ANIMAL TUMORS Production of Cmcer by Pure Hydrocarbons, Part III, G

EXPERIMENTAL STUDIES; ANIMAL TUMORS Production of Cmcer by Pure Hydrocarbons, Part III, G. BARRY,J. W. COOK,G. A. K. HASLEWOOD,C. L. HEWITP,1. HIEGERand E. L. KENNAWAY.Proc. Roy. ha., Ser. B. 117: 318-351, 1935. The carcinogenic properties of 1 : 2 : 5 : Bdibensanthracene, 5 : Bcyclo-penteno- 1 : 2-benaanthracene and other closely related compounds have been discussed in a number of contributions (see Absts. in Am. J. Cancer 17: 181, 472, 1933, and original articles 16: 57, 1932; 17: 1, 1933; 20: 58, 1934). Here the authors report the results of a systematic examination for carcinogenic activity of tetracyclic and pentacyclic aromatic hydrocarbons, made by applying the substance, usually dissolved in bensene, to the interscapular region of mice twice weekly, for the production of carcinoma and papillomas, and by injecting it subcutaneously, in a fatty medium, usually lard, for the production of sarcomas in rats and mice. Only one of the six possible hydrocarbons, consisting of four condensed aromatic rin~,showed any considerable carcinogenic power. This compound, 3 : 4-benzphen- anthne, is the simplest hydrocarbon so far shown to have such power in a pronounced degree, and the only one yet made which is not derived from or related to 1 : 2-bensanthracene. Of the fifteen possible hydrocarbons containing systems of five condensed bensene rings in the molecule, twelve have now been tested, and only two of these 1 : 2 : 6 : 6dibenzanthracene and 1 : 2-benspyrene, have shown pronounced activity. Testa on twenty simple derivatives of the former are now almost complete, and the results justify Cook’s conclusion that substitution, especially in the meso position, tends to diminish the carcinogenic power. 1 : 2-benzpyrene is the only carcinogenic substance so far examined which has been shown to occur in coal tar, besides having been prepared synthetically from pyrene. The natural and synthetic materials gave similar results, and from the high incidence of tumors (47 epitheliomas and 11 papillomas in 100 mice) this appears to be a considerably more active agent than 1 :2 :6 :Mibensanthracene. The investigation of pure synthetic carcinogenic agents of known molecular structure haa eegumed an entirely new aspect with the recognition and proof of tho true molecular struotures of the group of natural products which comprise the sterola and bile acids, between which and the carcinogenic hydrocarbons there is a definite similarity in structure. In particular the sterols and bile acids contain in their molecules condensed carbon-ring systems to which is attached a long side chain in such a position that a new six-membered ring can be formed so as to give the 1 : 2-bensanthrscene ring system without molecular rearrangement or group migration. The purely aromatic hydrocarbon, methylcholanthracene, obtained thus from the bile acid, dioxycholic acid, and recently synthesized by Fieser and Seligman (J. Am. Chem. Sac. 57: ,228, 1935), is a bensanthrscene with substituents in positions 5 and 6, a favorable type of molecular structure for the development of carcinogenic properties. Testa by the authors have shown that its activity is at least equal to that of 1 : 2-benspyrene. In one series of 20 mice it produced 17 epitheliomas and one papilloma within 180 days, and in a second series the 6rst tumor appeared after 31 days. When it was dissolved in lard and injected into the thighs of 15 r&s, connective-tissue tumors arose in every one of the 9 animals which lived for more than 70 days. That is, it produces connective-tissue tumors more rapidly than any other hydrocarbon so far tested. The tumors were spindle-celled, and some contained numerous giant cells. They rarely metastasised, despite their great sise, but gave vigorous autografts. Of four beterografts three were negative and the fourth failed after the third generation, as compared with a 1 : 2 : 5 : 6 dibenranthracene tumor which has now reached the 71st generation. The authors have now examined for carcinogenic activity 71 compounds not related in molecular structure to 1 : 2-bensanthracene, and 65 of these have given entirely 846 846 ABSTRACTS negative results on 20.26 tested mice. Of the 6 compounds which gave positive results (22 tumors in 380 mice) only 3 : 4-benephenanthrene has considerable activity. On the other hand, out of 69 compounds related to 1 : 2-benaanthracene 25 gave positive results (437 tumors in 1220 mice); the remaining 44 (no tumors in 619 mice) were for the most part derivatives in which the substituents were attached to the molecule in positions other than 5 and 6. There are seven photomicrographs, and a full bibliography is appended. F. CAVERS

Reduction of Cancer in the Rabbit with 1 :2 :5 :bDibenzanthracene, A. LACASSAGNE. Essais de production de cancer chee le lapin au moyen du 1-2-58 dibeneanthracbne. Compt. rend. SOC.de biol. 114 : 660-662, 1933. Dibeneanthracene was dissolved in lard in dilutions of 1 to 4 mg. per C.C. and injections of 1 C.C. were made in rabbits every two weeks. The material was introduced into the breast, the knee joint, the marginal vein of the ear, and the testicle. Up to the time of the report the only tumor produced was one of the testicle. The tumor appeared in about six months. None of the autografts or subcutaneous grafts in 9 small rabbits, or the intracerebral grafts in 5 adult rabbits grew. About a year after the first inoculation the animal was killed and was found to have invasion of the pre- aortic lymph nodes and extensive metastases in the lung. The exact type of the growth is still uncertain. [Prof. Lacassagne informs the abstractor that further study of the tumor suggests that it might be derived from the remnants of adrenal cortex which normally occur in the rabbit’s testicle.]

Lesions Induced in the Lungs by Intravenoue Injection of Tar, JAMESP. SIMONDSAND JOHN8. CURTIS. Arch. Path. 19: 287-302, 1935. Though a number of investigators have attempted to induce carcinoma of the lungs by the introduction of tar into these organs, the results have been sufficiently confusing to warrant repetition of the experiment. The authors therefore injected 31 rabbits (2,500 to 5,000 gm.)with 0.2 or 0.4 C.C. of liquid petrolatum containing 5 per cent of a tar known to be carcinogenic for mice. This mixture was slowly introduced into a vein of the ear, usually once a week unless the rabbit became sick or appeared undernourished; in such an event the injections were discontinued. The animals survived for from eight days to more than eighteen months after the first injection; all were allowed to die epontaneously. [There is no mention of controls injected with oil alone.] In 17 rabbits that lived for more than two weeks, there were varying degrees of epithelial proliferation combined with such pathologic processes as thrombosis, em- bolism, and chronic inflammation. In 12 of this group (and in one additional rabbit injected with anthracene) the epithelial hyperplasia was advanced. The authors are not convinced, however, that actual carcinoma had been induced, for although the proliferation was sufficiently massive and atypical to suggest strongly a malignant growth, there were no discoverable metastases, the lesion was multicentric, and it was constantly and intimately associated with granulation tissue .without definite relation to the amount of tar injected or the length of time that the animal survived. It is remarkable that such extensive and even atypical epithelial proliferation can take place without acquiring a definitely malignant character. The normal cell, at least in the rabbit lung, must possess a large measure of inertia that resists transfer across the ill-defined border separating inflammatory hyperplasia from the true neoplasms. WM.H. WOGLOM Scarlet Red as a Possible Carcinogenic Agent. An Experimental Study, CLARENCET. ECKERT,ZOLA K. COOPIW~AND M. G. SEELIO. Arch. Path. 19: 83-90, 1935. As the authors could find no record of long-continued surface and subepithelial applications of scarlet red, they applied a 2.6 per cent solution of the dye in olive oil to the skin of 161 young white mice three times weekly over a period of 312 days and during this time made 7 subcutaneous injections (0.50 to 0.75 C.C. each) of the same EXPERIMENTAL STUDIES ; ANIMAL TUMORS 847

preparation as nearly as possible under the painted area. They saw no such epithelial hyperactivity as waa described in rabbits by B. Fischer and many of his followers. WM. H. WOQLOM Experimental Papillomu of the Urinary Bladder. (1) The Production of Papilloma in the Rat Bladder with Pellets of Tar, Scarlet Red, and Par&, 8. WATANABE. Experimentelle Papillombildung in der Harnblaae. (1). Eraeugung von Papillom in der Rattenblase durch Einbringen von Teer-Scharlachrot-Paraffin-Kugeln, Acta Dermat. 23: 28-31, 1934. Pellets made of equal parts by weight of coal tar, scarlet red, and paraffin were placed in the urinary bladders of rats. There were ultimately available for histological examination 55 bladders from survivors killed after the lapse of various periods (14 to 396 days). In 9 of these, heterotopic and atypical growth of epithelium had taken place. Where the lesion was most advanced alveolar cell nests had penetrated as far down as the muscularis, and in a few instances this layer had been damaged by pressure. In brief, proliferation was definitely of the malignant type. [Such invasion is not, under the circumstances of the experiment, any proof of malignancy. See, for example, Bullock and Rohdenburg; J. Cancer Res. 3: 227, 1918.1 The remaining bladders were the seat of papillomas in various stages of growth, except for 4 which contained no outgrowths and 2 in which the wall of the viscus had undergone necrosis. Examination of the retroperitoneal and iliac lymph-nodes from 7 animals disclosed no metastases. [It is not stated whether these came from the 9 rats with atypical growth of epithelium.] The article is accompanied by 2 plates. WM. H. WOGLOM

Production of Sarcoma by Repeated Injections of Highly Concentrated Glucose Solu- tion in Rats Fed with o-Amidoazotoluol, Y. NISHIYAMA.tfber die Sarkombildung durch wiederholte Injektionen der hochkonaentrierten Glukose-losung bei den mit o-Amidoazotoluol geffitterten Ratten, Gann 29: 1-9, 1935. Twenty-two healthy rats were fed with a ration consisting of 2 gm. of a 5 per cent solution of o-amidoazotoluol in olive oil and 98 gm. of unpolished rice. At the same time these animals received subcutaneous injections of a 25 per cent aqueous solution of glucose, 4 C.C. daily for each 100 gm. of body weight. Only 7 out of 22 animals lived more than 200 days. Five of them developed tumors of the subcutaneous tissues at the injection site. The histologic picture was that of a polymorphic-cell sarcoma. Photographs of the animals and photomicrographs are included. [The experiment should be repeated omitting the ortho-amidoal;otoluo1.] K. SUQIURA Unexpected Development of Tumors in Rats during an Experiment Unrelated to leoplasia, PAULOQ. T. TIBIRICA.Curieuse apparition de nt3oplasmes sur des Rats en exp&ience, Compt. rend. SOC.de biol. 118: 177-178, 1935. During an investigation on the growth of teeth in rodents the incisors were broken off weekly under ether. In November 1933 the author operated thus on the right upper inohre of 3 rats. At the end of about six months one of the animals, a female, died with an angio-endothelioma of the mesentery disseminated throughout the abdominal cavity and metastasizing to the mediastinum. Although the tumor was contaminated, transplantation was attempted in 10 rats; only abscesses resulted. About eight months after the beginning of the experiment one of the 2 remaining rafe [sex not stated], which appeared to be ill, was sacrificed and autopsied under aseptic conditions. It had a similar neoplasm and this time transplantation was successful in one of 10 rats. A second generation, however, failed. After some ten months the third rat [sex not stated] presented a palpable growth in the abdomen, and at the time when the paper was written was still under observation. The author ia inclined to believe that either the anesthetic or the operation on the teeth played some part in etiology and is repeating the experiment in the hope of finding an explanation for his curious observation. Wbf. H. WOQLOM 848 ABSTBACTS

Experiments Concerning the So-called Tomato Sarcoma, S. HOSONO. Gann 29: 40-49, 1935. Ripe tomatoes collected from various districts in Japan were found on bacteriological examination to harbor bacilli and cocci of various sorts, including B. eublilie. Tomato juice injected into the abdominal cavities of white rats failed to produce tumors. K. SUQIURA So-called Tomato-pulp Sarcoma in Rodents, H. STAER. uber das Genfer Tomaten- sarkom und seine Bewertung, Med. Welt 8: 42-44, 1934. The author made a small series of subcutaneous and intraperitoneal injections of tomato pulp in white rats, mice and guinea-pigs. Each animal showed nodules in the liver and peritoneum, all presenting the features of granulomas consisting mainly of fibroblasts with foreign body giant cells. The peritoneal nodules showed rapid regression. F. CAVERS Mificial Anus for the Introduction of Carcinogenic Substances into the Colon of the Rat, F. THOMAS.La technique de l’anus contre nature abdominal et de I’introduction de substances canc6righnes dans un segment colique isol6, ches le Rat, Compt. rend. SOC. de biol. 118: 384-386, 1936. This article describes a method of isolating a segment of colon in the rat for the purpose of applying carcinogenic agents to its mucosa. WM. H. WOOLOM Synthesis of Carcinogenic Substances, G. HOLM. La synthhse de substances can- cdrigenes, Scalpel 88: 45-48, 1935. A brief review of the literature. H. Q. WOODARD

Propem in Cancer Research, E. JUSTERAND F. CAILLIAU. Lee donn6es actuelles du problhme du cancer, Presse m6d. 42: 1054-1057, 1934. An editorial review of some of the recent work on the chemistry of the cancer cell and on the r8le of the dibensanthracene group in causing cancer. JOHN8. LOCKWOOD Nature of the Carcinogenic Agent, FERDINANDBLUMENTHAL. Wesen und Bedeutung des Canceragens, Acts Cancrologica 1 : 193-204, 1935. This is a lecture containing no new material. WM. H. WOQLOM Mucous Membrane as a Portal of Entry for the Vhrof Mouae Sarcoma, A. BESREDKA AND L. GROSS. Die Schleimhaut, als Eingangspforte flir das Sarkomvirus bei der Maus, Acts Cancrologica 1: 189-192, 1935. The Ehrlich mouse sarcoma was not transferable by feeding, but when incisions were made in the lower lip one mouse out of the 5 thus treated developed the tumor. When the sarcoma was introduced into the rectum it gave rise to tumors if retained long enough, even without incisions having been made. WM. H. WOQLOM

Skin as a Portal of Entry for and Defence againet Cancer. Experiments with the Ehrlich Moure Sarcoma, A. BEBREDKAAND L. GROSS. Die Haut als Eingangs- pforte und Abwehrorgan in der Krebskrankheit. Versuche mit dem Ehrlich’schen Mllusesarkom, Wien. med. Wchnechr. 85: 170-171, 1935. Importance of the Portal of Entry in the Evolution of Ehrlich Sarcoma, A. BNSREDSA AND L. GROSS. De l’importance de la porte d’entde dans 1’6volution du sarcome d’Ehrlich, Compt. rend. Acad. d. m. 200: 175-176, 1935. When the Ehrlich mouse sarcoma is inoculated subcutaneously, intramuscularly, or intraperitoneally, the animal inevitably dies of the tumor within three or four weeks. Not so, however, with intradermal inoculation. Here the llvirus” produces a tumor which remains benign and which may finally disappear. [This observation certainly does not apply to all transplantable neoplasmtl. Both Murphy (Monographs of the Rockefeller Institute for Medical Research, 1926, No. 21, EXPEBIMENTAL STUDIES ; ANIMAL TUMOBS 849

95), and, later, the abstractor have inooulated other growths intracutaneously for various purposes and have obtained progressively growing tumors.] WM. H. WOOLOM Failure to Transmit Carcinogenic Agents from the Pregnant Mouse Embryos in Utero, C. C. LITTLEAND 8. G. WARNER. Proo. SOC.Exper. Biol. & Med. 32: 866-869, 1935. Several investigators [e.g. Tesauro: Ztschr. f. Krebsforsch. 35: 109, 1932. Abst. in Am. J. Cancer 16: abst. p. 739, 19321 have reported the development of neoplasms in mice injected with embryos from tumor-bearing mothers. This would imply the existence of an etiological agent smaller than and separable from the cancer cell, and as most of the evidence for mammalian growths controverts such a conclusion the authors thought it worth while to repeat the experiment. In so doing they followed as cloeely as possible the technic described by Tesauro, even employing one of the tumors used by him (sarcoma 37). Fifty-six mice in all were injected-47 with embryos from mice with tumors (sarcoma 37, sarcoma 15091a, carcinoma d Br B, and a spontaneous carcinoma) and 9 with those from normal females. Although the mice that received the embryo mash were from strains known to be susceptible to the various transplantable tumors used, in no case did a malignant growth arise. WM. H. WOOLOM Contribution to the Question of Cancer Cages, I. GHEOROHIU.Contribution h 1’6tude de la cage B cancer, Compt. rend. SOC.de biol. 114: 756-758, 1933. As a contribution to the cancer-cage question, which has been more or less under discueeion since 1900, the author offers the following observations. Twelve mice were put into an undisinfected cage which had formerly housed mice bearing propagable tumors. Three carcinomas arose in these animals 2 years, 2 1/3 years, and 2-3/4 years later, all at the nape of the neck. Two of the 3 growths were transplantable. These mice were swarming with parasites, the nape of the neck in particular, where the animals could not scratch, being completely covered with fleas. The author concludes that the etiological r8le of parasites is evident. WM. H. WOOLOM

Carcinomatous Changes in Virus-induced Papillomas of the Skin of the Rabbit, PEYTON Roue AND J. W. BEARD. Proc. SOC.Exper. Biol. & Med. 32: 578-580, 1935. The Shope rabbit papilloma, a skin growth caused by a virus (J. Exper. Med. 58: 607, 1933. Abst. in Am. J. Cancer 20: 887, 1934), frequently looks and behaves like a malignant neoplasm when implanted within the host (J. Exper. Med. 60: 701, 1934. Abst. in Am. J. Cancer 23: 841, 1935). The present report, however, is concerned with instances in which papillomas on the skin have spontaneously become carcinomatous. This change has now been noted in 5 out of 10 domestic rabbits with growths that had been in existence for from four to eight months. The malignant transformation may first attract attention when a fissure exuding serosanguineous fluid opens in the midst of the papilloma, but more often there occurs a generaliaed, fleshy, discoid thickening of the base of the growth which gradually raises the tumor some millimeters above the skin surface and also bulges downward. On biopsy a squamous-cell carcinoma is found, or an invasive papilloma or, most frequently, a combination of the two. The growth may then remain circumscribed for some weeks or rapidly extend under the skin, involving it and the muscle and becoming fixed upon the deep tissues. Metastasis to a regional lymph node has occurred once. Trans- plantation into the leg muscle of the host has resulted in a highly invasive squamous-cell oarcinoma. In rabbits with multiple discrete papillomas nearly all the growths undergo the malignant change within a few weeks of one another. The virus engendering the Shope papilloma must be held primarily responsible for the carcinomas as well, but their proximate oause remains to be determined. It is plain that from an early period the cells of the papilloma possess potentialities for malignant behavior, but rabbits appropriately tarred may develop carcinoma within two weeks, yet tar cannot be considered the proximal cause of the cancer. Even if the Shope virus 850 ABSTRACTS gave rise forthwith to carcinoma, the view would still be tenable that it had done no more than to provide the conditions requisite for a cancerous change of unknown cause. At the moment only this much seems certain: the virus gives rise to skin growths which for some time remain benign tumors, though their cells have malignant potentialities. Gradually, by alterations that involve no discontinuity of form or behavior, the growths take on the characteristics of typical carcinoma. Bacterial infection frequently precipitates the change. WM. H. WOQLOM

Serial Transmission of Virus of Infectious Papillomatods in Domestic Rabbits, RICHARD E. SHOPE. Proc. SOC.Exper. Biol. & Med. 32: 830-832, 1935. The virus of infectious papillomatosis produced warts which were readily transmissible in its natural host, the wild cottontail rabbit, but the warts regularly induced in domestic rabbits were not at first transmissible serially in either wild or domestic ones (J. Exper. Med. 58: 607, 1933. Abst. in Am. J. Cancer 20: 887, 1934). A similar situation has been described in respect to the transmission of the Rous sarcoma 1 to turkeys, guinea-fowls, and pheasants. The purpose of the present paper is to report the successful transmission of the virus serially in domestic rabbits. The technic of infection was the same as that which had been used unsuccessfully in 26 fruitless efforts; yet of 32 more recent attempts to carry the virus beyond its first domestic rabbit passage, 13 succeeded and eventually a tenth paRsage was obtained. Why the domestic rabbit papilloma should be transmissible in series at one time and not at another is not yet clear. The maturity of the warts when attempta were made to transmit them was not a determining factor, nor was the breed of rabbit. Age, however, may be of importance, for warts taken from rabbits over two years old have proved serially transmissible more often than those from animals two to four months old. The concentration of the inciting agent in the tumors used as the source of infection, the natural threshold of resistance to the virus in the animal to be infected, and a gradually acquired adaptability on the part of the virus are other probable determining factors. In any case, this preliminary report is published only to correct the impression, created by the earlier paper, that the virus of infectious papillomatosis is never serially transmissible in domestic rabbits. WM. H. WOOLOM Experimental Approach to the Cancer Problem. I. Four Important Phases of Cancer Research. II. Avian Tumors in Relation to the General Problem of Malignancy, JAMESB. MURPHY. Bull. Johns Hopkins Hosp. 56: 1-31, 1935. The four important phases discussed in the first of these two Thayer lectures are the biology of the cancer cell as determined in transplantable neoplasms, the experimental production of malignant tumors by carcinogenic agents, the study of inherited susceptibility to spontaneous new growths, and the investigation of avian neoplasms. The second lecture reviews the attempts of the author and his colleagues to introduce some semblance of order into the problem of malignancy, and describes certain developments growing out of their efforts. Among these are the demonstration of growth- stimulating and growth-inhibiting factors in a fowl tumor and the resulting hypothesis that some such influences may control the growth and d8erentiation of normal tissues. Evidence for the existence of a stimulating agent is not so definite as for that for a retarding factor. [The experiments concerned in demonstrating the latter have been recently reviewed in the Am. J. Cancer: 19: 99, 1933; 23: 357, 1935.1 The general conclusion is drawn that mammalian neoplasms are not the product of an exogenous factor or parasite, and that the etiological agent of the fowl tumors is probably an inanimate substance, a transmiseibk mutagen, rather than a true virus. WM. H. WOOLOM Propertieo of the Causative Agent of a Chicken Tumor. X. Chemical Properties of Chicken Tumor Extracts, ALBERTCLAUDE. J. Exper. Med. 61 : 27-40, 1935. The major part of the proteins, which are adsorbed on alumina gel, and a carbo- EXPEBIMENTAL STUDIES ; ANIMAL TUMORS 851 hydrate, which is eliminated by precipitation in combination with gelatin, were removed from extracts of the Rous sarcoma with practically no reduction in their activity. WM. H. WOGLOM Properties of the Causative Agent of a Chicken Tumor. XI. Chemical Composition of Purifled Chicken Tumor Extracts Containing the Active Principle, ALBERTCLAUDE. J. Exper. Med. 61: 41-57, 1935. By a rapid method of dialysis a diffusible fraction of extracts of the Rous sarcoma, from which most of the proteins had been removed with aluminum hydroxide, were eliminated without decreasing tumor-producing activity. These diff usible products represent about 75 per cent of the solids in the treated extract. Combined methods of fractionation have resulted in the elimination of as much as 95 per cent of the total solids. Since there was some concomitant enhancement of the activity of the agent, the result WBE equivalent to a 25-fold concentration of it in terms of dry weight. Theachemidcontent of the undiffusible fraction has been determined in terms of total nitrogen, ,reducing substances, sulphur, phosphorus, and lipoids. The evidence suggests that a protein and a phospholipoid are the principal constituents of the active residue. Further fractionation is being attempted. WM.H. WOGLOM The Development of Malignant Tumors, S. FUJINAGA;Beitrage zur Kenntnis der Entwicklung maligner Geschwlllste, Fukuoka-Ikwadaigaku-Zasshi 27: 1121-1204, 1934. The author obtained a transplantable spindle-cell sarcoma by repeated implantations of a papillary mouse adenocarcinoma. He obtained a second transplantable spindle- cell sarcoma through implantation of another mouse carcinoma, and made an extensive study of the growth of these two sarcomas, comparing them with a third transplantable spindle-cell sarcoma which was found by Asada. The first of the author’s spindle-cell sarcomas appeared in the 19th generation after implantation of the papillary adenocarcinoma. However, in this first appearance there were no changes in the structure of the carcinoma parenchyma. Only in the stroma was there found a malignant structure which in the following generation developed into spindle-cell sarcoma. Further transplantation of this tumor showed mor- phologiaally and biologically true spindle-cell sarcoma. This phenomenon is to be regarded as a malignant change in the stroma of the adenocarcinoma. It is the general opinion that malignant change is due to chemical irritation of the cancer cells acting on the supporting tissue. But in this opinion the author does not concur, stating that disposition and other intrinsic factors play an important rble. In the second case, there was noted, after transplantation of the stroma-poor solid carcinoma, a gradual change in form and arrangement of the carcinoma cells. This developed gradually, with repeated implantations, into a spindle-cell sarcoma. The author transplanted this sarcoma many times, but he never observed a carcinomatous element in it. From these observations it may be said that the development of connective-tissue spindle-cell sarcoma from epithelial carcinoma cells is within the realm of possibility, although in general it has been held impossible for connective-tissue cells to form from epithelial cells. One must assume that in the transformation from carcinoma to sarcoma there are two histogenetic possibilities: in one the stroma of the carcinoma undergoes transformation; in the other the carcinoma cells themselves are transformed. [After all it is scarcely possible to generalize from these observations. There are in the various cancer research laboratories throughout the world numbers of mouse carcinomas which have been transplanted thousands of times and yet still retain their original morphology.] K. SUGIURA 852 ABSTRACTS

Hormones and Carciaoma, FRITZLUDWIG AND Juwus VON RIES. Hormone und Karsinom, SChWeia. med. Wchnschr. 16: 6-7, 1936. The observation that the hormone of the anterior hypophyseal lobe (prolan) will inhibit the germination and growth of seeds led the authors to try its effect on the cancer cell. They found that mice inoculated with a oarcinoma [unspecified] emulsion treated with prolan did not develop tumors. Furthermore, both prolan and an extract of spleen (splenoglandol) inhibited the growth of human carcinoma in uitro, the latter much more effectively than the former. The authors therefore attribute special importance to the spleen for the control of malignant disease, and suggest a more extensive clinical trid of splenoglandol and prolan than has yet been given. [It is evident that the authors have never seen Stevensode pictures of tumor cells growing in the presence of spleen in the chick embryo (J. Cancer Reeearch 2: 246, 449, 1917) or heard of the comparative frequency with which metastasis takes place to this organ in man.] WM. H. WOGLOM Suprarenal Function and Malignant Tumors, T. TAMURA.Jap. J. Obst. dz Gynec. 17: 349-363, 1934. Tamura’s experiments were carried out with white rats inoculated with the Flexner- Jobling carcinoma and rabbits bearing the Kato rabbit sarcoma. The effect of the tumors on the adrenals and the effect of the physiological activity of the adrenals on the tumors were studied. Twelve tumor-bearing rib showed constant swelling and proliferation of the adrenal cortex, so that the average volume of the gland was 1.3 times and its weight 1.4 times the normal. A similar increase in weight, 1.7 times, was found in the adrenals of 12 rabbits, but microscopically these showed regressive degeneration. Thirty-five rats had one adrenal removed, and in some of these part or all of the other adrenal was cauteriaed either at the htoperation or two weeks later. Such treatment had no apparent effect on tumor growth. Similar experiments in 34 rabbits resulted in a slight inhibition in the rate of tumor growth. Tumor-bearing animals were then subjected to repeated injections of various adrenal extracts. Twenty-two rats were injected daily with 0.1 to 1.6 C.C. of “interenin;” 10 rats were injected with an extract of adrenal cortex in saline, and 10 were fed adrenal cortex. Twenty-seven rabbits were used in similar experiments. Small doses were found to have little effect, but large doses produced slight inhibition of tumor growth. Fifty-two rats received injections of adrenalin, from 0.03 0.0. to 0.2 0.0. daily, at varying times after tumor inoculation. Twenty-seven rabbits were similarly treated. Animals receiving small doses showed no effect. Those receiving large amounts ten days after tumor inoculation showed a distinct though transitory acceleration of tumor growth. The acceleration was more marked in the rabbits than in the rats. GRAYH. TWOMBLY

Hietologic Changer fa the Adrenal8 of Tumor-bearing Rate, C. 5. MCEUENAND H. SELYE. Am. J. M.Sc. 189: 423-424, 1935. Areas of infiltrating cells have often been observed by the authors in the adrenals of rats bearing the Walker carcinosarcoma 266, and similar changes have been reported by others in a variety of diseases, including cancer, in man. In the medulla the infiltrating cells were leukocytes and lymphocytea or, occasionally, eosinophiles only. In the cortex the same varietiea were found, in addition to epithelioid cells closely resembling the cortical elements except that they possessed a decidedly basophilic cytoplasm. In some cases, infiltrations were observed in the periadrenal tissue, the spleen, and the liver. These changes were found in about one-third of a series of 130 rats bearing this tumor, but as serial sections were not made the incidence may have been higher. They were never present in normal rats or in those with tumors weighing less than 60 gm.,and may therefore represent a reaction to necrotic processes ocourring within the larger growths rather than to the malignant neoplasm as such. This is all the more probable, since the authors have shown that the changes in the pituitary gland of tumor-bearing rats, EXPEBIMENTAL STUDIES ; ANIMAL TUMOBS 853

which have been described as characteristic of cancer, are simply the result of tissue decomposition (Brit. J. Exper. Path. 1s: 221, 1934. Abet. in Am. J. Cancer 23: 839, 1936). Furthermore, they were found in some rats injected with necrotic tumor. WM. H. WOGLOM The Thkoid Gland in Tumor-be- Mice after Repeated Injections of Thyroxine, L. MERCIERAND L. GOBEELIN.La glande thyroIde de Souris cancbreuses aprb des hjections rbpetees de thyroxine, Compt. rend. SOC.de biol. 118: 17-19, 1935. The authors have already described over-activity of the thyroid in mice with spontaneous lymphosarcoma or mammary carcinoma (Compt. rend. SOC.de biol. 116: 310, 1934. Abet. in Am. J. Cancer 23: 360, 1935. Compt. rend. SOC.de biol. 117: 762, 1934. Abst. in Am. J. Cancer 24: 672,1935)and have suggested a connection between the resulting hypersecretion and the cancer diathesis. Wishing to know the effect of suppression of the thyroid function they administered to mice of their lymphoma strain 0.33 C.C. of thyroxine intraperitoneally every fifteen days, beginning when the animals were two months old and continuing the treatments for nine months. The thyroids were found more or less distinctly atrophic, according to the number of injections given; the interstitial cells had almost entirely disappeared and the alveoli were greatly distended by colloid, so that the effect amounted to that which would follow blockade of the gland. Lymphomata developed as often in these mice as in those with an over- active thyroid, and it is difficult, therefore, to regard the secretion of this gland as a factor favorable to the development of neoplasia. Thyroid hyperactivity thus appears to be a consequence, rather than a cause, of malignant growth. WV. H. WOQLOM Experinrental Cancer Growth and Ovarian Function, H. KONDO.Japanese J. Obst. & Gynec. 17: 452-460, 1934. The author used 5 series of rabbits: (1) a control series of healthy adult virgin animals; (2) a series which had been castrated; (3) an “incompletely castrated” series, in which one-third of the ovarian tissue on one side was left in eitu; (4) a series receiving ovarian transplants and injections of folliculin-some for two months only (4A) and some for the duration of’the experiment (4B); (5) a series in which the pituitary body was irradiated with x-rays. These animals were tarred two or three times a week on the inside of one ear. The results of the experiments are shown in the accompanying table:

Number of Number of animals True cancer experimental surviving longer production series animsls than 5 months (per cent) 1st (Control) 18 12 18.7 2nd 25 14 14.3 3rd 20 12 41.7 4th 23 15 33.3 6th 11 7 14.3

In group 2 cancer production was slightly delayed, requiring eleven or twelve months as compared with eight to ten months in the controls. In the third group cancer appeared as early as five months after operation in one animal and after seven to eight months in 3 others. In the 4th group the animals receiving injections of folliculin for two months only showed cancer formation in the eighth and ninth months; no cancer appeared in the animals in which the folliculin injections were continued beyond this period. . Series 5 did not differ appreciably from the control group. The author concludes that the differences observed between the castrated and “ inaompletely castrated ” groups are to be explained by the greater degree of die- organisation of “ functional balance ’’ between accessory endocrine glands when diminished ovarian activity is continued over a period of time, as evidenced by the gross and 854 ABSTRACTS microscopic changes found in these glands. In Seriee 4A and B it is felt that the excessive quantity of folliculin prevented cancer growth, but the sudden withdrawal in 4A resulted in the over-production of progestin, which, theoretically, might tend to accelerate tumor growth. Variations in susceptibility to cancer and in resistance to. invasion are thought to be attributable not to changes in ovarian activity per se, but to the disorganization of general endocrine activity which may be initiated by changes in ovarian function. There are 24 illustrations, including photomicrographs. [The author does not state how he differentiates “ true cancer ” and the extensive cancer-like hyperplasiss so easily produced by tar painting in the rabbit.] JOHN S. LOCKWOOD Inhibiting Effect on Transplantable Cancer of a Combination of Ferric Chloride and Salts of 1-Ascorbic Acid, F. ARLOINO.A. MORELAND A. JOSEBRAND..E5et, via-a- vis des cancers ex@rimentaux, d’un produit d’action du chlorure ferrique Bur les eels de l’acide I-ascorbique, Compt. rend. SOC.de biol. 118: 551-554, 1935. hcorboferrine, a name given by the authors for convenience to a substance produced by the interaction of ferric chloride and salts of 1-ascorbic acid, delayed the growth of a tranSplant8bh? mouse carcinoma [unspecified] when injected subcutaneously at a distance from the tumor. [The number of animals is not given.] Ih two thirds of a group of rabbits [number not given] bearing a transplantable cancer of the testis and treated by intravenous injections of the same agent, the neoplasm regressed. In the remainder the tumors grew more slowly than in untreated controls. WY. H. WOOLOM Demonstration of a Tumor Growth-inhibiting Factor from Normal Human Connective Tieeue, JOHNJ. MORTONAND DANIELN. BEERS. J. Exper. Med. 61: 59-66. 1935 Fresh human connective tissue from the rectus sheath was ground with sand in sterile alkaline 0.9 per cent saline (NaOH 1-10oO), 30 C.C. of this solution and 3 C.C. of glycerine being added to each 10 gm. of tissue. The mixture was washed once with ether to remove any fat present, centrifuged, and the ether was then removed from the supernatant fluid. Grafts of carcinosarcoma 256 soaked for fifteen to twenty minutes in such an extract were distinctly retarded. There was complete inhibition in 66 per cent of the rats, definitely delayed growth in another 15 per cent, and in only one experiment was there failure to obtain a lasting effect. The tumors in them animals (lQ per cent), although showing an initial retardation, eventually overcame the restraint and at the end of five weeks were larger than the control series. Muscle extracts exerted no inhibiting action. The few attempts that were made to cause regreasion of established transplants by intraperitoneal and subcutaneous injection of the connective tissue extract were not successful. The authors regard their observations 8s too few in number to warrant any sweeping conclusions, and are continuing the investigation with other tumors. WY. H. WOGLOM Eff ecte of Artificially Induced Lymphopeoia in Cancer-resistant and Cancer-susceptible Rats, M. F. GUYER,F. E. MOHSAND E. M. SHEBESTA. Arch. Path. 19: 66-74, 1935. The distinct lymphopenia produced by repeated roentgen irradiation did not destroy the reRistance of a refractory strain of rate to the Flexner-Jobling carcinoma, or alter the response in a susceptible strain. The usual pronounced lymphocytic and fibrotic reaction about cancer grafts in immune rats waa reduced by irradiation, but the tumors regressed just as promptly as in untreated animals. Hence other protective mechanism8 mu& have been operative, for the lymphocyte did not seem to be an important factor in maintaining the resistance so characteristic of this strain of rats. These refractory animals, lees than one per cent of which allowed the FlexnerJobling carcinoma to grow progressively, were obtained by selective breeding from a strain that was about 85 per cent susceptible. EXPERIMENTAL STUDIES ; ANIMAL TUMORS ,855

The backs of the animals were exposed to 50 to 200 r every two or fhree days until a total dose of 300 to 400 r was given. The rate was 18 r per minute, with an effective wavelength of 0.31 A. The tumor was implanted from eight to twenty-five days after the first treatment. WM. H. WOQLOM Meet of Dietary Fats on Growth and Composition of Tumors, FRANCESL. HAVEN. Proc. SOC. Exper. Biol. & Med. 32: 734-737, 1935. Few observations have been published on the quality of the dietary fat and its effect upon the lipid content of tumors. The present report deals with the effect of a synthetic diet, varying only in the nature of its fat, on the growth of the Walker carcinbsarcoma 256. On the day of inoculation the rats were placed on Sinclair’s diet 262 (J. Biol. Chem. 92: 245, 1931) with cocoanut, cod-liver, or menhaden oil. From four to seven weeks later the tumor was removed and weighed and portions of the periphery were taken for analysis. Cholesterol, fatty acids, and phospholipids were determined by Bloor’s method (J. Biol. Chem. 82: 273, 1929) and the micro-iodine numbers by Yasuda’s modification (J. Biol. Chem. 94: 401, 1931) of the Rosemund-Kuhnhenn method. Cod-liver oil was found to inhibit the growth of the tumor, and the iodine numbers of its phospholipid fatty acids were low compared with those of muscle on the same diets Possible explanations for these findings are discussed. WM. H. WOQLOM

