not Well Dead traced Total Local lesions less than 1.5 cm. diameter...... lo7 16 4 127 Lesions more than 1.5 cm. diameter...... 25 17 2 44 Cases with palpable lymph nodes...... 7 23 1 31 For other carcinomas of the oral cavity treated by the present technic .the following figures are given.

Well Less than Not 5 yrs. 3 yrs. 3 yrs. Dead traced Tongue ...... 16 5 6 77 2 Cheek...... 7 10 5 19 3 Tonsil ...... 2 2 6 14 3 Lowerjaw...... 6 3 2 26 2 Palate and pharynx. ...., ...... 9 6 3 29 1 GRAYH. TWOMBLY

Treatment of Malignant Tumors of the Upper Jaw and Ethmoid Bone at the Sabbatsberg Ear Clinic, G. OHNGREN. Om behandling av maligna overkaks-och silbenstumorer vid Sabbatsbergs Bronklinik, Nord. med. tidskr. 7: 135-143, 1934. In the first ten years of the Sabbatsberg Ear Clinic the usual treatment for malignant tumors of the upper jaw and ethmoid consisted in open resection, occasionally combined with postoperative irradiation. Results were not satisfactory, however, and the method of hot cauterization as used by Crile and New was tried but this was replaced by Paterson’s method of internal heating of the tissues by electric currents. For the past ten years nearly all cases have been treated by this method, either alone or in combination with irradiation. There was a marked improvement in results following its adop- tion, with a lower operative mortality rate and greater frequency of primary healing and of lasting cures. In nearly all cases electrosurgery was followed by radium treatment. In all 253 cases were treated, about 80 per cent being operated upon, the other 20 per cent being too far advanced for operation. As the first period was regarded as more or 682 ABSTRACTS less experimental, the author has chosen the 142 cases treated during the period 1924-31 as a basis for his study. Of these tumors, 111 were aarcinoma and 20 sarcoma. There were 11 rnaligriant tumors of the parotid and salivary glands. The orbit was involved in on(’ third of the cases and there were metastases in nearly one fourth of all the operated CtlS(’S. ‘I‘he symptoms and prognosis vary according to the site of origin. In antcrior, inferior and medial tumors an early diagnosis is possible, and in these cases prognosis is relatively good owing to the facility with which resection can be accomplished, wilhout injury to the dura or large vessels. The inferior lateral and superior lateral tumors are not, as a rule, diagnosed until a later stage owing to their more hidden location, and prognosis in these cases is less favorable, though far from hopeless. The superior and posterior medial tumors are difficult to heal and are associated with early involvement of the dura so that radical electrosurgery is impossible and the possibilities of radiotherapy are limited. Often electrosurgery is possible without external incision (Holmgren’s technic), but in tumors invading the external cheek and ethmoid tumors of difficult access, an external incision may be necessary. Immediately after operation 100 mg. of radium distributed in 4 tubes, with a filtration equivalent to 3 to 4 mm. lead, is introduced and left in aitu for fifteen hours. The dosage of radium varies according to whether the patient was given preoperative irradiation and according to the distance of the tumor from the dura. Later irradiation of the node region is undertaken, whether or not metastases are dernonstrable. In cases treated by Holmgren’s method, the final defect is often minimal, but after coagulation of tumors infiltrating the skin and invading the orbit extensive plastic reconstructidn may be necessary. The larger defects may be closed fairly simply with pedicled skin flaps from the region of the shoulder blade. Skin from the forehead has also been used, but this method leaves a visible scar. At the turn of the century prognosis in these cases was almost hopeless, with a primary mortality from hemorrhage and pneumonia of 20 to 40 per cent, and rapid recurrence in the remaining cases. After the introduction of roentgen therapy the results improved somewhat. Electrosurgery combined with irradiation has represented a decided advance. The percentage of five-year cures at the Sabbatsberg clinic is given as 38 per cent. A patient with tumor of the upper jaw or ethmoid may now remain well from five to nine years after beginning of combined treatment with electrosurgery and irradiation. The author urges more careful examination of persons over fifty years of age with unilateral nasal obstruction or unilateral empyema of the antrum or pain in the region of the medial branch of the trigeminus. Roentgen control, exploratory trephination, and histologic examination may prevent such subjects from suffering for months under a diagnosis of nasal polyp, maxillary sinus empyema, or trigeminal neuralgia.

Diagnosis and Treatment of Adamantinoma, C. M. LOOSDON.J. Am. Dental A. 21: 1838-1841, 1934. A case of adamantinoma occurring in the maxilla of a thirty-six-year-old woman is reported. It was treated successfully by resection, curettage and cauterization of the cavity with 90 per cent phenol. The defect was packed with iodoform gauze and . allowed to granulate slowly. Logsdon points out that unless all of the adamantine tissue is destroyed, rapid recurrence will take place. GRAYH. TWOMBLY

Cystic Adamantinoma of the Lower Jaw, A. T. MOORE. South. M. J. 27: 928-933,1934. Cystic adamantinoma of the jaw is a commoner tumor than is usually supposed. Five cases have been personally observed by the author. The tumors are of slow growth and may be classified according to cell type as cuboidal-cell, columnar-cell (or cylin- droma), and stellate-cell. The first patient of three described in detail was a woman of twenty-eight who had had a slowly enlarging tumor of the lower jaw for seven years. She had been told that this was a hopeless cancer and had refused all treatment until the tumor was larger than THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 683

a child’s head and had almost occluded the esophagus and trachea. Because of emacia- tion, a gastrostomy was done and three transfusions were given. Three weeks later the tumor was resected after a preliminary tracheotomy, but the patient failed to survive the operation. A second case occurred in a man of thirty-eight. The tumor was first noticed eight years before resection. It was treated by curettage and had recurred eight times in seven years. The jaw was partially resected but when the patient was last seen he apparently had another area of recurrence in the mandibular stump. The third patient was a negress of twenty-five who noticed a painless swelling of the lower jaw three years before entry. It increased slowly to the size of a small orange and was unsuccessfully curretted, following which almost the entire jaw became involved. The mouth could not be closed. Saliva and foul discharge dripped con- tinuously from the corners of the mouth, The patient lost 50 pounds in weight and could swallow only liquids. This tumor was successfully resected, although it was adherent to the under side of the tongue and to the front of the larynx. There was no recurrence after twelve months. In discussing this paper Dr. A. R. Shands reported three more cases seen at the Duke Hospital, Durham, N. C. GRAYH. TWOMBLY

Periapical ,Osteofibrosis with Formation of Cementoma, E. C. STAFNE. J. Am. Dent. A. 21: 1822-1829, 1934. A complete dental roentgenographic examination of 10,000 consecutive adult patients at the Mayo Clinic showed 24 cases of cementoma, indicating that this tumor is less rare than is usually believed. Mandibular teeth are involved seventeen times as frequently as maxillary teeth. Of 65 cases observed, 81 per cent involved the mandibular incisors. Trauma seems to be of no etiological significance. Some tumors have been found in edentulous areas. In no instance was pain present and with two exceptions all the involved teeth were vital. The ages of the patients varied from twenty to sixty-two years. Three typical roentgenological stages can be distinguished. The first is usually confused with periapical abscess, but may be distinguished by the lack of symptoms, normal color and vitality of the tooth, and a slightly more radio-opaque appearance than the usual granuloma. The second stage shows a radio-opaque central mass of cementum in the radiolucent cavity. In the third, quiescent or mature stage the tumor ceases to grow. There is a dense opaque central mass of cementum separated from the surrounding bone by a narrow radiolucent band. No treatment is required, as a rule, as the tumors remain small and the teeth affected invariably remain vital. Eight excellent photomicrographs and 14 roentgenographs accompany the article. GRAYH. TWOMBLY

Case of Odontoma Revealed by X-ray, LAMARQUEAND DAMON. Un cas d’odontome d6cel6 A la radiographie, Bull. et m6m. SOC.de radiol. m6d. de France 22: 294-295, 1934. In a twenty-five-year-old man who presented himself with a fistula of the lower jaw, the x-ray showed a well defined tumor of increased density in the mandible. It was successfully removed and proved to be an odontoma. An x-ray photograph of the lesion is presented. There is no bibliography. C. R. MULLINS

Case of Sarcoma of the Upper Jaw with Sinusitis of the Antrum of Highmore, B. SUKHAVANAM.Indian M. Gaz. 69: 510, 1934. This is a short report of the successful surgical excision of a primary sarcoma originating in the maxillary antrum of a four-year-old child. The histologic characteristics of the growth and a record of the patient after leaving the hospital are not included. There are no illustrations. BENJAMINR. SHORE 684 ABSTRACTS

Neuro-epithelial Dysembryoma of the Pharyngo-Hypophyseal Region Invading the Superior Maxilla in a Fetus of Seven and a Half Months, V. LE LORIERAND P. ISIDOR.Dysembryome neuro-6pitheliomateux de la region pharyngo-hypophysaire ayant envahi le maxillaire superieur chez un foetus de sept mois et demi, Ann. d’anat. path. 12: 167-174, 1935. A neoplasm causing an enormous tumefaction of the left side of the face was observed in a female fetus of seven-and-a-half months, particularly about the region of the parotid gland. The growth, which contained ependyma, choroid, retina, and tissue reminiscent of the choroid plexus, is referred to abnormalities in the development of the chorda dordis and the neural tube. The tumor had invaded the surrounding tissues after the manner of a malignant growth. WM. H. WOGLOM Adenocancroid of the Tongue, K. SUMII. ther einen Fall von Adenocancroid der Zunge, Gann 29: 121-131, 1935. A woman fifty-seven years of age had a tumor, the size of a finger tip, on the right side of the tongue. In spite of irradiation with x-rays and radium the tumor grew larger and at the same time the condition of the patient became worse. The tumor was removed. Histologically it was unlike a common squamous-cell epithelioma, being made up of glandular carcinoma and squamous-cell epithelioma, i.e., an adenocancroid. The report is illustrated by a photograph of the gross specimen and three photomicrographs. K. SUGIURA Cancer of the Nasal Accessory Sinuses, F. L. LEDEHER. Arch. Phys. Therapy 16: 199-206, 1935. One of the reasons for the poor prognosis attending malignant growth of the nasal sinuses is that, for obvious reasons, the tumor cannot be diagnosed clinically. In the presence of pain, nasal obstruction, cranial nerve disturbances, and swelling about the eye and face, the possibility of tumor should be borne in mind. Diagnostic procedures should include rhinoscopy, roentgen examination, and biopsy. Even these frequently fail to disclose the type of growth and the extent of invasion. The most satisfactory treatment for cancer of the accessory sinuses, in the light of our present knowledge, combines electrosurgery with irradiation; the neoplasm is radically removed with its osseous attachments, followed by the application of radium to the cavity thus formed. The literature is reviewed briefly and there are seven illustrations, some of which show patients before and after treatment. No actual figures on mortality and curability are presented. A short bibliography is appended. THEODORES. RAIFORD Cured Carcinoma of Nose and Antrum, M. H. SHUTES. Laryngoscope 44: 924-928, 1934. A woman of‘ fifty-one complained of left tinnitus auris subsiding after six weeks of treatment. Two years later she was again seen, with left nasal obstruction of four months’ duration. Examination revealed a friable cauliflower-like carcinoma filling the left naris. Biopsy showed this to be a papillary squamous-cell carcinoma, grade 11. Curettage was performed through a Caldwell-Luc incision. The antral walls were thoroughly cauterized with the electrodesiccating current and the intranasal mass transfixed and thoroughly desiccated. In the following week six x-ray treatments were given. Two weeks after operation 500 mg. hrs. of radium with 1 mm. brass and 2 mm. rubber filtration were applied in the left nostril; 750 mg. hr. of radium were given in the left antrum with 0.5 mm. lead and 2 mm. rubber filtration. Five months later 1200 mg. hr. were given in the antrum (0.5 mm. platinum and 2 mm. rubber filtration) because of an area in which recurrence was suspected. There was no evidence of further recurrence five years after the original operation. GRAYH. TWOMBLY Epithelial Tumor of the Baso-sphenoid Encroaching on the Nasopharynx and Both Ethmoids, T. 0. HOWIE. J. Laryng. & Otol. 49: 852-854, 1934. A baso-sphenoid tumor is reported which had caused nasal obstruction, loss of smell, frontal headache, and right external rectus paralysis. In spite of treatment with radium, THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 685

the patient died. Biopsy showed an epithelial tumor which the author considers an atypical adenocarcinoma of the hypophyseal stalk arising from an ependymal rest. There are no illustrations. THEODORES. RAIFORD

Nasal Polyps with Special Reference to the Polyp of Allergic Origin, J. A. M. CAMERON. J. Laryng. & Otol. 49: 833-836, 1934. Cameron classifies nasal polyps as follows: (1) simple mucous polyps; (2) cystic polyps: (3) glandular polyps; (4) amyloid polyps; (5) eosinophile polyps. The last type, with which this paper deals, is thought to be of allergic origin. The primary differences between it and other types are the predominance of eosinophils and the degree of edema of the matrix. As a rule, these polyps occur in patients suffering from asthma, hay fever, and vasomotor rhinitis, and sometimes in patients sensitive to food and aspirin. The cells of the polyp, aside from the fibroblasts of the matrix, consist of eosinophils and plasma cells, with a small proportion of lymphocytes. Two types of eosinophils are described : one a cell with bilobed nucleus and coarse oxyphile granules, indistinguishable from the eosinophils of the blood stream; the other a mononuclear type with fine granules, of the same size as a plasma cell. The latter type Cameron believes, is conceivably a tissue cell, altered and adapted to meet a chemical change in the tissue. The former type seems to predominate in rapidly growing polyps while the latter is found in the chronic, slowly developing polyps. It is suggested that all polyps be examined microscopically after removal. If they prove to be of the eosinophile type, treatment for the underlying allergic basis should be instituted. There are no illustrations. THEODORES. RAIFORD

Further Observations on a Case of Plasmacytoma of the Nasal Cavity: Case of Nasal Plasmacytoma and Carcinoma of the Stomach, H. ROSENWASSER.Laryngoscope 44: 826-828, 1934. This case is one originally reported in the Laryngoscope 40: 576, 1930 (Abst. in Am. J. Cancer 15: 984, 1931). It was treated by radium and deep roentgen irradiation with relief of symptoms, and the tumor was thought to be composed chiefly of lymphoblasts and lymphoblastic plasma cells. Eight months after the earlier report the patient was again admitted to the hospital, complaining of numerous small nasal hemorrhages, and a recurrence in the left antrum and ethmoid was removed by means of a Caldwell-Luc operation. Two months later a second recurrence was treated by wide excision with the electrocautery. Seven months after this, a third recurrence was excised with a second Caldwell-Luc operation. A year later the patient was free of local disease but had lost 39 pounds and complained of gas and abdominal distress. X-rays showed a large carcinoma of the fundus of the stomach. Autopsy failed to show any evidence of the plasmacytoma. The tumor in the stomach was an anaplastic carcinoma with metastases to liver, pancreas, pleura, and regional lymph nodes. GRAYH. TWOMBLY

TwoCases of Nasal Neurofibromata, M. MITTLEBACHAND F. WOLETZ.Zwei Falle von Neurinom der Nase, Med. Klin. 31: 275-277, 1935. The author reports the histories of two patients with intranasal neurofibromata. In the first case the growth was about 6 cm. in diameter and had eroded the inferior orbital plate and medial wall of the antrum. In the second case the tumor was much smaller and lay completely within the right nasal cavity. Histologic study of both specimens showed them to be typical neurofibromata. [Though there are no photomicrographs the type of tumor is the one now variously called schwannoma, neuro- fibroma, neuroma, or neurinoma. The latter term is due to Verocay, whose paper (Beitr. I. path. Anat. u. z. allg. Path. 48: 1, 1910) is still worth reading. Stout (Am. J. C. 24: 751, 1935) has suggested a new name to obviate the present confusion and proposes neurilemoma.] BENJAMINR. SHORE 686 ABSTEACTS

Treatment of Nasal Angioma of a Child, P. N. RAY. Calcutta M. J. 29: 1~1-122,1934. A six-year-old girl complained of repeated severe hemorrhages from an angioma on the tip of the nose. The hemorrhage was controlled by fine catgut ligatures inserted through the skin around the lesion. Aspiration caused a considerable reduction in the size of the tumor, and ten days after application of a pressure bandage the bulk was still further reduced, with cessation of pulsation. Two injections of sodium morrhuate were necessary for complete thrombosis of the growth. A photograph of the patient is included. BENJAMINR. SHORE