R6le of Diet in Tar Cancer of the Mouse, A. DEI COULONAND A UQO. Le r8le de l’alimentation dans le cancer du goudron de Is aouris, Actes d. SOC.HelvBtique d. so. naturelles 1933, pp. 419-422. A diet composed exclusively of boiled egg yolk, or one containing dried pig’s liver or dried yeast, accelerated the genesis of tar cancer in mice, whereas one containing dried gastric mucosa, intestine, and pancreas from the pig, a mixture of amino-acids (cystine and glutamic acid), or stovarsol exerted an inhibitory action. Each experiment comprised 30 tarred mice. The control was a “ standard curve ” based on some 50 curves representing groups of thirty mice each that had been subjected to no experimental procedure but tarring. [Nothing is said of the source of these mice. The abstractor would feel a little uneasy about employing such a control, even though all mice belonged to a homogeneous strain.] WM. H. WOQLOM PhpuSco-chemical Properties of the Tissues in Relation to the Normal or Pathological Organism. 18th Part. Treatment of Spontaneous Mouse Cancer with Amino- acids. Appendix: Pathological Anatomy of the Tumors, F. VL%B,A. DE COULON, I. G. HOERNERAND J. L. NICOD. Recherche8 sur ies propriktes physico-chimiques des tissue en relation avec 1’6tat normal ou pathologique de l’organisme. 18” partie. Essais de therapeutique A base d’acides aminBs sur les cancers spontanks de la Souris. Appendice: Anatomie pathologique des tumeurs, Aroh. de physique biol. 11: 135-152, 1934. The addition of various dried and powdered tissues (gastric and duodenal mucosa, pancreas, skin, thyroid, hypophysis, testis, suprarenal, thymus, and bone marrow) to a mixture of amino-acids (I-cystine, d.1. alenine, d.1. proline) resulted in the recession of more spontaneous tumors, when the combination was fed to mice, than the amino- acids alone. Fifteen out of thirty-eight such growths disappeared. According to the pathological report, all the neoplasms were mammary carcinomas. WM. H. WOQLOM Statistics of Survival for Mice with Tar Cancer after Extirpation of the Tumor: Toxic meet of the Neoplasm, F. VLES, A. DE COULONAND A. UQO. Lea statistiques de survie dans les cancers de goudron de la Souris apds l’enl8vement de la tumeur; Btude du r8le toxique de celle-ci, Compt. rend. Acad. d. sc. 199: 245-247, 1934. When mice with tar cancer were treated with substances that inhibit or accelerate tumor growth [see preceding abstract], those in which the tumor regressed did not live as long as those in which the growth was stimulated or as the untreated controls. Toxic materials appear to have been set free by the breaking down of the neoplasm. A comparison of mice treated but not subjected to operation with others treated and operated upon seemed to support this hypothesis. WM. H. WOQLOM 866 ABSTRACTS

Phprico-chemiul Propertier of the Tisnrer in Relation to the Aodor Pathological Organism. 19th Part. Statirticr of Survival for Mice with Tar Cancer rfter Extirpation of the.Tumor. The Toxic mctof the Tumor. Appendix: Hirtobgiul Enminrtion of the Tumors, F. VL~,A. DZ COULON,A. UOO,AND J. L. NICOD. Recherche8 Bur les propri6tes physico-chimiques des tissue en relation avec 1’6tat normal ou pathologique de l’organisme. 19’ partie. Lea statietiques de survie des cancers de goudron apds enlbvement de la tumeur; le rble toxique de celle-ci. Appendice: Examen histologique des tumeurs, Arch. de physique biol. 11: 333-351, 1934. The authors suggest [see preceding abstract] that tar tumors exert a toxic action on the host and point out that mice in which they were extirpated lived longer thad those in which the neoplasm had regressed as a result of treatment. All the growths examined were carcinomas. [Asthe authors realhe, the hypothesis of a specifia cancer toxin is not new. It has been given up, however, by nearly all students of the dmase. Tar cancers are prone to ulceration and no proof is given that this and ita secondary infection did not shorten life rather than the tumor per ue. Furthermore, laboratory animals suffer from so many diseases that it is extremely hasardous, in the opinion of the abstractor, to refer their death to a neoplasm except in the presence of demonstrable infection or hemorrhage. The grafted neoplasm seems to grow in the albino rodenta, so widely used for transplanting tumors, without influencing very greatly the health of the animal until Ulceration takes place. It is not uncommon to see an animal live for a considerable period with a slow-growing transplanted tumor when the sise of the neoplasm is one-half the sise of the body of the host. One reason for this is that these tumors are not apt to metastasise spontaneously; hence this and other interference with organ function, so obvious in human tumors, are missing. The terminal infections so rare in human beings with cancer are almost constant findings in the albino mice and rate used for transplantation.] WM.H. WOQLOM Enzymatic Eilsciency in Mdig~ncy,BARNZTT SURHI, M: C. KIK,K. 8. BUCHANAN, HARVBY8. THATCHERAND A. F. DEGROAT. Proc. SOC.Exper. Biol. &, Med. 32: 658-689, 1936. The tumor employed was the Walker rat carcinosarcoma 256. The experiments were conducted in pairs, for every animal with an implanted tumor a litter-mate control of the same sex being restricted to the same plane of nutrition aa the tumor-bearing animal. Forty-two groups were studied in the case of most ensymes. The age of the tumors ranged from three to five weeks in most cases, but some were allowed to proceed to the stage of pronounced ulceration and consequent infection (seven weeks). Ten different blood and tissue enaymes were investigated. The most distinct changes were a decrease in the blood-serum amylase, blood-serum esterase, and trypsin in tumor-bearing rats. A slight but definite fall in hepatic esteraae, pancreatic amylase, and blood-eerum phosphataae was noted, but the decrease in hepatic and pancreatic lipase, pancreatic esterase, and erepsin was too small to be significant. Practically the same drop in blood-eerum amylase and esterase was found in rats bearing the Flexner-Jobling carcinoma. The details of these experimenta will be published elsewhere. WM. H. WOGLOM Coagulating Power of a Guinea-& Tumor, P. MENDZL~ZFF.Le pouvoir coagulant de tissus canc6reux de Cobayes, Compt. rend. SOC.de biol. 118: 196-198, 1935. Tissue juice from embryonal guinea-pigs, and particularly that of the thymus, had a strong coagulating influence in uilro on the heparinised plasma of adult guinea-pigs, and the acceleration was more pronounced than ever when the plasma was obtained from a pregnant animal. Tumor juice from a tramplantsble guinea-pig sarcoma also hastened the coagulation of guinea-pig and normal rabbit plasma, but exerted no effect on chicken plasma and delayed the coagulation of plasma from a rabbit immunised against the tumor. EXPERIMENTAL STUDIELl ; ANIMAL TUMORS 857

When tumor juioe was fractionated into its growth-accelerating and growth-inhibiting portions, it wes found that the former contained also the principle that hastened coagulation, while the growth-inhibiting agent and the substance delaying coagulation were in the other fraction. WM.H. WOOLOM Coagulating Action of Tiluue Extracts from Tumor-bearing Guinea-pigs, P. M~NDBL- ~QFF. Action coagulante des extraits de tiesue, ches lee Cobayes canc6reux, Compt. rend. SOC.de biol. 118: 364-369, 1935. The juice of thymus, pancrew, suprarenal, lymph nodes, and liver from sarcoma- bearing guinea-pigs had the same accelerating action on the coagulation of plasma 88 tumor juice [see preceding abstract], whereas that of spleen, bone marrow, and leukocytes exerted a retarding effect. These properties became evident when the tumor was no larger than a coffee-bean, and persisted throughout the life of the animal. WM. H. WOQLOM Coagulating Power of the Blood Cob from Nodand Tumor-bearing Guinea-pig& P. MENDEL~EFF.Pouvoir coagulant d’616ments fi&s du mug de cobayea candreux et de cobayes normaux, Compt. rend. SOC.de biol. 118: 806-807,1936. As the hematopoietic tissues of tumor-bearing guinea-pigs retarded the coagulation of plasma [see preceding abstract] whereas all the others accelerated it, the author has undertaken an investigation of the coagulating powera of the erythrocytes and the leukocytes. Extracts of the leukocytes from guinea-pigs with a transplantable sarcoma were found to retard considerably the coagulation of normal guinea-pig plasma, whereas extracts of red cells hastened it. It is suggested that the observation may ultimately prove to have some diagnostic value. WM.H. WOOLOM Coagulating Power of ,ae Polynucleu and Mononuclear Leukocptps from Nodand Tumor-bearing Guinea-pigs, P. MENDEL~EFF.Pouvoir coagulant de8 leucocytes polynucl6aires et mononucl6aires provenent de cobayes canc6reux et de cobayes normaux, Compt. rend. SOC.de biol. 118: 807-809, 1936. Continuing her analysis of the coagulating power of blood cells from tumor-bearing guinea-pigs [see preceding abstract], the author found that the mononuclear leukocyte8 had an accelerating effect. These cells were obtained by Bordet’s method-intraperitoneal injection of a foreign (rabbit) serum. WM.H. WOOLOM Cell Type8 Bound in the Harding and Passey Mouse Melanoma Grown in vitro, C. G. GEAND. Proc. 800. Exper. Biol. & Med. 32: 1196-1197, 1936. In sections of the Herding and Peeaey mouse melanoma the study of individual cells is diffioult because of the heavy pigmentation. In tissue cultures, however, cells mi- grate from the margin of the explant and are more easily identified. Early attempts to grow this neoplasm in uitro failed because it rendered the medium alkaline. Later it was discovered that this alkalinity could be counteracted by the presence of bits of normal tissue and healthy growth thus obtained. It was found, also, that even fragments of the tumor by themselves would grow provided that their margins contained relatively non-pigmented macrophagee, the continuous growth of which also reduced the alkalinity of the medium. ‘ Three types of cells appeared in the outgrowths-macrophages, fibroblasts, and melanoblaste. The macrophages could be differentiated into actively moving, sparsely laden cells, and swollen, sluggish elements densely filled with melanin granules. The fibroblasts had oval nuclei and were often spindlwhaped. The melanoblasts had spherical nuclei, were highly dendritic and, like the macrophagee, could be separated into two classes: small cells with slender uniform dendrites, and large ones with stouter dendrites, possessing knobbed swellings along their lengths. Melanin granules were found in all these types. In the macrophages they were usually messed in irregular clumps throughout the entire protoplasm, in the fibroblasts about the nucleus, and in the melanoblasts in the dendritio proceeses and at the periphery of the main cell body. 858 ABSTRACTS

The melanoblasts gave a positive reaction to dioxyphenylalanine (Dopa reaction). Mitoses were observed in the small type melanoblast. No epithelium was ever found. WM. H. WOOLOM

Cholesterol as a Constituent of the Malignant Cell, I. A. BRONSTEINAND D. V. WOL- KENSOHN. Recherche8 sur le r8le de la cholesterine comme partie constituante de la cellule maligne, Acta Cancrologica 1: 205-214, 1935. In the necrotic portions of various transplantable tumors (Jensen rat 88rcom8, Fischer chicken sarcoma, and the Ehrlich and the Petroff N1 mouse carcinomas) there was from two to two and a half times 8s much cholesterol as at the periphery. These findings coincide with those of several investigators, but conflict with the experience of certain others. While not denying that cholesterol may exert some influence on the tumor cell, the authors do not agree with Roffo that the increased cholesterol content found by him at the pheriphery suggests a close relationship between cholesterol and malignancy. Neither could they confirm Roffo’s statements that the treatment of tumors in uiuo by x-rays cauaes a definite and regular fall in their cholesterol content, and that explants of propagable tumors reduce the cholesterol content of their nutrient medium by 70 to 83 per cent after forty-eight hours’ growth. WM. H. WOOLOM Leulrosir, in Domestic Animals, K. JXRMAI. Die Leukosen der Haustiere. Ergebn. d. allg. Path. u. path. Anat. 28: 227-312, 1934. The author reviews leukosis in horses, cattle, swine, dogs, cats, and chickens. He is of the opinion that among the various types described in the domestic fowl, only the lymphatic form is comparable with the corresponding disease in man. The two are not identical, however. The different distribution of the lymphatic apparatus and the absence of lymph nodes in chickens result in an extravascular type of disease analogous to aleukemic lymphadenosis in the human subject. A bibliography of 441 references is appended. WM. H. WOGLOM Truurmiulon of Myeloid Leukemia of Mice. Its Relation to Myeloma, J. FURTH. J. Exper. Med. 61: 423-445, 1935. A transmissible strain of myeloid leukemia of the mouse is described which can be readily transferred to healthy mice, though only by living basophile myelocytes, the characteristic malignant cell of this strain. Inoculation is almost always successful when resistance has been lowered by x-rays, often successful in the breed in which the spontaneous leukemia originated, and occasionally successful in unrelated mice. The systemic diffuse disease (myeloid leukemia) is produced only by intravenous injection with relatively large doses of tissues or blood. 8ubcutaneous or intraperitoneal inoculation results in the formation of tumors composed of basophile myelocytes. Intravenous inoculation with small doses in susceptible mice, or with larger doses in somewhat resistant ones, produces multiple myeloma. The experiments suggest that transmissible myeloid leukemia of the mouse is a neoplasm. Some of the factors that determine what type the transmitted myelosis shall assume are the resistance of the host, the route of entry, the character of the malignant cell and, probably, the dose administered. It is not likely that all myeloid leukemias of mice that prove to be transmissible will behave similarly to this strain. Indeed, experience with 5 strains of lymphoid leukemia points to the contrary, for each of these had its distinguishing characteristics. There are 4 plates, one of them in color. WM. H. WOOLOM

Induced Resistance to Tnasmisrible Leukemia in Mice, C. P. RHOADSAND D. K. MILLER. Proc. SOC.Exper. Biol. & Med. 32: 817-819, 1935. The fact that mice can be immuniced against transplantable leukemia by treatment with smdl numbers of leukemic cells, and against tranSpl8nt8bh tumors by the injection of normal mouse tissues, suggested the possibility of protecting against leukemia with normal tissues. In 5 experiments comprising 57 treated mice and 30 controls, the EXPERIMENTAL STUDIES ; ANIMAL TUMORS 859

average survival percentage of those intravenously injected with an emulsion of normal spleen and lymph-nodes (filtered through cotton) wae 78.6, as compared with the failure of any of the controls to survive. WM. H. WOQLOM

Quantitative Studies of the Total Sulfur and Iodine in Normal and Malignant Tissues, H. TOYODA,S. KISHI AND W. NAKAHARA.Gann. 29: 29-39, 1935. The total sulphur content of normal and tumor tissues was determined, and iodine assays were aiso made. The tumors were excised from animals ten to fourteen days after transplantation. The total sulphur content of Fujinawa rat sarcoma, Bashford mouse carcinoma, and Rous chicken sarcoma is no greater than that of normal kidney or spleen, though it exceeds that of skeletal muscle, blood, heart, and liver. The tumor tissues were found to contain more iodine than did normal liver or skeletal muscle. The total sulphur content of various tissues of rats bearing the Fujinawa sarcoma was found to be generally in excess of normal, and there were indications that an increase of iodine parallelled that of total sulphur. The iodine content of the thyroid gland of sarcoma-bearing rate was appreciably decreased. K. SUQIURA Studies on the Metabolism of Malignant Tumor. I. On the Influence of Amino-acids upon the Tissue Respiration of Tumour, 8. MIYAO. Gann 29: 10-28, 1935. The author measured the tissue respiration of Kato rabbit sarcoma by Warburg’s method, using spleen and liver of normal young adult male rats as a control. Each of the amino-acids was added to a Ringer solution in the concentration of 1/50 to 1/500 M. After the measurement of tissue respiration, the ammonia content was determined by Folin-Bell’s method The results of these experiments were as follows. Alanine, phenylalsnine, tyrosine, tryptophane, histidine and cystine increased the tissue respiration of the rat spleen; glycocoll and leucine were without effect, while tyramine and arginine caused a slight decrease. Glycocoll, alanine, tryrosine, tyramine, arginine and cystine increased the tissue respiration of rat liver; leucine, phenylalanine, tryptophane, and histidine had no effect upon it. Glycocoll, alanine, leucine, phenylalanine, tyramine, tryptophane, arginine, and histidine had no influence upon the tissue respiration of rabbit sarcoma; tyroeine and cystine increased it. Spleen and liver tissues liberated a large amount of ammonia from alanine and histidine, but there was no appreciable amount of ammonia from glycocoll, leucine, tyramine, and cystine. Sarcoma tissue did not liberate ammonia from glycocoll, alanine, leucine, phenylalanine, tryrosine, tyramine, tryptophane, arginine and cystine. Histidine liberated a small amount. The tissue respiration of spleen, liver, and rabbit sarcoma liberated ammonia, but the amount for spleen and rabbit sarcoma was far greater than that of liver. ‘K.SUQIURA A Glioma in a Hen, V. BELMONTE.uber ein Gliom beim Haushuhn, Virchows Arch. f. path. Anat. 294: 329-333, 1935. Brain tumors have been but seldom reported in domestic animals, and in birds not at all so far as the author is aware. The hen which is the subject of this report came from a flock in which a chronic infectious neuritis-neurolymphomatosis or the fowl paralysis of Marek-was prevalent, and accordingly it was this disease which was first suspected when the bird began to show signs of illness. At autopsy, however, there was a striking absence of its characteristic lesions and, in their stead, considerable enlargement of both cerebral hemispheres with advanced internal hydrocephalus. Median section of the brain disclosed a grayish white, rather firm tumor about the size of a small bean, lying between the cerebellum and the medulla and obliterating entirely the cavity of the fourth ventricle. Sections were stained in the customary ways and also by the several variations of Hortega’s silver carbonate method. Even upon examination with the low power it was evident at once that the neoplasm was a cellular growth which had invaded exten- 860 ABSTRACTS sively the medulla and the white substance of the aerebellum and had produced numerous small local metastases. Its cells were arranged partly in strands, partlyinrounded mseees, and were separated from one another by a fibrillar connective tissue. Most of them were small and intensely stained, but here and there larger cell bodies with clear nuclei were to be seen. The neuroglia stain brought out numerous fibrils of varying thickness which assumed a definite radial arrangement within the roundish groups of tumor cells. Besides these true glia fibrils, however, many precollagenous and collagenous fibrils were demonstrable by the double impregnation method. In various parts of the growth there could be found cells which differed from all the others in their large she; they had clear, round or oval, usually eccentric nuclei and a variable number of processes, one of which was generally very long. Occasionally these processes appeared to be attempting connection with blood-vessels after the manner of iretroblasts, though on the whole the cells of this neoplasm showed but little angiotropism. Several other cell types were found-polygonal, spindle-shaped, or triangular elements, monopolar and bipolar glioblasts with fibrillar differentiation, eta. At the margins of the tumor there was an advanced reactive gliosis and, contrary to what is usually found in man, an aative mobilisation of Hortega's cells. "he author regards the growth as an isomorphous glioblastoma originating in glio- epithelial remnants from the ependyma and showing a tendency to develop as an astroblastoma. WM. H. WOQLOM Immunity Reactions of Plants against B. tumefaciens, J. MAQROW.RBactions d'im- munife des plantes vis-&vis du Bacterium tumefaciens, Compt. rend. Aced. d. sc. 200: 256-258, 1935. Extracts of tumefaciens tumors of Pelargoniicm zonae and Chrysanthemum frutes- cens agglutinated suspensions of B. tumefaciena. Extracts of healthy plants had some agglutinative power, but only in a narrow concentration range. The phenomenon was moderately specific. Extracts of the plant tumors also precipitated filtered extracts of B. tumejaciena. H. Q. WOODARD

ETIOLOGICAL THEORIES

The Enzyme or Catalyst Theory of Cancer, L. D. BRIBTOL. Med. Record 141: 11-13, 1935. During the past twenty-two years the author has published a number of papers emphasising special aspects of his enzyme hypothesis, tirst advanced in 1913 (Med. Rec. 83: 787, 1913). According to his view, cancer follows a local disturbance in the balance between growth-accelerating and growth-retarding ensymes or other biochemical and physical catalytic agents, involving two specific faators: (a) a local formative stimulus due to a concentration of growth-promoting ensymes or an increase in the co-enaymes; (b) local or general decrease in the activities of the ensymes controlling proliferation. The theory is now re-stated in the hope that it may be thought worthy of investigation in properly equipped laboratories. WM. H. WOQLOM

Aetiology of Cancer, H. W. KMENS. Med. World, London 41: 714-718, 1934. According to the author, four things more or less simultaneously began to happen about the middle of the ninebenth century: the use of artificial soil fertilisers, the extraction from the soil of aluminum and the manufacture therefrom of cooking utensils, the appearance of hitherto non-exiatent parasitic disease agents in plants, and a rapid increase in the incidence of malignant dieease in man and animals. All thew happen- ings must, of course, be causally related, and the author proves to his own satisfaction that aluminum saucepans and the food cooked therein form the cause of cancer. It is impossible to follow this flight of imagination, which to a plain mind is simply one of those exhibitions of imbecility which still disfigure the pages of too many medioal journals. F. CAVBlRB CLINICAL OBSEBVATIONS ; LABORATORY STUDIES 861

CLINICAL OBSERVATIONS; LABORATORY STUDIES

Tumor Metastasis VI: Ovarian Metastasis of Carcinoma, SHIELDSWARREN AND W. B. MACOMBIDR.Arch. Path. 19: 75-82, 1935. Inveatigation has been made of the autopsy material in 800 cases of malignant disease in women. In this series there were 40 cases of unquestioned metastasis of carcinoma to the ovaries, excluding cases of generalized peritoneal carcinosis. In 16 instances the primary tumors were breast carcinomas; in all but two of these the route of metastasis had been vascular or lymphatic; in the two exceptions the route was transperitoneel. Nine tumors were primary in the stomach (Krukenberg type) and the evidence suggested that all of these had reached the ovary via vascular or lymphatic channels. Six originated in the colon and rectum, 3 in the fundus uteri, 2 in the cervix, and one each in the bladder, vulva, and suprarenal glands. There was a somewhat higher incidence of ovarian metastasis in the premenopausal group, suggesting that ovarian activity favors metastasis to that organ, at least to a slight degree. In only 5 cases was the ovarian metastasis the only one, the majority being characterised by widespread metastasis to regional and distant nodes and organs. JOHNS. LOCKWOOD Late Recurrences of Carcinoma, H. HARTMANN.QuelqueR cas de rdcidives tardives de cancers, Bull. Acad. de mdd., Paris 113: 281-283, 1935. The author gives brief notes of eight cases. (1) Woman of thirty-two; breast cancer operated on in 1922, with irradiation of the supraclavicular region; in 1931, scar recurrence excised; in 1933 and 1934, skin recurrences (? metastases) which disappeared after x-ray treatment; at time of reporting, signs of pulmonary metastases. (2) Woman of sixty; total hysterectomy for corporeal cancer; metastasis in vagina fourteen years later. (3) Radium treatment for cervical cancer in 1921; in 1935, recurrence in the bladder. (4) Breast operation in 1918; sixteen years later, cancer in supraclavicular nodes. (5) Man of forty operated on in 1903 for rectal cancer; in 1920, operation for cancer of ascending colon; death from recurrence of second tumor a year later. (6) Man of forty operated on in 1904 for gastric cancer by gastropylorectomy; in 1931, recurrence, demonstrated by x-rays; death within a year with cachexia and pleural effusion. [This might well be a new tumor rather than a recurrence.] (7) Woman of fifty-three; left breast removed in 1902; in 1924, operation for cancer of right breast; alive and well in 1933. (8) Breast cancer operated in 1892; ulcerating carcinoma in the operation scar observed forty-three years later, at the age of ninety-two years. F. CAVERS

Late Recurrence of Carcinoma, C. L. SPACKMAN.Brit. M. J. 2: 115, 1934. A woman of sixty-one had twelve years previously been operated upon for carcinoma of the vulva, of which there had been no local recurrence. She now complained of shortness of breath and considerable loss of weight. There was a lump, the size of a haselnut, on the left eyebrow, and several smaller ones were scattered over the scalp. X-ray examination showed areas of rarefaction in various bones, especially those of the oranium and pelvis. Sections taken from the scalp and the ilium showed anaplastic differentiated carcinoma, suggesting an origin from squamous epithelium but without prickle cells. There are two illustrations. F. CAV~R~

Spontaneour Regression of Cancer, DAVIDROXBURQH, Brit. M. J. 1: 39, 1935; W. THOMAS,Brit. M. J. 1: 86, 1935; J. B. SCOTT,Brit. M. J. 1: 230, 1935. The first of these three letters reports the case of a woman between sixty and seventy years with a large ulcer of the tongue opposite a jagged tooth, and enlarged cervical nodes. The lesion was believed to be a cancer, but the patient would consent to nothing more than extraction of the tooth and the subsequent use of a permanganate of potash mouth wash. A small section was submitted to a pathologist and diagnosed as cancer, but the ulcer healed promptly and the nodes disappeared. The author asks whether the diagnosis was incorrect or if cancer does sometime regress. [There are certainly more erroneous diagnoses of cancer than regressions.] 862 ABSTRACTS

Thomas reports three instances of regression of tumors clinically diagnosed as malignant. [None of these can be accepted as demonstrated. There is no mention of histologic examination of the epigastric tumor in the first case, the ‘I inoperable cancerous growth ” somewhere in the abdomen in the second, or the (( sarcoma of left eyeball, considered inoperable, which gradually subsided ” in the third case.] Scott’s patient was a woman of about forty who, six years after having had her left breast removed for carcinoma, had small nodules in the scar and clinical evidence of metastases in the liver and lung, etc.” After an unstated lapse of time the hepatic enlargement and pulmonary consolidation disappeared; eventually the patient died during an attack of asthma. [No mention of histologic or radiographic cxamination is made.] F. CAVERS

Negative Result following Inoculation with Cancer Cells, GUSTAVBLUNCK. Erfolglose Impfung mit Karainomaellsaft, Mllnchen. med. Wchnschr. 81 : 1933-1934, 1934. Inoculation with Cancer Cells, HEINRICRM~Nz. Impfung mit Karainomrellsaft, Munchen. med. Wchnschr. 82: 266-267, 1935. In 1922 the author broke a flask in which there was press-juice from a mammary cancer, and suffered a deep, jagged, 5 cm. cut. Twelve years have passed since the accident, and although the wound was flooded with a fluid which must have contained living tumor cells and wm not disinfected at the time, no neoplasm has developed. This is strong evidence against the existence of a specific cancer agent. Many surgeons must have injured their hands during operations on cancer patients and if cancer were infectious a number of them would certainly have contracted it in consequence, for the toll from demonstrably infectious diseases is sadly high. Mtina, replying to Blunck’s communication, says that the fact that contact with an extract of carcinoma containing live cancer cells caused no ‘I infection ” is a8 little evidence against the infection hypothesis as the fact that certain infectious diseases, well known to be transmissible, are often not transferred even after the closest contact with their bacterial cause is evidence against the infectiousness of these disorders. Although not himself an adherent of the infection hypothesis, Mtina cites a number of instances which might suggest transfer from one person to another. [These are all to be found in the literature and the reader is referred to Mtina’s article for a brief discussion of them. To the abstractor they lack cogency, particularly as in two cases the patient had carcinoma and the attendant developed a sarcoma.] WM.H. WOGLOM Case of Multiplicity of Tumor$, F. HARBITZ.Ein Fall von multiplen Geschwtilsten: Hamangiome und Gliomatose mit Syringomyelie des Zentralnervensystems, sowie Zystenpankreas und andere Geschwillste der Abdominalorgane (Lindaus Krankheit) ; kasuitische Mitteilung, Acta path. et microbiol. Scandinav. 11 : 442-451, 1934. A woman of thirty-nine had in early childhood lost the sight of both eyes owing to retinal detachment. Inquiry elicited that the enucleated globes had not been examined histologically. The patient now attended hospital on account of right hemiplegia, and shortly after admission became dyspneic and died in coma. Necropsy revealed a large cystic pancreas, cystic kidneys, hypernephroma of the right kidney, two uterine fibromm, and a polypoid gastric adenoma. Throughout the cervical and thoracic cord there were, as seen in cross-sections, numerous transversely elongated syringomyelic cavities, and in the twelfth thoracic vertebra was an hemangioma. There are five illustrations. F. CAVERS A Case of Double Cancer, TOSAIONAKAMURA. Ein Fall von Doppelkrebs, Okayama- Igakkai-Zasshi 46: 848-853, 1934. In a man of seventy years with an unusually large primary carcinoma in the left kidney there was found a small gastric carcinoma. The former had metastasiaed to both lungs and to the left testis. The author considers this to be a case of primary multiple carcinomas. K. SUGIURA CLINICAL OBSERVATIONS ; LABORATORY STUDIES 863

The Relation between Injuries and Tumors in Compensation Cases, G. SEQRE. Traumi e tumori nell' infortunistica, Minerva med. 2: 194-199, 1933. Segre reports three cases of associated trauma and tumor development, discussing their legal aspects. In two cases women were compensated by the Italian courts for tumors of the breast appearing two and three months respectively after severe trauma to the breast. One was a carcinoma; the nature of the other is not specified. The courts have held that a tumor noticed only after trauma and within a reasonable time after the injury and appearing in the region traumatized may be considered traumatic in origin. [This statement, if properly publicized would almost guarantee compensation to all patients with breast carcinoma. It is interesting that courts hold that three months is sufficient time to produce cancer when it takes six to eight months to produce one in an albino rat.] The third case, still sub judice at the time of writing, concerned a man who received a violent blow at the base of the thorax, was laid up immediately, and never recovered sufficiently to resume work. Eight months after the accident operation disclosed an inoperable carcinoma of the stomach. Autopsy confirmed the diagnosis and showed no evidence of fractured ribs or other injury to the thorax. The author reviews the literature on the relation between trauma and tumor development and discusses some of the complicated legal points involved. JEANNETTEMUNRO Review of the Inheritability of Cancer, OTTOSTRAWS. Sammelreferat. Uber Krebs und Krebsvererbung, Med. Klin. 31: 217-221, 1935. The author reviews the question of the inheritability of carcinoma under two headings-genealogy and experiments. The first of these two methods of investigation has demonstrated beyond any doubt the existence of an occasional cancer family, though most investigators discount the influence of heredity in man. The Bonaparte family, so often cited as an example, however, now appears not to have been one. Ae for the second method, a voluminous literature on the inheritability of mouse cancer has already accumulated, but Strauss holds that the findings are not transferable to man for the reason that familial inbreeding plays an important r81e in these investigations whereas in the human family it can be neglected for all practical purposes. A long bibliography is appended. WM. H. WOGLOM

The Urinary pH in Cancer, DUPONTAND DALLONQEVILLM.Du pH urinaire chez les an&reux, Gas. m6d. d. Nantes 46: 627-835, 1933. The authors determined the pH of fasting urine colorimetricslly, checking the values occasionally with the potentiometer. Fifty-seven determinations on specimens from 4 normal individuals gave a pH range of 5.2-5.7. Numeraus observations on 29 patients, most of whom had neoplastic disease, showed normal urinary pH values in all cases except in cancer of the gastro-intestinal tract, where somewhat high figures were obtained. This is not in accord with the findings of Delbet and F'ranicevic, who reported definitely alkaline urine in cancer (Tribune m6d. 67: 1, 1933. Abst. in Am. J. Cancer 21: 878,1934). H. Q. WOODARD

The Urinary Phenol Content, Particularly Post-partum and in Cancer, L. SERVANTIE AND A. BARON. Le dosage des phenols urinaires, en particulier dans le post parlum et lea &ate cancbreux, Compt. rend. SOC.de biol. 118: 147-149, 1935. The ratio of combined to total phenols in the urine of untreated cancer patients was almost always higher thsn 30 : 100. WM. H. WOQLOM Cranial Cholesteatomas, E. LOEPP. Die Cholesteatome des Schiidels, Arch. f. Ohren-, Nasen- u. Kehlkopfh. 138: 66-79, 1934. The author gives a general account of cranial cholesteatoma, based on a series of 77 cam seen during less than three years; in 56 cases operation was done. A few cases are described in which the operative findings were more or less at variance with those of the clinical and roentgenographic examinations. There were 11 cases in which the chief 864 ABSTRACTS involvement was found to be antral and periantrd, 4 affecting the attic, 13 the antrum and attic, and 8 widespread in the mastoid. In two cases there was erosion of the upper tegmental plate, and in two erosion of the bony wall of the lateral sinus. In the cases affecting the attic there was early destruction of the lateral attic wall, usually not indicated in the roentgenogram. An interesting case is reported in which the x-ray findings pointed to a calcified supraseller pituitary tumor with secondary dilatation of the left lateral ventricle and obliteration of the right ventricle. At operation the sellar region waa found to be normal. The patient died next day, and at necropsy a calcified cholesteatoma was found in the base of the third ventricle, showing no connection with the pituitary or with Rathke’s pouch. The author considers that the true or congenital cholesteatomas of the pyramid form a connecting link between the aural tumors and those of the upper region of the cranium. There are five illustrations. F. CAVERS

Sacrococcygeal Teratoma in the Newborn, GONNET,J. F. MARTINAND POUZET. Tumeur sacro-coccygienne du nouveau-n6, Bull. SOC.d’obst. et de gyn6c. 23: 531- 534, 1934. ‘Thirteen hours after birth a baby girl was operated upon for a sacrococcygeal tumor covered by healthy skin containing dilated veins. The tumor was attached by a stalk to the anterior aspect of the sacrum and coccyx and was readily removed. The child was eighteen months old at the time of the report, and was fit and well. The tumor measured 7x6~5 cm. The outer layers consisted of vascular adipose and fibrous tissue, containing cavities lined by several layera of pavement epithelium. In the central portion were masses of glands lined by calyciform muciparous cells; around some of these alveoli were wavy bundles of smooth muscle fiber, the whole suggesting embryonal bronchi. In some places there were patches of undifferentiated tissue containing narrow tubules lined by cubical cells, suggestive of renal elements. Small nodules of cartilage were scattered through this internal tissue. The greater part of the latter consisted of nerve tissue, including neuroglid elements of various forms, some resembling spongioblasts. Among this nervous tissue were cavities lined by ciliated cells, and in one instance by melanin-containing cells (suggesting embryonal retinal tissue). Unfortunately the excellent histologic description is not accompanied by illustrations. F. CAVERS

An Intrunusculnr Lipoma, P. BENINI. Su di un caso di lipoma intremuscolsre, Poli- clinic0 (sea. prat.) 40: 858-859, 1933. A woman of fifty-six complained of pain in the region of the right lower rib in the axillary line. A tumor was found there, freely movable under the skin and over the bony wall of the chest, but which became fixed in position upon contraction of the external oblique muscle. The x-ray showed a sharply defined area of decreased density outside of the ribs. The tumor was endomuscular and lipomatous. The author considers that it derived its origin from the adipose cells of the perimysium. JEANNETTEMUNRO Huge Connective-tissue Tumor of the Soft Puts of the Mlla. Interecrpulothoracic Amputation, E. MOURQUE-MOLINEBAND W. ARNAL. Volumineuse tumeur con- jonctive des parties molles du creux de l’aisselle. Amputation interscapulo-thora- cique, Bull. et m6m. Soc. net. de chir. 60: 401-409, 1934. A sixty-seven-year-old woman had vague pain in the left shoulder and arm, followed soon afterward by the appearance of a rounded tumor mass beneath the clavicle. This tumor grew rapidly and after eight months the entire axilla was occupied by a firm, rounded maas measuring 16 cm. in diameter, and so 6rdyfixed in position as to prevent any motion of the arm. The tumor was removed by an interscapulothoracic amputation. Histologic study showed a malignant connective-tissue tumor arising from retic- tlloendothelial oells. WILLIAMJ. HOFFMAN DIAGNOSIS AND TREATMENT 866

Cue of Generalized Xauthomatosie with Abnormal Fat Metabolism, H. BRANDT. Ein Fall von generalisierter Xanthomatose mit Dysregulation innerhalb des Lipoidstoff- wechsels, Dermat. Wchnschr. 100: 11-17, 1935. The author report8 the case of a girl of two and a half years, with generalized xanthomatous skin nodules. Studies of the blood showed an increased cholesterin and diminished phosphatid content. The article is not illustrated. BBINJAMINR. SHORBI Aunl Mmifestcltione of Lipoid Grandomatode (Xanthomatosis) of the Skull, F. L. LBIDBIRER,H. G. PONCHERAND N. D. FABRICANT.Arch. Otolaryng. 21: 27-40, 1935. After a lengthy discussion of the literature, a case of xanthomatosis occurring in a boy of two is described. Two months before entry a marble-siaed lump appeared on the forehead and another larger swelling in the left parietal region. These grew slowly larger. Physic81 examination was negative save for the presence of the tumors. Blood cholesterol was 208 mg. per 100 C.C. X-rays showed bony rarefaction in the involved areas. A biopsy showed a granulomatous xanthoma. Treatment with x-rays resulted in improvement. One year later a granulomatous mass was found filling the left external auditory canal. Biopsy showed the same picture as was originally found in the frontal tumor. Radiation again resulted in satisfactory regression. GRAYH. TWOMBLY Genesir of Tiesues in Embryonal Tumore. I. The Chordoma, A. I. SMIRNOWA- ZAMKOWA.Zum Studium der Genese von Geweben in embryonalen Geschwtklsten. I. Das Chordom, Act8 Cancrologica 1: 249-278, 1935. Investigation of a malignant chordoma showed the presence of mesenchymal derivatives (cartilage, collagen, and bone), and it is suggested, therefore, that the chord8 dorsalis, referred by various writers to ectoderm, mesoderm, and entoderm, originates in mesenchyme. The article is accompanied by 15 poorly reproduced photo- ~niCrOgraphsand one roentgenogram. WM, H. WOGLO~~

DIAGNOSIS AND TREATMENT Cancer: Frequency, Disposition, Prevention, W. BERBLINGER.Krebshaufigkeit, Krebsdisposition und Krebeverhtitung, Med. Welt. 8: 5-8, 1934. The author states that in the necropsy material at Jena from 1910 to 1933 there has been no appreCi8ble rise in the annual number of cancer deaths or in the proportion of these to all deaths, with the exception of intrathoracic carcinoma, which has shown 8 steady but slight rise during this period. He considers that there is not sufficient evidence to warrant a belief in the existence in man of individual or hereditary predisposition to malignancy. There remains a wide field for cancer prevention in the way of periodic examinations and prompt prophylactic treatment of lesions, mostly of a chronic irritative nature, which may in a wide sense be regarded as precancerous. The author attaches considerable importance to serodiagnosis, especially by easily made teaha such 8s Roffo’s and Kahn’s, not because they are specific or even highly reliable, but because their positivity may lead to more thorough examination and the keeping under observation of suspected cases. He applied Kahn’s test to the blood of 204 CadBVeTB, 29 with histologically proved cancer, and obtained the same (unstated) high percentage of correct results as had been given during life. F. CAVERB

CUICer, A. PRIMROSE.Canadian M. A. J. 32: 233-238, 1935. Cancer-the Pathological Aspect, W. J. DEADMAN.Ibid. 32: 238-244, 1935. In these two contributions to a cancer symposium the authors state clearly and fairly comprehensively the various problems, findings, and generalizations concerning the etiology, diagnosis, and treatment of malignant diseaae. F. CAVERS 866 ABGTBACTS

Further Investigations on the Fractionation of Tumor Antigens, ELISA MORELLI. Ancora sul frarionamento degli antigeni neoplastici, Gior. di batteriol. e immunol. 13: 621-634, 1934. Abst., Weiteres fiber die Fraktionierung von Geschwulstanti- genen, Ztschr. f. Immunitktaforsch. u. exper. Therap. 83: 521-526, 1934. Lehmann-Facius (Ztschr. f. Immunitiitsforsch. 82: 09,1934. Abst. in Am. J. Cancer 23: 133, 1935) is of the opinion that alcoholic tumor extracts will yield a specific fraction reacting only with tumor antisera. The author failed, however, both with his method and with another that seemed to her more suitable, to recover a sharply specific carcinoma antigen, WM. H. WOQLOM Serologic Diagnosis of Cancer with Special Reference to the Lehmann-Facius Reaction, S. NAKAQAWA,T. TAKABUQI,S. OQAWAAND J. YOBH~DA.Unsere serologische Krebsdiagnostik mit besonderer Berlicksichtigung der Lehmann-Faciusschen Krebs- reaktion, Klin. Wchnschr. 13 : 1755-1758, 1934. As the Lehmann-Facius reaction (centrifugaliaation of carcinoma phosphatides in a iiolution of euglobulin from carcinoma serum, and suspension of the precipitate in weak formalin) rests upon an entirely new principle, and has not yet been investigated by any- one except its originator, the authors have tested its diagnostic value on 110 patients with carcinoma of various organs. Serum from 104 (94.5 per cent) of these gave a positive and from 6 (5.5 per cent) a negative reaction. Serum from 305 patienta with other diseases gave a positive reaction for carcinoma in only 11 instances (3.6 per cent). With the so-called " labile " serum of tuberculosis, syphilis, and pregnancy, the test was uniformly negative, thus confirming the results of Lehmann-Facius. Though the reaction was positive in most patients with carcinoma and usually negative in the presence of other disorders, it would be premature to conclude that it is specific for carcinoma. The authors accordingly set about investigating its specificity. Lehmann-Facius had reported it positive with sarcoma and " various other tumors " but did not definitely name the neoplasms included in the latter group. The authors found it positive for all growths, malignant or benign, including even nasal polyps, and occssionally positive even in the absence of a tumor of any sort. In the last instance, aneurysm and valvular disease of the heart most frequently gave a positive reaction. In 2 patients with lymphogranulomatosis and in an equal number with chronic leukemia, on the other hand, it waa negative, Thus its clinical value is considerably restricted, even though it be so often positive in the presence of carcinoma, and the authors recommend supplementing it with a second test in which a sarcoma extract replaces the original preparation from carcinoma. This combined test has proved to be very valuable, though the authors expressly disclaim any implication that it will provide a sharp serological distinction between carcinoma and all other neoplasms. It will separate carcinoma from sarcoma and other connective-tissue tumors, but does not discriminate between carcinoma and ovarian cystoma. WY. H. WOQLOM Specific and Non-specific Reactions in T hue, Cancer, and Tuberculosis, L. HIRSZFELD, W. HALBERAND Z. SZWOJNICKA.77 ber sperifische und unsperifische Reaktionen bei Flecktyphus, Krebs und Tuberkulose, Klin Wchnschr. 14: 154-158, 1935. The investigations of the author and his group have shown that many suitably cholesterolired cancer extracts fix complement in the presence of serum from cancer patients. Most of those who have repeated these observations, however, have ascribed the result to a lability reaction. As this type of reaction occurs in other diseases, whose etiological agent is known, the authors have compared the specific and non- specific reactions of typhus and tuberculosis with those of cancer. Before describing their experiments, they discuss briefly the specific and non-specifia reactions. The immunological reaction, in its strict sense, depends upon a specifio absorption of globulins containing antibodies, in the course of which immune globulin is denatured and becomes less hydrophilic in consequence. A reduction in the electrical charge follows, with an increased cohesion of particles that terminates in agglutination or precipitation. But particles may absorb globulin unspecifically. Thus bacteria have been de- DIAQNOSIS AND TREATMENT 867 scribed which are unspecifically agglutinated in high dilution by many sera, the reaction being regarded as an expression of lability. The Flexner bacillus, again, is often agglutinated by the serum of pregnancy in high dilution, while a too labile Wassermann antigen will react with normal serum. The nature of this serum lability is still a mystery. Experiment showed that the serum of patients with typhus, cancer, or tuberculosis reacted in a certain number of cases with organ lipoids, lecithin, cholesterol, and cancer extracts, but when the percentage of positive reactions between the serum of tuberculosis or cancer and tuberculosis or cancer antigen waa compared, a much higher reactivity with the homologous antigen was apparent, an observation supporting the hypothesis of a specific affinity, though not definitely proving it. WM. H. WOQLOM

Precipitating Power of Cancer Serum, M. L. CHEVREL-BODIN,F. CHEVRELAND M. CORMIER. Recherche8 Bur le pouvoir floculant du serum des canc6reaux, Compt. rend. SOC.de biol. 118: 520-523, 1933. Serum from many, but by no means all, cancer patients caused flocculation in appropriately treated organ extracts. This reaction, which appeared late in the course of the disease, could be elicited also with syphilitic serum. WM. H. WOQLOM

Tumor Immunity, 11, 2. ZAKRZEWSKIAND HANSJ. FUCHS.Uber Tumorimmunitiit. (11. Mitteilung.), Klin. Wchnschr. 14: 127-131, 1935. This article is an extension of a brief note by Fuchs (Klin. Wchnschr. 13: 292, 1934. Abst. in Am J. Cancer 21: 683, 1934). The presence of an agent of still unknown nature in all patients with malignant disease can now be regarded as established by the carcinoma reaction. Its demonstration in the blood strongly suggests malignancy, but the test will ultimately prove to be infallible only if the following questions can be answered in the affirmative. (1) Is the agent specific for the malignant cell? (2) When malignant disease is present does the agent invariably enter the blood stream? The reply to both is in the negative. First, there is a partial identity between the tumor cell and the embryonal cell, and secondly, certain neoplasms (of the esophagus, for example) are not accompanied by the appearance of this principle in the blood stream. WM. H. WOQLOM Experiences with the Gruskin Skin Test for the Diagnosis of Cancer, J. MCFARLAND, J. H. CLARKAND M. FRIEDMAN.J. Lab. & Clin. Med. 20: 468-474, 1935. Of 27 patients proved by biopsy to be suffering from cancer but not yet subjected to radiotherapy, and appropriate for the Gruskin skin test from every point of view, only 68.7 per cent reacted positively. Of 14 young persons in perfect health and above any suspicion of cancer, 57 per cent gave positive reactions. Yet these tests were made with the cooperation of Gruskin himself, and with antigen (extract of embryonic calf, sheep, or pig liver) made and furnished by him. WM. H. WOQLOM

Contribution to the Chemistry of Cancer, A. FREIHERRNVON CHRISTIANI. Beitriige 5ur Chemie des Carcinoms, Ztschr. f. Krebsforsch. 41: 44-47, 1935.

The “ carcinoma acid ” of Freund and Kaminer was separated into an acid and a neutral fraction. The neutral, ether-soluble fraction was found to contain all the protective action towards carcinoma cells of the original substance, and to be a cholesterol ester. H. Q. WOODARD

Action of Urinary Extracts on the Adrenal8 of Rabbits and Its Application to Cancer Diagnosis, G. ROUSSY,C. OBERLINQAND P. GU~RIN.L’action d’extraits urinaires sur les surrenales du lapin et son application au diagnostic du cancer, Presse m6d. 42: 1641-1642, 1934. The Aron test for cancer, in which a supposed specific cancer principle in the urine of cancer patients excites an alleged characteristic reaction in rabbit adrenals (seeAbsts. in Am. J. Cancer 22: 918, 1934; 24: 158, 1935) has been completely discredited by the controlled researches of these authors. In a series of 70 cases an error of 50 per cent 868 ABBTRACTS was found, or what would be expected by random sampling. One more attempt at simplification of a necessarily complex problem has failed. [See following abstract.] JORN8. LOCKWOOD Improved Technic for the Demonstration in the Urine of Cancer Patients of a Principle which Acts on the Supwenrl Cortex, MAXABON. Nouveaux procBdBs techniques pour la mise en Bvidence, dans l’urine des canc6reux, d’un principe actif sur le cortex surrBnal (avec d6monstration), Compt. rend. SOC.de biol. 118: 85-88, 1935. Continuing his investigations [see Absts. in Am. J. Cancer 22: 918, 1934; 24: 158,18351 on an agent precipitated by alcohol or acetone from the urine of cancer patients which reacts upon the suprarenal cortex of rabbits when injected in watery solution, the author has endeavored to remove certain serious sources of error-one of them the great histological variability of the gland. It is now proposed to remove a control fragment of adrenal before injection of the extract, a procedure which has been found not to interfere with the test. The effect of the extract is to diminish the siae and the lipoid content of the spongio- cytes, and where the reaction is distinct the difference before and after injection is evident at the first glance; weaker reactions require considerable experience for their interpretation. No such difference has been elicited by extracts of normal urine or that of patients with diseases other than cancer. This is Aron’s reply to Roussy, Oberling and GuBrin [see preceding abstract], who have denied not only the practical value of the test but even the validity of the principle upon which it rests. On the basis of more than 700 trials the author now confirms his preliminary conclusions. WM.H. WOGLOM Presence in Urine from Cancer Patient6 of an Incraned Amount of a Gonad-stimulating Agent, and the Demonstration of this Substance, MAX ARON. F’deence, dans l’urine des canct.5reuxJ de taux Blevt.5 d’une gonado-stimuline et mise en Bvidence de ce principe (avec dBmonstration), Compt. rend. SOC.de biol. 118: 88-90, 1035. The author proposes the name gonudo-stimdins for the hormone of the anterior hypophyseal lobe as well as for the similar principle from the placenta and the urine of pregnant women, since this term makes no commitments in respect to either its origin or its nature. He has elicited a distinct ovarian reaction in the rabbit with an extract of urine from 16 out of 20 patients with cancer, in 15 of which the growth W&B extra- genital (breast, stomach, large intestine). In the 4 others the changes were microscopic only, but in 3 of these a smaller amount of extract had been available. A positive test did not follow the injection of an extract from the urine of 14 normal persons or patients with dieeases other than cancer. The reaction, which differs from that produced by the urine of pregnancy, consists in follicular dilatation advanced enough, in extreme oases, to confer the appearance of a polycystic ovary. The follicles enlarge until their walls are in contact with one another but there is no appreciable increase in the sire of the ovary itself and follicular hemorrhages are rare. As the method of extraction is the same for both ovarian and suprarenal [see preceding abstract] reactions, a single animal will suffice for these two tests, which may thus be made to supplement one another. WY.H. WOGLOM

Early Diagnosis of Neoplaei., P. TIBSERANDET.Sur le dbpistage prBcoce des nboforma- tions, NBoplasmes 13: 316-320, 1934. The author reviews a few of the more recent clinical tests for cancer, and concludes that a specific diagnostic reaction will in all probability never be discovered. WY.H. WOGLOM DIAGNOSIS AND TREATMENT 869

Practical Value of " Quantitative Microscopy" in Cancer, K. A. HEIBERO.Die praktische Redeutung der ,,Quantitativen Mikroskopie" beim Krebs, Acta Cancro- logics 1: 215-22G, 1935. Enlargement of the cell, including nucleus and nucleolus, is the basis of autonomous growth, and there is thus no longer any reason for speaking of a mystical return of the cell to its embryonal state. The condition is much simpler than that, being but an increase in dimensions brought about by trauma, chemical insult, developmental disturbances, aging, hormonal anomalies, and so on. All act through the medium of chronic inflamniation or, in a more direct and mechanical way, by causing continuous protoplasmic traction. As tumors with relatively small cells offer, in general, a better prognosis, cell measurements may have a clinical valuc, particularly in the case of carcinoma involving the cervix or breast. WM.H. WOQLOM Instruments for Taking Biopsy Specimens with Description of a New Model, K. IJNDULOM.Acta radiol. 16: 2!)5-300, 1!)35. A spccial punch for the taking of biopsies is described and illustrated by drawings. BENJAMINR. SHORE Heredity in Cancer, and Its Value as an Aid in Early Diagnosis, M. T. MACKLIN. Edinburgh M. J. 42: 49-67, 1935. This paper contains little not covered by previous publications in which the author has contended that heredity plays an important part in determining the incidence and site of cancer [see, for example, Absts. in Am. J. Cancer 20: 661, !)74, 1934). She believes that the hereditary factor is not a mere predisposition to the development of malignancy in general, but that what is inherited is a strong tendency to the development of cancer of a specific type in a specific organ at a specific age and urges special medical examinations with this in view. [Apart from such well established instances as retinoblastoma, various other writers who have investigated extensive material have found no evidence of an abnormally high incidence of, say, uterine or mammary carcinoma, in certain families as compared with the general population. However, the author rightly stresses the point that the chronic irritation theory has been considerably overworked.1 F. CAVERB

Curability of Cancer, 6.8. JUDDAND M. T. HOERNER.Rev. Gastroenterol. 2: 7-17, 1936. The word cancer has infused such dcxpair into the minds of the medical profession that the literature still reflects the tragedy of the disease, obscuring the steady increase in ita aurability. Tables showing five-year cures of 393 patients with cancers of the etomaoh, 1339 with cancers of the breast, 762 with carcinomas of the large intestine, 367 with carcinomas of the lip, and 58 with malignant tumors of the tongue are included to demonstrate the fact that cancer is curable. Radical surgical removal still remains the method of choice in the treatment of most malignant tumors, although in selected om,radium or roentgen-ray therapy may be used in sufficient amounts to effect a cure. The thoroughness in the initial treatment determines the permanency of the relief. BENJAMINIt. SHORE R61e of Radiotherapy in the Problem of Mal'ignancy, E. E. SHEPLEY.Canadian M.A. J. 32: 252-258, 1935. The author cites statistics showillg appr,oximately 20 per cent five-year cures of breast cancer with surgery RI'OI~P, 35 per ceni)c or more with combined surgery and irradiation. In early operable cases surgery alo pc and radium alone have in some hands given about equal results, up to 70 per cent fi\,w-year cures. [There is no basis for the statement that radium has given 70 pcr cent' five-year cures.] The author believes that radiotherapy will displace operation entireI)y in the treatment of breast cancer. In cancer of the uterine cervix, it would seem thai surgery, with its mortality of ahout 17 Per cent, has secured a total salvage below that t obtained by radiotherapy. Moreover, 870 A B 6TRACT 8

surgery offers little in the large group of inoperable oases, in which radiotherapy frequently prolongs life. The author specially commends, and cites freely from, the timely publication in this JOURNAL(20: 848, 868, 1934) of Forssell’s account of the building up of the Swedish radiotherapeutic organiaation. F. CAVERS

Important Physical and Biological Principles in Radiation Therapy, R. E. MYERS. J. Oklahoma M. A. 27: 324-320, 1934. Myers discusses briefly some of the fundamental principles of radiotherapy and reviews the history of the dosage problem. CHARLESPACKARD

Reaction of Tumors to Irradiation, F. C. HELWIG.J. Kansas M. SOC.35: 169-173,1034. An outline in tabular form of an article by F. W.Stewart (Arch. Surg. 27: 979-1064, 1933). which the author believes presents the best knowledge available on the radiosensitivity of tumors. GRAYTWOMBLY

Status of Irradiation in Living Tissue, E. W.ROWE. Nebraska M. J. 19: 241-248, 1934. A brief text-book statement of the nature of x-rays, the history of their use in therapy, and methods of measurement. Mention is also made of radiosensitivity, recovery, the effectiveness of different wavelengths, and the influence of these rays on hereditary material. No new facts are presented. CHARLESPACKARD The Total Dose Versus the Cumulative Dose in Radiation Therapy, M. C. REINHARD AND H. L. GOLTZ. Radiology 23: 166-169, 1934. A description of the doses of short-wave x-rays given by the protracted method should include not only the total number of roentgens delivered, but also the number per treatment, the length of time during which treatments are given, and the dose per field. Since there is a loss of radiation effect amounting to 8 per cent per day, when the wavelength of the incident beam is 0.16A.,the cumulative dose, which is the sum of the residual doses after this loss, is very different from the total dose. The authors present curves to show the rate of increase in the cumulative dose when 100 to 300 r are given to single fields at intervals of one, two, and three days. The curves show that a condition of equilibrium is attained when the daily increment balances the loss. As an upper limit for the cumulative dose 2000 r is chosen. This is reached when 200 r are given daily for nineteen days, or 300 r daily for nine days. [The doses mentioned are evidently measured in air, without scatter, but the authors do not say so.] CHARLESPACKARD

A Dosage System for Gamma Ray Therapy, RALSTO&ATERSONAND H. M. PAIIKER. Brit. J. Radiol. 7: 502-632, 1934. In the first part of this paper Paterson describes in simple, non-mathematioal language a dosage system for radiotherapy, applicable to practically all caseR. In the second part Parker presents the physical and mathematical data on which this system is based. The questions involved are: how much rrdum is required, and how shall it be arranged to best advantage in an applicator. Paterson u8es many needles containing 1 mg./cm. of active length. Rules are giver1 for placing them so that they will give a8 nearly as possible uniform radiation over the entire area. Whenever possible they should be arranged in a circle. If the distance (i.e. the thickness of the applicator or the distance separating the plane on whi.ch the radium is mounted and the plane at which the dose is assessed-the treated frrea) is from three to six times the diameter of the applicator, 5 per cent of the radiurb should be placed at the center of the circle. For large areas two concentrio circles +odd be used. The proper construction of square and rectangular applicators is des ribed. The roentgen is used as a basis for doc$& measurement. The authors accept a value of 8.4 r per hour for the intensity at 1 c b. from a point source of 1 mg. radium filtered by 0.5 mm. platinum. This agrees closlely with the determinations of Mayneord and Roberts (Brit. J. Radiol. 7: 158, 1034). Graphs show the number of mg. hours needed DIAGNOSIS AND TREATMENT 871

to deliver lo00 r at various distances and over fields of various siaes. From this number can be found the amount of radium necessary to give the desired dose in eight days, either in a continuous exposure, or in several fractions each at least twelve hours long. To simplify the conditions in calculating the depth dose, scattering and absorption in the tissues are disregarded, only the distance being used. The calculation of the dose is illustrated by several examples. Paterson finds that 3000 r given in eight days produce a faint erythema; 4500 r produce a strong reaction; 6000 r result in epidermitis. [See Marie’s paper on The Value of Measurements of Intensity of Radiation in Establishing a Rational Radiation Therapy, J. Cancer Research 11 : 377, 19271. CHARLESPACKARD

Heublein’s Method of Continuous Irradiation of the Entire Body for Generalized Neoplaoms, LLOYDF. CRAVERAND WILLIAM5. MACCOMB.Am. J. Roentgenol. 32: 654-674, 1934. Imdiation of the Entire Body, LLOYDF. CRAVERAND WILLIAMS. MACCOMB.New York State J. M. 34: 249-255, 1934. For many years both practical workers and laboratory investigators have studied the effects of radiation of the entire body on human beings and animals. Most of this work has been done with relatively low voltages and on a small scale, but in 1931 Heu- blein proposed a method of irradiation of the entire body employing roentgen rays continuously at low intensity, over periods of several days to three weeks, with target akin distances of over 5 meters and a tube operating at 185 kv. (see Radiology 18: 1051, 1932). From May 1931, when Heublein began the application of this method, to May 1933, 134 patients were treated. Thirty-five of these patients were treated twice, 9 three times, and 2 the fourth time. Local irradiation had been given previously to 85, and was used during or after the Heublein treatment in 55. The Heublein method waa the only form of irradiation used in 37 cases. In the beginning only 5 per cent of a skin erythema dose was given over a period of two to three weeks, this low intensity having been obtained by high filtration. Later it was found possible to increase the intensity and the dose step by step. Special caution had to be used in cases of leukemia, but in other diseases doses of 50 to 60 per cent of a skin erythema (375 and 450 r) were eventually given. No higher dose was given to the entire body in any instance, but one patient with Hodgkin’s disease received 560r to the neck and thorax, the rest of the body being shielded. The cases treated are divided into two groups: (1) a radioresistant group, numbering 25 patients, of which 12 had mammary carcinoma, and (2) a radiosensitive group, including Hodgkin’s disease, lymphosarcoma, lymphatic pseudoleukemia, lymphatic leukemia, myeloid leukemia, multiple myeloma, endothelial myeloma, mycosis fungoides, lymphadenoma (Brill-Symmers Disease), transitional-cell carcinoma, lympho-epithelioma and Wilm’s tumor of the kidney. In this second group there were 44 patients with Hodgkin’s disease, of whom 26 were improved and were still living at the time of the report (2 over a year). The authors reach the conclusion that this method is a valuable addition to the treatment of several radiosensitive tumor processes, such as the leukemias, lymphosarcoma, Hodgkin’s disease and multiple myeloma, and that its results in the treatment of chronic lymphatic leukemia and pseudoleukemia seem superior to those obtainable by local irradiation. It appears to be of only slight value in the treatment of radioresistant tumors. Leukopenia is observed rather routinely following treatment. In leukemia there was a tendency to thrombocytopenia, and anemia appeared in some cases. The authors believe that it is likely that modification in dosage and duration and spacing of treatments will yield better results in the future. Various modifications of the method for future investigation are proposed: the treatment of restricted areas of the body by continuous prolonged short-wave therapy, the use of small doses of general irradiation supplementary to 1ocal.irradiation for the treatment of latent foci of radiosensitive processes, and the use of prolonged long-distance unfiltered or lightly filtered radiation for certain cutaneous disemes. Both these papers include a description of the continuous therapy unit and both 872 ABLSTBACTS contain illustrations showing the results of treatment. The later one (Am. J. Roent- genol.) is accompanied by numerous tables showing the results of treatment in detail and the effect on the blood count, and by reports of typical cases. It also includes a bibliography. [Careful study of the detailed protocols of the patients treated does not give the impression that the results obtained were superior to those which are observed to follow radiation over smaller areas, and the great expense of the method has led to its abandonment at the Memorial Hospital, at least for the present.] X-ray Treatment of Some Uncommon Tumoure, R. F. PHILLIPS. Brit. J. Radiol. 7: 670-884, 1934. Phillips presents briefly the histories of 23 heterogeneous cases of sarcoma treated with radiation. The first of these was an inguinal tumor which he believes to have arisen from the extra-abdominal portion of the round ligament in a woman of fifty-six with an inguinal hernia. Radiation (1040 t to each of two fields) resulted in a reduction in the size of the mass, though how much this was due to change in the hernia is hard to say. Six months after treatment was begun the tumor was removed. Its histologic appearance was that of a fibroma. However, the patient died six months later with clinical evidence of metastases. Phillips classifies this tumor es the ninth sarcoma of the round ligament to be reported. Other cases reported include two neurogenic sarcomas unaffected by radiation; a solitary plasmocytoma of the sacrum apparently cured (two years) by divided doses of x-rays (1400r to each of three fields), and a similar case unverified by biopsy; four sarcomas of the ilium, either unverified or showing no improvement with treatment; four cases of “ endosteal ” sarcoma; five osteogenic sarcomas unimproved by radiation; two osteogenio sarcomas showing slight temporary improvement, with death from pulmonary metastases; two osteogenic sarcomas apparently cured one year after radiation and amputation, and one case, unverified by biopsy, apparently cured by radiation alone. GRAYH. TWOMBLY Follow-up Results in the Use of X-Ray and Radium in Cancer, M. d’HALLuIN. Action des rayons x et du radium dens le cancer et suites BloignBes d’observations person- nelles publides, J. de sc. m6d. de Lille 51: 137-142, 1933. Also in Bull. et mem. SOC. radiol. mBd. de France 21: 572-578, 1933. In this brief paper the author attempts to bring up to date the follow-up reports of a miscellaneous group of 25 patients treated by him, by x-rays and radium, over a period of fifteen years. They include cases of carcinoma of the cervix, rectum, breast, and skin. Apparently 44 per cent of the patients have been free of disease for, seven to thirteen years, but a coneiderable number of these were never proved histologically to have cancer. JOHNS. LOCKWOOD Results of Radiation Therapy of Malignant Tumors in 1933, H. R. SCHINZ,A. ZUPPINOER, R. STEWART-HARRISONAND C. ROHRER. Bilans ilber die Bestrahlungsresultate bei malignen Tumoren in Jahre 1933, RBntgenpraxis 6: 432-440, 1934. In this annual report from the University of Zurich [for earlier reports see Absts. in Am. J. Cancer 17: 493, 1933; 20: 672, 1934) the authors emphasiae the importance of attention to the patient’s general condition if the clinioal results following radiotherapy are to be improved. The firat half year after treatment is a critical period. The report deals with 739 patients, of which number 308 were first seen in 1933. Of the 739 patients, 304 are now symptom-free, a much better proportion than has heretofore been obtained. About half were given the protracted fractional treatment; nearly as many received simple fractional doses, while the remainder received massive doses, a combination of x-rays and radium, or radium alone. Tables show the detailed results obtained in the lest five years. CHARLEBPACKARD

The Protection of Stdand Patients in Radiotherapy, C.BOURNE AND A. H. MERRITT. J. Cancer Res. Comm. Univ. of Sydney 6:39-56,1934. The author8 report a continuation of earlier studies (Bourne: J. Cancer Research Comm. Univ. Sydney 5: 142, 1933. Abst. in Am. J. Cancer 22: 921, 1934) in which it DIAQNOSIEI AND TREATMENT 873 was found that the protection afforded to the personnel of the Radiology Department of the Perth Hospital was sufficient to prevent any undesirable blood effects. A series of blood counts, now extending over a period of two years, has shown practically nothing abnormal which could be attributed to the effects of irradiation. Protective measures are not discussed here in any detail, but the importance of instructing nurses as to the physical properties of radium and impressing them with the dangers of carelessness is mentioned. A special study was made of the blood counte in patients undergoing therapy, and the following conclusions were reached: The initial effect of deep therapy irradiation on the blood of a cancer patient is, generally speaking, a fall in the red cells and either a rise or a fall in the white cells. Although the red cell count may fall to a rather low figure, it never, in the cases examined, became dangerous. In every case it was found that whether the treatment was continued or not, the red cells recovered from their drop, and rose to a more normal figure. The leukocytes varied very much, sometimes falling and sometimes rising, with no consistency, but never reaching a very high or a very low figure. This study was carried out over a period of only three and a half months and included 7 patients receiving deep therapy and 3 control cases, one of cancer and two fracture cases.

Preliminuy Study of the Effect of Artificial Fever upon Hopeless Tumor Cases, S. L. WARREN. Am. J. Roentgenol. 33: 75-87, 1935. The author has repeated the work of Rohdenburg and Prime (Arch. Surg. 2: 116r 1921) and finds that slices of mouse and rat tumors are killed when kept at 41.5' C. for twelve hours. The Brown-Pearce rabbit carcinoma is killed regularly by fifteen hours exposure to a temperature of 42' C. Animals bearing these tumors, however, can not be cured by merely raising their temperature over prolonged periods, as has been shown by Woglom (Am. J. Cancer 21 : 604, 1934) and others. Schereschewsky (Radiology 20: 246,1933) was able to localise the heat and cure some 25 to 75 per cent of mouse tumors with short radio-waves as a heating agent. There is considerable evidence that tumor tissue in an animal or man can be maintained at an elevated temperature by the application of external heat such as is supplied by carbon filament lamps in a cradle. On this basis 32 patients with advanced cancer of various types were treated by generalised fever therapy, the rectal temperature being maintained at 41.5' C. for as long as twenty-four hours. The fever therapy was combined in mme cases with radiation. Ten of these patients are listed as showing improvement. In most of the cases there was some regression in the size of metastatic masses attributed by the author to the fever therapy. He believes that further work with this form of therapy is promising, though no cures have been obtained. The bibliography refers only to the author's work. Illustrative charts, roentgenograms, and photomicrographs are reproduced. GRAYH. TWOMBLY

Lead Therapy in Cancer, R. DALIMIERAND A. SCHWARTZ.Essais de traitement des cancers par le plomb, Presse m6d. 42: 922-923, 1934. The authors have attempted to reproduce the satisfactory results claimed by Blair Bell for the use of lead therapy in cancer. Two preparations were employed, the first a colloidal form of lead resembling that used by Bell. This was administered intramuscularly to 7 patients with breast, ovarian, and large bowel lesions, all of fairly advanced type. The other preparation was an organic compound, phenylamylacetate of lead, which seemed less toxic than the colloidal form, making possible the administration of amounts as high as 1.39 grams of lead in divided doses. This was used in 17 cases of carcinoma, of which only 5 were followed satisfactorily. Although in most cases a slight regression of the tumor occurred in the early days of treatment with both preparations, the end-results did not seem to be changed in any degree by either form of lead. Chemical analysis of tumor tissue removed post mortem did not indicate the fixation of any metallic or combined lead. The authors conclude that lead treatment is of no value. JOHN 5. LOCKWOOD 874 ABSTRACTS

A Combination Oxygen Therapy for Cancer, J. CHOLEWA.Uber eine kombinierte Sauerstofftherapie bei Krebskrankheiten, Acta Cancrologica 1: 243-248, 1935. After a brief review of gas therapy in malignant disease the author describes a treatment consisting of the subcutaneous injection of 300-500 C.C. of oxygen twice a week and the administration by mouth of large doses of hydrochloric acid and pepsin with meals and of ferrum reductum after eating. The hydrochloric acid is supposed to correct alkalosis and at the same time to further assimilation of the iron. Methylene blue is given, also, to reinforce the action of the hydrochloric acid and iron. Seven patients have been treated so far, but only one is described-an almost moribund woman with a hopelessly inoperable metastasihg carcinoma of the pylorus (verified by operation and biopsy) who appeared to have been greatly benefitted. At least she was alive twenty-two months later, felt well, was able to work, had gained 22.5 kg., and was not especially tired by the four-hour walk to the hospital. Nothing is said of the tumor at this time, but about nine months after treatment had been begun it was still palpable, though smaller and freely movable. WM. H. WOGLOM

Biology and Cancer, CUVIERAND CARRERE.Biologie et cancer, Alg6rie m6d. 38: 217- 221 , 1934. The authors discuss the palliative effects of a tumor extract in advanced cases of malignant disease. The preparation is given by mouth in solution or powder form in small doses, or may be applied locally. C. R. MULLINS

Experience witp Fichera’s Treatment for Cancer, G. SCHULTEAND W. LUTTEKEN. Unsere Erfahrungen mit der Krebsbehandlung nach Fichera, Strahlentherapie 52 : 247-251, 1935. The authors tried Fichera’s treatment [see Abst. in Am. J. Cancer 23: 617, 19351 in 61 patients with inoperable cancer. In not a single one was there seen the slightest trace of even transitory benefit, despite Fichera’s assertion that in 9 per cent of his patients the tumor was entirely cured, and was arrested in its growth in 8 per cent. WM. H. WOGLOM

Chlorophyll and Cancer, R. DUPONTAND G. DUHAMEL.Chlorophylle et cancer, Bull. Assoc. frang. p. 1’6tude du cancer 24: 15-30, 1935. The authors injected solutions of the sodium salt of chlorophyll intravenously and directly into the tumor in hopeless cases of cancer. They believe that the general condition of the patients was improved, pain was diminished, and radiation treatments better tolerated as a result of the injections. No untoward reactions were observed with doses up to 100 mg. Six cases are reported. H. Q. WOODARD Treatment of Cancer Patients with Cobra Venom, J. LAVEDAN.Le traitement des tumeurs malignes de l’homme par le venin de cobra, Bull. Acad. de m6d., Paris 113: 195-201, 1935. Also in Paris m6d. 25: 221-227, 1935. The author has during two years treated with cobra venom 51 cases of histologically verified carcinoma, including 12 of the uterine cervix, 10 of the breast, and 6 of the tongue. Forty-five of the patients had been treated by surgery or irradiation or both, and now showed metastases; the remaining 6 were obviously inoperable and had received no previous treatment. A solution of venom containing 10 lethal mouse units per c.c., prepared in Calmette’s laboratory, was used. The injections were increased gradually until two doses of 50 units were given each week. All the patients were treated for at least four months. In 42 cases the injections were given intramuscularly at a distance from the tumor, usually into the shoulder. Lasting relief of pain was reported by only 5 patients. All of them seemed to have at first, while the smaller doses were being given, a feeling of satisfaction and hopefulness, expressed by improved spirits and appetite, but this psychic effect lasted for only a few weeks in most cases. No patient showed evidence of even transitory arrest of growth of the tumor. Only two lived for longer than a year, and both were given radium treatment along with the injections. DIAGNOSIS AND TREATMENT 876

In 9 cam intratumoral injections were given. Six of these patients had large breast cancers with axillary and supraclavicular invasion, and received from 82 to 81 injections. In no oase was diminution of the tumors observed. In 3 cases even small outaneoue metastases remained unaffected by the injections. All the patients died after from six to eight months. There was not the slightest evidence that either intratumoral or intramuscular injections prolonged life. In the majority of the cases reported, biopsies were made, and these failed to reveal histologic change of any kind in the tumors following treatment. The author concludes that cobra venom very rarely relieves pain in cancer, that it has sometimes the same paychic effects as may follow any sort of medical treatment, and that it has no influence whatever on the course of the disease. F. CAVERE Treatment of Pain in Cancer, J. HA~UENAU.Le traitement des algies cancdreuses, Semaine d. hbp. de Paris 11: 110-117, 1935. If snake venom is to be employed for the relief of pain, that of the cobra should be chosen for the reason that it is neurotropic, Venom is measured in mouse units, one unit being the amount that will kill a 25 gm. mouse in five to seven hours. It is customary to begin with 6 mouse units every four to five days until two to three such treatments have been given. A similar number of doses of 10 units each may then be administered, observing the same intervals; then 3 doses each of 12M, 18, and finally of 26 units. When the large dose is given; the iutervals should be increased to eight days or more. The injections cause neither local reaction nor pain. The skin must be cleansed with alcohol or ether-not iodine, which attenuates the venom. Thus venom is not administered to patients who are under treatment with iodides, and radiotherapy also is regarded as a contraindication, though this opinion may not be sustained in the future. It may be said in a general way that the treatment seems more efficacious when injectione are made in the vicinity of the pain. Too much must not be expected, however, for while the results in some patients are brilliant, in others there is no effeot. Thoae with visceral neoplasms seem to be more susceptible to treatment than those with peripheral growths. [Most of the recent reports on snake venom are unfavorable even as to its analgesic power.] Relief of pain may be obtained sometimes, also, with anti-rabies vaccine, which has, in addition, a remarkably tonic effect. Radiotherapy may be a useful analgesic when large doses are directed at the tumor iteelf and at the nerve roots of the area involved, but here again too muoh is not to be expected, for it generally fails in patients with visceral neoplasms. In primary or seoondsry tumors of the bones, on the other hand, extraordinary relief from pain is. often achieved! particularly in the case of the spine. Aa for surepcal methods, the injection of alcohol or other neurolytic agents into the nervea hea proved a disappointment, while radicotomy is of severely restricted value. The relief afforded by chordotomy, on the other hand,.is immediate and definite, assuming that the operation has been properly done, and the danger to life is praotically negligible. Patients tortured by infiltrating growths of the pelvis, abdomen, or spine are permanently freed of pain and the disease progresses to its inevitable termination with no further distress. WM.H. WOOLOM Venins, Vipers and Cancer, L. PITON. Venins, viflres et cancer, Bull. Acad. de mdd., Paris 112: 645-647, 1934. The author points out that long before Calmette and later workers used the venom of various snakes in the treatment of cancer, Profemor Billard had in 1913 given in- jeotions of the venom of the common viper in a case of carcinoma (site not stated), claiming that cervical node metastases had disappeared and that pain was greatly relieved. The author himself has treated 50 cases of cancer with viper venom, but observed only partial relief of pain and occasional transitory arrest of tumor growth. F. CAVERS 876 ABSTRACTS

Three Cases of Musculo-aponeurotic Sarcoma Treated with Anti-rabies Vaccine, J. HAQUENAU,L. CRUVEILIUERAND L. GALLY. Trois cas de sarcome musculo- apon6wotique traites 8. l’aide du virus-vaccin antirabique, Bull. et m6m. SOC.m6d. d. h8p. de Paris 51: 341-343, 1935. A report of three cases in which antirabies vaccine was used as a supplement to radiation therapy with good results. H. Q. WOODARD

THE SKIN

Potentialities of Precancerous Lesions of the Skin, T. GAINES. J. M. A. Alabama 4: 133-135, 1934. A brief description of the more common lesions of the skin, especially the keratoses, which may lead to the later development of malignancy. Early removal of such lesions is advocated. There are no illustrations, and the article offers nothing new. THEODORES RAIFORD