Carcinoma of the Tonsil. Clinical Study of 176 Cases with Histologic Diagnoses, J. J. DUFFY,New York State J. Med. 34: 865-869, 1934. Of the patients entering the Memorial Hospital between 1919 and 1929, one of every ten with intraoral cancer had carcinoma of the tonsil. The usual complaints are a sense of constant irritation or soreness in the throat, especially on swallowing, and in advanced cases pain referred to the ear, head, or neck. The duration of symptoms before hospital admission is rarely less than two months and usually four to six months. A painless mass in the upper cervical region over the carotid bulb may be a metastasis from a small primary tumor in the tonsil. Such masses are frequently incised under the diagnosis of ‘I abscess.” Of the 176 cases forming the basis of this report, 40 were classified as early primary and 136 as advanced. If, however, only those cases were considered early in which the primary growth was limited to two contiguous regions, and which at the same time showed no cervical metastases, the number of early cases was only 15. Eight per cent of the series were graded I, 72 per cent 11, 5 per cent 111, and 15 per cent as transitional- cell carcinoma and lympho-epithelioma. One adenoid cystic epithelioma was found. Sixty-four patients did not have cervical metastases on admission (36.4 per cent). 111 18 of these, cervical metastases developed. Forty-five patients had operable nodes on admission; 67 had advanced inoperable metastases. Fourteen patients had bilateral node involvement on admission; in 5 with nodes on the same side as the lesion nodes promptly developed on the opposite side; 3 patients had cross metastases when first seen; that is 12.5 per cent showed either cross or bilateral metastases. All cases in the group were treated either with radium or x-rays, the details of the therapy varying from year to year. Following external irradiation the residual tumor was implanted with gold radon seeds. Seventeen of the patients without node involvement on admission died of uncontrolled primary lesions. If the primary growth was of adult type and controllable by irradiation, radical neck dissection was performed in cases with metastatic nodes. Of 46 patients who had no cervical metastases, 15 or 32.6 per cent remained free of disease for three years or more. Of 18 patients with node metastases appearing after admission, 5 or 27.7 per cent remained free of disease for three years or more. The presence of operable metastases on admission reduced the three-year cure rate to 15.5 per cent, 7 out of 45 patients. Of 67 patients with inoperable cervical metastases on admission, only 5 survived three years. Three patients were lost from observation. The total three-year cure rate for the whole group was 32 out of 176, or 18.1 per cent. GRAYH. TWOMBLY

Congenital Adenoma in the Supratonsillar Recess, L. ELOY. Tumeur fibromateuse cong6nitale au niveau du recessus sus-amygdalien, Bruxelles-m6d. IS : 251-252, 1934. An account of a mucous gland adenoma behind the left tonsil, in a thirty-year-old woman. [The report has no value, as there is no information as to the structure of the tumor and no proof of its cnngenital origin. No illuntrations are furnished.] WM. H. WOGLOM

Malignant Disease of the Larynx and Pharynx, A. ZUPPINGERAND R. STEWARTHAR- RISON. J. Laryng. & Otol. 49: 720-731, 1934. This is a statistical report on the results of treatment in 159 cases of carcinoma of the larynx and pharynx at the Roentgen Institute at Zurich. One hundred and twenty THE ORAL CAVITY ANT) UPPER RESPIRATORY TTlACT 687 patients completed treatment; 27 were living and free from all evidence of recurrence at the time of the report, two and one:half years or more after treatment; 9 died of intercurrent disease, but free from local evidence of pathology, during the first half year after treatment; 14 died of intercurrent disease more than one year after treatment. In ‘25 cases distant metastases developed, although in these cases there was no evidence of local or regional recurrence. Fifteen recurrences were encountered, but only one of these developed after the first year had elapsed. It is therefore calculated that after two and one fourth years from completion of treatment the absolute success or number entirely well, was 17 per cent. Relative success, or the percentage remaining well of all patients seen, was 26 per cent. The local success of treatment was 53 per cent. While the treatment administered is not described in detail, the authors consider protracted fractional irradiation preferable in all malignant lesions of the pharynx and the vast majority of carcinomas of the larynx. Statistical data are presented in four tables. For a more detailed study of the results the reader is referred to the original article. THEODORES. RAIFORD

Normal and Pathological Larynx under Suspension Laryngoscopy, F. E. LEJEUNE. South. M. J. 27: 770-772, 1934. This is a description of a number of motion pictures, taken with the help of suspension laryngoscopy, showing normal and pathological larynges. Photographs of a normal larynx, vocal cord nodules, multiple papilloma of the larynx, inoperable carcinoma of the mouth of the esophagus, and a hemangio-endothelioma of the false cord are reproduced. GRAYH. TWOMBLY

Cancer of the Larynx: Laryngectomy, E. A. LOOPER. South. M. J. 27: 772-776, 1934. According to Looper, 4 per cent of all cancer cases are laryngeal and of these 1 per cent are papillary carcinomata, 2 per cent are basal-cell carcinomata, and 96 per cent are squamous-cell carcinomata. Early diagnosis is of first importance, the most characteristic symptom being hoarseness or alteration in the voice. The growth usually starts in the anterior two thirds of the cord. It must be distinguished from tuberculous laryngitis, chronic laryngitis, and syphilis. Biopsy is the most important diagnostic procedure. Localized lesions may be successfully removed through a laryngeal fissure. Larger ones require total laryngectomy, best done under avertin anesthesia. Three drawings of carcinonia of the intrinsic larynx illustrate the article. GRAYH. TWOMBLY

Treatment of Cancer of the Larynx: Laryngofissure vs. Laryngectomy, M. EQUEN. South. M. J. 27: 776-780, 1934. According to Equen carcinoma of the larynx constitutes 5 per cent of all cancers. Hoarseness is the most important early symptom. Equen believes that biopsy is best obtained by the use of the Lynch suspension laryngoscope with the patient under a general anesthetic. Twenty per cent of the cases of laryngeal carcinomata are suitable for removal through a laryngeal fissure. Of these, 80 per cent can be cured. Larger growths may be treated by laryngectomy done in one stage under avertin anesthesia. ‘I Radiation, sometimes coupled with tracheotomy, often gives marked temporary palliation in inoperable cases.” Laryngectomy is absolutely contraindicated only by the presence of distant metastases. GRAYH. TWOMBLY

Papillomata of the Larynx with Case Reports, B. F. GLOWACKI.J. Michigan M. SOC. 33: 564-565, 1934. A girl of two years was so hoarse that she could neither cry nor speak. Following the removal of numerous papillomata from the larynx she remained well for six months. The tumors recurred, however, were removed, and again recurred, with dyspnea, in two months. Tracheotomy was then performed and the tumors slowly disappeared. After a year and a half the tracheotomy tube was removed and at the time of the report the patient had remained symptom-free for two years. 688 ABSTRACTS

A similar case occurred in another child of two, who had been treated for colds and hoaraeness since the age of seven months. The tumors caused dyspnea, and crying resulted in laryngeal spasm with partial asphyxia. Tracheotomy was performed, and magnesium oxide was given daily, but without appreciable effect. At the end of a year the tumors were still present and were then removed surgically. GRAYH. TWOMBLY Malignancy and Benign Growths of the Gums, Cheeks, etc., CHAS. M. PROCTOR. Internat. J. M. & Surg. 47: 311-312, 1934. A few brief observations on tumors of the oral cavity.

THE SALIVARY GLANDS

An Inquiry into the Origin of the Mixed Tumors of the Salivary Glands, with Reference to Their Embryonic Interrelationships, P. L. Lr AND CHI-SHIH YANQ. Am. J. Cancer 25: 259-272, 1935. After an examination of 25 mixed tumors about the head in regions other than the salivary glands the authors conclude that this type of growth is probably embryonic in origin. The intra-oral group seems to be derived by invagination of the oral ectoderm, a’s was assumed by Wilms, while extra-oral growths result from ectodermal inclusions caused by the fusion of branchial clefts and various fissures of the head and neck, or arise from anlagen of mucous or lacrimal glands or of hair follicles. The paper is accompanied by 9 photomicrographs and an extensive bibliography. WM. H. WOGLOM Tumor of the Submaxillary Gland, C. R. MARTIN. Tumeur de la loge sous-maxillaire, Arch. m6d. d’bngers 38: 58-59, 1934. This is a short report of a patient from whom a cyst of the submaxillary gland was successfully removed. There is no mention of microscopic examination. C. R. MULLINS

THE THYROID GLAND

A Rare Form of Thyroid Cancer, H. GAUDIERAND E. HOUCKE.A propos d’une forme rare de cancer thyroldien, Echo m6d. du nord 2: 257-259, 1934. The author reports a rare type of thyroid malignancy. The patient was a thirty- two-year-old woman with a goiter of nineteen years’ duration, growing rapidly for one year. The gland was removed surgically but the patient died within a few weeks with clinical and x-ray evidence of pulmonary metastases. Pathologically the tumor was malignant in nature, with a mixture of epithelial, cartilaginous, and osseous elements. ??here are no illustrations and no references. C. R. MULLINS

INTRATHORACIC TUMORS Round Shadows in the Lungs, L. UDVARDY.TJber die in den Lungen sichtbaren Rund- schatten, Rontgenpraxis 6: 713-723, 1934. The author points out that while rounded, well circumscribed x-ray shadows in the lung fields usually indicate a tumor of some type, this finding cannot be taken a8 an absolute criterion, since not onIy do certain other conditions, such as bronchopneumonia, produce it, but certain tumors, even if metastatic, not infrequently form irregular shadows. Of utmost importance in differentiating neoplasms is a careful examination of the margin of the shadow. Benign tumors have the most sharply demarcated borders, with perhaps some fibrous reaction in the surrounding lung tissue. Circular shadows due to infectious processes, on the other hand, are more likely to present a hazy outline. Malignant primary lung tumors are apt to infiltrate at their margins and excite con- THE DIGESTIVE TEACT 089

siderable fibrous and inflammatory reaction. Confirmatory signs of malignancy are bronchial stenosis, atelectasis, elevation of the diaphragm, and exudate in the pleural cavity. Invaluable as adjuncts to roentgenography are the response to irradiation and the clinical findings. Primary malignant tumors and tuberculous and echinococcus infections show little response to radiotherapy, while secondary malignancy and the lymphoid tumors are radiosensitive, usually diminishing in size after treatment. The history, sputum examination, blood examination, and other tests are of aid in confirming or ruling out certain specific lesions. T’welve illustrations depict the radiographic findings in proved cases. A short bibliography is appended. [The radiation of tuberculous pulmonary lesions is not without danger, as death has been known to follow from hemorrhage.] THEODOREs. RtlIFORD Radiologic Bronchoscopy in the Diagnosis of Primary Cancer of the Lung, R. HUGUENIN AND NEMOURS-AUGUSTE.La bronchoscopie radiologique dans le diagnostic du cancer primitif du poumon, Bull. et m6m. Soc. de radiol. mCd. de France 22: 454-461, 1934. The authors discuss the use of lipiodol injections into the bronchi in neoplasms of the - -%rig. They favor injection through a tracheal catheter, with fluoroscopic observation at short intervals, the patient being placed in various positions to control the distribution of the liquid. X-ray plates are taken at intervals. In this way the bronchial stenosis, which in the authors’ opinion always accompanies a tumor, can be detected. In their experience this method has been very helpful in the diagnosis of lung tumors. Illustra- tive x-ray photographs are presented. C. R. MULLINS

So-called Endothelioma of the Pleura, S. SCHEIDEGGER.t’ber die sog. Endotheliome der Pleura, Ztschr. f. Krebsforsch. 42: 93-116, 1935. Cells resembling endothelium were found in three primary tumors of the pleura in addition to masses of typical epithelium. But similar elements were discovered in a carcinoma that was unquestionably of bronchial origin, and in another that originated in the parenchyma of the liver. Malignant growths of the pleura spring in all probability from misplaced epithelial remnants and the terms endothelioma, mesothelioma, and perithelioma should be dis- carded, except in the case of tumors actually arising in the vessels, which may properly be called endotheliomas. The paper is illustrated by three photomicrographs and an equal number of drawings. WM. H. WOGLOM

THE DIGESTIVE TRACT

Three Cases of Carcinoma of the Esophagus Treated by Radon, G. YOUNG. J. Laryng. & Otol. 49: 848-850, 1934. Three patients with carcinoma of the esophagus were treated by radon. At the time of this report, all three were improving, were gaining in weight, and were symp- tomatically much relieved. The time elapsed since treatment in the three cases was eleven, eight, and eight months. THEODORES. RAIFORD Carcinoma of the Esophagus with Fistula into the Air Passages, W. G. SCOTT-BROWN. Lancet 2: 544-545, 1934. Four cases are reported, one in some detail, in which a carcinoma of the esophagus had perforated into the air passages so that a barium emulsion taken by mouth was seen by x-ray to have passed into the bronchial system. All four patients died as a result of the malignant disease. [They have been known to die of the barium.] It is suggested that in any case of esophageal carcinoma in which productive cough is a prominent symptom, especially when aggravated by taking food, a fistula should be suspected. The apparent good health of the patient may be misleading, for usually such a lesion leads to early death. One patient lived for seven months after the diag- GOO ABSTRACTS nosis was definitely established. A roentgenogram is included showing barium which liss passcd from the esophagus into tlic smaller hranches of the bronchial tree. ‘rHEODOltE s. RAIPORD

Cancer of the Esophagus Opening into the Right Bronchus, ,I. ‘l’irmx AND 1,. (’miis- ‘VIAENS. Cancer dc l’oesophage ouvcrt duns la brunche droitc, 1i:cho ni6d. du nord. 2: (57-69, 1934. Autopsy upon a forty-four-year-old man who had died rather suddenly showed a carcinoma of the esophagus with perforation into the right bronchus. The patient had suffered from some gastric symptoms for three months prior to death but there had been nothing to suggest an esophageal lesion. There are no illustrations and no references. C. R. MULLINR

Cancer of the Esophagus Revealed by a Metastatic Tumor of the Elbow, B. D’HALLUIN, BELLEAND DERBONNETS.Cancer de l’oesophage r6v6l6 par une tumeur m6tasta- tique du coude, Bull. et m6m. Soc. de radiol. m6d. de France 22: 404-405, 1934. In a patient with a tumor of the elbow, diagnosed clinically and radiologically BS a sarcoma, the arm was amputated. Microscopic examination showed a metastatic epithelial tumor. At a later date, fluoroscopic examination of the esophagus revealed a tumor in the upper portion. No biopsy was done. There are no illustrations and no references. C. R. MULLINS

Case of Pharyngeal Diverticulum Following Malignant Stricture of the Esophagus, E. J. G. GLABS. J. Laryng. & Otol. 49: 741-742, 1934. Glass reports a case of pharyngeal diverticulum which was first diagnosed thirteen months after the treatment by irradiation of a carcinoma of the esophagus. This, he believes, may indicate two features in the development of diverticula: first that it is possible for them to form within a year; second, that malignant stricture may be a contributing factor. The patient died from the effects of the cancer five months after the presence of the diverticulum was observed. There are no illustrations. THEODORES. RAIFORD

Case of Cancer of the Esophagus, L. LARUE. Un cas de cancer de I’csophage, Bull. 8oc. m6d. d. hap. Universitaires de QuBbec, pp. 399-400, November 1934. A report of a carcinoma of the esophagus in a forty-six-year-old woman, this being the only one in a series of 900 autopsier;;. It presented no unusual features. C. R. MULLINH

Precancerous Lesions of the Stomach and Intestine, W. J. M. SCOTT. Med. Times 81 Long Island M. J. 61: 280-281, 1933. A brief discussion of intestinal polyposis and adenomas.

Polyposis of the Gastro-intestinal Tract, C. GuTra AND A. HERZOG. Polypenbildung im ganzen Magen-Darmtrakt, Rontgenpraxis 6: 671-676, 1934. wthorsreport a case of polyposis of the entire gastro-intestinal tract, which was diagnoi3ed roentgenographically, in a girl of sixteen. The large number and small size of the small intestinal lesions, however, made diagnosis extremely difficult since they appeared, as was the case in the stomach also, as mere indentations of the transverse folds of the mucosa. Complete autopsy findings are presented with the detailed case report, and six illustrations depict the roentgenographic appearance of the various portions of the bowel and the gross lesions. There is a short bibliography. THEODORES. RAIFORD

Carcinoma of the Stomach, U. 1’. 13Asu. Indian M. Gas. 69: 828-830, 1934. This is a general review of carcinoma of the stomach based upon 12 cases autopsied nt the Calcutta Medical College between 1914 and 1933. This small number of cases is THE DIGESTIVE TRACT 691 dependent upon the fact that very few autopsies can be obtained in the Calcutta hospi- tals. The author is extremely pessimistic about the treatment of these cases and suggests that surgery and irradiation are only palliative in their effects. BENJAMINR. SHORE

Clinical Importance of Achlorhydria, A. F. HURST. Brit. M. J. 2: 665-669, 1934. Hurst devotes a section of this paper to achlorhydria and gastric carcinoma. He believes that achlorhydria is a result of the combination of chronic gastritis and a hypos- thenic gastric constitution. Hence when free acid is absent in the presence of gastric carcinoma, gastritis must have been a forerunner of the malignant disease. The same combination of factors, he believes, may produce the true picture of Addisonian anemia, and it is not unusual to see this disease associated with carcinoma. He considers gastritis the basic factor for the development of gastric malignancy. A short bibliography is appended. THEODORES. RAIFORD

The Diagnosis between Gastric Ulcer and Cancer, R. A. GUTYANN.A propos du diagnostic entre l’ulchre gastrique et le cancer, Arch. d. mal. d. l’app. digestif 25: 281-288, 1935. The author gives a short discussion of the clinical and laboratory features differentiating gastric ulcer and cancer, with illustrative case reports. In some cases it appeared that cancer developed in a pre-existing ulcer, while in others the crater was apparently malignant from the start. No new observations are presented. There are no illustrations and no references. C. R. MULLINS

Cancer of the Pylorus and Old Ulcer of the Lesser Curvature, R. CUVELIERAND L CHRISTIAENS.Cancer du pylore et ulcke ancien de la petite courbure, Echo m6d. du nord 2: 18-21, 1934. Because of the rarity of the simultaneous occurrence of ulcer and neoplasm in the stomach, the author reports this case in a sixty-two-year-old man. Symptoms suggestive of ulcer had been present for two years, with a change in the nature of the symptoms for two months. In the resected specimen there was a carcinoma of the pyloric region with a benign chronic ulcer on the lesser curvature about 9 cm. proximal to it. There are no illustrations and no references. C. R. MULLINS

False Radiographic Image of Pyloric Cancer. Probable Spasm, J. TIPREZAND R. CUVELIER.Fausse image radiologique de cancer pylorique. Spasme probable, Echo m6d. du nord 1: 747-749, 1934. A forty-nine-year-old woman showed clinical and x-ray signs of a pyloric neoplasm, with a palpable mass in the epigastrium. About three weeks later the mass had disappeared and repetition of the barium x-ray studies showed the stomach to be normal in appearance. The patient is well six years later. The authors regard antral spasm as the most likely cause of the phenomena observed. C. R. MULLINS

Radiologic Image of an Ulcer of the Lesser Curvature Simulating a Pyloric Cancer, R. CUVELIERAND H. MALATRAY.Image radiologique fournie par un ulchre de la petite courbure et simulant un cancer pylorique, Echo m6d. du nord 2: 558-560,1934, In a fifty-five-year-old man who had suffered with gastric disturbances for one year, x-ray examination indicated a carcinoma of the pylorus with a crater, the walls being fairly rigid in this region. Resection was done and the lesion was apparently an ulcer. No microscopic examination is reported. There are no illustrations and no bibliography. C. It. MULLINS

Cancer of the Stomach in Brothers, GEoitGE T. PACK. Ann. Surg. 100: 1010-1018,1934. A report of cancer of the stomach in brothers aged fifty-two and fifty-four years of age. Thc younger man was admitted to the hospital complaining of postprandial pain and loss of weight. A tumor was palpable in the epigastrium and at operation was found 692 ABSTRACTS to occupy the pylorus, antrum, and part of the pars media. Excision was followed by an uneventful recovery. The pathologic diagnosis was adenocarcinoma of tubulo-alveolar structure, grade 111. The only complaint of the older patient, who was seen while his brother was still in the hospital, was loss of weight. He had no palpable tumor, but x-ray study revealed a carcinoma in the prepyloric segment. This tumor proved to be an alveolar and diffuse adenocarcinoma, Grade 111, with areas of typical malignant colloid adenoma. Both patients were well seven months after operation with no sign of recurrence. A study of the family history revealed no other case of cancer.

Rapid Evolution of a Cancer of the Stomach, WEIGEL. Evolution rapide d’un cancer de l’estomac, Bull. et m6m. SOC.de radiol. m6d. de France 22: 56-57, 1934. A forty-five-year-old man had a malignant lesion of the stomach which on exploration proved to be inoperable, though four months previously an x-ray examination of the stomach with barium had been negative. The author stresses the necessity of repeated x-ray examinations in the presence of suggestive symptoms. c. R. MuLLINa Some Rare Tumors of the Stomach (Sarcoma, Syphilis and Lymphogranulomatosis), GUNSETT,SICHEL, BOUTON, CORNU, RITTER AND SCHNEIDER.Quelques tumeurs rares de l’estomac (sarcome, syphilis, lymphogranulomatose), Bull. et m6m. SOC.de radiol. m6d. de France 22: 5&63, 1934. Three cases are discussed. (1) A forty-eight-year-old man had an extensive tumor of the stomach and surrounding nodes. Biopsy showed lymphosarcoma. Radio- therapy was given and the patient is well ten years later. (2) The second case was not proved by biopsy. The patient was a forty-seven-year-old woman with syphilis who had a lesion of the stomach diagnosed roentgenographically as malignant. The clinical and x-ray symptoms disappeared following radiotherapy. The author believes that radiotherapy is effective in syphilitic lesions of the stomach. (3) A forty-three-year-old man had proved Hodgkin’s disease and gastric disturbances. Roentgen examination of the stomach showed absence of folds and hyperperistalsis. The clinical and x-ray signs disappeared following radiotherapy to the stomach. The ultimate result is not given. The author cites four other reported cases of Hodgkin’s disease with gastric involvement. There are no illustrations and no references. C. R. MULLINS

Tumor of the Stomach and Epigastric Region Treated by Roentgen Therapy, GuNaETT, SICHEL,BOUTON, CORNU AND SCHNEIDER.Affection tumorale de l’estomac et de la region kpigastrique, traitbe par roentgenthbrapie, Bull et mem. SOC.de radiol. m6d. de France 22: 522-523, 1934. A woman twenty years of age had a large tumor of the stomach, confirmed by laparotomy. Biopsy of a regional node showed hyperplasia with no tumor. The blood count was normal. Following radiotherapy the tumor disappeared and the patient was well about six months later. There are no illustrations and no references. C. R. MULLINS

Submucous Lipomas of the Stomach, J. VERNE,J. TROISIER,M. BARIOTYAND G. BROUET. Lipomas sous-muqueux de l’estomac, Ann. d’anat. path. 12: 475-476, 1935. A sixty-four-year-old man was admitted to the hospital in a semiconscious and exsanguinated condition suggesting internal hemorrhage. He died fifteen hours later. At autopsy, the widely dilated stomach was found to contain a large quantity of blackish fluid. After this had been washed away a uniform fatty coating about 2 mm. thick was visible through the atrophic mucosa and lining the entire organ. About 10 tumors of the same lipoid nature projected into its cavity, the largest approximating the size of an almond, the smallest that of a pea. The fatty coating did not extend into the duodenum nor were any additional lipomas found in other portions of the digestivo tract. Microscopic examination showed that the tumors were typical lipomas and that the mucosa was the seat of a chronic atrophic gastritis. WM. €I. Wwxmi THE DIGESTIVE TRACT 693

Benign Tumor of the Duodenal Bulb, J. SENEQUE,R. A. GUTMANNAND DIOCL~S. Tumeur bknigne du bulbe duodknal, Bull. et mem. Soc. de radiol. m6d. de France 22: 314-315, 1934. In a fifty-eight-year-old woman who had suffered with indigestion for thirty years x-rays showed a tumor of the duodenal bulb. At operation a small pedunculated polyp was removed from the first portion of the duodenum. The patient was well five months later. There are no illustrations and no bibliography. C. R. MULLINS

Circumscribed Angioma of the Intestinal Tract, R. BENSAUDE,P. HILLEMANDAND J. M. GENESTOUX.Un nouveau cas d’angiomes circonscrits du tractus intestinal, Arch. d. mal. d. I’app. digestif 25: 95-97, 1935. The authors report the case of a fifty-five-year-old woman who suffered for several months with bloody diarrhea and progressive anemia, and died following exploratory laparotomy. At autopsy, multiple small angiomata of the small intestine were found, as well as four lesions in the sigmoid colon. Microscopically, they resembled cavernous angiomata. References are given but there are no illustrations. C. R. MULLINS

Carcinoma of the Jejunum, E. W. MITCHELL. Canadian M. A. J. 31: 395-397, 1934. The case of a seventy-year-old man from whom 35 cm. of the jejunum containing a stenosing carcinoma were successfully resected is reported. Histologic study showed the growth to be an adenocarcinoma with extension to the regional lymph nodes. No follow-up is given. BENJAMINR. SHORE

Radiologic Examination of the Mucosa of the Colon. Radiologic Diagnosis of Some Affections and Tumors of the Colon, R. MATHEY-CORNAT.Contribution i l’examen radiologique de la muqueuse colique. Le radio-diagnostic de quelques affections et tumeurs des cdlons Bull. et m6m. Soc. de radiol. mBd. de France 22: 435-437, 1934. The author discusses the x-ray diagnosis of lesions of the colon, stressing especially , the use of the air contrast method for showing up the mucosal pattern. By this method, minor changes can be detected, including inflammatory changes and early neoplasms. Illustrat,ive cases are cited. There. are no illustrations and only a scanty bibliography is included. C. R. ,MULLINS

Growth and Differentiation in Papillary Adenocarcinoma, R. BAUMANN.Wachstum und Differenzierung papillarer Driisencarcinome, Ztschr. f. Krebsforsch. 42: 178-191, 1935. A papillary adenocarcinoma of the large intestine developed after the manner of normal glandular tissue. The striking general uniformity in distance between tubules and the orderly arrangement of these along the main excretory ducts indicated a regularity in growth and structure far removed from the disorderly proliferation that is so widely believed to be characteristic of malignant growth. The article is illustrated by photomicrographs and diagrams. WM. H. WOGLOM

Large ‘‘ Fecaloma ” of the Transverse Colon Proximal to a Constricting Neoplasm, COSTANTINIAND LE GENISSEL. Volumineux fBcalome du cBlon transverse en amont dlun n6oplasme en virole, Bull. et m6m. Soc. de radiol. m6d. de France 22: 197-199, 1934. The authors report the unusual case of a seventy-four-year-old man who had a large abdominal mass which at operation proved to be a hard collection of fecal material proximal to a constricting neoplasm. Death was due to peritonitis. A roentgenogram is included. There is no bibliography. C. R. MULLINS

Early Diagnosis in Rectal Cancer and Prognosis on the gasis of Dukes’ Classification, E. A. DANIELS. Canad. M. A. J. 31: 012-610, 1934. The principle of the Dukes method is the classification of rectal cancers, after the rectum has been excised and examined, into three categories according to the extent of spread by direct continuity. In Group A are those cases in which the carcinoma is 604 ABSTRACTS limited to the wall of the rectum, there being no extension into the extrarectal tissues and no metastases to regional lymph nodes; in Group B are those cases in which the carcinoma has spread by direct continuity to the extrarectal tissues, but has not yet invaded the regional lymph nodes; and in Group C are those cases in which, after extrarectal spread, metastases are present in the regional lymph nodes. Preoperative clinical appraisal of the prognosis on the bases of Dukes’ studies leads to the following conclusions. In Group A the symptoms and signs are few and arc usually of a vague character. The lesion may be discovered accidentally during examination, or, because of increasing constipation, the physician’s attention may have been directed to the terminal bowel. The striking thing about a patient in this group will be his good color and robust appearance. In Group B cases there is usually a history of persistent, unexplained constipation, perhaps alternating with periods of diarrhea. In some cases blood may be present in the stools.. The patient’s general condition is fair, although there may be unexplained fatigue, low backache of a dull nagging character, hypogastric discomfort, and perhaps attacks of vesical irritability. The Group C case is characteristic; rectal signs and symptoms may have been present for many months or distressing rectal symptoms and signs may have recently presented themselves, following upon a period of disturbed bowel action and failing health. The patient looks ill and there is an obvious anemia. Inguinal adenopathy is however not present in the advanced group C cases unless the growth has extended down and involved the anal circumference. This study suggests the possibility of a preoperative grouping of rectal cancers based on the clinical history of the disease. BENJAMINR. SHORE

Cancer of the Rectum, Hartmann Operation, J. CHARRrER. Cancer du rectum; nouvelle methode d’ablation par la voie abdominale (operation de H. Hartmann), J. de chir. 44: 26-45, 1934. In a certain number of cases of cancer of the rectum it is unnecessary, in the author’s opinion, to do the combined abdominoperineal resection. In 16 of 55 cases he has employed a modification of Hartmann’s technic, which consists in removal by the abdominal route without resection of the terminal rectum. This would seem to be desirable in patients who are poor operative risks, as in those of advanced age. The inethod is applicable to lesions of the rectum corresponding to the reflection of peritoneum in the pouch of Douglas, as well as the recto-sigmoid region. Such an operation is usually done in two stages, the first being a permanent colostomy and the second a resection of the tumor with closure of the peritoneum and suprapubic extraperitoneal drainage after the method of Coffey. A rectal drain is left in. Among 16 cases treated by this method, the operative mortality was 18 per ccnt (3 cases). Twelve patients have been followed for periods up to three years and two have had recurrences, the others being apparently well. An extensive discussion is included, with illustrations of the operative technic and a fairly complete bibliography. One photograph of a gross specimen is also shown. C. R. MULLINS

Prolonged Survival in a Case of Inoperable Cancer of the Rectum Treated by Colostomy, R. CLEUET. A propos d’une survie prolong6e dans un cas de cancer inoperable du rectum trait6 par un anus iliaque, Echo m6d. du nord. 1: 213-214, 1934. In a fifty-eight-year-old woman with symptoms of chronic low intestinal obstruction rectal exanhation revealed what seemed to be a typical carcinoma of the rectum. Colostomy was done and the patient lived slightly over ten years, dying apparently of metastases. Neither biopsy nor autopsy was done. C. It. MIJIAINS

Villous Papilloma of the Rectum, I?,€3. ROWMAN.Canadian hf. A. ,J. 31 : 488-489, 1931. Villous papillonias of the rectum vary in size, some being quite small, others as largc :IS a cauliflower. They are usually not pedunculated, having a more or less Iiroad nttaclr- nrcnt to the rectal wall, The surface is villous in character, and the finger-like processcAs ifill float if placed in water. The tumors are grayish-red and arc soft and spongy. There is usually no induration at the base, and the tendency to recurrence is slight. hdenoniatous areas arc frequently found, and malignant changes can be expected in from 12 to 20 per cent of the growths if neglected. All papillomas should be considered precancerous Icsions. The trcatinciit ih radical and the tumor should be removed completely, if possible, before infection has set in. This can be well done by electrocoagulation, even if malignancy is proved, although radical cxcision or irradiation with radium may be undertaken. The author reports the case of a fifty-six-year-old man who died of a large neglected villous papilloma of the rectum. Early malignant changes were found in the growth at autopsy. One photograph of the gross specimen and two photomicrographs are included. BENSAMINR. SHORE

RETROPERITONEAL TUMORS Retroperitoneal Sarcomatosis, €1. F. G. IRWIN. Brit. M. J. 2: 1149, 1934. A forty-seven-year-old woman died after rapidly progressing cachexia and abdominal distention of one month’s duration. Autopsy disclosed an advanced retroperitoneal lymphosarcomatosis with peritoneal metastases, presumably of lymphoid origin. THEODORES. RAIFORD An Autopsied Case of Retroperitoneal Teratoma in a Woman with Extensive Metastases in Organs and Lymph Nodes, M. NISHI. Ein Sektionsfall von Retroperitoneal- teratom bei einer Frau, welches zum Teil malignos entartet und an den verschiedenen Organen und Lymphdrusen metastasiert gefunden wurde, Gann 29: 101-120, 1935. In a woman of thirty-seven years there was accidentally discovered, after her third normal parturition, a tumor in the left hypochondrium. In the course of four years this gradually enlarged and eventually icterus, nausea, distention and dilatation of thc stomach were observed. Autopsy revealed a retroperitoneal dermoid cyst with malignant changes. This case is of interest because the tumor was found far removed from the ovary and because it had undergone malignant changes and given rise to extensive metastases. The article is illustrated by a photograph and several photomicrographs. K. SUGIURA

THE PANCREAS Cancer of the Pancreas, R. SOULIGNAC.Cancer du pancr6as, Avenir m6d. 32: 56-62 1935. The author presents a general discussion of pancreatic malignancy from the point of view of pathology and clinical evaluation. No cases are reported and no new observations are made. There is a fairly extensive review of the literature, with a bibliography. C. R. MULLINS

Mussulman Prayer Attitude in a Patient with Cancer of the Pancreas, R. MESSIMYAND P. ISIDOR.Attitude de la prihre Musulmane dans un cancer du corps du pancr6as, Ann. d’anat. path. 12: 213-215, 1935. Report of a cancer of the pancreas causing severe pain, to alleviate which the patient knelt almost constantly, day and night, with her body inclined sharply forward and her face pressed against the side of the bed, supporting herself on her semiflexed arms. The bizarre attitude and the perpetual complaint are ascribed to her deficient mentality. WM. H. WOGLOM

THE BILIARY TRACT Primary Carcinoma of the Liver Revealed by Vertebral Metastasis, P. BRODIN,M. UOLGERTAND A. PLACA. A propos d’un bpithblioma primitif du foie r6v616 par une mbtastase vertbbrale, Ann. d’anat. path. 12: 355-359, 1935. A case of bone metastasis from a liver carcinoma is reported in a man forty-seven years of age. No similar instance could be found in the’literature. For a long period 096 ABSTRACTS there was nothing to direct attention to the liver, whose enlargement did not become manifest until five months after the appearance of the first symptom, excruciating pain in the legs, and three months before death. The only signs discoverable for some time were those of a radiculitis. WM. H. WOGLOM

THIC FEMALE GENITAL TRACT

Cancer and Fibromyoma, ROUFFART-MARIN.Cancer et fibrome, Bruxelles-m6d. 15 : 332-335, 1935. Cancer of the cervix or of the body of the uterus may remain unrecognized for a long time in the presence of a fibromyoma, for the bleeding is obscured by the hemorrhage from the latter. Several illustrative cases are recorded. Curettage offers the only reliable diagnostic aid. WM. H. WOQLOM

Management of Carcinoma Cervix-Uteri, S. MITRA. Calcutta M. J. 28: 120-132, 1933. Contrary to general belief, cancer is not an infrequent disease in Bengal. The patients usually come late for treatment and little can be done for them. Of 360 cases of carcinoma of the uterine cervix treated during the past six years, 60 per cent showed infiltration of the parametria and 37 per cent involvement of the base of the bladder. Since 1932 vaginal hysterectomy with postoperative irradiation has been used for all operable cases. Twenty-four of the total number of 360 patients were treated more than five years previously, and 16.6 per cent, including both early and late cases, survived the five-year period. BENJAMINR. SHORE