Diagnosis and Management of Cutaneous Cancer, G. M. MACKEEAND A. C. CIPOLLARO. Arch. Physical Therapy 16: 139-144, 1935. The subject of cutaneous cancer is discussed under the following headings: basal-cell epithelioma, basal squamous-cell epithelioma, squamous-cell epithelioma, transitional- cell epithelioma, Paget’s disease, Bowen’s disease, melanoma, sarcoma. Each is briefly described grossly and microscopically and the treatment of choice is mentioned. There are several illustrations of the gross lesions. GRAY H. TWOMULY Origin and Nature of Pigmented Nevi (Schwamomas), W. 13. BECKER. Arch. Dcrmat. & Syph. 30: 779-784, 1934. Becker gives a general discussion of nevi which he states may be of the cellular type or the nerve type, or a combination of the two. The former result from the multiplica- tion of melanoblasts or the “clear cells ” at the epidermo-dermal junction. The nerve type usually contains structures resembling Wagner-Meissner corpuscles. Photo- micrographs of both types are included. GRAYH. TWOMBLY Metamorphosis of Nevus Cells to Sebaceous Gland Cells, G. MIESCHER.Unwandlung von Naevuszellen in TalgdrIisenzellen? Arch. f. Dermat. u. Syph. 171: 119-124, 1935. . Histologic study of a pigmented nevus removed from the left cheek of a nine-year- old boy showed areas of transition from the basal epithelial cells to typical nevus cells. In other areas a direct transition from the pigmented nevus cells into large clear cells resembling those of the sebaceous glands could be demonstrated. It is concluded from the study of this case that the basal or cambium layer of the epidermis is capable of assuming the characteristics of many different types of adult epithelial cells. The article is well illustrated with photomicrographs. BENJAMINR. SHORE Nevocucinoma Supervening on Skin Bite by a Tick, JAMAIN. A propos d’un naevo- carcinome d’origine peu commune, Ann. de dermat. et syph. 5: 1093-1094, 1934. A woman of thirty-six stated that about thirteen years previously, while spending a summer holiday with friends who kept dogs, she was bitten on the right thigh by a dog-tick, finding the insect some hours afterwards still adherent to the skin and bloated with her blood to the size of a pea. The spot became swollen and painful. Four year8 later, under similar circumstances, she was bitten in the right axilla; this time she acted more promptly and the bite soon healed, leaving a small dark spot. The first lesion persisted as a blackish nodule and the inguinal nodes became enlarged. The author excised the thigh nodule and the lymph nodes, and applied electrocoagulation to the wounds. He omits, however, to mention the histologic findings if any, and gives no illustrations. F. CAVERB THE BKIN 877

Epithelioma Following Avulsion of the Scalp, Report of a Case, E. L. BURNB. Arch. Surg. 30: 266-276, 1935. Burns reports the case of a thirty-four-year-old woman who had suffered a complete avulsion of the scalp twenty-one years previously. Complete spontaneous epithelisa- tion of the resulting wound was accomplished after sixteen years. However, four years before the patient’s fatal illness, an ulcer developed which never healed. Attempts at a plastic repair of the denuded area were interrupted by the death of the patient due to meningitis and a brain abscess. Histologic study of the scalp showed an epithelioma growing in the infected granulating wound and invading the brain substance. The wall of the brain abscess also contained carcinoma cells. The article is illustrated with a photograph of a cut section of the brain and photomicrographs. BENJAMINR. SHORE)

Sqwmoua-eell Carcinoma Appearing a Few Months After a Burn, L. CORNILAND J. LAMY. Sur le cancer aigu des brtllures, Bull. Assoc. franp. p. 1’6tude du cancer 24: 39-45, 1935. After a good review of the literature of skin cancer arising on burns, in which special reference is made to the comprehensive study by Treves and Pack (Surg., Gynec. B; Obst. 51: 749, 1930. Abst. in Am. J. Cancer 15: 1649, 1931), the authors report an interesting case of “ acute ” burn cancer. A man of twenty-six had months previously been hammering a red-hot horseshoe when a splinter flew to his lower lip. The wound became infected and ulcerated, and failed to scab, and five months after the accident B swelling was noticed below the ulcerated surface. This was treated at another hospital for four months by silver nitrate cauterization. At the authors’ clinic the lesion waa removed by wedge excision. During the four years that had elapsed up to the time of reporting the patient had returned for examination every six months, and showed no recurrence. There is one illustration. F. CAVERB

SqMmoue-cell Cancer Arising on an Old Wound Scar, J. GAT&,BRANCHE AND P. DUGOIS. Vaste plaie atone de la jambe de date ancienne. NBoplasme volumineux rBcent, Bull. SOC.franp. de dermat. et syph. 42: 14-15, 1935. A man of twenty-nine had at the age of about seven years sustained an accidental wound, the exact nature of which he could not remember, which left a large sore over the right knee and shin. The sore had never healed properly, and at the age of twenty-five the patient had noticed a small proliferating tumor. This was excised, but a year later it recurred and had spread over the whole wound. There was no adenopathy. Biopsy led to a diagnosis of squamous-cell cancer, and mid-thigh amputation was done. There is one illustration. F. CAVERB Rare Form of Skin Cancer, E. RIECKE. Zur Kenntnis seltener Formen des Haut- karainoms, Wien. klin. Wchnschr. 48: 162-164, 1935. The author reports the case of a forty-eightyear-old man with rapidly ulcerating tumors of the right inguinal region and skin of the thigh. Because of the marked tendency to degeneration, a diagnosis of syphilis, sarcoma, or mycosis fungoides seemed most likely. Histologic study of biopsy specimens and tissue removed at autopsy showed the growths to be basal-cell carcinomas with the formation of numerous small and large cysts. The article is not illustrated. BENJAMINR. SHORE Sarcoma Arising on Lupus, M. SCHWARZWALD.Sarkoma in Lupo, Acta derm.-venereol. 15: 365-372, 1934. A woman of sixty-two had twenty years previously had a tumor excised from the right side of her neck; no report was available concerning its histology. The wound healed well, but the neighboring skin remained red, and from time to time showed scaling. A diagnosis of lupus vulgaris was made and injections of tuberculin were given, but there was no further treatment until fifteen yeam after the excision of the nodule, when x-rays were applied once or twice a week for four years. The irradiated skin be- oame reddened and was now of a dark brown color. A few months before attending the author’s clinic, soon after the end of the x-ray treatment, there appeared in the skin at 878 ABSTRACTS this site a tumor which was now ulcerated. Biopsy showed squamous-cell carcinoma. The lesion was treated by the electric snare but promptly recurred, as it did twice more after similar treatment. The tissue removed at each of the three operations was diagnosed as spindle-cell sarcoma. The further history of the case is not given. The author’s general discussion of lupus sarcoma contains nothing new and is very incomplete. There are two illustrations. F. CAVERS Sarcoma Idiopathicum Multiplex Haemonhagicum (Kaposi): Variations from the UedCliaical Picture, J. R. WEBSTER. Arch. Dermat. & Syph. 30: 363-368, 1934. A Polish Jew of seventy-seven had observed alteration in the skin of the back of the right hand for two years. This began as a thickening followed by bluish discolor- ation. At bhe time of examination the right hand was much larger than the left, and the lesion was of a bluish to a brownish violet color. The transition from normal to diseased skin was gradual and there was edema. Scattered throughout the area were many reddish brown nodules, 2 to 8 mm. in diameter. The disease was confined to the hand save for some swelling of the forearm with a few isolated subcutaneous nodules. A biopsy showed a histological picture consistent with Kaposi’s sarcoma. Following irradiation (details not stated] the thickening of the skin practically disappeared and the bluish-red to brown-violet color was replaced by a dark brownish tint. Four years later the patient died in another hospital of “ myooardial degeneration.” The condition of the skin had shown no further change and no tracee of the disease were found elsewhere in the body. A photograph of the patient’s hands and one photomicrograph are included. There is a short bibliography. GRAYH. TWOMBLY

Hirtogenesir of Syringocyetadenomas, G. RIEHL. Zur Histogenese des Syringocyst- adenoms, Wien. klin. Wchnschr. 48: 209-211, 1935. The case of a forty-three-year-old woman with diffuse lesions of syringocystadenoma of the vulva is reported. One photograph of the grw leeion is included. These tumors are considered to be congenital abnormalities of the apocrine sweat glands. BENJAMINR. 8~0~0 Multiple Nevi of Prhgle mdv. Recklinghaurede Dbease, T. NIMPFER. Naevus multiplex Pringle und Morbus Recklinghaueen, Dermat. Ztschr. 68: 112-118, 1933. A male of twenty-seven years bad had generalired convulsive seirurea since the age of nineteen. When examined he showed multiple lesions on the skin of the body and head, some of which were considered to be the lesions described by Pringle [sebaceous adenoma] while others were characteristic of von Reeklinghausen’s disease. There were also areas of pigmentation on the trunk. Neurological studies and x-rays of the skull led to the additional clinical diagnosis of tuberous sclerosis. EDWINM. DEERY Neuromatous Nature of Chronic Nodular LicheniUcation of the Skin, L. M. PAUTRIER. Le nbvrome de la lich6nification circomcrite nodulaire chronique (lichen ruber obtusus cornb, prurigo nodularis), Ann. de dermat. et syph. 5: 897-919, 1934. Using various special staining methods, the author claims to have demonstrated the essentially neuromatous nature of a skin lesion which has long been regarded as a variety of lichen ruber. This interpretation is supported by a series of eighteen beau- tiful colored illustrations. F. CAVERS Bone Formation in the Skin, A. MUSQER..Knochenbildung in der Haut, Wien. klin. Wchmchr. 48: 200-205, 1935. This is a general artiole concerning the formation of bone in the skin. In a destructive tumor of a seventy-eight-year-old man, spicules of true bone were found scattered throughout the growth. Histologic study of the tumor showed parts of it to be typical of a basal-cell epithelioma, while other parts were typical of a bone-producing sarcoma. The diagnosis of a carcinosarcoma was made. The article is illustrated with a photograph and 3 photomicrographs. BENJAMINR. SHORE THE BBEABT 879

Treatment of Angiomu of the Eyelids with Scleroeing Injectione, L. WEEKERSAND S. LAPINRE. Traitement des angiomes des paupiims par lee injections scl6rosantes, Arch, d’opht. 52: 14-22, 1936. Also in Bull. SOC. belge d’opht. No. 68, pp. 23-36, 1934. The authors say they have had su5cient experience with the radium treatment of angiomas of the lids to convince them that such treatment is better left to the extremely expert radiotherapist. They have obtained good results with injections of the double hydrochloride of quinine and urea in the case of tuberous angiomas. The risk of ne- orosis is praotically abolished by the use of repeated injection8 of weak solutions. Applications of solid carbon dioxide suffice for small flat angiomas; larger ones are, they think, best left alone. F. CAVERS THE BREAST

Cancer of the Breast, 0. J. SEIBERT. J. Med. 15: 444-447, 1934. An attitude of pessimism toward cancer of the breast is to be deplored. Early diagnosis is important. Fixation of the skin is present in 82 per cent of the cases, and about 70 per cent show axillary metastases. In doubtful cases the tumor should be excised and examined by frosen section and a radical operation done at once if the section shows malignancy. Statistics show that 65 to 74 per cent of the patients without lymph node involvement live five yem or more, while only 26 per cent of those with node involvement live an equal length of time. Thirty-five case8 operated upon by the author follow this general rule. He does not consider removal of the pectoral mueclea neceesary or desirable if the sxilla is carefully dissected. Postoperative irradiation ie of undoubted value, particularly in cases of a high degree of malignancy. Trauma to the breast during an operation is conducive to the formation of distant metastaaea and should be avoided by rapid careful removal of the breast before dissection of the axilla is undertaken. GRAYH. TWOMBLY

Tumors of the Breast, A. MAXWELL.J. M. A. Alabama 4: 136-138, 1934. A review of the pathological aspects of the more common types of breast tumors in which emphasis is placed upon the forms of cystic disease and the possible development of malignancy in cases of this type. The article contributes little of value. THEODORE8. RAIFORD

Paget%Diseas-e of the Breast, A. LOUSTEAND F. CAILLIAU.La maladie de Paget du mamelon, Presse m6d 42: 1838-1842, 1934. After outlining the histological appearance of four specimens of Paget’s disease, the authors undertake to describe the histogenesis of this condition. They first of all rejeat the hypothesis that Paget’s disease is a manifestation of a process of dyskeratini- sation analogous to Bowen’s disease, because of the lack of any transition forms. They find that the point of origin is most frequently in the terminal ducts, that the direction of spread from that point may be either inward to the breast tissue, or outward to the skin, but usually both. They believe that Paget’s disease may also arise from sweat, or sebaceous ducts in the nipple region, as evidenced by the inclusion in some specimens of sebaceous material, presumably a result of secretory activity. The vacuolieation of the cytoplasm of many Paget’s cells is also an indication of secretory function, which superficial epidermal cells would not show. The mode of local dissemination of the tumor, the replacement of duct epithelium by tumor cells, the breaking through the ducts and the invasion of the surrounding tissue and finally the skin, speak in favor of the duct origin of Paget’s disease. The presence of melanin and melanoblasts in some tumors is consistent with their common ectodermal origin. A lesion diagnosed as Paget’s disease should be considered malignant from the outset, although its development into a disseminated form may occur only after a prolonged latent period. JOHNS. LOCKWOOD 880 ABSTBACTS

Diagnosis and Treatment of Breast Lesioni, F. E. ADAIR. New England J. Med. 212: 336-340, 1035. This is a general discussion of the diagnosis and treatment of benign and malignant lesions of the breast. BENJAMINR. SHORE

Transillumination of Breast Tumors, R. HUQUENIN.La transillumination dans le diagnostic des tumeurs du sein, Presse m6d. 42: 1534-1536, 1934. The author discussea at some length the differential diagnosis of breast lesions by transillumination and describes a simple instrument for facilitating this procedure. He does not consider transillumination a substitute for biopsy and frozen section, but suggesta that in hospitals lacking an adequate pathological service the test may be of eRpecial value. Tuberculosis and gumma of the breast are likely to show an opacity as dense as that of cancer, and for this and other reasons the possibility of error is great. However, in the management of a lesion as difficult to diagnose as cancer of the breast, no diagnostio aid of possible value should be ignored. JOHN5. LOCKWOOD

Technic for the Removal of Supraclavicular Ganglia in Cancer of the Breast, P. DUVAL AND H. ROUVIBRE.Technique de l’extirpation des ganglions sus-claviculaires, en particulidre dans les cancers du sein, J. de chir. 41 : 849-860, 1933. Technic of Radical Operation for Breast Cancer, M. FIOLLE.Une technique d’ablation en bloc du sein cancereux et des ganglions sus-claviculaires, J. de chir 45: 49-53, 1935. In 1033 Duval and Rouvidre after calling attention to the topography of the axillary and cervical groups of lymph nodes, developed an extensive operation for the removal of these nodes en mame. The proposed technic required the section of the clavicle and ligature of the external jugular vein and also the spinal accessory nerve. Care must be taken not to damage the large lymphatic trunks in the angle between the jugular vein and the clavicle, After the neck dissection is completed it is possible to clear the axilla and then go on to removal of the breast. The article is illustrated by excellent drawings. Fiolle, inspired by the description of the above technic, has devised a new incision which he finds very satisfactory in permitting easy closure of the skin wound. He recommends the removal of 6 to 7 cm. of the clavicle. Two drawings illustrate the surgical technic and a photograph of a patient two days after the operation shows the mobility of the arm and the slight interference with function. Obviously, while the operation is not extremely difficult from a technical point of view, care must be taken not to damage any of the vessels and to see that the nutrition of the flaps is not interfered with by excessive traction. While the author believes in the completeness and effectiveness of the operation from a technical point of view, he grants that its value is not yet determined. , [From time to time surgeons have attempted the block disaection of the supraclavicular node groups after section of the clavicle, but in the United States, at least, it is now rarely practised, as the consensus of opinion among surgeons is that if the supraclavicular or cervical nodes are invaded the disease has probably already extended to the thorax, so that no permanent benefit is gained by so extensive an operation. It. is wiser to do a palliative excision, clearing the axilla and removing the breast, and then attempting to control the disease above the alavicle by radiation.] F. CAVERB

Discussion on the Prevention and Treatment of MetaetPses in Carcinoma M-e, A. T. TODD,Proc. Roy. Sou. Med. 28: 681-884, 1935; 8. Gilbert Scott, ibid. pp. 684-889,894; H. Coke, ibid. pp. 684890; N. 8. Finzi, ibid. p. 890; J. H. Douglas Web- ster, ibid. pp. 891-692; J. E. A. Lynham, ibid. p. 892; R. Phillips, ibid. pp. 692683; F. Hernaman-Johnson, ibid. p. 694. In opening this discussion Dr. Todd gave an account of his methods [see Abst. in Am. J. Cancer 23: 145, 19351 for the combined treatment of advanced cases of breast cancer by colloids of selenium and by x-rays. He postulates a defense mechanism in THE BREAST 881

cancer, represented by .the stroma, and believes also that a benign adenoma is a neoplasm around which the defense tissue is adequate ta prevent invasion; “ if this defense fails, the adenoma becomes malignant.” The basis of the selenide treatment is to increase the defense. In his first attempts he found that massive radiation (300 t or more at one seance) applied to patients recently treated with lead selenide did not turn the saale in favor of the lead therapy but gave the opposite result-the neoplasm proliferated much more rapidly in every case [300 t would scarcely deserve the term massive and should not visibly affect a neoplasm]. Apparently the selenide had con- verted a relatively small x-ray dose into an enormous one which failed to kill the neoplastic cells but succeeded in damaging the defense tissue. It was thought that a smaller dosage, combined with a less sensitive selenium preparation, might have the desired effect. After many trials a sulphur selenium colloid was found to be suitable. According to Todd, the defense mechanism is controlled by certain endothelial cells. These secrete substances which activate the rest of the defense tissue, and if they take up electronegative colloid particles which are of such a chemical nature that their break- down stimulates the metabolism of the cell, then greater defense action will result. Penetrating electromagnetic waves alter the electrical charge on selenium particles and SO cause the latter to take up, or give off, available ions, and this change in the stability of the selenium phagocyted by the endothelial cell makes its action much more powerful than that of the neutral particle. The rapidity of this ionizing effect varies directly with the wavelength employed. In order to get a feeble but continuous ionization effeat in the defense tissue, an electronegative radio-active selenide colloid was made; this is selenium combined with the lead-like products of radium disintegration. Todd’s present method of treating cancer is, briefly, to impregnate the defense tissue with selenium colloid and to activate this by repeated small x-ray doses. Then the radio-active colloid is administered to obtain continuous activation. If growth is not ahecked, further x-ray ionization is given. The dosage of radiation and colloid will vary with each patient because the number of endothelial cells in the defense tissue is variable. If these cells are few, a small dose of colloid will 6ll them; then the activation of the selenium by x-rays will cause cell death, the defense failing and the patient experiencing severe reaction. If there are many endothelial cells, an appropriate dose of colloid will not cause blockade, hence reaction to colloid (pain, malaise, nausea, etc.) will be slight, subsequent radiation will not cause more than a temporary depression of defense, and x-ray reaction will be trivial. A temporary diminution of endothelial aativity is found to be followed by a lasting augmentation, and so, with suitable dosage, the ddense is increased. In inoperable cases with neglected primary growth, the latter is removed, especially if ideated or hemorrhagic, before beginning the routine treatment. The latter is used for metastases after the usual incisions1surgery, with irradiation of any metastases found and any suspected site. Hepatic metastases are very sensitive [this is a unique observation], and the liver should be shielded from an x-ray dose exceeding 25 t. Recurrences after radium treatment are usually non-reactive, and the outlook is not so good. Ra- dium seems to break down all defense, and metastases seem to appear more quickly and at unusual sites. These patients usually fail to react to selenide treatment, but they are not refused treatment, because there is nothing else to be done for them. Dr. Todd believes that his method is likely to do the most good in the prophylactic treatment of the supposed surgical cure; but he does not treat such patients because his time is fully occupied in trying to improve his system, working on cases otherwise untreatable. of 27 patients with mammary metastases, few of whom were considered likely to live for more than a few months, 5 are still on treatment-two being reasonably well after four and five years, two doing well, one badly; two died from pneumonia, one year and eighteen months after apparent curenecropsy of one of these showed no sign of cancer; 12 are dead, most of them exceeding their expectation of life, while half had prolonged periods of symptomatic relief; 8 have been discharged with apparent cures, persbting in 4 cases for one year and in 4 for two years. Scott said that with few exceptions both surgeons and radiotherapists have hitherto concerned themselves with treating cancer locally both as to space and time, and have made only feeble efforts towards the prevention of metastases. Whatever treatment is 882 ABSTBACTS given, the patients are ultimately sent away to sink or swim, and despite every effort 80 per cent succumb to metastases. The only safe basis for treatment must be the assumption that metastases have established themaelvea in every case. In the modifled Bendien test Scott believes we have a fairly acourate method of estimating the patient’s resistance, supplying theoretically an approximate indication of whether metastases are present or are likely to develop at any time. A method of wide field irradiation is briefly outlined, controlled by serologio testing and combined with selenium treatment and with a modified diet to counteract acidosis during treatment. It is assumed 88 a working theory that the patient is ‘‘ in the best fighting trim ” in relation to cancer when the serum graph is that of a normal person. Coke briefly stated his experience with wide field irradiation and control by the vanadate test, the latter being sensitive enough to demonstrate changes in the mum after a doee of 100 r at 100 kv. with 1 mm. aluminium filter. He conaidere it easy to overdose and get a severe negative phase in the blood, indicating a period in which the general defense mechanism of the patient is at its lowest. Finai believes that the only way to prevent metastasis is complete removal of the disease. Postoperative irradiation is essentially a treatment of possible small metastatic remnants, and for this purpose it is necessary to give a full dose just as if obvious palpable metastatic deposits were present. Obvious dietant metastases can be treated by full dome of penetrating x-rays, though when metsstseis is widespread through the body irradiation can only relieve pain in particular regions. Webster also pointed out that much has been done in the treatment of distant metastases by x-rays alone or with adjuvants, as pain relievers or sensitisere, of infre red rays or short-wave diathermy. He questioned how Dr. Todd distinguished the rationale of his method from that of protein therapy, which gives similar focal and general reactions, improves the patient’s sense of well-being, and may even lead to temporary softening and shrinkage of the tumor. During the past nine months Webster had treated eight cases by Todd’s method, but most of them had been failures. At- tempts at general methods of treatment, for instance by total irradiation (as at the Memorial Hospital, New York), or by chemical or gland therapy, had so far produced very few good results. Lynham said he had tried various injections in association with irradiation of breast cancer, and though several of the oolloide seemed to be useful in some oases, none of them could be relied upon. He considered that where there was deep extension or skin involvement, more lasting results would follow surgical removal with thorough irradiation than would be obtained by extensive operations. R. Phillips said that radiotheraphta would welcome any method which would aug- ment the effects of irradiation. Mindful of Dr. Todd’s warning that severe reactions might follow even minute doses of x-rays when given after injections of sulphur selenide, he had followed this technic in 20 cases. In most of these the disease was too advanced or widespread for x-ray treatment, whereas some which he had seen at Dr. Todd’s clinic in Bristol, which had been rejected for radiotherapy, he personally would have treated with confident expeotation of obtaining considerable amelioration. The general condition of the patients had certainly been remarkably good, but there had been “ no shadow of a sign of diminution of the actual palpable growth; not 13 skin nodule had disappeared, nor did an apparently isolated hepatic metastasis (which Dr. Todd regarded as especially sensitive) do anything but continue to grow.” No reaction had been observed after x-radiation in these 20 CBBBB, in which the weekly dosage had been kept down to 80 or 100 r, nor in later cases given 400 r, Weekly injections of selenide with daily dosee of 180 r (twioe the dose given by Dr. Todd weekly) were now being given and possibly better effect was being obtained than would be expected from x-rays alone. Phillips doubted the existence of “ resistance ” in cancer, whether in slow-growing cancers of adult histologic type with dense adult fibrous avaacular strome or in rapidly growing anapleetio typea with highly vssoular young oonneutive-tiesue stroma. Sulphur eelenide, in so far as it had any action, had either a direct necrotising aotion on certain kinds of malignant cell or an indirect effect by a process allied to protein shock. The less one explained failures by talking about failure of the patient’s resistance and the more one attempted to find out how best to attack the cancer cell, the more quickly would one attain control over cancerous processes. THE BBEAGT 883

F. Hernamadohnson said that he had recently vhited Dr. Todd’s clinic, and could mure members that, whether they believed or disbelieved in Dr. Todd’s theories, the clinical facfe were as stated. In particular, two cases of cancer en cuirmee were shown- one completely healed, the other in process of healing, He had not previously seen such cases benefitted by any treatment, and on his return he had tried the method in one case each of inflammatory carcinoma with massive involvement of axillary and cervical nodes and of a breast of orange skin appearance [these cases are reported separately, see Abstract below]. F. CAVERB

Inoperable Carcinoma of Breast, with Skin of ‘‘ Peau d’Orange ” Type, Treated by Todd’s Method of Selenium Injections Combined with X-Ray Exposures, F. HIURNAMANJOHNSON.Roc. Roy. SOC.Med. 28: 758, 1935. Secondary Ulceration of Brast Treated by Todd’s Method (Selenium Injectlone Followed by X-Rays), F. HQRNAMAN-JOHNSON.Ibid. 28: 758, 1935. In the first of these papers the author State8 that he first saw, a few weeks before the time of reporting, a woman of forty-four who about four months previously had noticed a lump in the left side of the neck. A month later the skin of the breast had become red, and since then there had been steady enlargement of the cervical nodes and the breast, the skin of the latter showing the orange peel appearance. The patient had had ten weekly injectibna of sulphur selenium, each followed by x-rays, 60 r over a wide field. The skin was no longer red, the breast was smaller, the cervical nodes diminished, and it would now be safe to carry out local excision of the breast, continuing with selenide plus x-ray8 to deal with nodes and possible metastases. The subject of the second report was a woman of fifty-five who had the left breast removed in October 1932. Recurrent breast skin nodules appeared just a year later. Local radium had been given from time to time, with some improvement but not complete disappearance of the nodules. During one month before the time of reporting, three selenium injections had been given, each followed by an x-ray dose of 50t. A small ulcerated area had healed and a larger one was diminishing. In commenting on the first case, C. A. Joll thought that the orange peel appearance was by no means so rare in breast cancer as the author had suggested. During the past ten years he had seen at least 50 cases of this kind. He found it difficult to accept the euggestion that treatment with Todd’s method had had any influence on the progress of the case, because the patient had had some x-ray therapy, though the dosage was sd. It was also within his experience that the orange peel condition sometimes improved remarkably without treatment. F. CAVERe Case of Breast Cancer with Metastases Resembling Linitis PlaetIca in Structure, J. V. J~RQENSEN.Un cas de cancer du sein avec m6tastases de type singulier, Acts path. et microbiol. Scandinav. 12: 192-202, 1935. A woman of fifty-seven refused operation for a tumor of the left breast and was given x-ray treatment. After a month the tumor became much smaller and the axillary edenopathy disappeared. Eighteen months later she was admitted to the author’s clinic with a diagnosis of gastric influensa, complaining of vomiting, diarrhea, and lumbar pain radiating to the lower extremities. A tumor was still present in the left bread., and recently there had appeared skin nodules on the trunk. Biopsy showed that the latter consisted of dense fibrous tissue containing scattered round cells with deeply staining nuolei. The latter seemed to be neoplastic cells, the whole recalling the structure of linitie plastica. The breast was removed, and the tumor found to be adenocarcinomatous. Soon afterwards ascites and edema set in, further skin nodules appeared, and death occurred about five years after the breast tumor was first noticed. Necropsy revealed extensive metastases in the lymph nodes and most of the abdominal and thoracic organs. Those in the lymph nodes showed the same adenocarcinomatous etructure as the breast tumor. Those in the internal organs were like the skin nodules, the cancer cells being isolated or occurring in small groups among the fibrous stroma. There are five photomicrographs. F. CAVERE 884 ABSTRACTS

Gelatinous Carcinoda of the Breast. Second Report, NORBERTENZER. Am. J. Clin. Path. 3: 443-445, 1933. The author in a previous report (Am. J. Clin. Path. 2: 457-462, 1932. Abst. in Am. J. Cancer 19: 718, 1933) recorded a case of gelatinous carcinoma of the breast with axillary involvement. Simple excision of the tumor was done. He now publishes a second case in which a radical breast amputation was performed. A photomicrograph of a metastatic axillary lymph node reveals a typical gelatinous carcinoma. Nothing new is added to our knowledge of this well known type of mammary neoplasm. Apparent Cure of Breast Cancer Following Infection of Biopsy Wound, T. PAPADO- POULO, J. KOPPAND A. HADJIGEORGES.Un cas de gu6rison d’Bpith6lioma du sein h Is suite d’infection grave de la tumeur, Bull. et m6m. SOC.nat. de chir. 60: 214-216, 1034. A woman of sixty-three had a tumor of the left breast, fixed to the skin, free from the deep tissue, and without palpable adenopathy. A wedge of tumor tissue was excised for biopsy, which led to a diagnosis of scirrhous carcinoma. Within twenty-four hours the biopsy wound had become infected, with acute fever and rigors. Lymphsngitis developed and eight days after biopsy the entire breast was inflamed and suppurated; pus smears and blood cultures showed hemolytic streptococci. X-ray treatment was given, the dosage being 90 R (internat.). The lymphangitis disappeared, and shortly afterwards the entire breast, tumor and all, sloughed away, leaving a surface which rapidly healed. The patient gained weight, and when seen more than three years later she was in good health, and there was no sign of recurrence. F. CAVERS Breast Tumors in Men, H. STAHR.Uber Mammatumoren beim Manne, Acta cancrologica 1: 227-242, 1935. During the past seventeen years the author has observed 7 cases of carcinoma and 10 of fibroplastic mastitis of the male breast. Rubbing of the clothes is thought to be an etiologic factor and may account for the number of growths beginning at or near the nipple in men. BENJAMINR. SHORE Case of Carcinoma of the Male Breast, H. C. P. CUNEWARDENE.J. Ceylon Branch Brit. M.A. 31: 23-34, 1934. A brief case report is given of a man of fifty-five who had an ulcerated carcinoma of the right breast seven inches in diameter. This began as a painless nodule near the right nipple two years before he was seen by the author. Autopsy. showed no metastases Have in the skin near the lesion and in the right axilla. GRAYH. TWOMULY Successive Carcinoma of the Breasts in a Man of Eighty-one, L. H. PETIT. Epi- th6lioma frappant successivement les deux seins, ches un homme bg6. Double amputation. Gubrison, Bull. et m6m. SOC.nat. de chir. 60: 938, 1934. A man, who was in good general health, was operated upon early in 1930 for a mall, hard, mobile tumor of the right breast, diagnosed as scirrhous adenocarcinoma. There were no palpable axillary nodes. Nearly four years after the amputation of the breast the patient returned with a similar but larger tumor in the left breast. Although now nearly eighty-four years old, he was still in excellent health and rapidly recovered after amputation of the left breast. The second tumor was of scirrhous type, like the first, containing abundant fibrous tissue, while the tumor cells showed few mitoses. F. CAVERS EYE AND EAR

Metastatic Carcinoma of the Optic Nerve and Choroid, C. E. MCDANNALDAND B. F. PAYNB.Arch. Ophth. 12: 86-92, 1934. Ten months after radical amputation of the right breast for carcinoma, a forty-two- year-old white woman complained of severe pain and total blindness of the right eye and drooping of the right upper lid. Examination showed ptosis of the lid and deviation EYE AND EAR 885

of the eye outward and upward with loss of the power of abduction. The pupil was dilated and fixed and reacted neither to light nor convergence tests. X-rays demonstrated cloudiness in the region of the right orbit. On ophthalmoscopic examination the retina appeared to be elevated for a short distance around the optic nerve. This elevation was continuous with a light gray, slightly elevated mass extending into the disc. Enucleation was performed, followed by irradiation, but the patient died five months later. No autopsy was peflormed, but pathologiacl study of the enucleated eye showed infiltration of both the optic nerve and choroid by cells similar to those of the carcinoma previously removed from the breast. In view of the preponderance of tumor in the nerve and its manner of extension, it was thought to have invaded the nerve first and to have involved the choroid by secondary extension. Metastatic carcinoma of the eye is rare. Payne (Texas State J. Med. 28: 227, 1932-33) found only 2 cases in 70,000 or more patients seen at the New York Eye and Ear Infirmary in 1929 and 1930, and figures of other writers are in accord with this. The most common source is the breast. The orbital lesion usually occurs from one to two years after the recognition of the primary growth, although periods of ten to fifteen years have been known to elapse. The average duration of life after diagnosis of the eye tumor has been estimated at from six to twelve months. The choroid in the vicinity of the posterior pole of the eye is usually the site of invasion. This is attributed to the increased vascularity and the entrance of the short posterior ciliary arteries. The iris and ciliary body and rarely the optic nerve may be affected. The metastatic lesions usually appear as flat, pale gray areas which may be multiple or single. The elevation is rarely more than one or two millimeters and the retina may be detached around it. The focal extension is usually lateral. Occasionally the retina may be broken through and the vitreous involved. Invasion of the disc with subsequent extension along the optic nerve into the brain is sometimes seen. Secondary glauooma appears later than in sarooma but pain appears earlier and may require enucleation for its relief. There are five illustrations and a short bibliography. THEODORES. RAIFORD

Acquired Cyeta of the Sclera, M. N. BEIQELMAN.Arch. Ophth. 12: 188-200, 1934. The part of trauma in the development of scleral cysts is indicated by the fact that in the 23 cases thus far reported there has been a definite history of injury in 17. In 2 of the remaining 8 there was histological evidence of injury. Observation of cases following operative procedures on the eyeball has shown that several months may elapse before such lesions develop. Scleral cysts are always found in the anterior part of the eye and most commonly at the limbus. The latter forms a limiting boundary and the cyst not infrequently grows in a semicircular fashion around the cornea, only occasionally penetrating it. Histological studies in a few of the cases reported have shown that the cyst is usually lined by epithelium and filled by a watery fluid. The origin and source of the epithelium can possibly be explained as a result of the trauma. When the healing of the injured eclera is in any way interfered with, the epithelium is allowed to proliferate inwardly, so that when closure finally does occur, there may remain an epithelial inclusion, gradually developing into a cystic lesion. Another theory postulates the transmission of epithelial cells into deeper parts of the sclera by the force of the injury. This is substantiated, in part at least, by the experimental production of cysts in animals. The presence of fluid in the cyst is more difficult to explain. In some instances a com- municating channel has been observed between the cyst and the interior of the eyeball. In the absence of a direct channel for the influx of intraocular fluid, a transudation from the uveal tract into the cyst has been assumed provided some uveal tissue was incarcerated in the scleral wall. This does not apply, however, to the many cases where the cyst lies entirely within the sclera and is walled off from the uvea by solid connective tissue, and various other theories have been proposed in an attempt to explain these. The infrequency of the lesion may possibly be explained by the limited vascularity of the sclera, which is thus an inadequate medium for epithelial proliferation. Treatment offers no special difficulties. If the vision has already been destroyed, enucleation is the easiest and simplest method of management. Otherwise the cyst 886 ABSTRACTS may be dealt with locally. Complete local excision L impracticable and unneceeeary. Removal of the outer wall of the cyst has thus far proved to be an adequate procedure. Three cases are reported by the author. Enuclestion was performed in one, removal of the anterior cyst wall in another, and exobion of the ,cyst, whioh was very small, in the third. Except for the fact that in the second there waa a marked indentation in the sclers several months after operation, the reeults are not mentioned. There are two illustrations and a review of the literature is presented. THEODORE8. RAIFORD

Neoplamr of the Lacrimal Gland, W. 8. DAVIES. Arch. Ophth. 12: 33-37, 1934. Two cases of neoplasms of the lacrimal gland are reported. One, a mixed tumor similar to those found in the salivary glands, was removed from the eye of a thirty-oQe- year-old white woman who complained of protrusion of the right eye, which radium bad failed to relieve. The second was an adenocarcinoma thought to have developed from a mixed tumor. It occurred in a forty-nine-year-old man whose only symptom was exophthalmos. When biopsy revealed the malignant nature of the lesion, complete exenteration was performed and part of the eroded orbit removed. One week after operation, x-ray therapy was instituted. Convalescence was uneventful in both cases, but the final results are not mentioned. Only 263 tumors of the lacrimal gland have appeared in the literature prior to the publication of these cases. Warthin (Arch. Ophth. 30: 601, 1901) classified them according to structural characteristics and hietogenesis, finding the mixed variety by far the most common. While he regarded them as endothelial in origin, the generally accepted view is that they arise from the anlage of the lacrimal gland, and are therefore epithelial. Clinically the lesions are most common in people beyond middle life, but they may occur in the young aa .well. The growth is slow, the history dating back from one to five years. Exophthalmos is the earliest symptom. Other signs are defective vision due to hyperemia of the papilla or pressure on the optic nerve or cornea. Extra-ocular movements are increasingly restricted y the protrusion increases. Pain may appear early. The tumor may be palpated in the region of the lacrimal gland, but if it ia located deeply, anesthesia is sometimes required before it can be felt. X-rays are of value in determining the extent of orbital deetruction. In a review of 95 lacrimal gland tumors (Lane: Am. J. Ophth. 5: 425, 1922) the mortality was found to be 12.6 per cent, and the recurrence rate 20 per cent. Early diagnosis and treatment are therefore essential. Operative removal of the tumor in its entirety is advocated. Postoperative irradiation is never amiss, regardless of the degree of malignancy exhibited by the pathological specimen. A short bibliography is included. There are no illustrations. THEODORES. RAIFORD

Cystic Adenoma of the Lacrimal Glandr, A. BUSACCA.Adenoma cistico delle ghiandule lacrimali, Pathologica 25: 499-504, 1933. The author reviews the literature on the varioue tumore of the lacrimal glands and reports a case of bilateral tumors of the acceeeory lacrimal glands in a woman of twenty- three. The tumors had appeared six years before, following an attack of acute tonsillitis. They had grown slowly and were not tender. The salivary glands were normal, and the lymph nodes were not involved. The larger tumor was removed for histologic examination and proved to be a cystic adenoma. The author discuellee the histological differentiation between these forms and tumors of the glands due to low-grade chronic inflammatory processes. Photomicrographs of the tumors are given, but are so poorly reproduced that it is difficult to make out the structural details. JEANNETTEMUNRO Cam of Orbital Neurinoma Clinically Simulating Optic Nerve Tumor, R. W. M~LLER. Ein Neurinom der Orbits mit den kliniechen Zeichen eines Sehnerventumors, Klin. Monatsbl. f. Augenh. 92: 592-800, 1934. A girl of sixteen years noticed progreeeive dimming of left vision, and a few months afterwards the eye became swollen. She now complained of left frontal headache, and OBAL CAVITY, SALIVARY OLANDS, AND UPPER RESPIRATORY TRAOT 887

there was fairly marked exophthalmos. The latter rapidly increased, and a tumor could be felt behind and above the globe. At operation e bluish red tumor was found filling the greater part of the orbit. It was adherent to the optic nerve, accompanying the latter into the optic canal. The exenterated tumor WBS found to be a typical neurinoma, but it was not possible to decide whether or not it had arisen from the sheath of the optic nerve. There are three illustrations. F. CAVBRS

Congenital Cyst of the Orbit, F. A. KIEHLE. .Am. J. Ophth. 18: 257-258, 1936. A case report of an orbital cyst in an infant seven weeks of age. It was surgically removed, but death occurred a few hours later. Microscopic examination showed that the cyst and the microphthalmic eye composed one large cavity. On one side the cyst wall consisted of a thick leyer of embryonic connective tissue representing sclera, to which the retina was closely applied without any intervening choroid. On the other side, the wall of the cyst was 1 cm. in thickness and consisted of neuroglia in which some connective tissue was intermingled. W. 8. MACCOMB Treatment of Malignant Tumours of the Middle Ear at Rndiumhemmet Stockholm, I. THORELL.Acta Radiologica 16: 242-253, 1935. Malignant tumors of the middle ear seen at the Radiumhemmet in Stockholm number 9 caroinomas, 1 malignant melanoma, 2 malignant mucous and salivary gland tumors probably originating in the external auditory meatus, and 1 sarcoma of the dura invading the middle ear. Of the 9 epitheliomas, 8 were squamous-cell tumors, and 1 a much less differentiated epithelioma. In 7 cases there was a history of chronic otitis with a long-standing discharge from the ear in which the tumor subsequently appeared. In 5 cams a purulent discharge had been present since childhood. Aggravation of the symptoms of chronic otitis which had previously been present seemed to be a sign that a malignant process had supervened. In most cases the tumors had extended rather widely before special treatment was given. Two of the patients with epitheliomas are still symptom-free nine and wven years respectively after the beginning of treatment; in one of the cases healing wan effected by radiation alone, while in the other a combination of electrocoagulation and radiation was used. The patient with the dural sarcoma was well for nine years after surgical removal of the growth and postoperative irradiation. The histories of the 13 patients are given in detail. The article is illustrated with several roentgenograms. BENJAMINR. SHORE

THE ORAL CAVITY, SALIVARY GLANDS, AND UPPER RESPIRATORY TRACT Treatment of Cancer of the Tongue,,R. WEILL. Traitement du cancer de la langue, J. de m6d. de Paris 54: 238-241, 1934. The author presents a concise summary of the therapy of cancer of the tongue, advocating treatment of the primary tumor by insertion of radium needles, and of the regiond lymph nodes by radical neck dissection. He employs routine postoperative radiation by means of a collar of Columbia paste bearing radium tubes, worn for eight to fifteen days. The type of neck dissection advocated by him ie the most radical and thorough which it is possible to perform, including en bloc removal of the eterno- mastoid musole, the internal jugular vein, and all the node-bearing tissue from the border of the mandible to the clavicle. There are no illustrations or bibliography. WILLIAMJ. HOFFMAN Treatment of Epithelioma of the Cheek, G. E. PFAELER.Radiology 24: 99-109, 1935. This is a general discussion of the irradiation treatment of epitheliomas ariaing in the mucous membrane of the cheek. In general the author believes that prolonged and more or less continuous irradiation with gamma rays will give the best results because these lesions are generally of the slow-growing type and relatively radioresistant. Surface apptications of radium, using 2 mm. of platinum filtration, so as to give from 888 ABSTBACTS

2,000 to 3,000 milligram hours on the inside of the cheek are recommended. Radium packs giving from 50,000 to 100,OOO milligram hours externally at a distance of 4 cm. are also used. The article is illustrated with photographs of patients before and after treatment. BENJAMINR. SHORE Radiation Treatment of Carcinomas of the Air Passages, A. HINTZE. Bestrahlungsbe- handlung bei Karsinom der Luftwege, Internat. Zentralbl. f. Ohrenh. 38: 171-175, 1934. From 1914 to 1933, 190 patients with carcinomas of the upper respiratory tract were treated in the Surgical, Laryngological, and Roentgen Divisions of the University Clinic in Berlin. There were 143 men and 47 women. One tumor WBS situated in the nose, 56 on the maxilla, 6 in the epipharynx, 45 in the mesopharynx and tonsils, 72 in the larynx and hypopharynx, and 10 in the trachea. Forty-eight patients were treated by surgery alone, 81 by irradiation alone, and 52 by a combination of both these methods. The time since treatment in many of the cases is too short for a detailed follow-up. BENJAMINR. SHORE Nourishment in Casee of Radiological Reaction in the Mucous Membranes of the Mouth and Throat, K. PALMSTIERNA.Act8 radiol. 16: 301-303, 1935. A special food mixture composed of loo0 grams of milk, 40 grams of butter, 20 grams of wheat flour, 30 grams of maltose, and the yolk of one egg is suggested 8s a means of nourishment for patients with a post-radiation reaction in the mucous membranes of the mouth and throat. This mixture contains 1100 calories per liter and 1.5 liters a day is just about ample to satisfy a patient’s caloric requirements. BENJAMINR. SHORE Granulocellular Myoblastoma of the Tongue, G. GANDER.Du rhabdomyome granul- ocellulaire de la langue, Bull. Assoc. frang. p. 1’6tude du cancer 24: 56-63, 1935. A woman of fifty-two while eating a piece of hard candy bit the right side of her tongue, and about six months later noticed a tumor, the size of a large grain of maiee, in the scar. This was widely resected. The raised portion of epidermis was thickened but otherwise normal. Immediately below it, replacing most of the submucous connective tissue, were clear globular or polyhedral cells with highly granular cytoplasm. In the deeper layers these cells were arranged in bands insinuated between the collagenous and muscular fibers, and here it seemed evident that the granular tumor cells had arisen from muscle cells. The histologic picture exactly resembled that reported by Roffo (Abst. in Am. J. Cancer 20: 182,1934)in two lingual tumors. Roffo regarded his two cases BB representing the result of degeneration (“ myolysis ”) of muscle fibere. The author points out that a tissue cannot degenerate where it does not exist, and that there is no muscular tissue immediately below the epithelium of the tongue. The lingual myoblastomas are derived from the deeplying adult muscle fibers, not by degeneration but by neoplastic change, usually subsequent to trauma, whereas most of the muscle tumors (myoblastomyomas) in other sites are apparently formed from congenital residual undifferentiated rhabdomyoblasts. There are two illustrations, and a good bibliography is given. F. CAVERS

Sublingual Epithelial Cyst. Report of a Case, J. B. HITZ. Arch. Otolaryng. 21: 338- 340, 1935. A woman of nineteen complained of a swelling under her tongue of one year’s duration. A cyst 6 x 4.5 x 4 cm. attached to the hyoid bone was removed by operation under local anesthesia. It contained a soft, putty-like sebaceous material. Micro- scopic examination showed the wall to be lined with stratified squamous epithelium. A photomicrograph is included. GRAYH. TWOMBLY Report of Eleven Instances of Adarmntinoma with a Review of the Malignant Cases in the Literature, L. MCGREOOR.Acta radiol. 16: 254-274, 1935. The author reports the histories of 11 patients with adamantinomas of the jaw seen at the Radiumhemmet in Stockholm. The records of 28 cases which have shown evi- ORAL CAVITY, SALIVARY GLANDS, AND UPPER RESPIRATOBY TRACT 889 dences of more or less malignancy have been collected from the literature and are reported in abstract form. In this latter group one or more of the following atypical histologic features have been present: (1) a marked cellularity of the stroma, in some cases as extensive as in fibrosarcoma; (2) a predominance of the cuboidal over the stel- late and cylindrical types of epithelial cells; (3) a preponderance of epithelium over stroma with marked intertwining and tree-like branching of the epithelial processes. The article is well illustrated with photomicrographs. BENJAMXNR. SHORFJ

Adamantine Tumors of the Jaws, 8. G. MAJOR,J. R. BELLAND R. 5. DEWATBIP~. Surg. Gynec. & Obst. 59: 878-885, 1934. This is a general discussion of the diagnosis and treatment of adamantine tumors of the jaws. Aside from the report of two cases no new material is included. BENJAMINR. SHORE Technic of Resection for Carcinoma of the Lower Jaw, N. V. AKERBLOM.La rdsection '' prolongbe du maxillaire infbrieur comme traitement du cancer de cet 08, Acta chir. Scandinav. 75: 513-518, 1934. In dealing with any except small tumors confined to the alveolar border the author has adopted a method of resection, followed by x-rays, intended to obviate the need to fit a prosthesis soon after excision. Two recent cases are reported. In each case the submaxillary and cervical nodes were excised; then with the cautery knife the jaw was resected so as to leave the lower border of the bone intact; this bar of bone was sterilized by diathermy, and finally the wound was completely closed except for its posterior end, which was left open for cervical drainage. About six weeks later, when radiography showed that the layer of sterilized bone had become detached from the healthy portion, the former was extracted and the patient fitted with a prosthesis. There are five good illustrations. F. CAVERB

Dentigerow Cyst of the Maxillary Antrum with Unusual Variations, J. MCGUIREAND H. L. HARRIS.Laryngoscope 44: 306-314, 1934. A white woman of twenty years had a unilocular dentigerous cyst filling the upper half of the maxillary antrum. By pressure and absorption it had caused definite bulging of the superior lateral nasal wall and marked asymmetry of the infra-orbital anterior wall of the sinus. No teeth were found, thereby showing that true follicular cysta need not contain teeth. No bony dehiscences or fistulous tracts were seen. Since the cyst probably originated from the tooth follicle at the time of second dentition, it must have been present for eight or ten years. The Caldwell-Luc or Denker operation is advocated for lesions of. this type. In this instance surgical excision was followed by apparent cure with regression of the bony deformity. There are four illustrations and a good bibliography. THEODORES. RAIFORD

Cyst Obliterating the Antnun. Report of a Caae, N. KAPLAN.J. Am. Dent. A. 21: 1999-2001, 1934. A woman of thirty suffered with aching pain in the region of the right bicuspid for five years. This was accompanied by the slow development of a swelling in the region of the sygoma and the right side of the nose, with slight exophthalmos. Examination showed a large area of bone destruction involving the right maxilla and hard palate, obliterating the antrum. At operation a huge cyst filled with fluid conbaining cholesterin crystals was successfully removed, exposing the inner surfaces of the rygomatic arch, the nasal fossa, the under surface of the orbit, the ethmoid, the sphenoid, and the palate. It had arisen from the roots of the bicuspid teeth. Convalescence was uneventful GRAYH. TWOMBLY Carcinoma of the Frontal Sinus, A. I. GESCHELIN.Zur Klinik der boeartigen Neubil- dungen in den Nebenhohlen der Nase. Primares Karzinom der Stirnhohle, Acta oto-laryng. 21 : 351-359, 1934. A man of forty had for about a month had pain in the left temple and had noticed rapidly progressive diminution of left vision. There was now optic atrophy, and on the 890 ABBTBACTS following day complete blindness ensued, with abducens and oculomotor paresis. With- in a few days exophthalmos developed, and pus was seen in the upper part of the left nasal cavity, which had shown a few days previously simple hyperemis. X-rays showed bilateral shading of the maxillary, frontal and ethmoidal sinuses, and irregular defects in the wall of each orbit. At operation tumor masses and pus were found filling the frontal and ethmoidal sinuses of both sides. That in the left frontal sinus bad caused thinning of the posterior wall and exposure of the dura. The material was curetted as completely as possible, and was diagnosed as alveolar carcinoma. The patient lived for a month, becoming increasingly cachectic. Necropsy was not permitted. The tumor had apparently arisen in the left frontal sinus and rapidly invaded the left orbit, the right frontal sinus, and both ethmoidal sinuses; the nasal cavities and maxillary sinuses showed only purulent inflammation, not tumor tissue. The author emphaaiaes the extremely bad prognosis of cancer of the frontal sinuses, especially when the ethmoidal sinuses have been invaded. The paper is illustrated by two good roentgenograms and a poor photomicrograph. F. CAVERE

Rodent Carcinoma of the lose in Mother and Daughter, SPILLMANNAND J. WATRIN. Epithhlioma baso-cellulaire du nea chea la mere et chea la fille, Bull. SOC.frang. de dermat. et syph. 42: 34-35, 1935. In a woman of twenty-seven a rodent epithelioma of the nose had been noticed a year previously, and apparent cure was obtained by curettage followed by applications of solid carbon dioxide and.of x-rays. The mother, aged sixty-eight, had for about eight years noticed a tumor in the same site, and encouraged by the good efiect obtained in her daughter’s ctwe she also came for treatment, the result being equally good. F. CAVERS Conrervative Treatment of Hasopharyngeal Fibroma, Y. SATO. Ueber konservative Behandlung des Nasenrachenfibroms, Nagasaki Igakkwai Zassi 12: 887-874, 1934. The author discusses the conservative treatment of the neeopharyngeal fibroma and refers to a case treated with Id Magnesin,” which promoted the involution of the tumor and facilitated extirpation. K. SIJQIURA

Hbtology of Mixed Tumors of the Sallvary Glands, F. TEERKELaEN. Uber den histo- logischen Bau der primken MischgeschwlUste in den Speicheldrlisen des Menschen, Acta. path. et microbiol. Scandinav. 11: 275-311, 1934. The author has made a histokgic study of 78 mixed salivary gland tumors, of which 74 occurred in the salivary glands themselves (53 in the parotid) and 4 in other sites (two in the lips, one each in the nasal cavity and the eyebrow). A table shows the frequency incidence in these tumors of such features as glandular, papillomatoue and cy- lindromatous tissue, mucus, cartilage, and fat. The author considers that the somewhat varied histologic pictures presented by these mixed salivary tumors are easily explained by the varying share taken by the epithelial and the mesenchymal (stromal) components of the buccal mucosa from which the salivary glands are derived. When the tumor is not formed in a normal salivary gland, it has clearly arisen from an aberrant or ectopic salivary gland. That there is no need to frame an elaborate histologic cleeeification of these tumors is shown by the fact that in several of those examined (the author used the serial section method) every transition from normal to neoplastic tissue- could be traced, that is, from normal epithelial alveoli to adenomatous or carcinomatous ones, and from stromal connective tissue fibers to myxoid and chondroid tiesue. The tumom are essentially epithelial, and whether or not the tumor becomes malignant depends entirely on the changes occurring in the parent epithelium. The paper ie not illustrated, but readers interested in these tumors will find a histologic picture gallery in a recent paper by Leroux and Leroux-Robert (Bull. de 1’Assoc. frang. p. 1’8tude du cancer 23: 304, 1934. Abst. in Am. J. Cancer 23: 394, 1935). F. CAVERS ORAL CAVITY, BALIVARY OWNIIB, AND UPPER RESPIRATORY TRACT 891

Histogeneais of Cartilage in Mixed Tumon of the Salivary Glands, E. TI~CHOUEYRES. La genbse du tieeu cartilagineux dans lee tumeurs mixtes des glandes sdivaires, Ann. d’anat. path. 11: 905-910, 1934. The author reports no cases, being occupied with a somewhat theoretical discussion of the chemical analogies between mucigenous and chondrogenous substances, from which he concludes that cartilage found in mixed salivary tumors arises by transformation of the mucoid material of the connective tissue. There are no illustrations. F. CAVERS pa tho lo^ of Nevo-cancer of the Parotid Gland in Man, V. BALL. La pathologie compar6e et la question controvers6e de l’existence du n~vocancerparotidien ches l’homme, Bull. Acad. de m6d. , Paris 11 1 : 370-371 , 1934. A brief description of a malignant melanoma of the parotid gland in an eight-year- old boy, illustrated by one photomicrograph. WILLIAMJ. HOFFMAN

Thyroid Carcinoma of Parotid. Extirpation. Cure. Complete Functional Recuper- ation of Paralyzed Facial Heme, G. WORMBAND A. G. WEISS. GpithBlioma thy- roidien de la parotide. Extirpation. GuBrison. RBcup6ration fonctionnelle COmpkte du nerf facial pSrSlYS6, Bull. et mem. 8OC. n8t. d. chir. 60: 499-502, 1934. The authors report a case of malignant tumor of the parotid gland, diagnosed histologically as a primary carcinoma of the thyroid originating in a parotid tumor. Repeated surgical excision was required for four successive recurrences. During the last operation the facial nerve was so severely damaged that a complete unilateral facial paby resulted. Eighteen months later spontaneous recovery of function com- menced and was complete within six months. There had been no recurrence of the tumor in more than seven years. WILLIAMJ. HOFFMAN

Hemaagioma of the Submddllary Salivary Gland, Three Cases, H. VASCOBOINICAND I. E. IONESCO.Les angiomee de la glande sous-maxillaire, Ann. d’anat. path. 11 : 371-381, 1934. These tumors occurred in young men aged twenty-two, twenty-three and twenty-one. In the Brst case the tumor had been first noticed about four years previously, in the second about eighteen years, in the third sixteen years. There are two illustrations. F. CAVERS Mixed Tumor of the Palate, A. I. CEMACH.Tumor des Gaumens. Endotheliom? bfieohtumor? Monatschr. f. Ohrenh. 68: 1012-1013, 1934. A woman of forty-one had a tumor the size of a plum at the junotion of the hard with the soft palate. It had been first noticed about ten years previously and had grown slowly, and the patient now attended hospital because of partial nasal obstruction. In the floor of the right nasal passage the mucosa was thickened and polypoid from the pressure of the neoplasm. X-rays showed no change in the bones. The patient refused dl intervention except curettage of the lesion. The removed material showed a mixture of cylinder and spindle cells. Various histologic diagnoses were suggested by the author and those taking part in the discussion of the csse-endothelioma, mixed tumor, spindle- cell sarcoma, fibrosarcoma, etc.-but all agreed that the tumor wm malignant, since it had evidently invaded the floor of the nose. There are no illustrations. [It is fairly obvioue from the discussion that this neoplasm wm one of the not infrequent mixed tumors of the hard palate. They arise from the mucous glands and not infrequently cause pressure resorption of the bone, but are not malignant. The proper tr~titmentis surgical removal and in no cme radium.] F. CAVER8

Mixed Salivary Tumour of the Palate, H. STOBIE. Proc. Roy. 800. Med. 28: 739-742, 1935. A man of sixty-five had a swelling on the left side of the soft palate, which had been noticed about thirty years previously and had recently grown larger. On excision it 892 ABSTRACTS was found to be a solid tumor of mixed salivary type, the partly fibrous and partly myxomatous stroma containing mseeee and columns of epithelial cells, in places forming alveoli. There are four good photomicrographs. F. CAVERS Squamoue-cell Carcinoma of the Uvula, Soft Palate, and Tonsils, C. KAPLAN. Laryn- goscope 44: 407-410, 1934. An extensive reddened lesion with small superficial ulcerations covering the soft palate and anterior fauces of a seventy-three-year-old man was found to be a grade 111 squamous-cell epithelioma. One enlarged node was found at the angle of the jaw. The lesion was treated by radium needles and x-rays since age precluded a radical operation. The local condition improved and the general condition of the patient was much better five months later. No later result is recorded and there are no illustrations. THEODORES. RAIFORD Laryngeal Cancer in Relation to Laryngeal and Pulmonary Tuberculosis, J. REBATTU, MOUNIER-KUHN,AND GROUBS. Cancer du larynx et tuberculose, Rev. d. laryng. 55: 1243-1281, 1934. Cancer of the Lprynx and Tuberculosis, J. REBATTUAND P. GROU~S.Cancer du larynx et tuberculose, J. m6d. de Lyon 15: 503-521, 1934. The authors point out that (1) laryngeal cancer may develop in a patient with ante- cedent extralaryngeal, usually pulmonary, tuberculosis; (2) it may develop in a larynx previously presenting a tuberculous lesion; (3) tuberculosis, either in the larynx or lungs, may appear in the course of development of laryngeal cancer. They give fairly detailed histories of 15 cases, of which 11 are regarded as exemplifying the first of these sequences, 3 the second, and one the third. The rest of the paper is occupied by a discussion of the possible etiologic relationships between the two diseases when they coexist in the same individual, whether in the same organ or in different organs. The authors wisely leave the question open, though they conclude from their experience that there is practically no evidence in favor of the supposed antagonism between these diseases. An extensive bibliography is appended. A single case of laryngeal cancer associated with tuberculosis is reported by Rebattu and Perron in Ann. d’oto-laryng. No. 12: 1290-1292, 1934. F. CAVERS Laryngeal Carcinoma Arising on the Basis of Chronic Catarrhal Laryngitis, PORTMANN. Sur un cas d’6pith6lioma du larynx greff6 sur une laryngite catarrhale chronique, Rev. de laryng. 55: 1043-1047, 1934. A man of fortyeight had been hoarse for several years, and had recently lost his voice. His entire larynx was reddened and injected, and the vocal cord was thickened, with an irregular pachydermio border. He was lost sight of for about a year, then returned complaining of dyspnea, dysphagia, and dysphonia. The right half of the larynx was fixed. Tracheotomy was done, and biopsy of the right cord showed papillary squamous carcinoma with monocytic infiltration of the submucous tissue. Thyrotomy was done, followed by partial laryngectomy, but the pathologist could find no car- cinomatoue tissue in the removed right cord. Evidently the growth was a small beginning carcinoma which had been entirely removed by the biopsy excision. [Several apparently authentic instances of this kind have been reported, especially in small carcinomas of the uterine cervix.] The author considers that in this case the chronic laryngitis had prepared the way for the development of cancer. No illustrations are given. F. CAVERS Atypical Chronic Laryngeal Lesions, K. M. MENEEL. Atypische chronische Larynx- verhnderungen, Wien. med. Wchnschr. 85 : 203-205, 1935. This is a general discussion of some of the unusual and atypical chronic lesions of the larynx. Included in the discussion are cases of lymphogranulomatosis, leukemia, local amyloid di8ease, and various forms of carcinoma. The article is illustrated with a photograph of a gross specimen and several. drawings. BENJAMINR. SHORE ORAL OAVITY, SALIVARY GLANDS, AND UPPER RESPIRATORY TRAOT 893

Carcinoma of the Larynx. Some Conclurions Derived from Personal Experience, J. C. BECKAND M. R. GUTTMAN.Laryngoscope 45: 163-173, 1935. Five hundred cases of carcinoma of the larynx are reviewed, of which 108 were operated upon, total laryngectomies being done in 86 and laryngofissures in 22. One hundred and twenty-four were classed as intrinsic, and in 113 of these the anterior two- thirds of the vocal cord was affected. The authors have designated as intrinsic only those growths that involve the true or false cord, or the ventricle of Morgagni, in the anterior two-thirds of the larynx. Growths that arose from the epiglottis, aryepiglottic folds, arytenoids, poqtcricoid area, pyriform sinuses, or the posterior third of the true and false cords, and primary intrinsic growths that involved these areas by extension were designated as extrinsic. The terms extrinsic and intrinsic are thus made synony- mous with inoperable and operable. The larger part of the series are classed m mixed, being anatomically both extrinsic and intrinsic. Many of these the authors believe were originally intrinsic and hence operable if they had been seen earlier. The histological data for the Reries are not given The fact that laryngeal carcinoma is so frequently of the fully differentiated type probably accounts for the slow growth and the relatively late occurrence of metastases. The authors state that no case of carcinoma of the larynx having palpable lymph nodes was cured. Although seven of these patients were treated by complete laryngectomy and bilateral block dissection of the neck, not one survivod. While the authors have observed no good results from the use of irradiation in the treatment of carcinoma of the larynx, they do use irradiation as a postoperative adjunct to eurgery. The operation of choice is laryngofissure, but this is suitable in only a very small percentage of caees, namely when the neoplasm is small and restricted to one vocal cord. The disease must not have invaded either the anterior or the posterior boundary of the cord, the cord must be mobile, and there must be no palpable lymph nodes in the neck. Of the 22 patients in the author’s series treated by thia method, all but one are reported as alive and well for periods varying from two to thirteen years. In one instance there wae recurrence four years after laryngofissure. Laryngectomy was refused by the patient and death ensued seven months later. In two others recurrence was seen three and seven months respectively after operation. Laryngectomy was performed, and the patients are now well seven and three years later. In all 19 cases in which laryngofissure was sufficient, a serviceable voice remained. Endothermic methods were used in excising the growth. Of the 86 patients treated by total laryngectomy, 51 or 59 per cent are reported as alive five years later. The authors have followed the surgical procedure outlined by MacKenty for this operation, as well as his preoperative and poetoperative routine. W. 8. MACCOMB Some Primup Results in Operative Treatment of Cancer of the Larynx, P. FRENCKNER. Acta Otolaryng. 21: 539-550, 1935. Fourteen cases in which total laryngectomy for carcinoma of the larynx was performed by the author during the past year are reviewed. There were 9 men and 5 women, ranging in age from twenty-nine to sixty-eight years. Twelve of the tumors belonged to Group I11 and 2 to Group IV. Twelve patients survived the operation and are at the present time free from recurrence. One patient died after operation with a phlegmon of the neck and the other of pulmonary hemorrhage. A pharyngeal fistula developed in two cases. Cosmetically the final primary result was very good in all cases. It is still too early to estimate the phonetic results, but in the 8 patients where vocal exercises have been begun, a good result has been obtained in 5 cases, a poor result in 2, and a completely negative result in one. By a good result is meant that after a relatively short period of practice these patients are able to get along without difficulty in conversation. Thie is due to the acquisition of the so-called esophageal voice, the sounds being made with the help of folds in the mucous membranes of the esophagus. At the present time it is believed that primary laryngectomy should be performed on all patients in whom there is a good prospect of extirpating the entire tumor and 894 ABSTRACTS where there are no contraindications against operation, Postoperative irradiation should be given to all patients. The operative technic used by the author is described in detail but there are no illustrations. BENJAMINR. SHORE

Laryngeal Papillomatoeir, P. L. ROYONEK.Nebraska M. J. 19: 130-134, 1934. True papillomata of the larynx are most frequently observed under the age of fourteen. The incidence is said to be approximately one in one thousand in children in this age group. Approximately one-fifth of the cases are believed to be congenital. Collected statistics show a mortality as high or higher in children than'from carcinoma of the larynx in adults. There is a marked tendency to rapid recurrence. Two pathological types are recognised, the simple or single and the multiple or villous papilloma. The first usually consists of a single projection formed by a connective- tissue core covered by stratified squamous epithelium. The multiple growths are similar in structure but form innumerable granular, bead-like projections over the surface of the mucosa. Implantations are frequent and, while strictly benign according to the usual clinical and pathological concepts, examplee have been reported in which growthe of similar nature were found in the lungs, having been presumably transmitted by aspiration. The major symptom is dyspnea from laryngeal obstruotion. Diagnosis depends upon this and the indrawing, during inspiration, of the soft tissues in the suprasternal notch, the supraclavicular fossae, the intercostal spaces, and the epigastrium. The first is supposedly diagnostic, as it does not occur with dyspnea due to other causes. Treatment has not been standardised, but the general types of therapy may be grouped as follows: (1) operation, both extralaryngeal and endolaryngeal; (2) irradiation; (3) electrocauterization and fulguration; (4) other methods. Many good results have been reported by simple removal of the papillomata without attempts to remove the base. Such treatment, however, necessitates the repetition of the procedure whenever the tumors recur, as they almost invariably do. The effects of irradiation seem to vary in different cases. While some authors have reported remarkable results, others believe that growth is actually stimulated. A few good results have been obtained after fulguration, but it is generally thought that cauteriration is hasardous in view of possible scarring and stricture. Among the other therapeutic methods reported are the local application of absolute alcohol, acid nitrate of mercury, and the administration of calcined magnesia. A case is reported in which numerous operative procedures were required for rapidly recurring multiple papillomata. Eventually the growths disappeared but were followed by adhesions between the vocal corde which so restricted their motion aa to render the patient speechless. Division of these was performed through a thyrotomy, with ulti- mate recovery. The papillomata had not recurred seven months after the last operation. There are four illustrations. THEODORE8. RAIFORD

Laryngotrached Papillomato&, G. PORTMANNAND R. PHILIP. Le papillomatose laryngotrach6ale, Rsv. de laryng. 55: 545-577, 1934. Papillomatosis involving the trachea as well as the larynx is of somewhat rare occurrence, and is found chiefly in children between the ages of two and ten years. In children the two sexes appear to be affected with about equal frequency, whereas in adults the condition is about three times commoner in males. There are two main types of papilloma, some being sessile and squamous-celled, others arborescent and covered by cylindrical epithelium, and both types are frequently found coexisting. These tumors are essentially benign and have by some writers been regarded as granulomas rather than neoplasms. The various caustics formerly employed as the sole method of treatment are still sometimes used as a supplement to surgical removal. In view of the tendency to recurrence, the author considers that the best treatment is endoscopic surgery completed by irradiation, preferably by x-rap. A boy of two and a half years was brought to hospital because of slight attacks of dyspnea, chiefly nocturnal. The enlarged tonsils were removed, but the dyspnea continued and became more intense, apd the child wm brought back owing to attacks of asphyxia requiring immediate tracheotomy. Endoscopic examination revealed INTUTHORAOIO TUMORS 896 swelling of the mucosa above and below the wound, with an adherent false membrane. Pieces of this were coughed up and found to oontain diphtheria-like bacilli. The child died of bronchopneumonia, and necropsy showed papillomatosis which had evidently developed in the larynx and invaded the entire trachea as far as the entrance of the right main bronchus. Two illustrations are given. F. CAVERS

Roentgentherapy in Papilloma of the Larynx, I. SOLOMONAND A. BLONDEAU.Eye, Ear, Nose & Throat Monthly 14: 85, 1935. A case report of a youth of seventeen who had had laryngeal papillomata for eight years. Radiation treatment cured him. W. 8. MACCOMB

Congenital Gtorso-epigIottic Cyst in m Infant, ROBERTCLBMBNT AND A. LBMARIEY. Kyste glossodpiglottique conghital du nourrisson, Bull. SOC.de p6diat. de Paris 31: 438441, 1933. A one-month-old infant developed progreedve laryngeal stridor, which after two months became extremely marked. Direct laryngoscopy showed a cyst, 2 cm. in diameter, arising from the gloseo-epiglottic fold. Aspiration yielded clear fluid. In the two and one-half years which have elapsed since the cyst waa punctured, no new fluid has accumulated. WILLIAMJ. HOFFMAN THE CAROTID BODY

Tumor of M Accersory Carotid Body, F. R~SSING.Struma eines akeessorischen Olomus caroticum, Arch. f. klin. Chir. 181: 571-574, 1935. The author describes a tumor of an accessory carotid body removed at autopsy from an eighty-six-year-old woman. The growth was well encapsulated and meaaured 9 by 6 by 4.5 cm. It had no connection with the thyroid gland, the parathyroid glands, or the normal carotid body. Histologic study showed it to be composed of nests of round and oval cells separated by septa of hyalinised connective tissue. The diagnosis of adenoma of an accessory carotid body was made. The article is illustrated by a drawing and a photomicrograph. BENJAMINR. SHORE

INTRATHORACIC TUMORS Diagnoda of Intrathoracic Tumors, C. E. HARRIS. Journal Lancet 55: 159, 183, 1935. €?& emphaaises that the diagnosis of pulmonary neoplasms is often more hindered than helped by the clinical symptoms, since these may be not at all characteristio. It h important, however, always to bear in mind the poseibility of cancer, especially if the patient ie in the so-called " cancer age." Of importance among the physical findings are the inoreased resistance to the percussing finger aqd chronic atelectasis. Examina- tion of pleural exudate is a valuable aid, since fluid of low specific gravity (leas than 1.014) practically excludes an inflammatory lesion. Other conditions from which neoplasms are to be differentiated are thickened pleura, effusions, consolidations, and atelectasis. There are no illuetrations and nothing new is contributed. TEEODORBS. RAIFORD Clinical Diagnode of Primary Cancer of the Lung, M. F. ARBUCKLE.Ann. Otol. . Rhin. & Laryng. 43: 1174-1191, 1934. Although the clinical recognition of pulmonary malignancy is extremely difficult, the author stresses two symptoms which are more or less characteristic. These are the peculiar racking, persistent and non-productive cough, and the feeling of discomfort in the region of the lesion, which gradually develops into severe pain in the later stages of the disease. Roentgenographic findings are of the utmost value. The only certain means of diagnosis is by bronchoscopic examination and biopsy. Treatment in the pset has been largely irradistion, but the recent developments of surgical teahnic have made operative removal of the affected lobe feasible in some cases. 896 ABSTRACTS

Four illustrative cases are reported. Two of these patients underwent partial pneumonectomy. One died from operative shock, but the other, a fortyeight-year-old physician, is well and able to carry on his practice eighteen months after the operation. There are seven illustrations showing the roentgenographic findings in the reported cases. A short bibliography is appended. THEODORES. RAIFORD

Silicosis and Carcinoma of the Lung, L. MAXWELL. M. J. Australia 2: 168-169, 1934. A man of fifty-nine had spent ten years of his earlier life as a driller in a gold mine. About two years before hospital admission he began to suffer from dyspnea on exertion, dry cough, and increasing weakness. X-rays showed a dense shadow in the apical lobe of the right lung. Lipiodol gave normal filling of the lower lobe, but did not enter the dense area of the upper lobe. Bronchoscopy revealed an ulcer in the mouth of the right lobe bronchus, and biopsy of this showed thickening of the surface epithelium and Bome downgrowth, giving rise to a suspicion of carcinoma. The later history is not given. F. CAVERB

Intrapulmonrry Extension of a Fibroma of an Intervertebral Disc, A. DELHAYBAND L. VAN BOQAERT.Sur l’extension intrapulmonaire dlun fibrome du disque interver- t6bra1, Bull. et m6m. SOC.m6d. d. hbp. de Paris 50: 1493-1496, 1934. For about a year a man of forty-two had pain in the left axilla, radiating towards the neck and the front of the thorax. A few months later he began to have pain in both lower extremities, soon followed by flaccid paraplegia. The symptoms pointed to cord compression at the level of the fourth thoracic segment. X-rays showed at this level a rounded mass projecting from the spine into the left upper pulmonary field, and the condition was diagnosed as mediastinal sarcoma with invasion of the spine. No intervention was attempted, and the patient died a few weeks later. Necropsy showed a fibroma, the sise of an orange, which had arisen in the disk between the third and fourth vertebrae. F. CAVERB

Carcinoma.of the Trachea. Review of Recent Literature and Report of a Cure, F. STDNN. Arch. Otolaryng. 21: 190-198, 1935. D’Aunoy and Zoeller in 1931 were able to find reports in the literature of only 91 instances of primary carcinoma of the trachea. Stenn reports a case occurring in a man of fifty-five who complained of dysphagia. Bronchoscopy showed a large cauliflower tumor of the posterior wall of the trachea at the level of the suprasternal notch. Esophagoscopy revealed no involvement of the esophageal mucosa. X-ray treatment was given. Pneumonia developed and the patient died three months later. Autopsy showed a large sloughing area in the trachea with perforation into the esophagus, but no microscopic evidence of viable tumor, and an unresolved pneumonia of the upper lobes of both lungs. GRAYH. TWOMBLY

Carcinoma of the Trachea, Recurring Four Years After Operation, P. SANTYAND R. GAILLARD.Epithblioma de la trach6e; r6cidive post-ophatoire aprhs quatre ans, Lyon m6d. 154: 123-125, 1934. A man of forty-four was first seen in 1928, when tracheotomy was done on account of threatening asphyxia following six months of increasing dyspnea. Endoscopy showed stenosis of the upper part of the trachea owing to infiltration of the posterior wall, which was diagnosed as syphilitic because of a history of infection [no mention of serologic tests or biopsy]; energetic antiluetic treatment was given, and the stenosis and dyspnea almost disappeared. In 1930 the patient returned, again complaining of dyspnea, and a small stalked tumor was found on the posterior tracheal wall below the tracheotomy scar. On removal this was diagnosed as a transitional-cell carcinoma, and 25 mg. of radium were inserted for five days. Four years later the patient complaingd that although hitherto the canula had functioned well, he had recently noticed intqr- mittent hemorrhage from it, with return of dyspnea. Incision carried 3 em. downwards from the tracheal stoma revealed a large proliferating mass, diagnosed on biopsy as squamous-cell carcinoma. Part of the mass was excised snd the rest treated by electrocoagulation. F. CAVERB INTRATHOBACIC TUMORS 897

Lymphowcoma Involving Heart; Specimen from a Girl Aged Eight Years, R. W. B. ELLIS.Proc. Roy. SOC.Med. 28: 667-669, 1935. Six weeke before hospital admission a girl of eight began to have paroxysmal cough with frothy sputum, increasing dyspnea, and swelling of the superficial veins of the neck. More than a liter of pleural fluid was withdrawn from the right side. X-ray showed a large upper mediastinal mass, enlargement of the heart shadow, and effusion and pneumothorax on the right. Under intensive x-ray treatment the tumor at first diminished in size, but the cough and dyspnea persisted, and the child died four months after the onset of symptoms. Necropsy revealed lymphosarcoma of the superior mediastinum, adherent to the pericardium and with metastases throughout the thoracic cavity. The thymus could not be identified, but sections of the tumor contained no recognirable thymic tissue. There is one illustration. F. CAVERS

Mediastinrt Cancer Resembling Pneumonia, CH. FLANDIN,A. ESCALIER AND F. JOLY. Une forme pneumonique de cancer m6diastino-pulmonaire, Presse m6d. 42: 1122- 1123, 1934. A case report in which emphasis is placed on the changing x-ray picture observed during the development of a mediastinal lesion. The signs were indistinguishable from those occurring in bronchiogenic carcinoma, with at first a partial, then a complete occlusion of one bronchus, succeeded by infiltration and occlusion of other bronchi on the affected side, with corresponding degrees of atelectasis at each stage. Roentgeno- grams and a bibliography are included. JOHN5. LOCKWOOD

Mediastinal Ganglioneuroma, I,. SOPHIAN.Ann. Burg. 101 : 827-833, 1935. The author reports the case of a girl of seven and a half years from whom a mediastinal ganglioneuroma was successfully removed. The tumor was ovoid, weighed 150 grams, and measured 10 by 7 by 6 cm. The patient has remained well without evidence of recurrence for two and one-half years after operation. The article is illustrated with photographs of the gross specimen, roentgenograms, and a photomicrograph. BENJAMINR. SHORE