Carcinoma of the Cervix Occurring after the Production of the Menopause by Radium, M. JONES.J. Obst. & Gynaec. Brit. Emp. 41: 848-849, 1934. This is an abstract of a short paper read by Jones in May 1934, in which he reported the case of a forty-eight-year-old woman in whom a carcinoma of the cervix developed two years after the production of an artificial menopause by irradiation. Histologic. study of tissue removed at the time of the first radium treatment showed no evidences of malignancy. The author stresses the fact that the diagnosis of malignant disease of the uterus cannot always be made by histologic study of curettings. The production of the menopause by irradiation is, in reality, the suppression of a symptom, leaving in many cases an unhealthy organ behind. BENJAMINR. SHORE

Heterotopic Bone in a Columnar-Celled Carcinoma, H. E. HARDINGAND F. S. KIRK. J. Obst. & Gynaec. Brit. Emp. 41: 760-761, 1934.. ?‘he authors report the case of a sixty-year-old woman with an extensive and inoperable carcinoma of the uterus. Histologic study of curettings showed a columnar- celled carcinoma with degenerative changes in the epithelium. One large nodule which required decalcification before sections could be cut showed definite bone trabeculae with bone corpuscles, osteoblasts, osteoclasts, and haversian canals. Blood-forming marrow was not found. The article is illufitrated with one photomicrograph. BENJAMINR. SHORE

Endometriosis as a Manifestation of Ovarian Dysfunction, T. N. A. JEFFCOATEAND A. L. POTTER.J. Obst. & Gynaec. Brit. Emp. 41: 684-707, 1934. No matter by what mechanism the origin of the endometrial elements in endometriomas is explained, their subsequent development is thought to be due to over- activity of the follicular secretory apparatus in the ovary. Follicular over-activity was demonstrated in the majority of 111 cases of endometriosis studied. This same underlying disorder accounts for the frequency with which overgrowth of fibromuscular tissue and uterine mucosa occurs in association with endometriosis. However, the factor which determines in the individual case whether the uterine response to ovarian over- THE FEMALE GENITAL TRACT 697 activity is by a myohyperplasia or an endometrial hyperplasia, or both, is not known. This conception of the etiology of endometriosis accounts for the frequent recurrence of these tumors in patients subjected to conservative operations and explains why the site of election is the ovary and why these neoplasms never develop after ovarian function has ceased. This last applies to removal of the ovaries by operation or to their destruction by irradiation, but does not necessarily mean that endometriomas do not arise after the menopause. This is explained by the fact that the climacterium, although characterized clinically by amenorrhea, is rarely, if ever, associated with immediate cessation of the secretion of estrin and the gonadotropic hormones. BENJAMINR. SHORE

On the So-called Sarcoma of the Endometrium, G. R. TUDHOPEAND A. E. CHIS- HOLM. J. Obst. & Gynaec. Brit. Emp. 41: 708-720, 1934. The authors describe 3 cases of diffuse primary carcinoma of the endometrium which formerly might have been called primary sarcoma. Subserous or interstitial fibroids were not present in any of the specimens and there was nothing to suggest an origin of the tumors from the myometrium. Histologically the growths were characterized by diffuse masses of short spindle cells with occasional round and multinucleated giant cells. Special staining of the stroma and impregnation of the reticulum brought out a typical and unquestionable alveolar structure. Although endometrial glands, typical or atypical, were recognized in only one case, the arrangement of the stroma and the appearance of the reticulum lead to the conclusion that all of the tumors were diffuse carcinomas of the solid alveolar type. The article is illustrated with photographs of gross specimens and photomicrographs. BENJAMINR. SHORE

Chorionepithelioma Following Full-time Pregnancy, J. CHISHOLM.J. Obst. & Gynaec. Brit. Emp. 41: 1053-1055, 1934. The author reports the case of a thirty-one-year-old woman in whom a chorionepithelioma developed one month after the spontaneous delivery of a normal, full-term child. The diagnosis was based on the persistence of a bloody uterine discharge and a positive Aschheim-Zondek reaction. The patient made a good recovery following panhysterectomy. BENJAMINR. SHORE

Chorionic Carcinoma, with Report of a Case following Ruptured Tuba1 Gestation, R. C. THOMAS. Brit. M. J. 2: 590-592, 1934. Between two and three months after successful operation for a ruptured tubal pregnancy the author’s patient was again operated on for a pelvic tumor. This proved to be a chorionepithelioma involving the whole of the right broad ligament, the right pole of the uterus, the bladder, and Douglas’ pouch. The author suggests three possible explanations for the development and extension of the growth: (1) the rupture of the tubal pregnancy may have allowed dissemination of chorionic elements which later underwent malignant degeneration ; (2) the malignant disease may have been already established and the rupture may have served to spread it more rapidly; (3) malignant cells may have been present in the veins of the broad ligament, in the course of rapid extension and invasion, and have been, therefore, unaffected by the rupture or its removal. There are no illustrations. Several similar cases found in the literature are mentioned. THEODORE8. RAIFORD

Commentary on a Case of Chorionepithelioma with Secondary Growths in the Vagina Treated by Removal of the Uterus, Tubes, Ovaries, and with Local Excision of the Vaginal Growths, N. ATTYGALLE.J. Ceylon Br. Brit. M. A. 31: 44-50, 1934. The author reports the case of a thirty-two-year-old patient with a chorionepithelioma of the uterus and local extension to the vagina occurring two years after the birth of her last child. The patient has remained well for fifteen months following a panhysterectomy, bilateral salpingo-oophorectomy, and local excision of the secondary vaginal growths. No postoperative irradiation was given. BENJAMINR. SHORE 698 ABSTRACTS

Fibroid of the Uterus, Its Relation to Age and Parity, S. BASU. J. Indian M. A. 4: 137-138, 1934. A study of 435 cases of fibroid of the uterus was made to determine the relation of age and parity to the development of these tumors. The youngest patient was twenty, the oldest sixty years of age and the highest incidence was between the ages of forty 1i11d forty-four years. Nulliparous women were affected in 22.54 per cent of the cases, and parous women in 77.46 per cent of the cases. Thirty-four per cent of the parous patients had had their last childbirth more than eighteen years previously, 58 per cent had had their last childbirth more than twelve years previously, and 81 per cent of the patients had had their last childbirth more than six years previously. Submucous fibroids were present in 30.34 per cent of the cases, and of these, 91 per cent occurred in parous and 9 per cent in nulliparous women. BENJAMINR. SHORE

General Indications for Roentgen Therapy in Fibroids, G. DANIEL.Indicatio& gbn6rales de la roentgenth6rapie dans les fibromes, Bull. et m6m. Soc. de radiol. mEd. de France 22: 137-147, 1934. Advantages and Indications for Roentgen Therapy in Fibroids, G. DANIEL. 1,ra avantages et les indications respectifs de la roentgentherapie dans les fibromes, Ibid. 22: 590-595, 1934. The author recognizes few contraindications to radiotherapy in uterine fibroids. He uses it even for the large and fixed types, calcified tumors, and those associated with chronic pelvic infection, employing vaccines and other measures as adjuncts to irradiation. He does not irradiate subserous and submucous types. Of 90 cases treated all gave clinically satisfactory results. Among these there were 6 very large lesions, 5 with fairly severe infection, 5 with pelvic infection, and one large calcified fibroid. The length of the follow-up is not given. The author believes that surgery is seldom indicated for fibroid tumors. In the second of his papers Daniel discusses the relative advantages and disadvan- tages of radium and x-ray therapy in the treatment of uterine fibroids. In many cases there is no choice, but radium would seem to be especially indicated in cases with profuse liernorrhage and severe anemia, in bedridden patients, and in submucous polyps in young women in whom it is desirable to preserve ovarian function. X-ray therapy is more desirable for the large tumors, the partially calcified tumors, and in cases associated with pelvic infection. [Calcification is usually held to be a definite objection to radiation of any sort.] At times a combination of the two methods is desirable. There are no illustrations and no references. C. R. MULLINS

Advantages and Indications, Absolute and Relative, of Radium Therapy in Uterine Fibroids, JULIEN.Les avantages et les indications respectifs, absolus et relatifH de la curiethbrapie des fibromes ut6rins, Bull. et m6m. Soc. de radiol. m6d. de France 22: 595-601, 1934. A short discussion of the mode of action of radium, with indications and contraindications for its uye in uterine fibroids. The contraindications include an impervious uterine canal, pelvic infection or local infection, severe general debility; coexistent surgical lesions of the abdomen, and a desire for. future pregnancies. There is a short bibliography. C. R. MULLINS

The Edematous Fibroid, It. D~MAREZ.Le fibrome oed6mateuxI Echo m6d. du nord 1: 845-860, 1934. In a review of published statistics, the incidence of edematous degeneration of fibroids was found to vary from 2 to 17 per cent. The author believes that cases of thc primary type (i.e. not due to physical causes such as torsion of the pedicle) do not exceed 2 per cent. Clinically, the condition may be recognized chiefly by rapid enlargement of the tumor and its soft consistency on palpation. Pain may be a symptom, arid there may be severe anemia and general debility. The treatment is early surgery. The author gives a fairly extensive review and discussion of this lesion, with a report THE FEMALE GENITAL TRACT G90 of a case successfully treated by hysterectomy. A photomicrograph and gross photograph of the lesion are included. Therc is no bibliography. C. R. MULLINS

Uterine Fibroid Causing Inversion of Uterus, H. A. RIDLER. M. J. Aubtralia 2: 453- 454, 1934. The author reports tlic case of a fifty-thrce-year-old woIIiaii ill whoiu the uterus was completely inverted into the vagina by a fibroid tumor attached to its fundus. An abdominal supravaginal hysterectomy was performed in order to free the uterus so that this organ and the fibroid could be delivered through the vaginal orifice. One drawing illustrates the article. BENJAMINR. SHORE

Fibroma with Twisted Pedicle Simulatin’g Ectopic Gestation, R. PIERRE.Fibrome p6dicul6 tordu simulant une grossesse ectopique, Bruxelles-m6d. 15 : 171-172, 1934. Report of a case. WM. H. WOGLOM

Carcinoma in the Prevesical Space of Retzius Simulating Pregnancy, KARHAUSEN. Carcinome de la cavit6 de Retzius simulant une grossesse, Bruxelles-m6d. 15: 252-255, 1934. Report of a carcinoma in a girl of eighteen years. The tumor was about 10 cm. in diameter and occupied the prevesical space of Retzius. It was probably secondary to an embryonal ovarian neoplasm. WM. H. WOGLOM

Treatment of Cancer of the Vulva and Anus, H. FRUCHAUD.Sur le traitement des cancers de la region p6rin6ale: cancer de la vulvae et de l’anus, Arch. m6d. d’Angers 38: 120-121, 1934. A short general discussion. C. R. MULLINS

THE GENITO-URINARY TRACT

Tumor of the Kidney, THOMASC. STELLWAGEN.Pennsylvania M. J. 36: 839442,1933. Roentgen-ray Diagnosis of Tumor of the Kidney, G. W. GRIER. Pennsylvania M. J. 36: 842-843, 1933. General discussions of renal neoplasms and their diagnosis by roentgenography.

Case of Carcinoma of the Kidney and Multiple Papillomata of the Ureter and Bladder Treated by Nephrectomy, Ureterectomy and Total Cystectomy, C. A. R. NITCH. Brit. J. Urol. 6: 349-353, 1934. The author reports the case of a fifty-three-year-old woman on whom a right nephrectomy for a carcinoma, and a subsequent right ureterectomy and total cystectomy were performed in different stages for multiple papillomas. ?‘he patient died two and one-half years after the nephrectomy from a secondary growth in the base of the right lung. In the light of the subsequent findings, it is highly probable that the original growth was benign and arose in the renal pelvis. The two lessons to be learned from a study of this case are: (1) that a ureterogram should be made in every case of supravesical hernaturia; (2) that the ureter should be removed in every case of carcinoma of the kidney. The article is illustrated with photographs of the gross specimens. BENJAMINR. SHORE

Two Histologically Different Malignant Tumors in the Kidneys of Children, JEANNE DELON. Deux types histologiques de tumeur rnaligne du rein chez l’enfant, Ann. d’anat. path. 12: 215-217, 1935. The author reports two neoplasms of the kidney. One, a pure fibrosarcoma with no trace of epithelium, an uncommon renal tumor in childhood, occurred in a girl three and a half years old. The other, a sarcoma containing epithelium and bone, involved the kidney of a two-year-old girl. WM. H. WOGLOM 700 ABSTRACTS

Case of Renal Tumour, J. R. ELDER.New Zealand M. J. 33: 37&380, 1934. The author reports the case of a fifty-five-year-old man from whom a large tumor of the left kidney was successfully removed. An interesting feature of the case was the fact that the patient was quite unaware of the existence of the large abdominal mass and that he had had no renal or urinary symptoms of any kind. Histologic study of the excised specimen showed it to be a necrotic adenocarcinoma probably originating as a mrtlignant papillonla of thc renal pelvis. There are no illustrations. BENJAMINR. SHORE

Serous Cyst of the Inferior Pole of the Left Kidney; Digestive Troubles due to the Displacement of the Duodenum as Shown Radiologically, P~RARD.Kyste sBreux du pole inferieur du rein gauche; troubles digestifs dus au refoulement du duodenum constate radiologiquement. Disparition de ces troubles aprhs ablation du kyste, Bull. SOC.franc. d’urol., pp. 215-219, May 14, 1934. Also in J. d’urol. 38: 61-65, 1934. After commenting on the rarity of compression of the gastro-intestinal tract by renal tumors, the author reports a case in which a large cyst of the lower pole of the left kidney caused digestive symptoms. Roentgen examination showed the pylorus, duodenum, and duodenojejunal angle displaced to the right. The cyst was removed and the symptoms disappeared. C. R. MULLINS

Latent Paranephritic Tumor with Multiple Bony Metastases, P. SwYNaHEDAuW AND A. QUENOE. Tumeur paran6phretique latente avec metastases osseuses multiples, Echo m6d. du nord 1: 679-680, 1934; 2: 289-293, 1934. A fifty-year-old man showed x-ray evidence of vertebral and cranial metastases. A biopsy revealed a tumor which was considered to have the characteristics of hypernephroma, though clinically there was no evidence of this lesion locally. For medico- legal reasons the body was exhumed and an autopsy was done several days after death. This revealed a suprarenal tumor microscopically resembling the biopsy specimen from the skull region. C. R. MULLINS

Voluminous Perinephritic Cyst in an Infant of Eighteen Months, C. LEPOUTRE,DE- LATTRE AND PAOET. Volumineux kyste p6rin6phrhtique chea un enfant de dix-huit mois (Lymphangiome kystique), Bull. SOC.franp. d’urol. pp. 42-48, Jan. 15, 1934. Also in J. d’urol. 37: 238-244, 1934. From an eighteen-months-old male infant, the authors removed a large cystic mass which had developed apparently in the capsule of the kidney, compressing the latter so that it was removed unknowingly with the cyst. The cyst was lined by endothelium and was considered as possibly a cystic lymphangioma. Other small cysts were present in the capsule of the kidney. Chemical analysis of the fluid from the tumor showed no similarity to urine. There is a brief discussion of the pathogenesis of perinephritic and paranephritic cysts. Gross and microscopic photographs of the tumor are included. No bibliography is given. C. R. MULLINS

Treatment of Refractory Tuberculous Cystitis and Neoplastic Neuralgias of the Bladder by Section of the Erector Nerves, V. RICHER. Traitement des cystites tuberculeuses rebelles et des cystalgies neoplasiques par la section des nerfs Brecteurs, Bull. SOC. franc. d’urol. pp. 294-297, Nov. 19, 1934. The author describes his operative technic for the alleviation of intolerable bladder pain in tuberculosis and advanced malignancy. It consists of resection of the posterior portion of the right and left hypogastric ganglia with the erector nerve filaments, A successful case of tuberculosis of the bladder is cited. There are no illustrations and no references. C. It. MULLINS THE GENITO-TJRINARY TRACT 70 I

Cystography with “ Collothor ” in a Case of Tumor of the Bladder, R. DARGET,WAN- GERMEZ AND J. LANGE. Cystographies au collothor dans un cas de tumeur de la vessie, Bull. Soc. franq. d’urol. pp. 157-159, March 19, 1934.