Mediastinal Cyst; Specimen, R. W. B. ELLIS.Proc. Roy. Soo. Med. 28: 666467,1935. A female infant suddenly became dyspneic and cyanosed, with marked rib retraction and stridor. The breath sounds were diminished over the whole left lung, and x-ray showed a tumor in the upper mediastinum displacing the left bronchus. The patient died four days later, and the tumor was found to be a loculated, thin-walled, air-con- tdning cyst lying between the trachea and esophagus, immediately above the right bronohus; its wall consisted of loose areolar tissue containing muscle and nerve fibers, with a lining of columnar epithelium. There is one illustration. F. CAVERS

Myasthenia Gravis associated with Thymom, Report of Two Came of Autopsy, J. BREMAND H. F. WECHSLER.Arch. Int. Med. 54: 901-915, 1934. Two detailed case histories are given of myasthenia gravis associated with thymoma. The first patient was a twenty-seven-year-old woman, the second a fifty-four-year-old man. In each the clinical diagnosis was encephalitis. Roentgenography of the chest in the first instance showed no abnormality. In the second case death occurred a few hours after admission, before x-ray studies had been made. Post-mortem examination in each instance revealed the presence of a tumor mass in the upper mediastinum, which on histological examination was found to be a thymoma. The outstanding pathologic changes in myasthenia gravis are the abnormalities of the thymus and the so-called lymphorrhages of the skeletal muscles. In obscure cases it is suggested that a biopsy of the skeletal muscle might be advisable. Starr (quoted by Bell: J. Nerv. & Ment. Die. 45: 103, 1917), in reviewing 250 autopsies upon persons dying of myasthenia gravis, noted that a pathologic condition of the thymus was recorded in 28 per cent of the cases. Bell collected reports of all cases with autopsy from 1901, when Weigert first described a thymic tumor in association with myasthenia 898 ABSTRACTS gravis, to 1017. He found the thymus to be definitely abnormal in 40 per cent of the oases, hyperplasia being recorded in 30 per cent and thymoma in 19 per cent. Some authors have observed suprarenal changes in association with myasthenia gravis. In the cases here reported the cortical cells of the suprarenals were the site of an extensive vacuolar degeneration which had in some areas gone on to complete necrosis of the cells. In each of the reported cases lymphorrhages similar to those in skeletal muscles were found in the cardiac musculature. There were also degenerative changes in the cardiac muscles. The cause of the lymphorrhages is unknown. It has been suggested that an infectious or toxic agent is responsible. Five photomicrographs are included, and a bibliography is given. W.8. MACCOMB

THE DIGESTIVE TRACT Place of Surgery in the Treatment of Crrcinoma of the Alimentary Tract, D. C. BALFOUR. Canadian M. A. J. 32: 245-252, 1035. The author believes that even should some method be found to detect and localise incipient malignancy in the alimentary tract, promises as to curability would be ex- cessively optimistic. He does not minimise the value of informing the publio of what little the medical profession knows about cancer, since the effect would be to diminish the percentage of cases in which the condition, when first encountered by a competent physician, is obviously beyond hope of cure. The rectum still remains the only region of the digestive tract in which cancer can be detected early by clinical examination, and for this reason digital examination should never be omitted; indeed, it may well be done first. The percentage of cases in which resection can be done varies from approximately none in esophageal to about 40 in rectal carcinoma.. For various reasons the chances of removing a carcinoma of the colon are at least twice greater than in the case of the stomach. The treatment of gastric cancer presenh many problems. For instance, the widest possible resection of lymph nodes is necessary. The rate of operability of gastric cancer at the Mayo Clinic has been consistently, year after year, 46 to 50 per cent of the cases in which exploration has been performed, while the mortality rate for combined resection of all types is approximately 10 per cent. Removal may be undertaken even when distant metastases are present, such as an isolated nodule in the liver or implantation in the pelvic peritoneum, to secure for the patient the advantages of an unob- structed alimentary tract. The author considers the best method of palliation in cancer of the stomach to be its exclusion, following the suggestion of Devine, who proposed, in the treatment of certaiq types of duodenal ulcer, division of the stomach above the angle, closure of the lower segment, and restoration of gastro-intestinal continuity by gastrojejunostomy. Palliative gastro-enterostomy 80 often fails in its purpose that it should rarely be performed; the length of life following this operation is little longer than if the disease is untreated, and too often it fails to protect the patient against the obstruction for which it was performed. F. CAVERS

CUChOIM pnd 8aCOIM Of the EaOphrgW, CHEVALIBR JACKSON.South. 8Urg0On 4: 1-11, 1935. According to Jackson, " malignant disease of the esophagus presents the remarkable combination of a mild, slowly metastasising, wily diagnosed malady and a form of malignant disease with a practically 100 per cent mortality." But in fact diagnoses are not made early, largely because text-book descriptions usually fit only the later stages; the history is misleading; the bougie is inconclusive and dangerous; anemia, cachexia, and weight loss are hopelessly late. Pain, which ie so oommon in other types of malig- nanay, is absent both early and late. X-ray examination followed by esophagosoopy represents the most important diagnostic aid and should be employed whenever a patient complains of difficulty in swallowing and an unexplained throat condition. This may disclose a certain number of cases of globus hysterious but will likewise demonstrate many early lesions. There is no reason to believe that, if the disease is discovered within THE DIQESTIVE TRACT 899 six months from the time of initial appearance, a fair percentage of oures cannot be obtained despite the major character of the operation. Palliation is rewonably efficient and may as a maximum add two years to the life of the patiept. To prolong life comfortably necessitates maintainance of good physical condition. This necessitates suitably prepared food and sometimes mechanical dilatation. There are five illustrations depicting the esophagoscopic appearance of typical conditions. A short list of the author's personal publications is appended. THEODORES. RAIFORD

Cucinama of the Esophagw, Its Diagnods and Treatment, W. A. HUDSON. Ann. Otol. Rhin. & Laryng. 43: 1198-1201, 1934. In spite of the extremely high mortality usually attending operative resection of the esophagus for malignant growth, even the few successful results already obtained justify its further use. Furthermore, the carcinomas commonly found in this region are of relatively low-grade malignancy. Four cases are reported. In three, reseotion of the growth was carried out by the trsnsthoracic approach. All three patients died from shock or other postoperative complications within twenty-four hours. The fourth was inoperable and died of inanition a few weeks later. There are no illustrations. The literature is briefly reviewed. THEODORES. RAIFORD Di8gnoeie of Esophageal Cancers, P. PREU~CHOFF.Ein Beitrag sur Diagnose des Oeaophagusksrsinoms, Mtknchen. med. Wchnechr. 82 : 142-143, 1935. The diagnosis of esophageal cancers is essentially radiographic, although it must be remembered that in many cases repeated studies are necessary in order to diagnose the early lesions. The article is illustrated with five roentgenograms. BENJA~NR. SHORE Results of the Endoscopic Removal of Esophageal Carcinomas, A. SEIFFERT.Result- ate der endoskopischen Operation des Oesophaguscarcinoms,Arch, f. klin. Chir. 181 : 612-514, 1935. The endoscopic removal of esophageal carcinomas has been performed by the author three cws. One patient died of pneumonia a few daya after the operation; the mond died fro perforation of the esophagus by a bougie nine months after operation, and the third dive and well after five years. The article ie not illustrated. pati BENJAMINR. SHORE 900 ABSTRACTS

Carcinoid and Carcinoma, F. FPIYRTER.Carcinoid und Carcinom, Ergeb. d. allg. Path. u. path. Anat. 29: 305-489, 1934. THE DIGESTIVE TRACT 901

earlier than has been done in the past. While roentgenographic examination is the most satisfactory diagnostic means available, even this is not infallible, and to obtain a cure it may sometimes be necessary to operate before diagnosie is established. AS a general rule to be followed in practice, the criteria of Maes (Ann. Surg. 98: 619-634, 1933. Abet. in Am. J. Cancer 20: 720, 1934) and Crohn (Affections of the Stomach, Philadelphia, W. 8. Saunders Co., 1927. Pp. 902) are accepted, “ We must regard as a suspected case of gastric carcinoma, (1) any patient who has indigestion that appears after middle age, (2) any patient who has acute digestive disturbances superimposed on a more chronic trouble, (3) any patient who suffers from fatigue, anemia, loss of weight or gastro-intestinal bleeding not adequately explained.” The clinician should forget the text-book picture of gastric malignancy; it represents the advanced and inoperable stages. Detection of the suspicious lesion in its early and insidious stage will do more to lessen the mortality from the disease. There are no illustrations. THEODORES. RAIFORD Early Diagnosis of Carcinoma of the Stomach, E. KALPEN. Zur F’rahdiagnose des Magenkarzinoms, Ztschr. f. iirztl. Fortbild. 31 : 612-615, 1934. A review of the premonitory signs and symptoms significant of gastric carcinoma. It is emphasized that of all laboratory aids to diagnosis roentgenography is the most valuable, while gastric analyses,are of help only in substantiating other clinical impres- sions. While gastroscopy is as yet in its infancy, its use is urged whenever possible. Nothing new is contributed. There are no illustrations. THEODORES. RAIFORD

Contribution to the Early Diagnosis of Gastric Cancer, F. SCHREIBER-ERMER.Beitrag IIU frtlhzeitigen Diagnose des Magenkarzinoms, Wien. med. Wchnschr. 84: 1269- 1270, 1934. Carcinoma of the stomach should be thought of in every case of exhaustion, anorexia, and epigastric pain in elderly people. According to the author the clue to early diagnosis lies in the history. Six illustrative cases are cited briefly. There are no photographs. THEODORE5. RAIFORD

Carcinoma of the Stomach with Early Leukocytosis, M. J. OWENSAND M. A. WALKER. J. Kansas M. SOC.35: 384-385, 1934. The authors report a case of gastric malignancy which was accompanied by an unusually high leukocyte count. This was first observed incidentally when the patient was hospitalized for the repair of a hernia in January 1933, at which time the white cells numbered 28,700. Two months later the symptoms of a gastric lesion had appeared and the white cell count was 51,000. Laboratory studies established the diagnosis of carcinoma of the pars media of the stomach and exploration was carried out. The lesion was obviously inoperable and no attempt was made at removal. Death followed three months later. No explanation is offered for the increased npmber of leukocytes. There are no illustrations. THEODORES. RAIFORD

Carcinoma of Lesser Cwature of Stomach, Associated with Diverticulum of Duodenum, GARIN,BERNAY AND DAUVERQNE.Diverticule de la deuxihme portion du duodenum avec neoplasrne de la petite courbure, Lyon mkd. 154: 636-638, 1934. A woman of eighty-three had during the past five months had attacks of epigastric pain, alternating periods of constipation and diarrhea, melena, and latterly edema of the lower extremities. Ascites was present, but no palpable tumor. Contrast radiography showed a filling defect in the lesser curvature, also a diverticulum of the second part of the duodenum on the pancreatic side. The ascites increased, necessitating repeated paracentesis. Death occurred five weeks after admission, and necropsy verified the diagnosis. Apposed to the lesser curvature was an enlarged lymph node containing carcinoma, and below this was a perforated carcinomatous ulcer of the stomach wall. F. CAVERS 902 ABBTRAOTS

Total Gastrectomy for Carcinoma Ventriculi, C. A. JOLL. Proc. Roy. Soc. Med. 28: 757-758, 1935. A man of forty-five had ‘‘ indigestion ” for several years, and eight months before operation had profuse hematemesis followed by .pain which began about half an hour after food and waa relieved by vomiting. The only other symptoms noted are anemia and achlorhydria; radiography is not mentioned. A large, indurated, ulcerating carcinoma being found on the posterior wall of the stomach, extending to the cardiac orifice, total gastrectomy was done. Two years later the patient had still some “ indigestion,” and was at the time of reporting under treatment for anemia. F. CAVERB

Ruptured Gutdc Abscese with Gastric Carcinoma, L. W. ANGLE. J. Kansas M. 800. 35: 468-469, 1934. The authors cite an unusual instance in which a typical scirrhous carcinoma of the stomach was accompanied by a large abscess outside the stomach but within its walls. Perforation of this abscess had caused a fibrinopurulent peritonitis which was apparently the cause of death. Strangely enough, however, there was no sign of a communication with the lumen of the stomach, and the origin of the abeam remained a riddle. While perforation of a carcinomatous ulcer is by no means a rare occurrence, the coincidence of a well defined cancer and an abscess of unknown origin is regarded aa a rare finding. Furthermore] there was no clinical or laboratory evidenbe of the presence of an infection. There are two illustrations depicting the goes and microscopic appearance of the lesion. A short bibliography is appended. THEODORES. RAIFORD

Bleeding Malignant Polypoid Lesions in the Cardia of the Stomach Asrociated with Severe Anemia: Report of Three Cares, J. T. PRIESTLEYAND F. J. HECK. Ann. Surg. 101: 839-843, 1935. Attention is called to the necessity for careful roentgenographic examination of the stomach in all cases of primary anemia. In a number of these cases bleeding malignant polyps are found in the cardiac end of the stomach. Three illustrative cases with two roentgenograms are included. BENJAMINR. SHORE

Lymphourcoma of the Stomach, Report of a Case with a Hineteon-Year SurgIcd Cure, T. E. JONESAND M. G. CARMODY.Ann. Surg. 101: 1138-1188, 1935. The authors report the case of a nine-year-old boy from whom a large tumor mass involving one-third of the pyloric end of the stomach was successfully removed. Histo- logic study of the growth showed it to be a diffuse, infiltrating round-cell sarcoma. More recent study of the preparations has resulted in the classification of this growth as a lymphosarcoma. At the present time, nineteen years after operation, this patient is perfectly well and free of evidences of recurrence. The article is illustrated with a photograph of the specimen and a photomicrograph. BENJAMINR. SHORE

Primary Isolated Lymphogrnnulomatosis of the Stomach, Report of a Case, H. N. COMANDO.Arch. Burg. 30: 228-335, 1935. The author reports the case of a twenty-seven-year-old man from whom a large portion of the distal end of the stomach was removed,for primary isolated lympho- granulomatosia of this organ. The patient has remained well for four years after operation. The lrrticle is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHORE Schwanuoma of the Stomach, A. TIERNY. Schwannome de l’eatomac, Bull. et m6m. Boo. nat. de chir. 60: 1228-1236, 1934. Schwmnoma of the Stomach, H, MONDORAND P. GAUTEIIER-VILLARS.Schwannome de l’estomac, Ibid. 60: 1253-1255, 1934. Each of these papers contains a single case report. Tierny’s patient, a man of forty, had noticed repeated melena during the past three years, but hnd never vomited or had epigastrio pain. At operation on a diagnosis of duodenal ulcer, there was found on the THE INGESTIVE TRACT 903

posterior wall of the stomach a tumor, the sise of a plum, covered by reddened serosa. This was taken to be a callous ulcer, and was widely resected, the hole left being used in making a gastrojejunoetomy. The resected tumor had a central cavity which contained blood and opened into the lumen of the stomach. The general structure of the tumor was that of a richly vascular fibroma, containing also smooth muscle fibers and short spindle cells in palisades; the pathologist’s diagnosis was fibromyoschwannoma. There are four illustrations. Following the reading of Tierny’s paper, three other surgeons briefly related single cases of gastric schwannoma. Among them was Monod, who reports his case more fully in the second of these papers. A woman of twenty-one had a large, freely mobile, round tumor in the left hypochondrium, which was diagnosed at first as a mesenteric cyst. The patient, who had no pain or other symptoms, said she had often chewed her hair, and the diagnosis was therefore changed to that of hairball. The radiologist reported that the lumen of the stomach was normal and suggested an extragastric tumor. This was confirmed at operation, the tumor being attached to the greater curvature by a stalk. Incision showed that the corresponding area of mucosa was ulcerated, and wide resection was done. The tumor consisted largely of large and small blood cavities, but in the partitions the tissue presented an appearance suggesting the diagnosis of schwannoma rather than angiorna. There are no illustrations. F. CAVERS

Solitary Intramural Fibroma of the ~IONB,Case Report, D. J. LEITEAUSERAND M. 0. CANTOR.J. Michigan M. SOC.34: 15-17, 1935. A white man aged fifty-four years complained of progressive epigastric discomfort over a period of six years, with symptoms of increasing obstruction during the last two. Examination and laboratory studies disclosed evidence of partial obstruction of the pylorus, although no definite filling defect could be seen. Exploratory laparotomy revealed a marked thickening of the pylorus which seemed to be due to an ill defined lump in the posterior wall. The pylorus and lower third of the stomach were resected by a modified Polya procedure. The ensuing convalescence was uneventful and the patient left the hospital on the twentieth day after operation markedly improved. Pathological examination showed a well defined, encapsulated tumor occupying the posterior wall of the pylorus and measuring 1.0 x 0.5 cm. Histologically this presented the picture of a typical fibroma. The absence of any break in the mucosa and of cellular infiltration was against an inflammatory origin. While fibromata of the stomach are not particularly rare, pyloric obstruction by such a lesion is an unusual finding. The authors point out that the presence of small leaions of this type may not infrequently produce syndromes of the type described above, but due to their small sise, they may escape detection until examined pathologically. Hence it is emphasised that benign tumors should be suspected in any case in which the symptoms are not characteristic, especially if the roentgen examination is not diagnostic. This is an interesting case and draws attention to a group of lesions not commonly known. There are two illustrations depicting the roentgenographic appearance of the stomach and the histologic structure of the tumor. THEODORFJS. RAIFORD

Primuy Cucinomr of the Duodenum, W. P. HARBIN,W. P. HARBINJR. AND L. HARBIN. Ann. Surg. 101: 961-965, 1935. The authors report the case of a twenty-four-year-old woman who died following cholecystoduodenostomy and gaatro-enterostomy, performed in two .stages, for an obstructing tumor of the duodenum. Autopsy showed an annular, stenosing malignant papillomatous tumor attached to the wall of the first part of the second portion of the duodenum. The pancreatic and common bile ducts entered the mass in its dietal part and were occluded. Histologic study of the growth showed it to be an adenocarcinoma. The article is illustrated with two drawings and a roentgenogram. BENJAMINR. SHORE 904 ABSTRACTS

Leiomyoma of the Jejunum, M. J. VERNBNGOAND D. COLILLAS.Mioma del yeyuno, Bol. y trab. SOC.de cir. de Buenos Aires 19: 39-47, 1935. A man of fifty-three had suffered for about eight days from severe periumbilical pain, with two attacks of copious melena. No tumor was found on abdominal palpation and rectal examination. Following a blood transfusion on account of the severe anemia, laparotomy revealed in the jejunum, at 12 cm. from the duodenojejunal angle, a tumor measuring 6 x 3.5 x 2 cm. Following resection of 15 cm. of bowel and terminal anastomosis, the patient had pain, vomiting, and meteorism, and death ensued on the fifth day. Necropsy was not allowed. The authors cite cases from the North American and European literature to show the frequent difficulty of locating benign intestinal tumors which have caused grave melena and been mistaken for gastric and duodenal ulceration, There are four illustrations. F. CAVERS

Leiomyoma of the Ileum with Volvulus Incarcerated in the Pelvis, BENOITAND C. N. ALIVISATOS. Uiomyome du gr@leenclave dans le pelvis avec volvulus, Bull. et mem. SOC.nat. de chir. 60: 1221-1228, 1934. A woman of thirty-six was sent to hospital by her physician with a diagnosis of fibromatous uterus or ovarian tumor. During the preceding six months she had complained of metrorrhagia, also attacks of pain in the umbilical region, with vomiting, constipation, and finally retention of urine. A pelvic mass was felt with its lower pole in the pouch of Douglas and its upper about 8 cm. above the pubic symphysis. At operation a large tumor with a red congested surface was found, which proved to be a volvulus containing a subserous tumor of the ileum. The loop of bowel was freed from its adhesions to the bladder and pelvic tissue, and resection was done. The authors illustrate the rarity of benign tumors of the small intestine by citations of such extensive series as those of Raiford (Arch. Surg. 25: 122,321,1932. Abat. in Am. J. Cancer 19:933, 1933) and of Rankin and Newel1 (Surg., Gynec. & Obst. 57: 601-507, 1933. Abst. in Am. J. Cancer 20: 720, 1934). About 60 per cent of these tumors, which are mostly myomas and adenomas, occur in the fourth decade. There are three good illustrations. F. CAVERS Carcinoma of the Large Bowel, W. A. FANBLER.Journal-Lancet 54: 614-818, 1934. A brief review of the salient features relating to the clinical and pathological aspectn of malignancy in the large bowel. Early diagnosis is emphasised as an important meana of lowering mortality. The paper is based upon no particular group of cases. There are no illustrations. THEODORE5. RAIFORD Carcinoma of the Transverse Colon Associated with Pernicious Anemia and Purpura, PhLLAssE). Cancer du cblon transverse avec anhie pernicieuee et purpura, Lyon m6d. 154: 693-695, 1934. A woman of sixty-nine was admitted to hospital because of anemia and purpura. Her illness had begun four months previously with severe headache, vertigo, and the appearance of a generahed purpuric eruption; just before admission she had hematemesis. A blood count showed 1,395,000 erythrocytes and 8000 leukocytes. No evidence is given for the diagnosis of pernicious anemia mentioned in the title of the paper. A tumor was felt in the left hypochondrium; the liver was not enlarged and there WBB no ascites. Death occurred a week after admission. Necropsy showed a vegetating adenocarcinoma in the left third of the transverse colon; but no metastases were found. F. CAVERS Cancer of the Left Colon, P. LEGAC. Traitement du cancer du c8lon gauche, Bull. et m6m. SOC.de m6d. de Paris, 138: 172-177, 1934. The author believes that operative mortality in cancer of the splenic flexure and descending colon may be reduced by preliminary cecostomy followed by oral administration of vaccines and lavage of the colon with creosote solution. The final resection is a modified Mikulics proceduie. There are no illustrations. JOHNS. LOCKWOOD THE DIGESTIVE TRACT 905

Cancer of the Rectum, C. C. MBCHLINQ.West Virginia M. J. 31: 57-59, 1935. A brief review of the typical clinical features of rectal cancer with scathing rebukes for the indiscriminate use of I‘ shotgun ” remedies for rectal ailments. There are no illustrations. THEODORES. RAIFORD Epitheliomata of the Lower Rectum and Anus, T. S. RAIFORD.Surg. Gynec. & Obst. 57: 21-35, 1933. Also, in Spanish, in Bol. Liga contra el cBncer 8: 275-283, 1933. Among the 352 malignant tumors of the rectum studied histologically at the Presby- terian Hospital in New York City, only 10, or 2.8 per cent, were of the squamous-cell type. In this group the most common premonitory symptoms were itching, pain, bleeding, and a palpable mass. The most frequent and constant physical findings were visible or palpable ulcers or masses and tenderness of the perineum. The tumors commonly assumed one of two definite gross forms, either a nodular indurated growth or a perianal ulcer. The first of these represented in the majority of cases a histologic type Characterized by cells growing throughout the subcutaneous and submucous tissues in a discrete, well circumscribed manner. The second was commonly composed of diflusely invading cells of a pure squamous type with few mitoses and many epithelial pearls. The end-results indicated that the tumors in the fir& group were the more malignant. It is believed that external irradiation followed by excision is at the present time the treatment of choice. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE

Diagnoab of Operability of Cancer of the Rectum, R. LEIBOVICIAND R. SOUPAULT. Un point important du diagnostic d’ophbilite du cancer du rectum chez l’homme; le cancer du Douglas, Presse m6d. 42: 580-581, 1934. The authors urge the necessity of doing an abdominal exploration before deciding on the operability of any case of cancer of the rectum. JOHNS. LOCKWOOD Radical Surgical Removal of Rectal Cancers Based on Ten Years’ Experience, E. GOLD AND 0. STRITZKO.Die radikale Operation des Rectumcarcinoms und Hand des klinischen Materials der letzten 10 Jahre, Arch. f. klin. Chir. 182: 31-40, 1935. From 1925 to 1934 inclusive, 256 patients with rectal cancers were seen in the First University Surgical Clinic in Vienna. In 52 cases for various reasons no operation was performed. A radical excision was done in 57 per cent of the remaining 204 patients, and colostomy only in 43 per cent. The mortality after colostomy alone was 17 per cent and after all types of radical operation, 23.9 per cent. There were 90 sacral resections, 17 combined abdominosacral resections, 4 intra-abdominal resections, and 6 atypical operations. The end-results in this group of cases, of course, can not be given. BENJAMINR. SHORE Statistical Analysiis of Rectal Cancer, S. TERASAKO.Uber die Stricture recti und unsere Statistik Uber den Mastdarmkrebs in den letsten 5 Jahren, Okayama-Igakkai- Zasshi 46: 435-459, 1934. The author studied the records of 3252 cases from Ieumi’s surgical clinic during the last five years. Among this number there were 200 cases of rectal and anal diseases, including 5 of inflammatory stenosis of the rectum and 36 of rectal cancer. Of the 36 cancer cases, 9 were associated with hemorrhoids, that is a quarter of the patients with rectal cancer were also patients with hemorrhoids. Of the 36 patients, 22 were males and 14 were females. The majority were between fifty and sixty years of age. The site of the disease was as follows: sigmoid 16.0 per cent; ampulla 61.1 per cent; lower rectum 11.1 per cent; anus 8.4 per cent. Thirty-eighb and four-tenths per cent of the lesions occurred on the anterior wall, 3.8 on the posterior wall, 15.4 per cent on the left wall, 11.5 per cent on the right wall; 30.7 per cent were of the napkin-ring type. Of those patients seen in 1928-30, 9 were radically operated upon, 8 had colostomies, and 4 were inoperable. Of 9 patients operated upon radically, 1 was lost, 5 died, and 3 were apparently cured over three years. None of the patients with colostomies or without operation survived as long as three years. K. SUQIURA 906 ABSTBACTS

THE BILIARY TRACT Primup Carcinoma in a Cirrhotic Liver, with Diosemkuted Metarbsee in the Lunge, J. PAWOT,J. F. MARTIN,A. GUICHARDAND P. GIURD. Cancer primitif trab6culo- v6siculaire d’un foie cinhotique; g6n6raliaation pulmonaire psudo-ganulique (a forme strictement traMculaire), Lyon m6d. 154: 508-611, 1934. A woman of fifty-five complained of epigastric pain and attacks of diarrhea which had begun about five months previously. During this time she had lost appetite and weight, and had an intermittent cough with occasionally blood-stained expectoration. There was a projecting rounded tumor of the liver, also a single large, hard lymph node in the left axilla. Contrast radiography revealed no gastro-intestinal abnormality, and the blood count was about normal.. The cough became worse, with increasingly copious and fetid green expectoration. X-rays showed numerous small opacities in the lower lobes, and cavities in the upper lobes, of both lungs. Death occurred two months after admission. At necropsy the upper lobe of each lung showed largely healed but in parts still active tuberculous cavitation ; the lower lobes contained numerous whitish tumor nodules. The greatly enlarged liver contained numerous nodules in addition to the large anterior tumor. The only other metastases were small nodules in the epi- cardium and the left euprarenal. The liver was highly cirrhotic, but nowhere were the cirrhotic and neoplastic tissues in close contact. The primary liver tumor is described as an adenocarcinoma which showed in some regions arrangement of the celle in cords and in others in alveoli. In the pulmonary metastases only the cord-lie arrangement was seen. The histologic description is not clear, and there are no illustrations. F. CAVERS

Adenoma of the Liver; Case Report, C. LENORYANT,I. BERTRAND AND JEANPATEL. Considhtions sur l’ad6nome solitaire pbdicul6 du foie, Presse m6d. 42: 1829-1831, 1934. A girl of twenty-two years had had intermittent brief episodes of right upper quadrant pain for two years, with radiation to the shoulder, but unrelated to digestive symptoms until four months before. Examination diaolosed a movable, pedunculated ms88 in the right hypoohondrium which was shown by x-ray studies to be anterior to the colon and not related to the stomach. There was nothing in the history or blood studies to suggest echinococcus infection. Exploration revealed a pedunculated tumor 18 cm. in diameter attached to .the anterior edge of the right lobe of the liver, in front of the gallbladder, to which it was adherent. Removal was effected by making a wedge- shaped incision into the liver at the point of attachment of the pedicle, and opposing the cut surfaces. Histological section showed a welldifferentiated adenoma, some areas showing trabeculated columns of epithelium, other areas occupied by liver cells arranged in acini. The chief problem in such cases ia the difficulty of securing hemo- stasis in the liver bed, which the authors feel was satisfactorily handled in this case, as the convalescence was uneventful. The paper is illustrated with photomicropaphe in color. JOHN8. LOCKWOOD

Resection of the Hepatic Ducts and Common Bile Duct for Carcinoma, R. DEYEL. Beitrag 5ur Rssektion des Ductus hepaticus und choledochus wegen Carcinoma, Arch. f. klin. Chir. 182: 148-151, 1935. The author reports the case of a eeventy-six-year-old man from whom a tumor situated at the bifurcation of the gystic and hepatic ducts was successfully resected. An end-to-end anastomosis WBB done over a rubber tube. The patient was well three months after operation, Hiatologic study of the growth showed it to be an adenocarcinoma. The article is illustrated with two drawings. BIUNJAMINR. SHORIU PERITONEAL AND RETROPERITONEAL TUMORS; OMENTAL CYSTS 907

THE PANCREAS

Carcinoma of the Head of the Pancreas, L. HESSAND J. FALTITSCHEK.Zur Klinik des Carcinoma capitis pancreatis, Wien. klin. Wchnschr. 48: 103-107, 1935. This is a general discussion of the differential diagnosis between carcinoma of the head of the pancreas and chronic pancrestitis. This histories of 4 illustrative cases are included. Early malignant changes in the pancreas should be suspected in patients of advanced years in whom changes in the outline of the duodenum can be delineated by x-rny. BENJAMINR. SHORB Normal Pancreatic Functioning in a Case of Carcinoma of the Pancreas, F. MEERSSE- MAN, P. BLANAND L. PERROT.Recherche8 sur la fonctionnement pancrbatique dans un cas de cancer de la t&tedu pancrbas. Lyon m6d. 154: 248-253, 1934 A man of forty-seven complained of progressive jaundice, first noticed a few months previously. He had become very anemic and lost considerable weight. The liver was somewhat enlarged and there was palpable a cystic swelling, thought to be a tumor of the gnllbladder. Duodenal sound tests showed complete biliary retention, but the trypsin and lipase contents were about normal. Bilirubinemia fell for a short period from J 7 to 7.2 Van den Berg units and then rose to 20 units. It was decided to attempt oholecystenterostomy, but intestinal hemorrhage set in and the patient died within fortyeight hours. Necropsy revealed an unsuspected carcinoma of canalicular type in the head of the pancreas. There were a few metastatic nodules in the duodenal mucosa, but no other metastases. The liver was enlarged, and the gallbaldder enor- mously so. F. CAVERS

Pancreatic Cyst; DUaculty in Preoperative Diagnosis, E. DELANNOYAND J. DRIESSENS. Kyste vrai du pancrbas; exbrhse totale; gu6rison, Bull. et m6m. SOC.nat. de chir. 60: 1369-1373, 1934. A woman of forty-two was referred to the authors with a diagnosis of ovarian cyst. She complained of pain and a feeling of weight in the left hypochondrium and flank. There was a large, smooth, rounded and very mobile tumor with its upper pole on the left of the umbilicus and its lower pole level with that of the kidney. By elimination the diagnosis was reduced to two probabilities-mesocolic cyst and pancreatic cyst. At operation both of these conditions were verified. The tumor was attached by a wide base to the tail of the pancreas and was growing between the layers of the mesocolon. In ita enucleation it was necessary to remove some pancreatic tissue. It was 13 cm. in diameter and was histologically diagnosed as a multilocular cystadenoma. Judd, Matt- son and Mahorner (Arch. Surg. 22: 838,1931) noted that 11 out of their series of 47 pancreatic cysts were freely movable, 9 of these being located in the tail. Yet in many text- books it is still stated that pancreatic ‘cysts are almost if not quite always fixed tumors. The same writers also commented on the fairlyfrequent mesocolic growth of these tumors. The authors emphasize the desirability of enucleation of pancreatic cysts, regarding marsupislization as an unsatisfactory procedure. F. CAVERS

PERITONEAL AND RETROPERITONEAL TUMORS; OMENTAL CYSTS Fibromyoma Free in the Peritoneal Cavity, A. CESTER. Fibromioma libero nel cavo peritoneale, I’oliclinico (sez. prat.) 40: 855-858, 1933. A woman of forty-six had noticed a progressive painless enlargement of the abdomen for one year. She suffered from menorrhagia and had a severe anemia. Examination disclosed a non-tender, freely movable abdominal tumor the size of an adult head, and an enlarged, tender uterus. At operation the tumor was found to be attached to the uterus by a slender bloodless band and to derive its nourishment from large vessels continuous with those of the omentum which surrounded it. Microscopically the tumor was a fibromyoma. The author contends that it originated as a gubserous fibromyoma of the uterus and had become detached following torsion and rupture of the pedicle. 908 ABBTBACTS

No painful abdominal crisis is recorded, however, in the history. A photograph and photomicrographs illustrate the article. JEANNETTPMUNRO Pseudomyxoma Peritonei; A Case Report, H. B. DORNBLASER.Journal-Lancet 55: 88-89, 1935. Removal of a large pseudomucinous cystadenoma from the left ovary was followed two years later by abdominal distention. A second operation disclosed a cyst 8 in. in diameter, arising from the sigmoid mesentery. This was removed and the patient recovered. No evidence of malignant growth could be found. No further record of the case is given. The procesa was thought to be a pseudomyxoma peritonei arising from the left ovary and recurring after removal. The pathology of the disease is briefly discussed. There are no illustrations. THEODORES. RAIFORD Retroperitoned Sarcoma with Pain Referred to the Thigh, D. L. Pow. Brit. M. J. I: 586, 1935. A woman of twenty-five complained of pain in the right loin and thigh for about three months, diagnosed as rheumatism. She died six days after admission to hospital. Necropsy revealed a .large retroperitoneal tumor, histologically a round-cell sarcoma, infiltrating the right iliopsoas muscle and the neighboring nerves; there were many outlying nodules, presumably metastatic. [The report is extremely condensed and omits a good deal of information,] F. CAVERS

Retroperitoned S~coxnn,T. SUZUKI.Ein Fall des Retroperitonealsarkome, Okayama- Igakkai-ZAeshi 46: 491-500, 1934. A boy of twelve had neuralgic pain for six months in the left leg, which caused him to limp. The leg was also slightly atrophied. A large, elastic, firm tumor was noticed on the left side of the abdomen, extending from the left hypochondrium to beneath the anterior superior iliac spine. Ballottement was evident. The tumor was located in the retroperitoneal space, was distinctly fluctuant, and covered with a vascular capeule. Enucleation of the tumor mass from the capsule was done. During the operation the boy died of shock. Histological examination of the tumor, which weighed 930 gm., revealed spindle-cell sarcoma. There was no metastatic growth. K. SU~IURA Cystic Dysembryoma of the Great Omentum, P. FOUCAULT.Dysembryome kystique du grand Bpiploon, Bull. et mBm. SOC. nat. de chir. 60: 972-978, 1934. A man of twenty-eight attended hospital on account of a right inguinal hernia which had been noticed two years previously and had recently become irreducible. When the sac was incised it was found to contain omentum which presented bn unusual appearance, its surface being covered by numerous small cysts, some sessile and others stalked, the whole simulating a hydatidiform mole. The entire omentum was later seen to be infiltrated by multitudinous cysts, present also on the parietal peritoneum and the bladder. ’ The author resected the omenturn, and destroyed with curette and electro- cautery the other cysts within reach. Deep x-ray therapy was given (details not stated). At the time of reporting, eight months after the operation, there was nothing to suggest recurrence. Histologically the omental tumor showed a core of hypertrophied smooth muscle fibers and connective tissue; then a lone consisting mainly of rounded cysts, recalling the picture of thyroid adenoma, the cysts containing colloid and acidophil material. The outer or vesicular layer contained newly formed blood and lymph vessels, resembling hemolymphangioma, and masees of lipomatous tissue. There are six good illustrations. F. CAVERS THE FEMALE GENITAL TRACT Frequency of Cancer of the Female Pelvic Orgum, F. E. DEPDS. Ohio State M. J. 30: 646-647, 1934. The author has reviewed the vital statistics from the States of Ohio and New York and for the U. S registration area, showing the high incidence of cancer in the female THE FEMALE GENITAL TRACT 909

genital tract. He points out that the mortality rate is almost twice as high in Ohio as in New York, where the rate is 35.9 per hundred thousand of population. The maximum incidence in Ohio is between the ages of fifty and fifty-four; in New York between fifty- five and sixty-four. Deeds joins in the plea for thorough periodic health examinations and education of the laity. JOHNS. LOCKWOOD

Bigdlcance of Menopausal Hemorrhage with Especial Reference to Carcinoma, C. C. NORRIS. Internat. Clin. 1: 182-197, March 1935. Of 1797 cases of uterine hemorrhage occurring before, at, or after the menopause, 20 per cent were due to malignant tumors; of the post-menopausal hemorrhages 52.9 per cent were due to cancer. In general it appears that periodic increase in flow is of benign origin, whereas an irregular, intermittent type of flow associated frequently with trauma is produced by cancer. The importance of routine treatment of cervical lacerations and erosions in younger women and the careful investigation of all abnormal flowing at or near the menopause is stressed. Of the benign causes of abnormal uterine bleeding the most frequent are fibroids, dysfunctional endocrine states, and polyps. JOHN8. LOCKWOOD Early Diagnosis of Gynecologic Cancers, K. LANGE. Die Krebsfrllhdiagnose des Gyniikologen, Deutsche med. Wchnschr. 61 : 130-132, 1935. This is a general discussion of the early diagnosis of carcinoma of the body of the uterus and the cervix. Emphasis is placed upon the use of the colposcope and histologic examination of biopsy specimens. BENJAMINR. SHORE