Thc authors believe that ‘I collothor ” injections into the bladder give a clearer x-ray picture than any other medium, and recommend its use in tumors of the bladder. Two illustrativc x-ray photographs are shown. C. R. MULLINS

Enormous Vesical Papilloma in a Young Child, BoPm AND J. E. MARCEL. Enorme papillome v6sical chez un tout jeune enfant, Bull. SOC.franq. d’urol. pp. 185-189, April 16, 1934. Papilloma of the bladder in children is rare. In Albarran’s large series of bladder tumors there was no case of papilloma under the age of twenty years. The authors’ patient was an eight-year-old boy who had suffered from hematuria and urinary discomfort for four years. At operation he was found to have a papilloma of the bladder 4 or 5 cm. in diameter. This was successfully removed and two years later the boy was well and the bladder apparently normal cystoscopically. There are no illustrations and no references. C. R. MULLINS

Sarcoma of the Prostate with a Review of the Literature, 0. S. LOWSLEYAND F. N. KIMBALL. Brit. J. Urol. 6: 328-348, 1934. A sixty-four-year-old man sought treatment because of urinary frequency and in- continence. Cystoscopic examination showed a moderate intrusion of the prostate, for which a suprapubic cystotomy was performed. The patient recovered but the kidney function was not greatly improved. The prostatic mass increased in size, renal function became progressively worse, and death from uremia ensued. Autopsy showed an enlarged prostate measuring 8 X 5.5 X 4.7 cm., which partially occluded both ureters. The enlargement of the prostate involved the middle and both lateral lobes. Histologic study showed sarcoma, apparently of smooth muscle origin. ’ The diagnosis was leiomyosarcoma of the prostate. The authors have collected 132 cases of sarcoma of the prostate from the literature and review them in tabular form. The onset of the disease is insidious and is common to all ages. Infiltration of the urinary bladder, seminal vesicles, and rectum is frequent, being observed in 76 per cent of the cases. It occurred most frequently with the round- cell and spindle-cell tumors. Metastases were known to exist in 55 cases, the most frequent site of the secondary growth being the kidneys. Sarcoma of the prostate is invariably fatal, and very little of permanent value can be obtained by any form of treatment. Operative intervention should be limited to relief of urinary obstruction and the treatment of complications. A complete bibliography is appended. BENJAMINR. SHORE Sarcoma of the Prostate Cured by Roentgen Therapy, L. POPP. uber ein mit Ront- genstrahlen dauernd geheiltes Prostatasarkom, Rontgenpraxis 6: 680-681, 1934. A twenty-four-year-old male suffered from abdominal pain, dysuria, and a much enlarged prostate which projected into the rectum and was hard and sensitive to bressure. He showed some cachexia. He was given three series of x-ray treatments through three large portals, suprapubic, sacral, and perineal, with a 40 cm. skin-focus distance, and 0.5 mm. zinc filter; 550 T was administered to each field. Improvement was rapid, and two years later the patient was perfectly normal with a palpably normal prostate. [Obviously, as the diagnosis is clinical and microscopic findings are not available, thereport is-of little value. It is not impossible that the patient was suffering from prostatic infection rather than a tumor. Presumably a simple adenomatous enlargement can be excluded on account of the man’s age.] Surgery of Prostatic Obstruction, E. R. REAY. Australian & New Zealand J. Surg. 4: 130-152, 1934. Obstructions at the neck of the bladder are attributable to three main causes: (I) hypertrophy of the prostate; (2) true median bar formation, a sclerotic process, causing 702 ABSTRACTS

prostatic atrophy from inflaininatory fibrosis; (3) carcinoma. Carcinoma is usually of tlic scirrlious type and may occur at an early age. The original growth is frequently situntcd in the posterior lohe but may IN anywhere in the gland. Grossly there are two types: one in which the tumor extends toward the niucosa of the urethra aid caiisrs c~rlyolJstriiction, and one in which tlic growth remains intracapsular for :L long period, its ext(~nsionbcing upward toward the seiiiinal vesicles. Metastasis may occur t)t~forc~ thcre is any dysuria. Carcinoma was shown in 20 per cent of all prostates reniovetl at thc author’s clinic during the past three years. Cancer of the prostate, when clinically recognizable, is, in the author’s opinion, incurable. Operation confers permanent benefit only in that small group in which the gland is removed in the belief that it is innocent. It shells out easily and the malignant changes are found deep in the substance of the gland. This limited group of cases provides one objection to the punch method of relieving prostatic obstruction. The article is illustrated with photographs of gross specimens, photomicrographs, and a roentgenogram. BENJAMINR. SHORE

Carcinoma of the Scrotum, J. C. Ross. Liverpool Med.-Chir. J. (pt. 2) 42: 170-175, 1934. In patients not engaged in mule spinning, a predisposing factor in the development of scrotal cancer is chronic irritation by clothes which have been stiffened by oil, dirt, or sweat. The actual appearance of the growth is frequently preceded by a single severe injury, as in one of the cases reported by the author. Early diagnosis in scrotal cancer should be possible and the rate of operability should be high. Of four patients treated surgically by the author, two are alive and well three years after operation, one had a recurrence in the groin shortly after discharge from the hospital, while the fourth was operated on only nine months previously. Surgical excision of both the primary lesion and inguinal lymph nodes is preferable to any form of irradiation. BENJAMINR. SHORE

Seminoma and Embryoid Tumor of the Testicle, U. ROSAAND 8. CARPINELLI.Semi- noma ed embrioide del testicolo, Folia clin. et bid. 5: 1-4, 1933. Rosa and Carpinclli’s patient was a man aged twenty-six who, while riding in a street car, was thrown against a support in such a manner that his right testicle was struck violently. The scrotum subsequently showed an area of ecchymosis. Fol- lowing the trauma the tcsticle steadily enlarged. An orchidectomy was not done until nine months after the injury. The tumor proved to he for the most part a seminoma. In its center, however, it had the structure of a teratoma with areas of well developed cartilage. No follow-up is included. There are two drawings of the microscopic sections. C. D. HAAQENSEN

Lymph Node Metastases from Tumors of the Testicle Treated by X-rays, G. CWAUMET. MBtastases ganglionnaires des tumeurs du testicule traitees par les rayons X, Bull. et mBm. Soc. de radiol. m6d. de France 22: 492-497, 1934. Four cases of seminoma of the testicle are reported. In all primary removal of the organ was done fairly early in the disease. Metastatic lesions were treated by irradia-’ tion as they manifested themselves. One of the patients is still living six years and a half after operation, a second is living two years, a third and fourth five years. Only one was clinically well when last seen. The general plan and technic of treatment are given. A short bibliography is included. C. R. MULLING k3UI’IiARENAI, GLANDS

Bilateral Malignancy of the Adrenal Glands with Metastases into the Left Lung, H. D. LUGE. Med. Bull. Vet. Admin. 12: 76-77, 1935. A case is reported in which death was caused by pulmonary metastases from bilateral hypernephromata. Complete autopsy findings are presented. There are no illustrations. THEODORES. RAIPWD THE NERVOUS SYSTEM 703

THE NERVOTJS SYSTEM

Recognition of Brain Tumors in General Practice, C. E. BENDA. Einige Winke fur die Erkennung der Hirntumoren in der Allgemeinpraxis, Med. Welt 8: 1803-1806, 1828-1832, 1934. General remarks on the clinical signs of tumors of the brain. In most cases a tumor first manifests itself by focal neurological signs. These may be so slight that they are not recognized. Later there appear the signs of a general increase in intracranial pressure, as generalized headaches, nausea, vomiting, and swelling of the optic nerve heads. When these later signs develop, it often becomes increasingly difficult to recognize the original focal syndrome. The author discusses briefly certain neurological signs such as focal and generalized convulsive seizures, visual disturbances, optic atrophy, papilledema, and pyramidal tract signs. EDWINM. DEERY

Brain Tumors in General Practice, A. A. MCCONNELL.Irish J. M. Sc. 107: 611-617, 1934. An endeavor has been made to determine what were the first signs that made the doctor in charge suspect that the patient had a tumor of the brain. These were found to be headache, especially in the morning, and of any type; vomiting, which did not materially interfere with appetite; epileptiform attacks, ranging from a transient lapse to full-fledged convulsions; changes in mentality; retardation of growth; failure of vision; queer feelings in the limbs, and noises in the ear. BENJAMINR. SHORE

The Headache of Brain Tumors, J. A. CHAVANY.La c6phal6e des tumeurs c6r6brales. (fitude skmkiologique et diagnostique), Gas. m6d. de France, pp. 35g-369, 1934. Basing his statements largely upon a review of the literature, the writer discusses headache as it occurs in patients with brain tumors. In such cases it is an index of the degree of increased intracranial pressure. The headache varies in location and intensity from case to case, sometimes from time to time in a given patient. It is apt to be most severe in the early morning. The pain is more prone to occur in parox- ysms than to be constantly present. When subjective failure of vision occurs and papilledema is found relatively late in the course of the disease, headache often becomes less severe. The reason for this paradox is not known. Tumor patients always suffer from increased headache following violent effort, straining, or movements of the head. The direction of radiation of the pain is of no localizing significance. Headache is one of the earliest signs of brain tumor and especially in children is often preceded by an attack of vomiting. A discussion of the differential diagnosis between the headache of brain tumor and that due to a wide variety of other causes is included. [Some patients with brain tumor never experience headaches.] EDWINM. DEERY

Brain Tumors and Their Prognosis, A. SCHMINCKE.t’ber die Ilirngeschwulste und ihre prognostische Uewertung, Med. Welt 8: 1796-1798, 1934. Brief remarks upon the gliomata and their prognosis, reflecting the generally known facts. The outlook for a patient with a glioma of the brain depends upon the location of the tumor as well as upon its biological characteristics. A moderately malignant glioma situated in a ‘I silent ” area of either cerebral hemisphere may have a fairly long clinical course. A more benign tumor situated elsewhere, as for example in the cerebellum, may by virtue of its position produce an early obstructive hydrocephalus with rapidly progressing signs and symptoms of increased intracranial pressure. Given tumors of comparable site, the least differentiated, most malignant tumors run the shortest clinical course and have the poorest prognosis. The medulloblastoma, a highly nialignant growth situated usually in a position to cause early pressure complications, and the glioblastoma multiforme are examples of poorly differentiated gliomas always rapidly fatal. Spongioblastoma [polarel is a more benign slow-growing glioma and may produce symptoms over a long period. It may recur after subtotal 704 ABSTR,ACTS removal, but slowly. The astrocytoma, composed as it is of mature astrocytes, is also a tumor of slow evolution, often producing symptoms over a number of years, After partial removal it may not give trouble again for months or years. When this tumor takes the form of a largely cystic lesion with a small mural nodule, a complete cure is often obtained by surgical removal. In general the mature gliomas are less responsive to roentgen therapy than the more malignant growths. EDWINM. DEERY

Diagnosis and Treatment of Cerebral Tumors, 0. FOERSTER.Die Diagnostik und Behandlung der Geschwulste des Grosshirns, Klin. Wchnschr. 13: 1737-1742, 1934. Increasingly good results may be expected in the surgery of intracranial tumors provided the clinicians recognize these cases earlier in the course of the disease. All too frequently histologically benign, favorable growths have gone so long undiagnosed that little can be done surgically either to preserve vision or even to prolong life. It is now recognized that many brain tumors may give no localizing signs, and when such a problem is encountered, recourse should be had to some means of visualizing the intracerebral structures. Of these measures, ventriculography, encephalography and arteriography are commonly used. A large group of brain tumors do not characteristically produce increased intracranial pressure except in the very late stages, and the older teaching of headache, vomiting, and papilledema as the diagnostic triad for brain tumor can no longer be considered adequate. The greater number of all brain tumors with or without increased intracranial pressure can be localized with reasonable accuracy by a careful history and neurological examination. A wide variety of brain tumor cases are mentioned in illustration of the author’s remarks, He has performed some four hundred craniotomies for tumor with a mortality of 17 per cent. The series includes gliomas, mesodermal, epithelial, and hemangio- Mastic tumors, and metastatic growths. Points as to the surgical handling of various tumors are briefly discussed. EDWINM. DEERY

Brain Surgery, C. M. BEHREND.Uber Hirnchirurgie, Med. Welt 8: 1799-1801, 1934. General remarks reflecting the present conceptions of modern intracranial surgery The writer’s material, drawn chiefly from the Augusta Hospital in Berlin, included some 437 operations for brain tumors. Many of the patients came to the clinic late in the course of their disease. In such cases focal neurological signs were often masked by advanced signs of increased intracranial pressure. X-ray studies of the skull were found to be most valuable and should be made routinely in studying patients suspected of having tumor. Where all clinical tcsts failed to localize the tumor, visualization of the ventricular system by means of encephalography or ventriculography was resorted to. Occasional simple puncture eithcr of the ventricular system or the suspected site of the tumor was carried out, and in the majority of cases yielded helpful information. [Occasionally a large gliomatous cyst can be reached and emptied in this manner with remarkable temporary relief .] Neurological operations are generally long and it is often desirable, when operating upon the brain, to have the patient conscious. For both of these reasons local anesthesia is usually advised. The operative technic of tumor removal has been greatly modified in recent years by the use of electrosurgical instruments. Hemostasis, formerly a difficult problem, has been greatly simplified by the use of the high-frequency current to seal off [the smaller] vessels of the brain. Postoperative complications following tumor removal are not infrequent, and demand great care in treatment. From incomplete hemostasis n large blood clot may form beneath the osteoplastic flap and require reopening of the wound. Postoperative respiratory or temperature regulation difficulties are likely to follow operations about the optic chiasm and fourth ventricle. The transnasal approach to the pituitary gland for the removal of adenomas was apparently used often. The patients with subtotal removal of brain tuniors received roentgen therapy. Short descriptions are included of various subtypes of gliomas, pituitary adenomas, and connective-tissue tumors met with, The remainder of the article deals with non-neoplastic neurosurgical problems. ERWJNN, DEERY THE NERVOUS SYSTEM * 705

Diagnosis of Brain Tumors in Children, R. CRUCHETAND G. CANTORN&,A propos du diagnostic des tumeurs ckr6brales chez l’enfant, J. de mdd. de Bordeaux 11 1: 593-595, 1934. General clinical remarks upon the recognition of brain‘ tumors in children. The writers consider that in general the diagnosis is difficult, requiring a careful study of the child’s antecedents, proper evaluation of the initial complaint, and a careful neurological examination. Ocular and otological tests, as well as an examination of the cerebro- spinal fluid, are helpful. [The latter is apt to be dangerous, inasmuch as many tumors of childhood are in the posterior fossa.] The writers resort to ventriculography in all doubtful cases for localization. They found that encephalomyelitis or serous epen- dymitis not infrequently simulate brain tumor in childhood. [These writers take a somewhat pessimistic point of view. The great majority of intracranial tumors of children are midline lesions i.e. suprasellar cysts of the chiasmal region, or one of two types of glioma arising in the midline of the cerebellum. Of the latter, one is known as the medulloblastorna and is highly malignant, with the worst possible prognosis. The other is the well differentiated astrocytoma, a benign, relatively favorable lesion, not infrequently completely removable. Tumors of the brain in children, other than these three, are relatively rare.] EDWINM. DEERY

Treatment of Brain Tumors in Children by Radiation, W. SCHWENK.Ein Beitrag zur Strahlenbehandlung der kindlichen Gehirngeschwulste, Monatschr. f. Kinderh. 62: 219-224, 1934. The majority of intracranial tumors occurring in children can be localized by routine or special testing. Most of them are to be treated surgically, and the results of operation upon these lesions are becoming increasingly good. There is, however, a small group of cases wherein all diagnostic procedures fail to localize the tumor. Moreover a few patients are seen in whom the neoplasm is so unfavorably situated that surgical intervention cannot be expected to give relief. In these two groups of cases x-ray therapy is indicated. The writer has collected a series of some 36 patients so treated. In a group of 13 children all receiving roentgen therapy, 6 survived following treatment. In a group of 23 children, none of whom was subjected to x-ray therapy, only one survived. In general the writer found that the Eases showing the greatest amount of clinical improvement were those receiving the largest amounts of roentgen therapy. The paper ends with a plea for earlier diagnosis in these unfavorable cases so that vision may be preserved and roentgen therapy may be instituted earlier. Histopathology in relation to treatment is not specifically discussed. EDWINM. DEERY

Tumors of the Olfactory Lobe; Symptomatology of Temporal Lobe Tumors. F. K. KESBEL. Ueber tumoren des Riechhirns. :in kurzer Reitrag Bur Kenntnis der Symptomatologie der Geschwulste des Schllfenlappens, Monatschr. f. Psychiat. u. Neurol. 90: 94-112, 1934. Two clinical case reports illustrate the signs and symptoms of tumors involving the temporal lobe. A young man of twenty years had attacks of vertigo, followed by generalized headaches, nausea, and vomiting. He often noticed peculiar odors and sometimes heard voices. Upon neurological examination he showed bilateral papilledema and increase of the deep reflexes on the side opposite the suspected location of the growth. At operation evidence of a malignant glioma of the temporal lobe was found. A woman of forty-nine years complained of headache, nausea, vomiting, and olfactory hallucinations. A clinical diagnosis of temporal lobe tumor was made but the case remains unverified. EDWINM. DEERY

Meningiomata, T. DE MARTEL. Les mhingiornes, J. d. sc. m6d. de Lille, 52 (part 2): 125-142, 1934. General clinical remarks upon the benign mesodermal tumors arising from the men- inges of the brain. Two cases of “ voluminous ” meningiomas removed at operation are reported. [The meningioma, arising as it does from the heninges, displaces but does not actually invade the brain parenchyma. Moreover it is a benign lesion of slow 706 ABSTRACTS

growth. For both of these reasons it is almost always and characteristically a voluminous lesion.] In the author's service the operative mortality for this type of brain tumor has, in recent years, been reduced from 40 to less than 10 per cent. EDWINM. DEERY

Clinical Signs of Meningioma of the Olfactory Groove, H. ROSENHAQEN.Beitrag zur Klinik der Meningeome der Olfactoriusrinne, Nervenarzt. 7 : 537-550, 1934. A woman of thirty-four years, previously in good health, suffered from generalized convulsive seizures, which persisted at intervals for some four years. Mild mental changes occurred during this period, and the patient occasionally experienced severe headaches. Because of recent failure of vision, a neurological examination was carried out, revealing optic atrophy and some anosmia. Operation and autopsy disclosed a meningioma arising from the olfactory groove pushing upward on the frontal lobes. A second patient, a woman of sixty-two, gave a history of mild mental changes, nnosmia, and headaches for three years. More recently increasing weakness of the legs and attacks of unconsciousness had'appeared. She was found to have poor vision, optic atrophy, and anosmia. Autopsy revealed a large olfactory groove meningioma compressing the frontal lobes. A man of forty years showed sexual impotency, blindness of the left eye, and mild mental changes. Examination revealed past pointing, a right temporal hemianopsia, and ataxia. A clinical diagnosis of olfactory groove meningioma was made, in spite of the recent development of cerebellar signs. The diagnosis was proved correct at operation, at which time the tumor was successfully removed. A woman of fifty-six had failing vision, mental changes, and generalized headaches. She showed optic atrophy, anosmia, and mild mental changes. The clinical diagnosis of olfactory groove meningioma was verified at operation. [Optic atrophy with or without papilledema in the other eye, anosmia, and roentgenographic evidence of bony changes along the midline in the anterior cranial fossa are early evidence of meningioma in this region. It is only later, as the growth severely compresses the frontal lobes, that mild mental changes may be expected. That these cases with favorable tumors are sometimes missed entirely is shown by autopsy figures from institutions for the insane.] EDWINM. DEERY