Precancerous and Carcinoid Lesions of the Cervix Uteri, with Coqents on the Schiller Teat, E. HENRIKSEN.Surg. Gynec. & Obst. 60:635-644, 1935. There has been a good deal of discussion lately of so-called precancerous lesions of the cervix, one school holding that in certain cases a diagnosis of cancer may he made histologically where them is evidence of increased cellular activity in the basal layer without actual invasion, the other school maintaining that such lesions rarely may, but usually do not, progress to the stage of unquestionable cancer. The settlement of this question has been difficult because of the ease and comparative safety with which ques- tionable lesions can be treated with radium. [See Smith and Pemberton: Surg., Gynec. & Obst. 59: 1, 1934. Abst. in Am. J. Cancer 23: 673, 1935.1 In the present paper Henriksen reports clinical and histological observations on 50 cam of border-line type which were treated conservatively, concluding that the assump tion of probable cancer development in such cases is unwarranted. Inflammatory changes alone may produce a picture of increased cellular activity of the basal layer, with many mitoses, hyperchromatosis, and polymorphia. The evaluation of these changes may be difficult when they occur in squamous metaplasia of the cervical canal, but the type of invasion is characteristically benign. It is also felt that leukoplakia in the cervix, identified so admirably by the Schiller test, is not of the same precancerous nature as that occurring in the mouth, for example. None of the conservatively treated cases of leukoplakia subsequently developed cancer. One example is reported in which a basal-cell carcinoma 1 mm. in diameter was discovered with aid of the Schiller test, developing in an area of squamous metaplasia. Two cases having cervical nodules with a histological picture closely resembling Bowen’s disease are described, and the question of possible identity is raised. The Schiller test is a valuable aid in studying cervical lesions, and especially practicable if the solution is applied with an atomiser. It is pointed out that leukocytes take up iodine readily, 80 that any infected erosion or tumor will show deep absorption. The test is useful only in selecting the site for biopsy. In order to avoid pitfalls in the diagnosis of cervical lesions, the use of serial sections of the freshly fixed biopsy material is of great value. Where there is doubt as to the presence of cancer it will not endanger the patient to delay treatment, while maintaining close observation, until definite diagnosis can be reached. 910 ABSTRACTS

[Unfortunately, detailed observations on the majority of the cases studied are not included, and we are left in doubt as to the length of the follow-up period which has been considered as indicative of benignity of the untreated border-line lesions. This is of especial importance, because in the paper of Smith and Pemberton cited above the authors described cases in which it apparently required several years for the final malignant invasion to occur.] The paper is profusely illustrated with photomicrographs, and there is a color plate of several cervices before and after application of Lugol’s solution. JOHNS. LOCKWOOD

Leukoplakia of the Cervix, E. FORTI.La leucoplasia del collo dell’ utero, Monitore ostet-ginec. 5: 621-636, 1933. Forti reviews the previous reports of leukoplakia of the cervix and describes one case which he observed. The patient was twenty-nine years of age and had had four pregnancies. There was a patch of leukoplakia on the anterior lip as well as one on the posterior lip of the cervix. Forti amputated the cervix and presents a detailed description of the histology, accompanied by six unsatisfactory photomicrographs. A bibliography is included. C. D. HAAGENSEN

Recognition of Early Cancer of the Cervix Uteri, K. H. MARTZLOFF.Internat. Clin. 4: 179-98, December 1934. A review of recent advances in the diagnosis of cervical malignancy, with particular reference to the Schiller test. The author holds that cancer may be diagnosed in ad- vance of any actual break in continuity of the basal layer of the epithelium, and that leukoplakia should, be considered as definitely precancerous, as maintained by Hinsel- mann, although Hinselmann goes farther in declaring that all cervical cancers start with leukoplakia. #Sinceevery cervical cancer must begin as a localised nidus of altered cell growth, and since cases have been reported in which there was proof of development of cancer in leukoplakia, the recognition of these areas of leukoplakia is much to be desired, and the Schiller test is valuable in making this possible. Shallow ulcers with slightly elevated edges, small elevated areas with somewhat .irregular surface contour which may or may not bleed on manipulation, and small papillary excrescences on an otherwise velvety surface are other lesions to be looked upon with suspicion and subjected to biopsy. Polyps should always be examined histologically because of the possibility of early cancer at some point. JOHNS. LOCKWOOD

Malignant Disease of the Cervix Uteri, H. H. SCHLINK,C. L. CHAPMANAND G. F. DAVIES. M. J. Australia 2: 237-238, 1934. This is a summary of a general discussion, in which special stress is laid on the importance of colposcopy and biopsy in early diagnosis. F. CAVERS

Dimorphous Tumors of the Cervix Uteri and Their Histogenesis, G. FROLA.Sui tumori dimorfi del collo dell’ utero e sulla loro istogenesi, Pathologica 25: 735-738, 1933. The author studied 43 cases of malignant growths of the cervix treated in the Cancor Institute uf Brussels. In each case he did daily biopsies both before and during radium and x-ray therapy over a period of a month or more. Before treatment 41 of the tumors showed the typical histological structure of epithelioma, one was an adenocarcinoma, and one a mixed tumor containing adenocarcinomatous and epitheliomatous elements which are described in detail. Following irradiation there was considerable change in the histological picture presented, and in 20 of the cases a definite dimorphism became evident. Metaplasia of the cervical glands was demonstrated both as a direct process and through undifferentiated elements arising from the cervical glands. Photomicrographs are included showing the post-irradiation changes. JEANNEWEMUNRO THE FEMALE QENITAL TRACT 911

Doe6 the Microscopical Diagnods Afford Prognostical Guidance in Cervical Cancer?, P. WETTERDAL. Acta obst. et gynaec. Scandinav. 14: 302-309, 1934. The author collates the clinical stages, the histologic grading (on the principles laid down by Healy and Cutler), and the five-year results obtained by radiotherapy in 354 cases of squamous-cell cancer of the uterine cervix treated at the Radiumhemmet, Stockholm. The details are summarized in the following table:

Group I Group I1 Group I11 Alive Dead Alive Dead Alive Dead

All Cases Total ...... 30 127 38 118 9 20 Percent...... 21.0 78.4 24.4 75.0 25.7 74.3 Btagea I and I1 Total ...... 24 36 25 43 8 10 Per cent...... 40 60 30.8 03.2 44.4 55.0 Shgm I11 and 1V Total...... 12 91 13 75 1 10 Percent ...... 11.0 88.4 14.8 85.2 5.9 94.1

As shown in this table, 83 patients were free from recurrence or metastasis for five years or more, the five-year cure rate being 23.4 per cent. The clinical stages I and I1 (operable) and I11 and IV (borderline or inoperable) have been added together to form two groups. In the histologic classification, Group I incrudes the mature keratinixed oanmrs, Group I11 the undifferentiated, immature forms, and I1 those which it was not found possible to place in groups I and 111. Of the total cases (354), 46.1 per cent were placed in the histologic Group I, 44.1 per cent in Group 11, 9.8 per cent in Group 111. The author believes that the unusually high frequency of mature cancers in this series may be in part explained by the fact that at Radiumhemmet the biopsy excisions have been so large that quite often isolated horny pearls are found in preparations which it would otherwise have been difficult to classify. Possibly the anaplastic immature form of cervical cancer is relatively rare in Sweden. As shown in the table, however, the percentages of cured cases in the three histologic goups very nearly coincide. This agrees with the experience of Kamniker (Zentralbl. f. Gyniik. 56: 457, 1932. Abst. in Am. J. Cancer 18: 757, 1933), who was unable to find any appreciable difference in operative results between the histologic groups. F. CAVER8

Blood VOS~OlS of Uterine Turnore. Part I. Roentgenographic Observation of the Distribution of Blood Vessels in Cervical Cancer, G. KAWANISHI.Japanese J. Obst. & Gynec. 17: 446-451, 1934. Kawanishi injected the vessels of extirpated uteri with a radio-opaque material and took roentgenogaphs of sections of the organ cut in the vertical axis. Three normal uteri and 15 harboring cancer of the cervix were so examined. It was found that vessels developed in abundance at the periphery of the tumor, forming almost a “ barrier.” Extension of tumor growth seemed to occur toward the thinnest portion of this barrier, the region of minimal vascular activity. The central portions of the tumors showed few vessels large enough to carry the injected fluid. There are several excellent illustrations. JOHN8. LOCKWOOD Additional Data on Uterine Cancer, R. M. COLLINS. J. Iowa M. SOC.24: 71-75, 1934. In a previous report, Miller (J. Iowa M. SOC.23: 132, 1933. Abst. in Am. J. Cancer 20: 231, 1934) recorded the statistics on a group of 219 consecutive carcinomas of the female genital organs seen from 1917 to 1927. Collins in this article reports on 395 additional cases seen in the University of Iowa College of Medicine since the completion of Miller’s work: Comparing the data on the two series of cases, one finds that the 912 ABBTRACTB

percentage of operable cases has been significantly increased. Furthermore, the percentage of correct diagnoses before admission has been increased, thus reducing the time Lost in securing adequate treatment by more than half. The time elapsing before the patient seeks medical advice, while unchanged in the group of cervical lesions, has been considerably reduced in the cases of carcinoma of the fundus. In spite of this striking improvement in early diagnosis and treatment, however, 72 per cent of the cervical and 19 per cent of tlie fundus carcinomas are advanced to the point of inoper- ability when first seen. The author’s statistics are set forth in 11 tables. There are no illustrations. THEODORE5. RAIFORD

Diagnosis of Carcinoma of the Uterine Cervix, H. SCHRIDDEAND H. RERNINQ.Unter- suchungen und Betrachtungen Iiber den Muttermundkrebs, Mtinchen. med. Wchn- schr. 82: 186-170, 1935. This is a general discussion of the early diagnosis of cancer of the cervix. Special stress is laid upon the value of visual examination with the colposcope and the radical treatment of all suspicious areas on the cervix. BENJAMINR. SHORE Skeletal Changes Aesociated with Malignant Uterine and Ovarian Tumors, H. L. KOTTMEIER.Knochenverhnderungen bei malignen Uterus- und Ovarialtumoren, Acta radiol. 16: 275-294, 1935. The following three types of skeletal changes may be observed in association with malignant tumors of the uterus and ovaries: (1) direct erosion by the tumor; (2) erosion by lymph node metastases; and (3) true metastatic tumors. In the author’s series of cases there are 11 in which neoplastic skeletal changes were associated with uterine tumors and 5 with ovarian tumors. In the latter group of cmes there were 2 papillary cystadenomas and 3 adenocarcinomas. The article is not illustrated. BENJAMINR. SHORE Prophylaxis and Treatment of Carcinoma of the Cervix, 11. SCHMITZ.Journal-Lancet 54: 748-750, 1934. A general discussion of the importance of the periodic health examination, including pelvic examination, in diagnosing early carcinoma of the cervix. JOHN8. LOCKWOOD

The Mortality from Cancer of the Uterue CM Be Reduced, J. C. LITZENBERQ.Journal- Lancet 55: 91-92, 1935. In an editorial Litzenberg points out the probability that the mortality from carcinoma of the uterus could be greatly reduced by education of the laity and by the applics- tion by all practising physicians of the relatively eimple diagnostic measures now available. JOHN0. LOCKWOOD Carcinoma of the Cervix, Results of Treatment in 136 Cases, EUGENES. AUER. J. Missouri M. A. 32: 47-50, 1935. Out of 177 patients with carcinoma of the cervix seen from 1927 to 1929 inclusive, 138 were treated, 27 of the remainder having been in Group 4 and presumably hopeless, and 14 having failed to appear for treatment. The 138 treated cases were followed completely and 29 or 21.3 per cent 118.3 per cent absolute] show five-year cures. This compares with 44 cures fn 352 cases (12.2 per cent) treated between the years 1917 and 1928. The improvement in results is perhaps explained by the considerable increase in the proportion of early cases, as the treatment was virtually the same. In the recent series 22 cases fitted into clinical Groups 1 and 2. In Group 1 cases the author recommends radical surgery, in all others radium and x-ray. He has employed 3000 to 3300 mg. hrs. of radium with comparatively light screening as the principal treatment, supplemented in many cmes by x-rays in doses of 700 to 900 r units, and in a few cases by a second dose of radium, 1000 to 1500 mgm. hrs. [Better results will probably be obtained with heavier screening of the radium and a longer exposure.] Even in very early case8 it is necessary to give a maximum tolerance dose of raditim at the outset. THE FEMALE GENITAL TRACT 913

as in 12 cases in this series where lighter doses were used there were recurrences after one to four years in spite of the early disappearance of the cervical lesion. JOHN S. LOCKWOOD

Treatment and Prognopis of Adenocarcinomas of the Cervix, F. NILESON. Prognose und Behandlung der Kollumadenokarsinome, Acta radiol. 16: 217-223, 1935. From 1916 to 1932,80 primary adenocarcinomas of the uterine cervix were observed in the Gynecologic Division of the Radiumhemmet in Stockholm. The outstanding feature of,these tumors was their unusual tendency towards early metastasis. In 16, or 20 per cent, of the caRes metastases to the vagina, inguinal regions, perineum, lymph nodes of the pelvis, liver, or lungs were evident at the time the patients first came for examination and treatment. About one-half of the entire group of tumors were considered operable. Five-year cures were obtained by radiation in 23 per cent of the entire group, in 35 per cent of the operable casee, and in 10 per cent of the inoperable cases. The article is not illustrated. BENJAMINR. SHORE

Surgical Treatment of Carcinoma of the Uterine Body, HAMANTAND VICHARD. A propos du traitement du cancer du corps utbrin, Bull. SOC. d’obst. et de gynbc. 23: 650-653, 1934. During six years the authors operated in 38 cases of cancer of the body of the uterus, in 20 by abdominal and 18 by vaginal hysterectomy. Four patients were alive and well for five years or more. The follow-up was poor. F. CAVERS

Radiotherapy in Carcinoma of the Uterus, Survey of IVth International Congress of Radiology, ZWch, 1934, J. HEYMAN.Acta. obst. et gynec. Scandinav. 14: 339-345, 1934. Supplementing and bringing to date an earlier report (Abst. in Am. J. Cancer 20: 237, 1934), Heyman presents here the results obtained with irradiatioq (mainly radium) treatment of uterine cancer at the Radiumhemmet, Stockholm, during the fifteen-year period 1914-1928 inclusive. The material comprised 1576 cases of cervical cancer, of which 112 (7.1 per cent) received no treatment, including patients who refused it and those to whom it was refused on account of advanced cachexia, distant metastases, or fistulae. Of the 1455 treated cases 327 (22.5 per cent) showed cure for five years or more. [It is worth while mentioning again that the Radiumhemmet five-year cure rate b based on the total number of cases treated, no deductions being made for patients lost sight of, or dying of intercurrent disease, during the five years following the incep tion of treatmentall such patients being reckoned, for statistical purposes, as having died of cancer.] The results in 1439 cases (16 treated by x-rays alone being excluded) are given in the following table:

Clinical I Number I Peroentage Number of Cure stage Treatad Fiveyear Cures Percentage

I 141 9.8 81 57.5 11 403 28.0 138 34.3 I11 557 38.7 90 16.2 IV 338 23.5 18 6.3

Further analysis of this large material shows that the five-year cure percentage has been much the same for each of the three quinquennia reviewed, despite the fact that during these periods the percentage of patients presenting themselves in the clinical stages I and I1 has risen from 22.3 to 41.8, while that of those first seen in stages I11 and IV has fallen from 77.7 to 58.2. In part this lack of concurrence of improved cure results with improvement in the material may be attributed to the relatively small number (296) of cases treated in the first six years, 1914-1919, as compared with 730 treated during the six years 1920-1925, and 413 during the three years 1926 to 1928. 914 ABSTRACTS

During the earlier years the smallness of the number treated allows chance variations to play a greater part. Also in this earlier period less strict attention was paid to t,he classification of patients and to the early recognition of recurrences. In the year 1925 there was a remarkable fall to 14.2 per cent cures. During this year there was a marked increase in the percentage of hopeless (stage IV) casee, but the poorest results lay in stages I and 111, where the cure figures were nearly 50 per cent lower than the average for the fifteen years covered in this report. Apparently no clinical explanation will suffice to account for the poor results of 1925. “ Such observations as this, which show the difficulty of estimating the results within different groups selected from even a very uniform material in one and the same clinic, illustrate how hopelessly complicated it beconies to draw conclusions from a comparison of the results of different clinics.” The 1914-1928 material included also 169 cases of corporeal carcinoma, of which 156 were treated, with a total of 76 five-year cures (48.7 per cent). No fewer than 14 cases previously registered as five-year cures have been discarded because the histologic diagnosis was not made in the Radiumhemmet itself. The routine treatment for corporeal cancer has been radium, with operation when aymptoms persisted or reappeared. There were also 56 cases in which carcinoma was present in both cervix and corpus; 35 of these were treated, with 9 five-year cures. F. CAVERS Radiotherapy in Cancer of the Cervix, A. LACASSAQNE.fivolution et orientation des techniques en radiotherapie des Bpith6liomas cervico-utbrins, Arch. d’electric. m6d. 42: 193-213, 1934. Also in Arch. Inst. du radium de 1’Univ. de Paris 3: 171-201, 1934, and, in German, in Strahlentherapie 51: 417-440, 1934. In a paper read in Zurich before the International Radiological Congress, Lacassagne gives a rbsume of recent developments in radiotherapy of cancer of the cervix, with particular emphasis on methods now in use at the Radium Institute in Paris, and the reasons for their adoption. With regard to the use of radium, he states that interstitial methods have not proved as satisfactory as intracavitary application because of the lack of precision and special dangers involved, and should be reserved for lesions causing complete occlusion of the cervical canal or for recurrences following other types of treatment. In providing intracavitary radiation there are two general technics in vogue, both agreeing as to the advisability of rather heavy filtration. One involves the use of large amounts of radium with two or three treatments of short duration. The other method, practised particularly in institutions where facilities make it possible, involves the prolonged administration of relatively small quantities of radium, a single treatment providing the complete dose. This method is followed at the Radium Institute and is advocated because of the opportunity for giving doses lethal to cancer cells without greatly damaging the normal tissues. Lacassagne feels that the interval between treatments in the first method may allow time for recovery of partially destroyed malignant tissues. There is perhaps less danger of infection when the shorter treatments are used. The amount of filtration should depend somewhat on the width of distribution and multiplicity of foci of radiation. The short treatment usually calls for the simultaneous application of vaginal and uterine elements. The author’s method usually involves use of the vaginal application first, particularly when there is any degree of stenosis, and introduction of the uterine applicator after a few days, when there is sufficient change in the tissues to permit more easy dilatation of the cervix, often without anesthesia. This also reduces the danger of infection. The average total dosage at the Radium Institute is about 8000 mgm. hours, with filtration by 1.5 mm. of platinum, in the vagina and 1 mm. in the cervical canal, whereas in clinics where the short massive doses are administered the maximum safe dose is 7000 mgm. hours. A significant step has been the adoption of the external application of radium by use of thc 4-gram, and more recently, the 8-gram pack, filtered by 1 mm. of platinum and applied at distances of 10 and 12.5 cm. respectively, directed at 6 fields for a total of twenty hours. The difficulties involved in directing the beam and in protecting the personnel have not been completely solved. X-ray treatment must still be considered an important adjunct in supplementing radium. Much is to be hoped from further development of technic in using the high- THE FEMALE GENITAL TRACT 915

voltage apparatus by which rays of shorter length and greater penetration can be applied. In x-ray therapy, also, there have been two distinct schools, one favoring repeated intensive treatments directed at small fields, the other using prolonged exposure of larger fields. At the Radium Institute the Coutard method is employed, 180-200 kv., 4 ma., 2 mm. sinc filtration, distance 80 cm., 4 to 8 fields of 250-400 sq. cm. each, a total of 12,000 roentgen units given in two daily sessions of one and a half hours for four to six weeks-in other words, 1500 to 3000 r measured in air per field. It is admitted that this method may not yet be practicable except in special institutes because of the lack of sufficient apparatus to handle the number of patients requiring treatment. The author does not believe that there is any proved value in intra-abdominal application of radon seeds or insertion of radium through perineal or vaginal incisions. He is also skeptical as to the rationale of combining hysterectomy with radiation, particularly postoperative radiation. Of this he says: “ If there are cancer cells left in du or disseminated by the surgeon in the operative field, or if involved nodes are not removed, postoperative irradiation has no chance of destroying those elements except by a dose as intense, as penetrating, as prolonged of action, covering a territory as wide, as that which would be required if x-ray therapy alone had been employed in the first place.” It would be more logical to reserve radiation for those cases in which recurrences appear, when a full effective therapeutic dose could be administered. No statistics are given and there are no illustrations. There is an extensive bibliography. JOHNs. LOCKWOOD

Radiation Therapy in Cercinomaa of the Uterine Cervix, H. SCHMITZ.Radiology 23: 548-550, 1934. This is a brief report on progress in the application of x-ray therapy to carcinomas of the cervix from 1914 to 1933. There have been five successive improvements in technic, involving either increased voltage from improved apparatus or increase in the effective dose through fractionation. These technical improvements are paralleled by a progressive increase in the percentage of ‘‘ good ” five-year end-results. From 1914 to 1919 there were a total of 132 cases, only 21 of which fell into clinical groups 1 and 2. The five-year salvage was 14.39 per cent, none of the good results occurring in the 35 group 4 cases. From 1924 to 1929, after fractionation was improved, 1500 T in 5 fractions or 2600 r in 10 fractions was administered to each of 2 to 5 fields. Out of 275 cases, 59 of which were in groups 1 and 2, a total of 28 per cent weredforded five-year cures, and 7 of the 116 group 4 cases were considered,to show good five-year results. Through the entire period the intracervical radium dosage has been constant, about 3600 to 4800 mgm. hrs. The author prefers the ‘‘ tolerance skin dose ’’ to the “ erythema dose ” for expressing quantity or x-radiation used. The former may be varied from 1350 to 2700 r according to the degree of fractionation. The crossed radiation of three “ tolerance skin doses ” can be effective in the mid-pelvis, but it requires 4.5 to 5 such doses to destroy cervical carcinomas. The remainder is supplied by the intracervical radium. Tables showing the factors employed during the several phases of therapy, and the detailed results of treatment of each clinical group for each period are provided. It is not stated by what method of follow-up the figures were obtained. JOHNS. LOCKWOOD

Radiation Treatment of Inoperable Carcinoma of the Cervix, G. Roux. Le traitement du cancer inopbrable du col de l’ut6rus par les radiations, Montpellier m6d. 5: 407- 411, 1934. Also in Bull. et m6m. SOC.de radiol. m6d. de France 22: 282-286, 1934. The author presents the results of treatment of 157 cases of Class 111 and IV carcinoma of the cervix at the Montpellier Cancer Institute between 1924 and 1928 inclusive. In all respects the statistics are said to conform to the rules laid down by Regaud for accurate compilation. Patients not followed are assumed to have died of cancer. ’ The results are distinctly encouraging, especially in view of the advanced character of the lesions. The 157 cases were almost equally distributed among the five years covered by the study. The percentage of five-year cures rose from 12.1 per cent for the first year to 32.2 per cent (10 patients surviving out of 31 treated) for the fifth year. The improvement is attributed to the adoption of single large doses of x-rays instead of the 916 ABSTRACT6 divided doses which the author found were unsati~factorybecause of the frequent interference of infectioh with completion of the series, and because of the immunity to small doses which many tumors seemed to acquire. It is felt, also, that the interstitial implantation of radium was a valuable adjunct to intracavitary radiation. The average of five-year cures for the entire series was 19.7 per cent. The mortality was as follows: 35.8 per cent of the patients died during the first year, 26.1 per cent during the second, 12.8 per cent during the third, 5.9 per cent during the fourth, and 0.6 per cent during the fifth year. Four patients died under treatment, all of sepsis. Most of the 00 per cent dying during the first eighteen months after treatment died of cervico- vaginal disease which had been uninfluenced by treatment. The 20 per cent dying after this period showed complete eradication of local disease in the cervix and va@na, but died of slowly progressive lesions in pelvic nodes, presumably not quite destroyed by the radiation. The symptomR of recurrence in the latter group were not characteriaed by sanguineous discharge, but usually consisted of pain secondary to nerve involvement, with appearance of masses in the iliac fossae. JOHNS. LOCKWOOD

Combined Intra-abdominal and Intravaginal Irradiation in the Treatment of Carcinoma of the Cervix, GEORGEGELLHORN. Am. J. Surg. 27: 422-424, 1935. The author reports the results of his combined intra-abdominal and intravaginal irradiation in the treatment of carcinoma of the cervix in 29 patients. Of these, 10 are clinically well at periods ranging from one and one-half to four and one-half years. During the same length of time, 313 additional cases were treated with radium of various forms and intensity with or without x-rays. Of these 313 patients, 95 are clinically well at periods ranging from one and one-half to four and one-half years. Expressed in percentages, 34.5 per cent were relieved by the combined intra-abdominal and intravaginal method, and 30 per cent by all other forms of radium treatment. It should be added, however, that by the new technic only advanced cases were attacked, whereas among the second and larger group there were also many of the border-line variety. The technic of the procedure is given but need not be repeated here as it has been abstracted previously (Am. J. Cancer 23: 421, 1935).

Late Complicationsin IrradiationTreatment of Cancer of the Cervix, Q. U. NEWELLAND H. 8. CROSSEN. Surg. Gynec. & Obst. 60: 763-768, 1935. The complications occurring in the treatment of a series of 371 cases of cancer of the cervix treated from July 1, 1921, to Jan. 1, 1933, are described. In most cases the radium was applied intracervically, screened with 0.5 mm. of silver and 1.0 mm. of brass, the capsules enclosed in rubber tubing and the bladder and rectum walled off with firm packing. The total radium dosage varied from 3000 to 4800 mgm. hrs. and was followed by deep x-ray therapy. There were rectal strictures in 5 cases, with symptoms developing one to two years following treatment, but responding well in all cases to simple digital dilatation. In 4 cases ulcerative bladder lesions developed, at intervals of three, three and a half, six, and three years respectively, with sudden onset of bladder distress and hematuria. These were treated satisfactorily with irrigations, instillations, and fulguration of bleeding surfaces. The most serious complication seemed to have been due to the x-ray therapy. It consisted of extensive sloughing of the lower abdominal skin and subcutaneous tissue after two years and a half of slowly progreasive dermatitis. This' eventually healed satisfactorily. There were lesser degrees of skin damage in two other cases. In none of these did the dose of x-ray appear to have been excessive (dosages are given), and there is no explanation for the poor skin tolerance in these cases. The detailed management of cases of carcinoma of the cervix at the Barnes Hospital is described. A number of illustrations are included, of which three are in color. JOHN8. LOCKWOOD THE FEMALE GENITAL TRACT 917

A Conddention of the Surgical Menopause after Hyeterectomy and the Occurrence Of Cancer in the stump Followhg Subtotal Hyrterectomy, N. R. KRETZBCHYAR AND 8. GARDINER.Am. J. Obst. dc Gynec. 29: 168-175, 1935. An analysis of questionnaires returned by 653 patients who had had hysterectomy for non-malignant lesions showed that about 58 per cent of women under thirty-six years of age will experience menopausal symptoms before the age of forty if hysterectomy with ovarian conservation is performed. Complete oophorectomy hastens the ap pearance but does not shorten the duration of hot fleshes, as has been supposed. Out of 1022 cases of cervical cancer treated over a thirty-year period, 18 occurred in the cervical stump, an incidence of 1.76 per cent. Symptoms suggesting the development of malignancy in the cervical stump were described by 5 out of 416 patients replying to questionnaires, and one additional case waa known to have developed, a total of 6 probable cases in which subtotal hysterectomy was followed by cervical cancer. [Convincing conclusions on this problem cannot be made without benefit of long-time follow-up examinations of patients after subtotal hysterectomy.] JOHN5. LOCKWOOD Carcinoma of the Cervix Disseminated by Curettage, DURAND-BOIBLEARD.Sur un ces d’dpith6lioma basilaire ut4rin B dvolution devenue suraigue h la suite d’un curettage explorateur et de Is conduite B tenir, Concours m6d. 57: 89-90, 1935. On the strength of one case in which the author was convinced that a diagnostic curettage had stimulated the growth of D cervical carcinoma he concludes that such a procedure is vmy hazardous and not justifiable except in doubtful cases. JOHNS. LOCKWOOD UtSrhe Cancer COeIhtOnt With UtOfh Fibromyomas, GUYOT, COURRIADEB AND c. ROCHER. A propos de deux cas de cancer ut4rin apparaiesant Bur des utdrus fibromateux, Bull. SOC.d’obst. et de gyn6c. 23: 721-724, 1934. The authors report two cases of hysterectomy for fibromyomatous uterus; in one there was also a carcinoma of the cervix, in the other a carcinoma of the body. F. CAVERS Bicornuate Uterus with Pregnancy in One Horn and Carcinoma in the Other, E. THIERS. Uths bicorne unicervical avec une corne gravide et I’autre canchreuse ; hystdrec- tomie abdominale totale; suites Bloignbes, Bull. SOC.d’obst. et de gyn6c. 23: 535-536, 1934. The condition described in the title waa found at laparotomy in a woman of thirty- two, who aomplained of metrorrhagia following six weeke of amenorrhea. The left horn contained an intact fetus of two months, the right horn a cylinder-cell carcinoma. Despite the abnormality of bhe uterus, there had been three normal pregnancies. Total abdominal hysterectomy was done, and the patient was well when seen five years later. F. CAVERS

Carcinoma in a Cervical Polyp, W. H. CONDIT. Journal-Lancet 55: 87-88, 1935. Examination of a polyp removed from the cervix of a forty-nine-year-old white womsn revealed beginning metaplasia and infiltration characteristic of a squamous-cell epithelioma of grade I. Treatment by cautery and irradiation had relieved the patient for fourteen months. No illustrations. THEODORES. RAIFORD

Treatment of Large Necrotic Uterine Polyps, HAMANT,CHALNOT AND VICHARD. A PMPOS du traitement des gros polypes sphacelbs de l’ut&us, Bull. SOC.d’obst. et de gyndc. 23: 653-655, 1934. Two cases are reported. Both patients, aged fifty-two and thirty-four years, were brought to the hospital in an extremely bad general condition, with metrorrhagia and putrid vaginal discharge. In both, hysterectomy was done for large, infected, necrosing polyps. The first patient died from septicemia three days after operation; the second had high fever for eight days but thereafter made a good recovery. The authors consider that in such cases polypectomy is contraindicated and that abdominal is preferable to vaginal hysterectomy. F. CAVERP 918 ABSTRACTS

Fibroid Tumors, L. J. NETTO. J. Florida M. A. 21: 236-241, 1934. A general discussion of uterine fibroids, including an historical review, theories as to etiology, symptoms, and the indications for surgical or radiation treatment. GRAYH. TWOMBLY

Uterine Fibroids: Importance of Diagnostic Curettage in Their Management, N. F. MILLERAND G. H. SEHRINQ.J. Michigan M. SOC.34: 4-7, 1935. Of 102 patienta with a clinical diagnosis of uterine fibroids admitted to the University of Michigan Hospital over a period of three years, 12, or 11.7 per cent, were found to have coexisting carcinoma of the fundus at the time of preliminary dilatation and curettage. Only 7 were then operated upon and one was found free of fibroids. In view of the fact that in only 4 of the cases was carcinoma suspected at the time of admission it is evident that the curettage was of great value in determining the course of treatment. Carcinoma can be ruled out in cases of fibroids only by preliminary curettage, and such a procedure should invariably precede any surgical or radiation treatment. JOHNS. LOCKWOOD

Treatment of Uterine Fibromyomas, J. DUCUINQ.Le traitement des fibromes de l’uths en dehors de la grossesse, Bull. SOC.d’obst. et de gyn6c. 23: 484-478, 1934. Result8 of X-ray and Radium Treatment of Uterine Fibromyomas, J. DUCUING,DE RERTRAND-I’IBRACAND GUILHEM.Nos rhltats dans la thhpeutique des fibromes par les agents physiques, Ibid. 23: 476483, 1934. Operative Treatment of Uterine Fibromyomas, C. DAMBRINAND L. DAMBRIN.Traite- ment des fibromes utbrins, Ibid. 23: 483-487, 1934. In opening this symposium on the treatment of uterine fibroids, excluding those complicating pregnancy, Ducuing said that he had used surgery in more than 300 cases and irradiation in nearly 200. He has seen a good many women in whom emall fibroids were found during routine examination but who had shown no symptoms clearly attributable to these tumors. In such cam he advises general tonic treatment. When latent fibroids of this type occur in women at or near the menopause he prescribes similar treatment, with hydrotherapy and other general or placebo measures, including light x-ray therapy, the patients being encouraged to return for examination, especially on the onset of menorrhagia. He has not found it always easy to make the accurate and complete diagnosis which is essential in order to determine what form of treatment should be adopted in individual cases, whether surgical or radiotherapeutic, and if the latter what dosage to give and the time over which treatment should be spread. Out of 250 cases operated upon up to 1931, he found that the diagnosis had been in the strict sense er- roneouH, chiefly as to complications, in nearly one third. He holds that in every case which eludes precise clinical diagnosis, not omitting the ruling out of pregnancy by the Aschheim-Zondek test and radiography, surgical treatment is indicated. Latterly he has used x-rays or radium in a increasing proportion of cases, falling back on surgery if necessary. Failures in irradiation treatment are few when the indications have been carefully studied. Ducuing has come to believe that at the present time only one third of cases at the most need be treated surgically. Ducuing, de Bertrand-Pibrac, and Guilhem analyse the results of irradiation treatment of fibroids in Ducuing’s clinic. Of the 200 cases treated during an unspecified period 164 have been traced (for how long is not stated). By pure coincidence 82 patients were treated with radium and 82 with x-rays; 70 of the former and 69 of the latter are reported as cured. C. and L. Dambrin have during thirty years operated upon some 1500 cases. They have frequently given preoperative radium because of its remarkably efficient hemo- static action. They have also used radium in cases in which operative treatment was contraindicated on general grounds, and have found that though the tumors diminish and often apparently disappear they frequently resume growth, necessitating operation. The material had not been fully analyzed statistically, but the death rate for subtotal hynterectomy in their hands has been only 2 to 3 per cent. THE FEMALE GENITAL TRACT 919

Ducuing, in closing the discussion, expressed astonishment at the low mortality claimed by the Dambrins for their large aeries of subtotal hysterectomies. F. CAVERS Sterility and Fibromyomas of the Uterus, M. RANDAZZO.Sterilith e fibromiomi dell’ utero, Monitore ostet-ginec. 6: 185-206, 1934. Randaaao reviews the data from the Gynecological Service of the University of Bologna which bear on the question of the relationship of sterility to the presence of myomas of the uterus. Three hundred and fifty-eight cases of myoma were available for study. In these the quinquennium of maximum frequency was between the ages of forty-one and forty-five, which included 25.42 per cent of the cases, although there were almost as many cases in the period from thirty-six to forty. Twenty-six and eight- tenths of the patients were nulliparous. In 60.4 per cent of the multiparous patients the last pregnancy had antedated the appearance of symptoms of the myoma by at least six years. The author concludes that nulliparity is the most important factor in the pathogensis of myomas. Myomas should not be regarded as a cause of sterility, but rather as its result. An exhaustive bibliography is included. C. D. HAAGENSEN

Outcome of Pregnanc; Complicated by Uterine Fibromyoma, R. D. MUSSEYAND R. S. HARDWICK.Am. J. Obst. & Gynec. 29: 192-198, 1935. Out of 297 cases of pregnancy in myomatous uteri observed at the Mayo Clinic, 97 showed symptoms of clinical significance attributable to the fibroids. Eleven patients were treated, by hysterectomy, of whom one died, and 32 received myomectomy early in pregnancy, with one death, while 15, or 46 per cent, either miscarried or had premature labor. There was no maternal mortality among the women allowed to go to term, although 45 per cent of them required operative delivery. The fetal mortality for the series was 29 per cent. There is a substantial bibliography. JOHN8. LOCKWOOD Relation Between Submucous Uterine Myomas and Pregnancy, H. PERLI. Quelques observations de myome et grossesse, GynBc. et obst. 30: 539-543, 1934. The author reports four cases in which women with a history of miscarriages were found to have submucous myomas. In each case the tumors were enucleated, and in due course a normal pregnancy ensued. F. CAVERS Hpterectomy in the Fourth Month for Large Uterine Myomas ComplicatingPregnancy, DUCUINGAND P. GUILAEM. Fibrome et grossesse; hysterectomie subtotale, Bull. Boo. d’obst. et de gyn6c. 23: 590-592, 1934. During the fourth month of her first pregnancy a woman of thirty-eight was suddenly seized with severe abdominal pain, after she had noticed unduly rapid abdominal enlargement. The pain was followed a week later by vomiting and obstinate constipation. The distended abdomen was rigid and painful on palpation, and there was a hard mass extending from the right of the epigastrium to the pouch of Douglas. At laparotomy this proved to consist of two large fibromyomas, one arising from the fundus of the uterus and the lower from the posterior wall. Between them lay the flattened and deformed uterus containing a dead fetus. Subtotal hysterectomy was done. As the authors point out, these uterine tumors must have been present before pregnancy, though causing no symptoms, and had assumed more rapid growth in early pregnancy. F. CAVERS Large Stalked Uterine Fibromyoma, G. LE FILLIATRE.Gros fibrome pBdicult5 rem- plissant le petit bassin et la region sous-ombilicale, Ann. d’anat. path. 11: 924r926, 1934. A woman of fifty had about fifteen years previously refused operation for a uterine fibroid, which had meanwhile grown so as practically to fill the pelvis and lower half of the abdominal cavity, causing severe symptoms by compression of the intestine, bladder, and ureter. At operation it was necessary to resect the great omentum which 920 ABSTRACTS had become adherent to the enormous tumor. The latter was connected with the left uterine horn by a thick vascular stalk. There is one illustration. F. CAVERS

Luge Fibromyoma of the Uterine Cervix, J. L. LAPEYRNIAND R. I. M. LLAMOZAS. Volumineux fibrome du col utkrin, Bull. SOC.d’obst. et de gyn6c. 24: 33-30, 1935. A woman of thirty-five presented an apparently vaginal tumor, first noticed three years previously and now projecting from the vulva. It was a malodorous, blackish, soft, smooth mass about the sise of a fetal head. Mistaken at first for an inverted uterus, it proved to be a fibromyoma arising from the anterior lip of the cervix. Total hysterectomy was done, in view of the extensive infection, and the sepsis cleared up rapidly after injections of B. coli vaccine. F. CAVER~