Meningiomas Attached to the Mesial Part of the Sphenoid Ridge, C. A. ELSBERGAND C. G. DYKE. Arch. Ophth. 12: 644-675, 1934. The object of this communication is to call attention to the characteristic symptoni complex of small meningeal tumors arising from the most mesial portion of the sphenoid ridge. These growths lie in close proximity to one optic nerve and for a considerablc time produce disturbances due solely to pressure on the optic nerve near the optic foramen. The syndrome of primary optic atrophy, bitemporal defects in the fields of vision, is characteristic of tumors that compress the optic chiasm. It is often the first and for long the only sign of a midline tumor under the frontal lobes. Meningiomas that arise from the dura, over the lesser wing of the sphenoid bone or over the lateral part of the sphenoid ridge, do not primarily press upon the optic chiasm. Not until such a tumor has attained considerable size does it cause a change in the visual fields. In the majority of cases of sphenoid ridge meningiomas encountered by the senior author the tumors have been large. It is possible, by the use of perimetry, x-ray, and encephalographic studies, to recognize these growths when they are small. The surgical problem and the outlook for the patient are much more favorable with early recognition. Four case histories, with illustrations, are presented. The patients were all adults wliose only complaint was that of slowly progressive loss of vision in one eye. Aside from unilateral optic atrophy with a defect in the field of vision on that side, the neurological examination was negative. In each instance the meningiorna was attached to the sphenoid ridge near one anterior elinoid process, so that from the beginning the optic nerve was subjected to pressure. The changes in the visual fields were the result of this pressure eierted near the foramen. The fact that the defects were often in the upper part of the visual field indicated that the lowermost fibers of the nerve THE NERVOUS SYSTEM 707 were affected. In each case slight atrophy of the floor of the sella or of one clirioid process was found roentgenographically. The exact location of the lesion in all was dctcrmined only after encephalography. l'hcsc experiences show the great importance ol' eiice~~halo~ri~~~liic:stiidiw of thr Imsilar arachnoid cisterns. In the differential diagnosis of such rases it tnrist IJCreirienibered that turnors arising froin the sheath of the optic nerve within the orbital cavity or aneurysm of the cavernous portion of the internal carotid artery may produce a similar clinical statc. To Summarize, a history of progressive diminution of vision in one cyc, accompanied by primary atrophy and a visual field defect on that side, is suggestive of pressure upon that nerve. If x-rays show slight atrophy of the clinoid process or of the floor of the sella turcica, it is likely that a neoplasm is present. The diagnosis is established with certainty if a defect in the interpeduncular cistern is found on the roentgen film after encephalography. EDWINM. DEERY

Case of Cerebral Tumor, W. P. E. MCINTYREAND J. J. KEEVIL. J. Roy. Naval M. Serv. 20: 365-366, 1934. The authors report the case of a twenty-seven-year-old man with an encapsulated tumor surrounded by an abscess of the left frontal lobe who died following the rupture of the abscess into the lateral ventricle. Autopsy showed erosion of the left frontal bone just above the eye. Histologic study of the growth showed it to be a fibro- endothelioma. There are no illustrations. BENJAMINR. SHORE

Brain Tumor (Oligodendroglioma) Simulating Acute Encephalitis, A. LEY, R. A. LEY AND L. VAN ROGAERT. Tumeur cerebrale (oligodendroglioma) ayant Bvolu6 cliniquement comme une encephalite aigue, J. belge de neurol. et de psychiat. 34: 495-497, 1934. The author reports the case of a woman of forty-three years with a questionable history of tuberculosis. The present illness began suddenly, after several years of good health, with a jacksonian convulsive seinure involving the right upper extremity. With- in a few days the patient experienced several similar attacks, and visual .hallucinations, mental symptoms, and coma developed. Death occurred twenty days after the onset of symptoms. During her illness the patient was at first thought to be suffering from hysteria, later from acute encephalitis. Autopsy revealed cerebral edema and a discrete tumor of the left rolandic cortex. Microscopically the tumor proved to be an oligodendroglioma. [This type of glioma, composed of oligodendroglial cells, is frequently the site of more or less calcification, sometimes recognized roentgenographically. Formerly considered a relatively benign type of glioma, this neoplasm is now known to be malignant in some instances.] EDWINM. DEERY

Tumor of the Posterior Cranial Fossa without Internal Hydrocephalus, E. DAHL-IVER- SEN. Un cas de tumeur de la fosse cranienne posterieure sans hydrocephalie interne, Lyon chir. 31: 689-691, 1934. A woman of forty-six years, previously in good health, complained of suboccipital discomfort followed by attacks of vertigo.. These symptoms continued at intervals for two years. There then appeared diplopia, failing vision, and dulling of conscious- ness. No convincing neurological signs were found. A clinical diagnosis of tumor of the right frontal lobe was made and exploration carried out with negative results. Autopsy some eighteen days later showed no frontal lobe tumor, but a growth in the left cerebellum and cerebellopontine angle. The tumor, which proved to be a ehoroid papilloma, appeared to take origin from plexus tissue within the fourth ventricle. EDWINM. DEERY

Ependymoma of Third Ventricle, A. R. VONDERAHEAND N. H. ABRAMS. Arch. Ophth. 12: 693-698, 1934. A man of forty years suffered from headaches and visual disturbances over a period of one year. He complained also of sexual impotence, increasing pigmentation of the skin, lethargy, and premature graying. In the past two weeks his gait had become a 708 ABSTRACTS

little ataxic. There followed vertigo and buzzing in the ears. For several months the patient’s family had observed a marked increase above normal in his water intake. Neurologic examination revealed choking of both optic nerve heads. The visual field on the right showed contraction in the temporal half; that on the left revealed a con- cwitric contraction. There was loss of hearing on the left and the abdominal reflexes were absent. Roentgenograms of the skull showed the sella turcica to be very shallow Init there was no erosion. Encephalography revealed dilatation of both lateral ven - triclcs. The third ventricle did not fill. A suboccipital exploration was carried out without revealing a neoplasm. Fifteen days after admission a left-sided exploration was performed, again with negative results. Autopsy showed marked evidence of cerebral edema. There was a moderate degree of internal hydrocephalus. Upon section of the brain a large tumor was found within the third ventricle, extending posteriorly to occlude the aqueduct of Sylvius. Anteriorly it had invaded the tuber cinereum, had destroyed the mamillary bodies, and infiltrated the optic chiasm. There follows a description of the microscopic features of the growth, which proved to be an ependymoma. Involvement and invasion of the optic chiasm by tumor from above are rare and only a few cases are reported. The vegetative signs and symptoms in this case may be readily explained by invasion of the tuber cinereum and the floor and walls of the third ventricle. EDWINM. DEERY

Metastatic Brain Tumors, Two Cases, J. A. BARRB AND J. PAILLAS.A propos de deux observations de tumeur cerebrale mhtastatique, Marseille m6d. 1 : 159-166, 1934. The clinical and pathological findings in two cases of metastatic tumor of the brain are presented. The first patient was an elderly man who entered the hospital because of sudden development of aphasia and a right hemiplegia. Neurological examination was otherwise negative. The general physical examination revealed considerable wasting and enlargement of the liver. Autopsy showed primary carcinoma of the liver with multiple metastatic nodules in the middle portion of the left cerebral hemisphere. The second patient was a woman of thirty-nine years, who complained of generalized convulsive seizures of one year’s duration. More recently there had been abdominal pain and rapid wasting. Autopsy revealed a primary carcinoma of one ovary with multiple metastatic nodules in the brain. EDWINM. DEERY

Role of the Microglia in a Metastatic Adenocarcinoma in the Dura Mater, G. MA- HINESCO AND M. GOLDSTEIN. Quelques consid6rations sur les elements constitutifs d’un ad6no-6pith6liome mhtastatique de la dure-mbe. R61e de la microglie, Ann. d’anat. path. 12: 101-112, 1935. Report of a metastasis, on the internal surface of the dura mater, from a mammary growth removed about three years before the appearance of the first cerebral symptoms of irascibility, taciturnity, incoherence in ideab, etc. Microglia was found exerting a phagocytic function, in and about the tumor. Its presence in a metastasis, which contained neither nervous elements nor gli,a, and thus at a site which it could have reached only by way of the blood stream, is a convincing argument for its mesodermal origin. The paper is accompanied by five drawings. WM. H. WOOLOM

Physiology and Pathology of the Hypophysis, G. BICKEL. Les acquisitions r6centes sur la physiopathologie de l’hypophyse, Rev. m6d. de la Suisse Rom. 54: 597-634, 1934. The writer has brought together in summary a review of the more recent literature dealing with the physiology of the pituitary gland. The field is well covered and there is a bibliography. The anatomy and embryology of the hypophysis are briefly described; its anatomical connections with the hypothalamus are shown, and the functions of the different lobes are discussed. The anterior lobe has an imporfant influence upon growth, and is THE NERVOUS SYSTEM 709

directly associated physiologically with the gonads and sexual activity, as well as lactation. The interrelationship between the anterior hypophyseal lobe and the thyroid gland is a close one. Similarly certain clinical and laboratory studies go to show that the adrenal cortex and the parathyroid glands are, in part at least, dependent for normal functioning upon anterior hypophyseal influences. The relation of the anterior lobe to fat metabolism, sugar metabolism, and other nutritional factors is discussed. The influence of the posterior lohe upon smooth muscle contraction and blood pressure is also considered. EDWINM. DEERY

X-ray Diagnosis of Tumors in the Region of the Sella Turcica, FARBEROW.Rontgen- diagnostik der Tumoren der Gegend der Sella turcica, Fortschr. a. d. Geb. d. Ront- genstrahlen 50: 445-465, 1934. A review of the literature is followed by a discussion of the writer’s experiences with some 71 sellar region tumors. The majority of the tumors arising within the sella turcica are adenomas of the pituitary gland. As the tumor enlarges, it exerts pressure upon the bony sella, causing it to change in a characteristic manner. The roentgenogram shows a ballooning of the sella, which becomes deeper and more rounded with rarefaction of both floor and dorsum. The anterior clinoid processes become shortened and appear pushed upward. As the sella floor deepens and thins, it approaches and eventually may compress the sphenoidal air cells. The result is an approximation of the outlines of the floor of the sella turcica to the floor of the middle cranial fossa. Tumors arising just above the sella turcica include Erdheim tumors or bucconeural pouch cysts, and suprasellar meningiomas. These may produce slight flattening of the superior margins of the sella and attenuation of the anterior clinoid processes. Tumors elsewhere in the cranium may, by producing an increase in intracranial pressure, cause changes in the outlines of the sella turcica. These changes include erosion of the posterior clinoid processes and dorsum. Such changes may be caused by third ventricle distention. More marked signs of increased intracranial pressure may follow and include deepening of the convolutional impressions on the inner table of the skull, an increase in the normal arterial and venous markings, and exaggeration of the pacchionian depressions. There follow descriptions of less common lesions and their effects upon the sella turcica. There are 23 illustrations. EDWINM. DEERY

Differential Diagnosis of Basophilic Adenomata of the Pituitary, C. V. MEDVEIAND P. WERMER. Zur Differentialdiagnose des basophilen Adenoms der Hypophyse, Med. Klin. 30: 992-994, 1934. A review of the literature is followed by a clinical study of 7 cases of basophilic pituitary adenoma.” The syndrome is characterized by obesity, osteoporosis of the spinal column or sometimes of the entire skeleton, wide purple striations on the abdomen, a red cyanotic facies, and hypertrichosis. The patients have high blood pressure, diabetes mellitus, and disturbances of sexual functions. In contrast to the more common chromophobe and eosinophile adenomas arising from the pituitary gland, the basophile adenoma usually does not produce enlargement of the bony sella turcica. The writers believe that the clinical syndrome of ‘‘ basophile adenoma of the pituitary ” can be distinguished from that caused by tumors of the adrenal cortex and by ovarian tumors resulting in disturbed sexual functions. A comparative tabulation of the clinical signs in the three conditions is included. EDWINM. DEERY

Mixed Adenoma of the Pituitary, G. PHILLIPS. M. J. Australia 2: 686-688, 1934. The author reports the case of a fifty-three-year-old man in whom marked clinical improvement was obtained by a transsphenoidal decompression of the brain. The patient obviously had a pituitary adenoma, and from the acromegalic appearance, which was characteristic of chromophile adenoma, and the loss of sexual potency, which was characteristic of chromophobe adenoma, the diagnosis of a mixed adenomlr of the pituitary gland was made. BENJAMINR. SHORE 710 ABSTRACTS

Cushing’s Syndrome and Pituitary Basophilism, P. BASTENIE. Syndrome de Cushing c.t basophilic hypophysaire, Scalpel 87: 1313-1320, 1934. A review of the literature on the suhject of ‘‘ pituitary basophilisni ” is followed by Iwo case reports and brief mention of a third case. A woman of forty-four years complained of back pains, difficulty in walking, shortt- iiess of breath, and obesity, developing over a period of years. Amenorrhea began at thc itge of thirty, and the increase in weight began some three years later. At about thc age of thirty-three an excessive growth of hair appeared on the extremities and the face. At thirty-eight the voice became very high. Obesity had progressed to the point where walking was impossible. A clinical diagnosis of pituitary basophilism was made. The second patient was a woman of thirty-nine years with obesity, hirsutism, and amenorrhea. The progress of signs and symptoms was similar to that in Case I. In the third case autopsy revealed a basophilic adenoma in a woman considered during her life to have had myxedema. EDWINM. DEERY

Adenohypophyseal Dystrophies of Infancy and Childhood, L. DODS. M. J. Australia 2: 277-286, 1934. Adenohypophyseal Dystrophies, W. S. LAURIE. M. J. Australia 2: 403-404, 1934. Despite the statements to the contrary, the author believes that the great majority of cases of dyspituitarism in childhood are not the result of tumor formation. In a group of twenty children apparently suffering from pituitary disturbances, a tumor was present in only one instance. The diagnosis of pituitary dystrophies in childhood seems to depend in the main on clinical examination and the exclusion of other causal factors, for both radiographic and biochemical examinations are frequently of little value. Radiographic evidences of changes in the sella turcica and its neighborhood inay be found in apparently normal children and are seldom of any diagnostic value unless there are gross alterations in size and disfiguration of the fossa or definite signs of calcification in the neighborhood. The fact that a sella turcica appears normal does not negative a diagnosis of pituitary disturbance nor does a report of some change in the size and shape of the fossa establish such a diagnosis. In a letter to the editor, Laurie takes exception to the view of nods that the hypophysis was the chief factor in disturbances of growth in some of the patients whose cases he reported. The common belief that all disturbances of growth are due to hypophyseal dysfunction is proved fallacious by cases of tumor of the adrenal cortex, testes, and ovaries, and probably also by lesions involving the pineal gland. The hypophysis ie but one of a chain of endocrine organs with some mutual interdependence, BENJAMINR. SHORE

Spinal Cord Tumour with Compression Paraplegia, Recovery after Operation, J. H. F. JAYASURIYA.J. Ceylon Br. Brit. M. A. 31: 51-59, 1934. A twenty-year-old girl had paraplegia caused by pressure of an extradural tumor sitii- ated at the level of the fifth and sixth thoracic segments. Histologic study of the surgically removed growth showed it to be a benign giant-cell tumor. Motor recovery sufficient for walking was evident three and one-half months after operation, The origin of the tumor was thought to be from the laminae of the fifth and sixth thoracic vertebrae. BENJAMINR. SHORE:

Spinal Cord Tumor; Extirpation and Cure, J. JIANO(I. JIANU).Un cas de tumkur medullaire; extirpation; gukrison, Rev. de chir., Bucaresti 37: 137-138, 1934. A man showed slowly progressive signs of spinal cord compression, considered by a local physician to be caused by Pott’s disease, though the reasons for this are not clear. Neurological examination showed bilateral spasticity of the lower extremities with a sensory level up to the tenth thoracic segment. Laminectomy revealed an intradural, cxtrarnedullary tumor, which was removed. The patient made a satisfactory neurological recovery. Histopathology is not discussed. EDWINM. DEERY THE NERVOUS SYSTEM 71 1

Intradural Tumor of the Cauda Equina Sixteen Centimeters Long, R. LERICHEAND J. FROMENT.Tumeur intradurale de la queue de cheval de seize centim6tres de long, Lyon chir. 31: 489-491, 1934. A single case report of an unusual, elongated connective-tissue tumor within the spinal dura. The patient, a woman, had noticed a slowly progressive spasticity with loss of muscle power in both lower extremities, becoming sufficiently serious after several years to prevent walking, Injection of descending lipiodol into the spinal subarachnoid space demonstrated a block at the eleventh dorsal level. A laminectomy disclosed a long, soft tumor extending from the eleventh thoracic to the fourth lumbar segment. The tumor was removed and the patient made a satisfactory neurological recovery. EDWINM. DEERY

Cavernous Angioma of the Vertebra, M. F. LACEYAND E. S. SMITH. Lancet 2: 1159- 1160, 1934. The authors report a case of cavernous angioma of the ninth dorsal vertebra which had produced the neurological signs of cord compression with complete paralysis of the lower extremities for twenty-six years. Death ensued four months after delayed admission to the hospital. The age of onset, twenty-one years, is thought to be the earliest reported. The muscular atrophy and contractures indicated a slow but constantly progressive lesion. The histological diagnosis was confirmed by autopsy, There are five illustrations. THEODORES. RATFORD Brief Survey of the Literature Relating to Ganglio-Neuromata with Report on an Un- usual Case, DONALDBARLOW. West London M. J. 39: 237-242, 1934. The author reports the case of a fifty-two-year-old man who died seven days after a laminectomy for a diffuse and inoperable tumor involving the first, second, and third lumbar segments. Histologic study showed the tumor to be a ganglioneuroma. BENJAMINR. SHORE Remarks on the Neuromas of Amputation Stumps, R. PROUST.Remarque sup les n6vromes des moignons des amput&, Ann. d. m6d. 16g. 14: 848-850, 1934. The author recognizes two types of nerve lesions associated with painful amputation stumps. One is the localized neuroma and the other comprises the more extensive nerve lesions such as fibrosis and thickening of the nerve or its sheath, which may be widespread. The treatment of each type is discussed. There are no illustrations and no bibliography. C. R. MULLINS

Tumors of the Peripheral Nerves, CHARLESF. GESCHICKTER.Am. J. Cancer 25: 377-410, 1935. The peripheral nerve fiber consists of an axon or neurite, usually encased in a myelin sheath which is surrounded by a protoplasmic envelope, the sheath of Schwann. False neuromas, or tumors of the sheath, are referred by one school to the sheath of Schwann and would therefore be of neuro-ectodermal origin, whereas another attributes them to the connective-tissue covering. They are far more common than neoplasms of the nerve fibers themselves. Tumors of the sheath include the neurinoma (perineural fibroblastoma, Schwannoma, neurilemoma, lemoma), palisaded or myxoid, and the sarcoma. Growths of the fiber are the amputation neuroma, the ganglioneuroma, and the peripheral neuro-epithelioma. The paper is generously illustrated with charts, diagrams, and photomicrographs. WM. H. WOGLOM

Glomic Tumours, BONNAIID,R. DE GRAILLYAND H. BONNARD.Les tumeurs glomi- ques, Gas. hebd. d. sc. med. de Bordeaux 55: 498-506, 1934. Reports of two interesting glomic tutiiors are preceded by a review of the literature; a bibliography is appended. Glomic tumors usually occur at the tips of the toes or the fingers, often near the nail. Incorrect diagnosis is frequent. Clinically the condition must be differentiated from 712 ABSTRACTS neurofibromatosis. Histologic descriptions of the tumors are included and due credit is given to 1’. Masson for special stains and studies of these lesions, Histologically they are related to the neuro-myo-arterial system and are frequently designated neuro- arterial glomic tumors. [For an excellent account of these tumors, and a full bibliography, see Stout: Am. J. Cancer 24: 255, 1935.1 EDWINM. DE~Y

THE BONES AND TENDON SHEATHS

Radium Treatment of Metastatic Carcinoma of Bone, V. CARULLA.Sobre la carcinomatosis metasthsica de 10s huesos y 10s resultados favorables de su tratamiento con las radiaciones, Ars med. Barcelona 10: 281-290, 1934. The author reports two cases in which he used radium treatment with good results. (1) Metastasis occurred in the middle of the left tibia of a woman of forty-two who had undergone hysterectomy four months previously for cancer of the uterine body. X- rays showed over a large area total destruction of bone except for a thin subperiosteal zone. Five radium element tubes of 13.3 mg. each, filtered by 1 mm. platinum, were applied in a Columbia paste mold 3 cm. in thickness, and the latter reinforced by plaster binding to secure immobilization and prevent spontaneous fracture. Treatment was given for seventeen days anteriorly and the same time posteriorly. Five weeks later there was intense epidermitis, with punctiform ulceration, but the bone showed complete reconstitution. Repeated radiography confirmed the disappearance of the metastasis in the tibia, but a year after treatment the patient died with metastases in both lungs, (2) A woman of forty-two had been operated upon in another clinic a year previously by limited excision of a tumor of the right breast. There was now a large mass of carcinomatous tissue in the pectoral muscles and axilla. This recurrence was treated by wide electrocautery excision, followed by insertion of 33 radium needles of 1 mg. each for ten days; finally x-ray treatment was given to the right hemithorax, including the axillary and supraclavicular regions, the total dosage being 3000 r in twelve days. The patient returned regularly for examination every three months. After two and a half years the breast region was still free from recurrence, but the patient had a spontaneous fracture of the middle of the left humerus, shown on radiography to have occurred through an area of rarefied bone. There were no signs of metastases in other bones. The author gave about the same treatment as in case 1, and within three months there was complete reossification, with excess callus at the site of fracture. The patient was in good health at the time of reporting, two years after the radium treatment of the humeral metastasis. There are twelve good x-ray illustrations. F. CAVERS

Some Cases of Bony Metastases from Lymphogranulomatosis, CuNswr, SICHEL, BOUTONAND CORNU. Quelques cas de metastases osseuses de lymphogranulomatose, Bull. et mem. SOC.de radiol. mEd. de France 22: 519-522, 1934. The authors present five cases of proved Hodgkin’s disease with x-ray evidence of bony involvement. One case showed lesions in the cervico-dorsal region; a second involved the pelvic bones and head of the femur; a third, in a six year old boy, affected the occipital region of the skull; the remaining two showed lesions in the lumbar vertebrae. Bone lesions in this disease are comparatively frequent. There are no illustrations. A short bibliography is appended. C. R. MULLINS

Three Cases of Osteosarcoma in Young Women, HUQUET. Trois cas simultan6s d’ost6osarcoma chez des jeunes femmes, Bull. et m6m. SOC.de radiol. med. de France 22: 601-608, 1934. The first of the author’s patients was a twenty-two-year-old woman with a lesion of the upper tibia which was operated upon and pathologically was considered to be benign. It grew rapidly, however, until controlled by radiotherapy, and the patient died after about two years with evidence of lung metastases. [Evidently the control was not very perfect.] The second patient, a woman of twenty-one, had a tumor of the maxilla THE BONES AND TENDON SHEATHS 712 which disappeared with radiotherapy. Death ensued in sixteen months, with radiographic evidence of lung metastases. The third case was that of a sixteen-year-old girl with a large tumor of the lower femur. This was treated by irradiation, followed by amputation, but death occurred in a year and a half from pulmonary metastases, in spite of prophylactic irradiation of the lungs. In the discussion, M. Paschetta mentioned five cases which he treated by irradiation with no cures, the longest survival being four years and eight months. There are no illustrations and no references. C. R. MULLINS

Osteosarcoma Revealed in the Course of Normal Work, MULLERAND MARCHAND. OstBo-sarcome rev616 au cours du travail normal, Ann. d. mBd. 1Bg. 15: 253-254, 1935. A thirty-seven-year-old man suffered a fracture of the neck of the humerus following very slight trauma, and with no previous symptoms referable to the region. X-ray showed bone destruction at the fracture site. The humeral head was resected and pathological examination showed osteosarcoma. There are no illustrations and no references. C. R. MULLINS

Five Cases of Giant-cell Sarcoma, GUNSETT,BOUTON AND SCHNEIDER.Cinq cas de sarcomes ii my6loplaxes, Bull. et m6m. SOC.de radiol. m6d. de France 22: 516-519, 1934. Five cases of giant-cell tumor of bone are reported. The first patient was a forty- four-year-old man with a lesion in the ilium, treated by curettage and radiotherapy, and apparently cured after three or four months. The second was a man of twenty with a tumor of the radius, treated by curettage and radiotherapy but with no healing after ten months, when he was lost to follow-up. The third patient was a twenty-six-year-old woman with a lesion in the lower femur. She was treated by x-ray therapy followed by bone grafting and was apparently well six years later. The fourth patient had a tumor of the great trochanter and was apparently well six years after curettage and irradiation. No follow-up is given for the fifth case. There are no illustrations. C. .R. MULLINS

Giant-cell Tumor of the Lower Extremity of the Radius, COSTANTINI,VIALLET AND MARCHIONI.Tumeur my6loplaxes de I’extrBmitB infhrieure du radius, Bull. et m6m. SOC.de radiol. m6d. de France 22: 346-351, 1934. The authors follow the course of a giant-cell tumor of the lower end of the radius in a twenty-five-year-old man, the diagnosis being confirmed microscopically. Curettage was done, but about eleven months later the process had extended and pathological fracture had occurred. Another curettage was carried out and osteoperiosteal grafts were taken from the tibia, Following this, heavy doses of radiotherapy were given and fifteen months later recalcification of the tumor area had occurred and the functional result was good. The authors include roentgenograms taken in the various stages of treatment. There is little discussion and no bibliography. C. R. MULLINS

Multiple Myeloma, NORBERTENZER AND BENJAMINLIEBERMAN. Ann. Int. Med. 8: 1062-1070, 1935, The renewed interest in diseases of bone had its inception in 1926, when Mandl established the etiological relationship between osteitis fibrosa cystica and tumor of the parathyroids. The increased hormone secreted by the neoplasm brings about de- mineralization of the skeletal system, the local bony changes being secondary to this process of resorption. Other conditions accompanied by generalized bone destruction, especially osteo- clastic carcinoma and multiple myeloma, may simulate hyperparathyroidism. The former is recognized if the presence of a primary cancer can be demonstrated, and often by the characteristic x-ray findings, but multiple myeloma may be hard to differentiate. An instance of this disease, which was clinically believed to represent hyperparathyroidism, is described. The patient was a sixty-six-year-old man who complained of pain in the lower back and loss of flesh and strength. He soon became bedridden, and x-ray examination, previously inconclusive though suggesting bone destruction. 714 ABSTRACTS now showed distinct lime deficiency in vertebrae, pelvis, femora, ribs, and skull. Rence- Jones protein was not found in the urhe in the one test made. The blo ’ ’ nm 011 ttco c~timutionsamounted to 11.8 mg. and 12.6 mg., as compared wit. .lc normal r:tiig~‘of 9-11 nig. Two weeks later it had risen to 13.7 mg. and the blooa phosphorus itas 3.2 nig. The urinary calcium excretion in twenty-four hour8 was 530 mg. on a diet containing approximately 200 mg. of calcium, indicating the likelihood of a negutivc calcium balance. It was felt that there was sufficient evidence to warrant exploration of the neck for a parathyroid tumor. None was found, but tissue presumed to be parathyroid after Fjtudy of frozen sections was removed. The patient died of bronchopneumonia on thc third postoperative day. Wide and careful post-mortem dissection of the neck revealed no parathyroid tissue, nor did examination of thin sections 0’ +he thyroid. Microscopic examination of bone sections disclosed diffuse, nodular myeh + in the marrow, with distinct atrophy and mild inflammatory changes in the br ~ Jl .ex. Whether or not the parathyroid glands in this patient were unusual atrophic for his age is a debatable question, but the case does indicate the compatibility of myelo- matosis with absence of parathyroid hyperplasia. Another interesting feature is the clinical similarity between multiple myeloma and hyperparathyroidism, a likeness that has already been noticed by others. It becdmes evident that one or two diagnostic procedures will not suffice in the group of diseases to which this case belongs, and that conclusions can be drawn only from comprehensive clinical, chemical, metabolic, roentgenological, and biopsy studies. WM. H. WOGI,<)M

Lipoid Granulomatosis of Bones (Hand-Schiiller-Christian Disease), J. S. FRASER. J. Laryng. & Otol. 49: 666-674, 1934. Lipoid granulomatosis of bones, commonly known as Hand-Schuller-Christian disease, appears to be due to an error in metabolism whereby lipoid material is deposited in various parts of the body, leading to the formation of granulation tissue with conse- quent decalcification and osteoporosis. These deposits occur where reticulo-endothelial tissue exists, since this tissue is intimately concerned in the metabolism of lipoids. With involvement of the hypothalamus, in the region of the pituitary gland, diabetes insipidus results, or dwarfism and dystrophia adiposogenitalis may develop. The infiltration may extend forward along the optic nerves producing exophthalmos. In the earlier stages of the disease, tissues rich in mesothelium, such as that between the pituitary and cavernous sinuses, the diploe, and bone marrow, may be involved. In more advanced cases other structures such as the liver may be affected. The endothelial elements of the smaller blood vessels are the first to be attacked, becoming detached from the vessel walls as swollen fusiform cells containing lipoid material. ?‘he foam cells are also quite characteristic. The disease is characterized by three features, diabetes insipidus, exophthalmos, and bony defects in the skull. The patient is underdeveloped, cross, and irritable. Al- though there is a tendency in untreated cases to progressive destruction and a fatal result, a spontaneous cure may be effected by the formation of fibrous tissue around the affected areas. In the gross the affected tissue is yellowish and caseous. The cancellous tissue of membranous bones is frequently infiltrated and eroded but at times is merely pushed aside. This is best illustrated at the base of the skull, where the tissue within the sella tnrcica protrudes through the walls of the cavernous sinuses and produces proptosis. The bony destruction may be so complete as to justify the descriptive term, ‘( gelatinous skull.” Diagnosis is not difficult if the above clinical features are borne in mind and the bony defects studied roentgenographically. Blood studies demonstrate an excess of cholesterol and lecithin. Treatment is directed first toward proper diet. This should be as free from cholesterol as possible and should contain an abundance of green vege- tables. The diabetes can be controlled by pituitary extract. The bone lesions must be given carefully directed radiotherapy. Fraser advises moderate but frequent irrndiatioii, THE BONES AND TENDON SHEATHS 715

One illustrative case is reported in some detail, and several others are cited from the literst, Be x-ray reproduction depicts the roentgenographic appearance of the skull lesio,! lltnd a short bibliography is appended. THEODORE 8. RAIFORD I Xanthomatosis and the Schiiller-Christian Syndrome, A Roentgenological and Clinical Study, S. REICH. Canadian M. A. J. 31: 256-265, 1934. The case of a four-year-old boy with multiple defects of the membranous and long bones, diabetes insipidus, and xanthoma tuberosum of the skin is reported and some of the literature concerning the Schuller-Christian syndrome is reviewed. Since xanthomatosis is a granuloma and not a tumor, the prognosis is not hopeless. The mortality is thought to be about 30 per cent. The only effective treatment is x-ray irradiation, ISspecially, tous are those cases with infiltration of the lungs, since the secondary fibrosic . ’eauses cardiac insufficiency. The end-result in the author’s case is not given. ” BENJAMINR. SHORE $11 Osteochondrdmatosis of the Elbow and Wrist, JEANCAVALII~. Ost6ochondromatosc du coude et du poignet, Ann. d. m6d. 16g. 14: 841-842, 1934. A fifty-eight-year-old man had ‘‘ osteochondromatosis ” of the wrist. Six years later the elbow had become involved and there were signs of nerve involvement. Roent- genograms revealed numerous osteophytes in the regions of the wrist and elbow, with involvement of the radio-ulnar joint. The author believes that trauma had some part in the progress of the lesion. Similar reported cases are referred to. C. R. MULLINS

Case of Sacrococcygeal Chordoma, A. DONATIAND L. MANGINELLI.Un caso di cordoma sacro-cocigeo, Folia clin. et biol. 5: 45-55, 1933. This is an account of a chordoma occurring in a man aged fifty-three. His first hymptom was a massive and unexplained hemorrhage from the bowel at the age of forty-nine. He was then perfectly well until five years later, when acute urinary retention developed. Examination showed a huge tumor invading the sacrum and filling the minor pelvis. Biopsy proved it to be a chordoma. No follow-up is included. There are three microscopic drawings and a cursory bibliography. C. D. HAAGENSEN

Reticulo-endothelioma of the Bones, GUNSETT,SICHEL AND BOUTON. Trois cas de r6ticulo-endoth6liomes osseux, Bull. et m6m. SOC.de radiol. m6d. de France 22: 524-526, 1934. Three cases of bone tumor histologically resembling the tumor described by Ewing are reported. The first patient was a thirteen-year-old girl with the primary lesion in the upper femur. Metastases to the lungs occurred and the patient died rapidly in spite of local control of the tumor by radiotherapy. In the second patient, a woman of seventy-seven years, the tumor was in the frontal bone. Some improvement followed radiotherapy but the follow-up is short. The third case was that of a thirty-five-year- old woman with a primary growth of the alveolar border which was removed surgically. Later multiple bone lesions were discovered, and these responded to radiotherapy. The length of the follow-up is not given. There are no illustrations and no references. C. R. MULLINS

A Case of Vertebral Hemangioma, NEMouns-AuausTE, Un cas d’h6mangiome vert6bral. Trouvaille radiologique, Bull. et m6m. Soc. de radiol. m6d. de France 22: 565-567, 1934. In a fifty-four-year-old man who was suffering with back pain, the x-ray showed rhangcs in the twelfth dorsal vertebra, which were interpreted as hemangiorna. The syniptoins improved following radiotherapy (2400 T). Another lesion was present in the skull, resexlibling that which has been described in hernangioma. The patient also hud cutaneoun angiomata of the abdomen, as well as gallstones. A short discussion of liemangiomata is presented. There are no illustrations and no references. C. R. MULLINS 716 ABSTRACTS

Tumors of the Tendon Sheaths, P. TISONAND JEANHUBERT. Leu tumeurs des gaines tendineuses, Echo m6d. du nord 1: 943-953, 1934. The authors review the subject of tumors of the tendon sheaths, the great majority of which are benign in nature. They discuss the clinical and pathological aspects, and report two cases. One patient was well a year after removal of a benign giant-cell tumor of the peroneal tendon sheath. In the second case the tumor involved the sheath and extensor tendon of the thumb. Treatment consisted in excision and tendon transplantation. Pathologically the growth resembled an arborescent lipoma, apparently benign. This patient also was well a year after treatment. There are no illustrations and the bibliography is brief. C. R. MULLINS

THE LEUKEMIAS, HODGKIN’S DISEASE, LYMPHOSARCOMA

Neurologic Aspect of Leukemia, ROBERTS. SCHWABAND SOMAWEISS. Am. J. Med. SC. 189: 766-778, 1935. Contrary to prevailing opinion, the authors believe that the central nervous system is affected in nearly all patients with leukemia, though its participation is often over- looked. The significance of its involvement is comparable in many respects to that in pernicious anemia and plumbism. In defense of their belief, the authors present a case report and an analysis of 480 cases of leukemia with involvement of the central nervous system gathered from the literature or from hospital records. Their patient, a twenty-four-year-old male, presented manifestations of facial diplegia and a spinal fluid, under elevated pressure, containing 2000 lymphocytes and increased amounts of protein. The usual clinical evidences of acute lymphatic leukemia, including the blood picture, developed later, over a period of ten weeks. The neurologic signs most frequently observed in the 480 analyzed cases were unilateral or bilateral palsies of the seventh and sixth nerves, with less frequent involvement of the 5th, 8th, Sth, loth, llth, and 12th. Absent deep reflexes, pyramidal signs, paresthesias, and signs of meningeal irritation have also been recorded. The neurologic signs, and particularly involvement of the cranial nerves, often exhibited rapid fluctuations. The frequency of neurologic complications in the acute and chronic types of leukemia, whether lymphatic or myelogenous, was about the same. WM. H. WOQLOM

Rapid Cardiac Failure as a Symptom of Acute Leukemia, C. A. MARKSON. Canadian M. A. J. 31: 363-365, 1934. The author reports the case of a forty-four-year-old man who died of cardiac failure two and one-half weeks after the onset of his illness. A comparison of the blood smears taken within a few days of each other showed interesting differences. At first there was only a suggestion of anemia, then a leukocytosis with an occasional megaloblast, a rare myelocyte and monocyte, and finally in the specimens made on the day of death evidences of an intense myelosis. The absence of glandular and splenic enlargement was noteworthy. The diagnosis of acute leukemia was made from the blood findings, but this could not be confirmed by histologic study of the bone marrow or viscera, as an autopsy could not be obtained. Three photomicrographs of blood smears are included. BENJAMINR. SHORE

Lymphoid Leukemia, J. GUERARDAND R. LESSARD. Leucemie lymphoide, Bull. SOC.m6d. d. hbp. Universitaires de Quebec, pp. 193-199, June, 1934. A case of lymphoid leukemia is reported in a sixty-five-year-old man with a white hlood count of 300,000, with 96 per cent lymphocytes. Some improvement followed radiotherapy to the nodes, but the follow-up was very short. There is a discussion of the general aspects of this disease, together with a brief bibliography. C. R. MULLINS THE LEUKEMIAS, HODOKIN ’S DISEASE, LYMPHOSARCOMA 717

Acute Eosinophilic Leukemia, D. J. STEPHENS. Am. J. Med. Sc. 189: 387-392, 1935. The author describes the fourth recorded instance of leukemia characterized by a preponderance of eosinophils in the peripheral blood and in tissue infiltrations. The patient was a seventeen-year-old school-girl who died with the characteristic symptoms of acute leukemia after an illness of two or three months, counting from the appearance of the first small areas of discoloration in the skin, a gradually increasing pallor, and a limitation of exercise tolerance. For about ten days before admission there had been constant headache, for seven days a purpuric eruption over the entire body, and for twenty-four hours fever and prostration with cyanosis and progressive dyspnea. There was no clinical or pathological evidence of trichiniasis, Hodgkin’s disease, or other condition which might have contributed to the striking eosinophilia. Though acute leukemia is generally characterized by the extreme immaturity of the type cell in the peripheral blood and the tissue infiltrations, all four cases of acute eosinophilic leukemia have had the adult eosinophil as the predominant element in the peripheral circulation, with smaller numbers of cells showing various degrees of immaturity. Evidence for the extramedullary production of eosinophils is presented. Lack of adequate neutrophilic myelopoiesis was reflected in the scarcity of neutrophilic granulocytes in the necrotizing inflammatory exudates, which were composed chiefly of adult eosinophils. The character of these lesions suggested that the eosinophil is unable to assume the responsibilities of the neutrophil in the inflammatory defensive reactions of the body, for there was widespread necrosis and very little evidence of healing. Except for the large numbers of eosinophils, the lesions resembled those of agranulocytosis. Only one blood count was possible, as the patient died six hours after admission to the hospital. The white blood cells numbered 130,000 per c. mm. The differential count was as follows: neutrophilic stab forms, 0.2 per cent; segmented neutrophils, 9.8; eosinophilic stab forms, 1; segmented eosinophils, 67.6; neutrophilic myelocytes, 2.6; myeloblasts, 16.6; lymphocytes, 2.2. The size and number of the granules in the eosinophils varied considerably; two-lobed and three-lobed nuclei predominated. In counting 500 leukocytes, one nucleated red blood cell was encountered. There was an almost complete absence of platelets in the smear. Time was not available for further laboratory study, but it was apparent from the appearance of the skin and mucous membranes that there was a moderately severe anemia. The author’s case differs from those previously reported in its longer duration, the large number of myeloblasts in the peripheral blood, the severity of the hemorrhagic phenomena, and in the terminal agranulocytic inflammatory changes. WM. H. WOGLOM

Malignant Monoblastoma. A Variant of Monocytic Leukemia, LOUISA. MITCHELL. Ann. Int. Med. 8: 1387-1403, 1935. Since the first case of monocytic leukemia was reported, in 1913, the disease has gradually gained recognition, and variations from its usual form, such as are found in association with other types of leukemia, have been observed. However, extensive tumor formation with primary multiple monoblastomas of the connective tissues ending in a terminal leukemic phase with large numbers of primitive monoblasts flooding the peripheral circulation, as in the patient herein described, has not previously been reported. The patient, a white male sixty-three years old, first noticed general weakness, persistent abdominal distention and discomfort, a slightly palpable reddish eruption on the legs which later examination showed to be caused by intracutaneous infiltration, and a few small subcutaneous nodules on the lower abdomen, which later spread over the trunk, arms, and scalp. These subcutaneous nodules, about 200 in number, were each about the size of a pea, firm, discrete, and freely movable in the subcutaneous fat, though a few were attached to the skin. All other findings were essentially negative. Temporary symptomatic improvement followed the exhibition of arsenic in the form of sodium cacodylate subcutaneously, the eruption on the legs rapidly disappeared 718 ABSTRACTS

and the subcutaneous nodules were reduced to not over 25 in number. Then, without change in the subjective symptoms, the nodules increased rapidly in number until there were about 100 of them, and the testicles enlarged to twice their normal size. The Aschheim-Zondek test was negative. Irradiation of the testicles and nodules was followed by prompt reduction in size, and after eleven exposures to radium and x-ray over a period of three weeks, only ten nodules remained. About two months later, however, in spite of continued irradiation and arsenic the nodules increased rapidly in number and the patient complained of a return of general weakness. Ten days before death, which occurred about eight months after the beginning of the illness, definite enlargement of the liver and spleen was noted, and there was oozing of blood from the gums with repeated small hemorrhages from the bowels and multiple small subcutaneous and submucous hemorrhages. There was never any palpable enlargement of the lymph nodes. The leukemic blood picture was a late development, discovered only one week before death. Microscopic examination of four nodules removed at biopsy showed large blast-like cells infiltrating fat. They possessed a moderate amount of cytoplasm without evident cell outline and large, vesicular, round or oval nuclei, deeply indented, often containing one nucleolus, and varying greatly in size. Many of these cells were in mitosis. There were no giant cells present, but a very few adult lymphocytes and collagen fibrils were seen. With Foot’s reticulum stain numerous fine argyrophil fibers could be demonstrated. In the aleukemic stage of the disease all the leukocytes were mature. From the first there was a relative increase in the monocytes of the blood, with their absolute count normal or slightly reduced. In the leukemic phase very primitive white blood cells, identified as njonoblasts, dominated the blood picture. Adult monocytes were rarely seen, and disappeared completely with the great increase in immaturity of all the leukemic cells at the last count, thirty hours before death. The peroxydase reaction was not satisfactorily determined. A very few typical myelocytes were present. All lymphocytes were small and distinctly adult in type. No specific granules existed in any cells except the few myelocytes just mentioned. A moderately severe secondary anemia persisted throughout the entire course of the disease. The autopsy material showed reticular hyperplasia in liver, spleen, and kidneys. The free mononuclear cells infiltrating the spaces of the reticulum were from one-and-a- half to four times the size of a small lymphocyte, highly phagocytic, and resembled the cells of the reticulum and the monoblasts of the peripheral blood, Multinuclear giant cells were present in these three organs where reticular hyperplasia was found, but did not occur in the blastomatous nodules or in the bone marrow. Marrow from the ribs possessed no myeloid tissue. The medulla of the bone contained fat which was extensively infiltrated by large mononuclear cells, a few of which were in mitosis. The case comes under the classification of leukosarcoma. There was an unusually widespread malignant hyperplasia of reticulo-endothelial cells with peculiar, multiple recurring monoblastomas formed by localized hyperplasia of histiocytes in the diffuse connective tissues. In the aleukemic phase these nodules constituted the only involvement of the reticulo-endothelium, while in the leukemic phase they were accompanied by hyperplasia of the reticulo-endothelial cells in the stroma of the organs. Since thc nodules antedated by at least five months both the leukemic blood picture and the clinical evidence of reticulo-endothelial hyperplasia in liver and spleen, they cannot be explained either as localized deposits of circulating monoblasts or as tissue metastases. Compared with the other hematopoietic tissues, monoblastic tissue varies greatly in character and is widely distributed throughout the body; hence it may be expected to produce a more complex disease syndrome. However, the course of events in the present case finds a close parallel in a disease of the lymphatic systen-malignant lymphoblastoma with terminal lymphatic leukemia. In both there is a characteristic type of malignant blastoma whose spread is usually limited to the tissue in which it originates, and the possibility at least of R terminal leukemia rrflecting the character of tlw cells forming the hlastomn. WM. If. WOG1,OM TIIE LETTICEMIAS, RO~OICIN’S DISEASE, Lk’MPKOSAl1COMA 710

Gout and Aleukemic Leukemia in a Boy Aged Five, C. W. VININGAND J. G. THOMSON. Arch. Dis. Childhood 9: 277-284, 1934. ‘I‘he CBSP of a five-ycar-old ~(JYwho died of alcukriiiic leukeniia and exterwive gouty deposits in the joints and subcutaneous tissues is reported. It, is Idieved that the Irukeniic state wsthe primary condition in this case and, occurring as it did, in a child whose ancestors were gouty, it led to the precipitation of an acute generalized deposit of urates. In leukemic conditions there are available large amounts of nuclein from the break-down of immature white cells and when leukemia occurs in a person carrying the latent tendency to gout the development of uratosis is not unlikely. The article is illustrated with photographs of the gross lesions and photomicrographs. BENJAMINR. SHORE Subleukemic Lymphadenosis in a Child, G. STEWARTSMITH. Brit. M. J. 2: 1097-1098, 1934. A male child of four and a half years was admitted to the hospital with a history of loss of weight for several weeks. The child’s gums were ulcerated, the lips excoriated, and the breath foul. Local treatment cleared up the condition. The child was discharged a month later, no blood examination having been made. Six months later he was readmitted and found to have severe lesions of the gums. The lymph nodes and spleen were not enlarged. Blood examination showed pronounced anemia, with 7000 leukocytes, of which 82 per cent were lymphocytes. After four weeks the mouth infection disappeared, but nodes began to appear in the cervical region and groin. Lym- phoid nodules also appeared in the upper eyelids and finally a purpuric rash developed on the limbs. X-ray examination showed an osteoporosis. Shortly before death the spleen became palpable and finally reached almost to the umbilicus, while the liver was one inch below the costal margin. A moderate degree of irregular fever was present throughout the illness. The urine contained neither albumin nor Bence-Jones albumose. The blood counts fluctuated between 4000 and 33,000. Toward the end of the disease the lymphocytes were replaced by lymphoblasts. Death occurred five months after the second admission. Autopsy revealed a diffuse lymph node involvement, hemorrhages in the skin and pericardium, and infarcts in the lung. The liver weighed 1000 grams and the spleen 170 grams. Examination of the subcutaneous nodules, the nodes, and the bone marrow showed large cells of a primitive lymphocytic type with a negative oxydase reaction. F. CAVERS Case of Lymphogranulomatosis Confined t6 the Esophagus, J. CHIOLI~RO.Un cas de lymphogranulomatose primitive de l’oesophage, Ann. d’anat. path. 12: 305-310, 1935. Lymphogranulomatosis, either primary or as a result of generalization, has been described in every portion of the gastro-intestinal tract, though but rarely in the esophagus. A case is reported in a seventy-four-year-old man who complained of pain and difficulty in swallowing and was thought, even at autopsy, to have esophageal carcinoma. Microscopic examination of the ulcerated lesion, however, showed it to be Hodgkin’s disease. As the mediastinal lymph nodes were normal, the lesion probably developed from the lymph follicles of the esophagus. WM. H. WOQLOM

Case of Neoplastic Disease Belonging to the Hodgkin Group, E. G. B. CALVERTAND H. H. SANGUINETTI.Lancet 2: 1444-1445, 1934. The authors report a case which clinically was not unlike Hodgkin’s disease but which from the histological standpoint offered some confusion in exact diagnosis. The diagnostic possibilities are discussed but no definite conclusion is reached. There are three illustrations and a short bibliography is appended. THEODORES. RAIFORD

Clinical Study of a Case of Generalized Adenopathy, J. GUERARDAND J. B. JOBIN. Etude clinique d’un cas d’adknopathies g6n6rsliskes, Bull. SOC.mBd. d. h6p. Uni- versitaires de Quebec, pp. 372-380, October 1934. After a somewhat lengthy discussion of the clinical differential diagnosis of the generalized adenopathies, the authors present the case of an eight-year-old child who 720 ABSTRACTS was shown by biopsy to have lymphosarcoma. The liver and spleen were enlarged. Death occurred rapidly in spite of radiotherapy. There are no illustrations and no rcfcrences. C. R. MULLINS

, EDUCATION; STATISTICS

Organization of a Tumor Clinic in a General Hospital, G. T. PACK. Surg. Gynec. & Obst. 58: 248-254, 1934. While the cancer institute would appear to offer the ideal solution of the problem of treatment of neoplastic disease, it is not feasible for all patients to be cared for in such institutions, especially in the United States, where distances between centers of large population are so much greater than in European countries. The needs of the average community would seem best to be met by the cancer clinic in a general hospital. Not only will such a clinic benefit by the established reputation of the hospital but it will share also the advantages of the hospital personnel and equipment. The tumor clinic in a general hospital should be autonomous. It should receive for treatment not only patients with advanced incurable cancers referred from other de- partments of the hospital, but it should be privileged at least to see in consultation or to outline the treatment of every patient with a benign or malignant tumor. All cancer patients discharged from the wards should be referred to the tumor clinic for follow-up observation, and this should extend over the remainder of the patient’s life. The staff should include an internist, gynecologist, urologist, dermatologist, rhino- laryngologist, proctologist, pathologist, roentgenologist, general surgeons and consultants together with specially trained nurses, radium technicians, and secretaries. The social and economic problems involved are best handled through the social service department of the hospital. In addition to facilities for x-ray diagnosis and radium therapy, the department of radiotherapy should be provided with high-voltage x-ray machines of sufficient voltage to insure effective irradiation. Cooperation with the physicians in the immediate vicinity is important, and the educational effects of the clinic must include the profession as well as the laity. Means to this end include lectures arranged with the cooperation of local medical organizations and clinico-pathological conferences conducted by the director of the clinic.

Placing the Responsibility for Increasing Cancer Mortality, E. G. C. WILLIAMS. Illinois M. J. 67: 255-259, 1935. This is a general article concerning the education of the laity on the subject of cancer and the education of the medical profession concerning the early diagnosis and adequate treatment of the disease. BENJAMINR. SHORE The Problem in Malignancy, V. ,&. MINEHART. M. Bull. Vet. Admin. 11: 342-343, 1935. Minehart believes that since growth and invasion are the two primary characteristics of malignant disease, the chief problem is to prevent or stop these. Unfortunately he does not suggest how this is to be done. There are no illustrations. THEODORBS. RAIFORD Differential Mortality from Cancer in the White and Colored Population, S. J. HOLMES. Am. J. Cancer 25: 358-376, 1935. A study of cancer mortality in the white and colored populations for the Registration States of 1920 has shown a considerable difference in the organs most frequently attacked and in the age at death. It seems impossible to refer the variation to greater or less diagnostic accuracy, and it is probable that the discrepancy, which increases enormously as age advances, is the result of inherent differences in race. WM. H. WOGLOM