Hydramnios in a Fibromatour Uterus, VERMELIN,CHALNOT AND J. LOUYOT. Un cas d’hydramnios dans un uths fibromateux, Bull. SOC.d’obst. et de gynhc. 23: 460- 462, 1934. A woman of thirty-six, who had eight years previously had a myomectomy and ligamentopexy for retroverted myomatous uterus, attended hospital because of morning vomiting and a missed period. The uterus was displaced to the left by a hard mass taken to be a myoma of the right wall. Two months later the patient returned because of rapid abdominal enlargement to the siae of full term pregnancy, with severe epigastric pain. The findings pointed to twin pregnancy complicated by acute hydramnios and by myoma praevia. The hydramnios ruptured spontaneously the day before operation. Total hysterectomy was done, and the diagnosis confirmed. The authors emphasize the dangers of intra-uterine intervention in such cases and the need for immediate radical operation. F. CAVERS Aschheim-Zondek Reaction in the Diagnods of Chorionepithelioma, 0. GR~N~. Beitrag Bur Frage der Diagnose des Chorionepithelioma mslignum, Acts obst. et gynec. Scandinav. 14: 213-231, 1934. The author reports a case of chorionepithelioma in which the clinical and biopsy findings suggested the correct diagnosis, but hysterectomy was postponed for several days becauee the urine contained less than 28,000 mouse units of prolan per liter. For comparison he reports a case of molar abortion in which the tissue obtained by curettage was suspected of being chorionepitheliomatous; the prolan reaction remained negative, and at operation, done on account of continued hemorrhage, the uterus was found to contain a fibromyoma and also a retained piece of placenta showing signs of chorionepitheliomatous change. The author refers to other reported cases in which chorionepithelioma was diagnosed by biopsy and confirmed at operation, though the Aschheim- Zondek reaction was feeble or negative. There are no illustrations. F. CAVERS Comparatively Low Levels of Oeatrin in Cases of Chorionepithelioma and Hydatidiform Mole, GEORGEVAN 8. SMITHAND 0. WATKINSSMITH. Proc. SOC.Exper. Biol. & Med. 32: 847-849, 1935. Although enormous amounts of anterior-pituitary like (A.P.L.) hormone have frequently been described in the blood and urine of patients with hydatidiform mole and chorionepithelioma, the authors have found no published determinations of oestrin in these patients. It has been assumed that the oestrin is high, probably because in pregnancy both hormones are easily demonstrable. The authors have been able to examine the blood and urine of 4 patients with chorionepithelioma, 3 of them males. Though the concentration of A.P.L. was higher than is ever found in normal pregnancy the oestrin content was very low-in fact, not demonstrable without concentration of the specimens by extraction. In a hydatidiform mole, also, there was an excess of A.P.L. and no demonstrable oestrin. Certain findings recorded in the paper might be interpreted as indicating a mutually antagonistic reaction between A.P.L. and oestrin, and lack of the latter in the presence of chorionepithelioma may be due to its inhibition or destruction by the enormous quantities of A.P.L. THE FEMALE GENITAL TRACT 92 1

The data presented indicate that the chorionic cells, when they become neoplastic, do not contain oestrin in amounts comparable with those of the normal placenta. WM. H. WOGLOM

Endometrioma of the Uterine Body, CRARBONNELAND DARMAILLACCJ.Sur un cas d’- endom6triome du corps utkrin, Bull. Soc. d’obst. et de gyn6c. 23: 713-714, 1934. In a woman of thirty-nine with a history of painful dysmenorrhea since the menarche at seventeen the uterus was strongly anteflexed and it and the left adnexa were painful on pressure. At laparotomy there was found on the posterior uterine wall a collection of bluish translucent cysts. Total hysterectomy was done. The cystic tumor was an endometrioma, and the uterine wall contained several small myomas. F. CAVERB Two Cases of Endometriosis Extema Extraperitonealilis, M. NIELSEN. Acts obst. et gynec. Scandinav. 14: 322-335, 1934. One of the endometriomas described by the author occupied the upper part of the vagina and measured about 2 x 1 x 1 cm.; the other was located in the round ligament and was three times this sire. The author discusses some of the theories of origin of endometriosis. He considers Sampson’s as the most reasonable and satisfactory, though it may not explain all cases. F. CAVERB Heterotopic and Metastatic Cortical Suprarenal Tumors in the Female Genital Organs, R. 0. NEUMANN.Nebennierenrinden-Blastome und Interrenalismus, Endokrin- ologie 15: 41-53, 1934. It has long been known that ectopic nodules of suprarenal cortex occur in the ovary and ot,her female genital organs, especially in the first few months of life, becoming increasingly rare towards the onset of puberty. The author has found such ectopic nodules in 8 out of 45 newborn girls in a systematio examination of the sexual organs. Meyer and others have reported persistence and hyperplasia of these nodules in the female organs, especially the ovary, in adults. More frequently metastaees from autoch- thonous cortical suprarenal tumors have been found in these organs. The author has collected from the literature 21 cases of ovarian tumors of this kind, in only 4 of which were there symptoms of virilism. In a fifth case, with marked mesculiniaation which disappeared after ovariectomy, the tumor was diagnosed by one pathologist as a hypernephroma and by a second as a luteinoma, but Neumann considers that it was an atypiaal arrhenoblastoma. He describes two cases of ectopic ovarian hypernephroma not seeociated with virilism. In the first case the tumors occupied both ovaries; in the eecond the primary tumor was also ectopic, being located retroperitoneally behind the cecum, with metastases to the right ovary and tube. For contrast three cases of cortical carcinoma of the suprarenals are reported, two with marked signs of virilism, the third ‘with none. Unfortunately no illustrations are given, and there is no tibli- ompb F. CAVERS Medullary Cords and Cysts and their Relation to Ovarian Tumors, R. JOACHIMOVITS. Markstriinge, Markcysten und Ovarpapillome, Arch. f. Gynilk. 159: 1-11, 1935. From the literature of ovarian embryology and his own examination of early fetuses, the author concludes that the mesenchymal medullary cords (Klllliker) of the ovary disappear entirely after the fourth: month of embryonal life. Yet several writers have attributed the formation of medullary cysts and papillary and other tumors to persistent remains of these cords. Cysts and tumors do occur ia the ovarian medulla, but apparently these develop either from the rete ovarii, which arises quite independently of the transient medullary cords of KBlliker, or from the celomic epithelium. The author found one apparently authentic exception to the general rule that in man the medullary cords do not continue to grow in post-fetal life and give rise to cysts; this was a case reported by Popoff (Arch. Path. 9: 31, 1930). That medullary cysts do arise from ingrowing rete epithelium has been established. The ingrowth of rete canals from the hilus into the medulla, without tumor formation, hse been reperrtedly observed in mrrn, while in many mammals such ingrowth is of 922 ABSTRACTS constant occurrence. Medullary cysts occur chiefly in the ovaries of elderly women, apparently in relation to the fact that the rete shows hypertrophy in old age. The author reports a case in which a cluster of medullary cysts was shown in serial sections to be continuous with the rete. In several cases reported, hypertrophied rete canals occurred at the base of a large cystoma. Again, ingrowth of the celomic germinal epithelium, especially that of the hilus, into the ovarian medulla has been observed. These ingrowths usually become covered by a connective tissue mantle and give rise to cysts. The author reports a case of this kind, in which numerous small medullary cysts and a large papillomatous cyst occurred in the medulla. In discussing mascu- linizing tumors (arrhenoblastomas, etc.) he expresses skepticism of the generally accepted view that these arise from sexually bivalent germ cells, and that they are benign tumors. He calls attention to the interesting tumor described by Taylor, Wolfermann and Krock (Surg., Gynec. & Obst. 56: 1040, 1933. Abet. in Am. J. Cancer 20: 508, 1934), which showed definitely malignant histologic characters, and consisted in part of definitely epithelial cells arranged in cords and tubules. There are eight good photomicrographs. F. CAVERS

Malignant Ovarian Tumonr Complicating hbor and the Puerperium, P. TRILLATAND A. PUTHOD. Tumeurs malignes de l’ovaire et puerpBralit6, GynBc. et obst. 29: 513-525, 1934. Two cases are reported. (1) At full term a large obstructing right ovarian tumor was found in a woman of twenty-two. Cesarean section was done, followed by ovariectomy. A year later the patient returned with abdominal enlargement, and a hard nodular right adnexal mass which on removal proved to be a recurrence of the earlier tumor, and like it was diagnosed as a lymphosarcoma. The histologic account is very scanty and is unillustrated. The patient died six weeks after operation. Necropsy was not permitted. (2) In a woman of twenty-seven twin pregnancy was suspected at first, because of the apparently large size of the uterus in the eighth month, but a few days later a normal single child was delivered, leaving a large bilobed mass and to the left of the uterus. At laparotomy about 10 liters of gelatinous ascitic fluid were evacuated, and a polycystic left ovarian tumor removed. The cysts were lined by columnar cells, some of which were ciliated, and a diagnosis of wolffian carcinoma was therefore made. The after-history is not given. There are four illustrations of the gross specimens. F. CAVER~

Malignant Tumors of the Ovary, the Suprarenal Gland and the Kidney in Children, F. P. MCNAMARA,W. A. HENNEGEHAND 0. C. LYTLE. J. Iowa M. SOC.24: 147-152, 1934. A fourteen-year-old girl complained of colicky pain in the region of the umbilicus and swelling of the abdomen. Four months before admission she had fallen and injured her right side and since that time the menstrual periods had been painful. Examination showed a pelvic tumor extending above the umbilicus. On operative removal this proved to be a carcinoma of the left ovary. Death occurred four years later of metastases, which had at first yielded to radiation therapy. A second child, three years and a half in age, a niece of the first patient, was brought to the hospital for swelling of the abdomen without other symptoms. Examination showed a large tumor in the left upper quadrant. Operation was refused and at autopsy a large neurocytoma of the kidney was found. The third patient, a boy of fourteen months, also showed a large abdominal tumor. It extended from the pelvis to the splenic region and on exploratory operation and subsequent autopsy proved to be a Wilms tumor of the kidney. The authors briefly review the literature in discussing these three cases. Photo- graphs of the gross specimens are included, but no photomicrographs. GRAYTWOMBLY THE FEMALE GENITAL TRACT 923

X-ray and Radium Treatment of Inoperable Ovarian Carcinomas, F. HEIMANN. Die R6ntgen-Radium-Bestrahlung des inoperablen Ovarialkarzinoms, Med. Klin. 30: 198-199, 1934. The intra-uterine application of radium element is strongly advocated as an adjunct to deep x-ray therapy in the treatment of inoperable malignancy of the ovary. Four cases so treated are cited briefly and the author agrees with Vogt (Med. Klin. 29: 1464, 1933. Abst. in Am. J. Cancer 23: 202, 1935) that the results seem much better than with x-ray alone, though no final observations are available. There are no illustrations. THEODORES. RAIFORD Two Cases of Ovarian Tumor (Seminoma, Krubenkerg Tumor) Simulating Pregnancy, LAFFONTAND BONAFOS. Deux cas de tumeurs de l’ovaire ayant simul6 la grossesse, Bull. SOC.d’obst. et de gyn6c. 23: 642-647, 1934. (1) A woman of twenty-one had amenorrhea for seven months and noticed a large, mobile, hard, painless mass in the left lower quadrant, which rapidly grew in size and reached the left flank. During this time she had become extremely weak, emaciated, and dyspneic. At last she called in a physician, who after drawing off 5 liters of ascitia fluid sent her to the hospital. At laparotomy 4 liters of fluid were evacuated and a tumor, which arose from the right ovary, was with difficulty separated from its adhesions to the great omentum, liver, and various parts of the bowel. Numerous enlarged mesenteric and para-aortic lymph nodes were left behind. The patient refused irradiation, strongly advised because a histologic diagnosis of seminoma was made, and left the hospital, only to return four months later in an even more deplorable state than before, with vomiting, diarrhea, cough and right pleural effusion. Two days later she died in a paroxysm of dyspnea. Necropsy showed a large hemorrhagic massh the left flank, with lymph node metastases throughout the abdomen. (2) A woman of thirty-six had amenorrhea for four months, with swelling of the breasts, vomiting, and abdominal enlargement. During this period she had lost considerable weight. A mass was palpated on the left of the uterus, and lipiodol radiography showed that the uterus was empty and the right tube permeable. This left undecided the question whether the tumor was a subserous fibromyoma or a left adnexal pregnancy or tumor. At laparotomy there was found, in addition to abundant ascitic fluid, a hard nodular mass replacing the left ovary, which was removed and diagnosed 88 8 Krukenbetg tumor. Death occurred next day from peritonitis. Necropsy was not permitted. The authors give very scanty histologic reports on the tumors in these two cases, and no illustrations, but their clear statement of the case histories and operative findings seems to justify their diagnosis in each case. F. CAVERS

Dedifferentiated Tumour of the Ovary Associated with Continuous Vaginal Bleeding, D. J. CANNON.Irish J. M. Sc., pp. 314-318, July 1934. The sole symptom presented by the patient, a woman of forty-eight, was metrorrhagia which had begun seven months after the menopause and had continued for five months. Bimanual examination revealed what appeared to be a aystic tumor of the right ovary. At operation it proved to be a solid ovarian tumor and was removed with the uterus. The uterus showed no signs of endometrial hyperplasia. Most of the tumor consisted of undifferentiated cells arranged in bundles. The cytology suggested a granulosa-cell tumor, while the columnar arrangement suggested a resemblance to the suprarenal cortex. Unfortunately no illustrations are given. F. CAVERS Large Leiomyomas of the Ovary, Two Cases, CAILLOT. Deux cas de trAs volumineuses tumeurs solides de l’ovaires (11 et 15 kilogrammes), Bull. SOC.d’obst. et de gyn6c. 24: 55-56, 1935. The author describes two cases which he calls fibromas, but gives the pathologist’s diagnosis as leiomyoma in each case. In neither case was there ascites, and both patiants recovered well after operation. F. CAVERS 924 ABSTBACTS

Ovarian Sarcoma with Widespread Cutaneous and Other Metastases, 0. SCHULZ. Ein bemerkenswerter ‘Fall von H8Utmet88tlrSen eines Sarkoms, Arch. f. Dermat. u. Syph. 170: 676677, 1934. A woman of seventy-four had noticed, three years before, a number of small red nodules on the right thigh, which spread to the trunk, grew in size, and largely became confluent. She w88 much emaciated and died a few days after hospital 8dmiSRiOn. Biopsy of a nodule showed that this consisted entirely of large round cells embedded in a highly vaecular stroma and showing numerous mitoses, suggesting a round-cell sarcoma. At necropey similar nodules were found in the peritoneum and practically all of the abdominal organs. Apparently the primary tumor was that occupying the enlarged right ovary, which showed the same structure as the external and internal nodules. There is one illustration. F. CAVER~

Studies In Tumour Formation, XV. A Foetiform Ovarian Teratoma; XVI. Foetiform Ovarian Teratomata, G. W. NICHOLBON.Guy’s Hosp. Rep. 84: 389-435, 1034; 8s: a-55,1~35. These two papers constitute the 15th and 16th of the author’s well known series of studies in tumor formation (see Abets. in Am. J. Cancer 21: 674, 1934; 23: 138, 1935). The first deals with a museum specimen described by Shattock (Trans. Path. Soc. Lond. 58: 267, 1907) as an acardiac acepha~ousovarian embryoma. As the author remarks, this object, introduced to science as the lower portion of a sexually mature woman, with Vulva, pubic hair, perineal raphe, two legs, one arm and celomic cavity complete, can be explained with equal ease and plausibility (by turning it through 180’) as the anterior end of a man. From the limited histologic examination permitted, the teratoma contained connective tissue, adipose tissue, hyaline cartilage, bone and marrow, and gut epithelium. The so-called vertebral column had no notochord and consisted of 8 fragment of cartilage with centers of ossification. There are twelve illustrations. In the second paper the author analyzes reports in the literature of 15 so-called fetiform ovarian teratomas, 4 of them too briefly described to allow of conclusions regarding their nature. He does not accept fetiformity in any one of these teratomae. “ Today, near the middle of the enlightened twentieth century, human teratology is 8 worthy continuation of Ovid’s Metamorphoses, satisfying the uncon- querable appetite for fairy tales and supported by guesses that in far simpler problems of chemistry or of physics would not be endured. We Catch sight of a pattern or plan, resembling at first sight, but not identified on scientiflc analysis with, the human body, and presenting no internal subjective evidence of orderly somatic evolution, that is, of embryogenesis. We aee similarity in many diaaimilarities. Surely, it is just this repetition of a simple plan-referable in part to elementary physics-that shatters the ‘ fmtal’ idea, 811 superficial suggestions of fmtiformity notwithstanding. Clear thinking is a6 necesaary in pathology &B in ‘ exact ’ science, and it is more than a mere matter of taste whether or not we speak of an object 8s a ‘ fcletus ’ or a manikin, unless we can show that it began life as a potentially independent viable human being.’’ There is one illustration. F. CAVERS

A Plea for More Detailed Study and Recording of Original and Follow-up Specimens of ovdan cysts, 8. B. SOLHAUQ,Journal-Lancet 55: 71-74, 1935. The author briefly reports several cases in which the importance of thorough examination of all patho~ogicalmaterial is emphasized, even when at operation the Ovarian lesion appears definitely benign. Gross specimens should be permanently preserved for poesible later re-examination because of the frequency of instances where 8 presumably benign lesion has later proved to be clinically malignant, with local recurrence, or development of contralateral implantation. JOHN8. LOCKWOOD THE FEMALE GENITAL TRACT 925

Two Cases of Ovarian Dennoids Showing Carcinomatous Change, J. CAILLOTAND N. BOULIOZ.Deux cas de dBgBnBrescence BpithBliomateuse de kystes dermoIdea de l’ovaire, Bull. SOC.d’obst. et de gyn6c. 23: 546-549, 1934. (1) A woman of forty-eight complained of difficulty in defecation and micturition, due to the presence of a tumor situated in the pouch of Douglas and found at operation to be invading the sacrum, sigmoid, rectum, and pelvic soft tissue. Following ad- nexectomy and total hysterectomy the patient’s condition deteriorated, cachexia increasing until death three months later. The cyst contained hair and sebaceous material, and its wall aonsisted of squamous-cell carcinoma. (2) In a patient of eighteen years similar symptoms appeared after loss of weight had been noticed during several months. There was a large subumbilical tumor diagnosed clinically as uterine carcinoma but found at operation to be a left ovarian cyst densely adherent to surrounding organs and removable only in part after subtotal hysterectomy. The part removed contained hairs, teeth, and bone, with squamous carcinoma in its wall. The patient was moribund at the time of reporting. F. CAVERS Bilateral Ovarian Dermoid Cysts Removed at Termination of Pregnancy, E. L~vY- SOLAL,M. SUREAUAND LAURET. A propos d‘un cas de kystes dermoldes ovariens op6r6s au terme de la gestation, Bull. SOC. d’obst. et de gynBc. 23: 613-615, 1934. In a primipara of twenty-five examination at full term showed that the fetal head was out of reach and obstructed by a fixed tumor in the posterior cul de sac. At laparotomy both ovaries were found to be cystic, the left tumor having a long stalk and being lodged in the cul de sac. Succeeeful cesarean section was done, followed by bilateral ovariectomy with conservation of the left tube; the authors refrained from hysterectomy on the ground that there might exist accessory aberrant ovarian tissue such as has been reported ss occurring, though rather exceptionally. The tumors were typical dermoids, containing hair, aartilage, bone, etc. F. CAVBRS

Treatment of Ovarian Cysts During Pregnancy, J. VORONAND A. BROCHIIOR.Quel- ques observations de kyste de l’ovaire et grossease ayant fait I’objet de thbrapeutiques diffbrentes, Bull. SOC.d’obst. et de gyn6c. 23: 528-527, 1934. In the first of the four cases here briefly reported the cystic ovarian tumor was discovered in the fifth month of pregnancy; in the remaining three cases at full term. The subsequent histories were as follows. (1) Cyst removed; pregnancy ended normally at full term. (2) Cyst removed during the eighth month; normal delivery three days later. (3) Cesarean section combined with ovariectomy; good result. (4) Ovariea- tomy, followed next day by normal delivery. F. CAVIRS

Removal of Ovarian Cyst in the Fifth Month of Pregnancy, AUDIBERT,GARIPUY AND E. EBTmNNY. Ablation d‘une kyste ovarique au cinquieme mois de la gestation; accouchement B terme, Bull. SOC.d’obst. et de gyn6o. 23: 606-607, 1934. The large tumor described by the authors had become lodged behind the lower uterine segment, threatening to obstruct labor, and the patient, a primipara of twenty- two, reluctantly agreed to its removal. The baby, born at full term, weighed only three pounds, but throve well. F. CAVERS

Giant Cyst of the Ovary Apparently Arising During Pregnancy, LAFFONTAND BONAFOS. Un cas de kyste &ant de l’ovaire Bvoluant au cours de Is grossease, Bull. SOC.d’obst. et de gynBc. 23: 508-510, 1934. A woman of twenty-seven had been regularly examined during her first pregnancy by a nurse, who reported the onset in the sixth month of colicky pain, rapid enlargement of the uterus, dyspnea, and tachycardia. There was a previous history of malarial infection, and the spleen wm considerably enlarged. The aymptoms were relieved by paracentesis, which yielded 5 liters of thick sscitic fluid, partly greenish and partly ohocolate brown. As the abdomen soon became swollen again and the tachycardia 926 ABSTRACTS and dyspnea returned, laparotomy was done and revealed a huge right ovarian cyst, adherent to practically all the other abdominal organs and giving on puncture 8 liters of chocolate colored fluid. It weighed 7 kilos. Paralytic ileus followed operation, but good recovery took place. What happened about the pregnancy is not stated. F. CAVEHS Ovarian Cyst Compressing the Lower Uterine Segment and Ascending Spontaneously Before Labor, AUDEBERTAND GUILHEM.Kyste de l’ovaire praevia; ascension spontanCe avant le debut du travail; accouchement normal, Bull. SOC. d’obst. et gynbc. 23: 600-601, 1934. During routine prenatal examination of a woman of thirty-five in the seventh month there was felt an obstructing mass projecting from behind the uterus. The patient said that two years previously she had noticed a tumor in the right iliac fossa. Just before the onset of labor the tumor spontaneously ascended and normal delivery ensued. The patient promised to return for treatment of the tumor, but at the time of reporting, a year later, had not done so. F. CAVERB Typhoid Infection of Ovarian Cyst Complicating Pregnancy, CAANG-KENCHI. Chinese M. J. 49: 179-183, 1935. A woman of twenty-one was first seen in the seventh month of pregnancy on account of rapid abdominal enlargement and general debility. Two months before she had had an irregular daily fever for three weeks. The cause of the symptoms was found to be an ovarian cystadenoma which was infected with B. typhosus. The cyst was ruptured during removal and the patient died five days later, presumably of peritonitis. JOHNS. LOCKWOOD Paratyphus Infection of a Corpus Luteum Cyst, R. KAIJSER. Ein Fall von I’araty- phusinfektion einer Corpus luteumzyste, Acta obst. et gynec. Scandinav. 14: 232- 240, 1934. A nullipara of twenty-seven was admitted to hospital with paratyphus B, the bacillus being found in the urine and feces. During her stay she missed a period and a tumor was felt in the left lower abdomen. Soon after her discharge the menses returned and she again became feverhh and was brought back. The swelling was diagnosed as a left ovarian cyst. It was found at operation to be a lutein cyst infected with paratyphus B, though no bacilli were found in the urine, feces, or blood. At operation the cyst burst and a large amount of pus escaped into the peritoneal cavity, but good recovery followed. The author cites other instances from the literature. F. CAVERB Rupture of Ovarian Dermoid Cyst by Torsion of its Stalk, B. I. SEIBILE.Sur la torsion du pedicule des tumeurs kystiques de l’ovaire ii propos d’un cas de rupture par tomion du p6dicule d’un kyste dermoide, Gynbc. et obst. 30: 352-355, 1934. According to the available literature torsion of the pedicle occurs in about one tenth of all ovarian cysts, though a twist through 180’ is usually considered as being within physiologic limits. In somewhat rare cases the tumor becomes detached or ruptured owing to torsion. The author reports a case of the latter kind occurring in a woman of fifty-six. Some of the hairy and sebaceous material of a right ovarian dermoid cyst was found at operation to have been escaped into the peritoneal cavity owing to rupture of the cyst. F. CAVERS

Ovarian Cyst Included in the Broad Ligament, L. DIEULAF~AND R. DIEULAF~.Kyste de l’ovaire inclus dans le ligament large, Bull. SOC.d’obst. et de gyn6c. 23: 603-604, 1934. In a woman of unstated age complaining of metrorrhagia a large, right abdomino- pelvic tumor was palpated and at first diagnosed as a subserous uterine fibroid. Further examination before operation showed it to be cystic and separate from the uterus. Its removal proved difficult, as it was a right ovarian cyst which had burrowed between the layers of the broad ligament and become closely adherent to the tube. F. CAVEHS THE FEMALE QENITAL TRACT 927

Primary Carcinoma of the Vagina, JOHNT. WILLIAMS. New England J. Med. 212: 158-157, 1935. Williams reports having found only 2 cases of undoubted carcinoma of the vagina among the pathological records at the Boston City Hospital from 1906 to 1930. Al- though not stating the exact percentage of incidence which this represents, he feels that the previously reported percentages (0.24 per cent of all carcinomas and 0.43 per cent of all cancer in females) are too high. Cancer of the vagina is always of squamous- cell type; it is believed that the occasional cases of adenocarcinoma reported were probably metastases from uterine lesions. The first of the 2 cases reported was an inoperable growth in a single woman of fifty years, involving the anterior vaginal wall just above the introitus and infiltrating the bladder wall. The uterus was normal. The second patient, treated by the author, was a woman of seventy-two, twenty-two years past the menopause. There was a five weeks’ history of staining. A cauliflower mass on the posterior vaginal wall was excised and 2000 mgm. hrs. of radium applied. Epidermoid carcinoma was found histologically. Three years after the first treatment a dose of 2400 mgm. hrs. of radium was given for a local recurrence. At the time of writing, one year later, the patient appeared free of disease. The average expectancy of five-year cure, as indicated by other reports, is between twelve and seventeen per cent. A third case was seen after submission of the author’s paper for publication. A polypoid tumor arising from the posterior vaginal wall was excised and postoperative radium therapy given (2500 mg-hrs.). JOHNS. LOCKWOOD

Cancer of the Vulva from the Material of the Institute for Neoplastic Disease, Lenin- grad, I. M. GRABEENKO.uber den Krebs der Vulva nach den Materialien des Onkologischen Instituts, Arch. f. Gynlk. 153: 155-165, 1933. Among the 4,152 women admitted to the Polyclinic of the Institute for Neoplastic Diseases, Leningrad, in the course of the last five years, 1,422 had tumors in the genital organs, and of these, 01 had cancer of the vulva. This figure represents 1.5 per cent of the total admissions and 4.3 per cent of the gynecological material. Pruritus vulvae seems to have a causative relation in half the patients, irritating discharges in about 10 per cent, condyloma in slightly less, and eczema in about 2 per cent. In 29 per cent there is no evident cause. The sites were as follows: labia major&, 37; clitoris, 10; labia minors, 7; region of the urethra, 5; perineum, 1; Bartholin’s gland, 1. The cases were clinically divided into four groups: (1) movable tumor without metastases in the lymph nodes, 14 cases; (2) movable tumor with movable glands in the lymph nodes in the groin, 29 cases; (3) fixed tumor with movable nodes in each inguinal region, 4 cases; (4) fixed tumor with fixed nodes in the groin, 14 cases. The two last groups were regarded as hopeless and included one third of the patients. Patients of the first group were treated without removal of the inguinal nodes, treatment being by radium, electro-excision, surgical diathermy, and other methods. Those of the second group were treated by various means, the majority with excision of the inguinal nodes. Of the 14 patients in the first group, 9 are living without recurrence, while of the 18 constituting the second group, following removal of the lymph nodes only 5 are living at various intervals of time. In general the writer believes that surgical treatment is preferable to radiation therapy. For the local lesions it makes little difference whether the scalpel or an electro- surgical apparatus is used except in the badly infected cases, in which coagulation is preferable. For the regional lymph nodes only the most radical scalpel extirpation can give hope of permanent cure. HOWARDC. TAYLOR,JR. 928 ABBTBACTB

THE CENITO-URINARY TRACT Preoperative Irradiation of Massive Tumors of the Kidney, a Clinical and Pathologic Study, L. R. WHARTON.Arch. Surg. 30: 35-51, 1935. The enormous sise of malignant kidney tumors is apt to prevent complete surgical removal and cause a high operative mortality. In order to reduce the sise of these tumors the author advocates a preoperative course of roentgen irradiation. In two cases of Wilms’ tumors and two of hypernephromas, marked reduction in sire of the growths was obtained before operation by this method. The amount of irradiation given is not dated. Histologic study of the tumors after removal showed definite cellular changes such as hyalinication, pyknosis, fragmentation, and destruction of the architecture of the kidney. In no case, however, were the tumor cells completely destroyed. The article is illustrated with photographs, photomicrographs, and pyelograms. BENJAMINR. SHORE Kidney with Four Large Cysts, Causing No Renal Symptoms, J. BEROER. Un cas de grands kystes du rein, Bull. et m6m. SOC.nat de chir. 60: 1029-1034, 1934. A woman of unstated age had twelve years previously noticed a mass in the right hypochondrium, which had gradually grown larger but had given rise to no symptoms apart from a dragging sensation. Tests showed no diminution of right kidney function, and pyelography revealed only slight dilatation of the pelvis and slight outward deviation of the right ureter. The clinical diagnosis was retroperitoneal or omental cyst. The kidney after removal presented a large cyst at both the upper and lower poles, and behind these a right and a left, somewhat smaller cyst. Each of the four cysts had arisen just below the renal capsule. This form of renal cystoma (oligocystic kidney) is intermediate between the more frequent solitary and polycystic types. There is a photograph of the gross operative specimen. F. CAVERS

Large Papillary Carcinoma of Rend Pelvis, E. TRUC,W. ARNALAND J. CADERAS. A propos d’un gros cancer du rein, Arch. Soc. d. so. m6d. et biol. de Montpellier 15: 36-40, 1934. A woman of twenty-four had two years previously noticed a swelling in the right loin, and during the past year had recurrent hematuria. The urine from the right kidney was scanty and deficient in urea and chlorides. Pyelography showed great enlargement and deformation of the pelvis. The right kidney was removed and was found to contain a tumor measuring 17 x 12 x 9 om., histologically a papillary carcinoma. The report was evidently written a few weeks after operation. F. CAVERS Nephrectomy for Papillomas of the Renal Pelvis, with Subsequent Repeated Recurrence of Bladder Papilloxrum, GIULIANI. PapiUomes du bassinet. Nhphrectomie. Disdmination sbcondaire dens la veesie, Lyon m6d. 151: 434-435, 1934. In a man of fifty-five with a history of intermittent painless hematuria for two years, ureteral catheterization showed abundant erythrocytes in the urine from the right kidney, and none from the left. At laparotomy the pelvis of the right kidney was incised and fragments of a villous tumor escaped. Nephrectomy was done, and the pelvis found filled with numerous stalked papillomas, diagnosed histologically as epitheliomatous. Immediately after operation the author regretted not having removed also the entire ureter. Nine months later the patient again had hematuria, and cystoscopy showed a large papilloma near the right ureteral orifice, which was treated byfulguration. During the ensuing two years, up to the time of reporting, the patient had been similarly treated eight times for single or multiple papillomse, in each case occupying the right half of the bladder wall. F. CAVERB Recurrent Pararenal Tumor, G. LABEY. Tumeur paran6phr6tique rdcidivbe, Bull. et m6m. SOC.nat. de chir. 60: 1149-1150, 1934. A woman of sixty-four had six years previously had a tumor removed, together with the left kidney, to which it was adherent. This tumor was diagnosed histologically as a THE OENITO-URINARY TRACT 929 pararenal lipotibroma. Recently a mass had been noticed in the same region and had grown rapidly in sise, causing slight pain and a dragging sensation. By palpation the mmcould be separated into a large upper and a small lower portion, apparently quite distinct. This finding was confirmed at operation, when two encapsulated tumors were enucleated. The larger tumor was diagnosed as lipofibroma; the smaller one showed markedly malignant features (lipofibrosarcoma). The author comments on the tendency of these pararenal tumors to undergo malignant change. F. CAVERR Partial Longitudinal Resection of Inferior Venn Cava in Removal of a Pararenal Tumor, A. GOSSET. b5section partielle longitudinale de la veine cave infhneure au coum de l’ablation d’une tumeur pararhnale droit, Compt. rend. Acad. d. sc. 200: 501-502, 1935. In operating on a woman of unstated age for a right pararenal tumor, the latter was found to be intimately adherent to the right side of the vena cava, below the renal vein, for a length of about 3 cm. The author resected this portion of the wall of the vein ~ongitudinally,removed it with the tumor, and sutured the rent, the patient making a good recovery. The tumor is not described further. F. CAVERS

Cancer of the Bladder, M. L. BOYD. J. M. A. Georgia 23: 378-383, 1934. Boyd emphasizes the necessity of cystoscopic examination in all cases of unexplained hematuria, for early diagnosis of bladder cancer, and places the responsibility upon both the patient and the family physician, the first for reporting his symptoms at once and the second for referring the patient to a competent urologist. The following therapeutic meeaures are suggested : (1) Deep x-ray therapy may be used in repeated courses regard- 1- of the type and sine of the growth. (2) Transurethral treatment is applicable to the smaller, less malignant types of papillary carcinoma, especially those of villous character. This usually consists in electrocoagulation followed by the implantation of radon seeds, the dosage depending upon the size and type of the tumor. (3) Treatment through a suprapubic cystotomy approach should be employed if the efficacy of the transurethral method is doubtful, especially when the tumor is resistant to radium, when its extent is not certain, and when it is so situated that removal can be carried out with relative safety. If resection seems inadvisable, excision by electrocoagulation to the level of the mucosa is followed by implantation of radon seeds in the base. (4) Radical resection of the bladder, including one of the ureteral orifices, should be done if the growth is not radiosensitive and provided there are no demonstrable metastases. With this procedure a ten-year survival can be expected if a local cure is obtained. (5) Total cystec- tomy preceded by nephrostomy is indicated if the involvement of the viscus is extensive but limited to it. The patient, however, should be of such age that his life expectancy is at leaet five years. (6) Double nephrostomy or nephrostomy with unilateral nephrectomy.ehould be done when the growth is extensive and incurable and palliation may be obtained by diverting the course of the urine. The efficacy of radium and x-ray depends almost entirely upon the sensitivity of the malignant cell, but it,s use should never be omitted in tumors of doubtful or definite malignancy. The best result.s, in the author’s experience, have been accomplished by radical resection. There are two illustrations of cystoscopes recommended by the author. THEODORES. RAIFORD Report of a Previously Published Care of Endometrioeie of the Urinary Bladder, F. SETTEROREN. Act8 chir. Scandinav. 75: 57&575, 1934. In reporting a case of vesical endometriosis (Acts chir. Scandinav. 73: 312, 1933) the author was unable to determine whether this condition was primary or had arisen in the uterus and invaded the bladder. Following operation the patient still complained of painful dysmenorrhea. Laparotomy was then done, and an apparently recurrent tumor of the posterior bladder wall was found to be closely adherent to the right tube and ovary. These organs were removed, together with the tumor in the bladder wall. The latter was endometriomatous, but no trace of such structure was found in the tube 930 ABGTRACTG or ovary. The author concludes that the bladder tumor was primary and had recurred owing to incomplete removal. At the time of reporting the patient was free from symptoms. The author does not cite the literature of vesical endometriosis, a useful and critical, though incomplete, review of which was given recently by Haselhorst (Zentralbl. f. Cyniik. 57: 3021, 1933. Abst. in Am. J. Cancer 23: 908, 1935). There are two illustrations. F. CAVERS

Fibroma of the Urinary Bladder, A. TRABUCCO.Fibrome du col vbsical, J. d’urol. 38: 43b441, 1934. The author reports a case to illustrate the well known fact that a benign tumor may by its mechanical obstructive action cause death. A man of sixty-nine was brought to the hospital in a semicomatose state. For some years he had had difficulty in urination, and catheterization had been necessary during the paat eight months. He died in coma on the third day, and necropsy revealed bilateral obstructive hydronephrosis due to the presence of a number of hard fibromas occupying the neck of the bladder. There are four photomicrographs. F. CAVERS

Some Urological Cases. Case 3 :Prostatic Hypertrophy and Neoplasm of the Bladder, G. M. W. CLEMONS.M. J. Australia2: 153, 1934. A man of seventy-eight had begun three years before to have dysuria with occasional hematuria. Latterly there had been daily hematuria. On suprapubic cystotomy the prostate was found to be hypertrophied and a sessile tumor was discovered in the right side of the bladder wall. The tumor was destroyed by the cautery loop; no mention is made of biopsy. At the time of reporting the hematuria had ceased. F. CAVERf3

Cancer of the Penis, C. LENORMANT.Sur le cancer de la verge, Presse m6d. 42: 723-726, 1934. A long text-book discussion of the incidence, etiology and treatment of cancer of the penis is presented, largely abstracted from the literature. The treatment recommended is amputation of the penis, with subsequent bilateral inguinal node dissection and supplementary x-ray therapy. JOHNS. LOCKWOOD

Fibrosarcoma of the Spermatic Cord, T. SORDINA.Fibrosarcome du cordon spermati- que, J. d’urol. 38: 433-434, 1934. A tumor, diagnosed by the pathologist as a spindle-cell sarcoma, was removed from the right spermatic cord of a youth of twenty. There was no history of trauma. There is one illustration. [The best recent account of spermatic cord tumors is that by Mackeiizie and Ratner (Abst. in Am. J. Cancer 21: 224, 1934), who found nearly 200 cases in the available literature.] F. CAVERS

Seminomas of the Testicle and Ovary, A. B~CL~RE.Le s6minome du testicule et le shminome de I’ovaire, Presse med. 42: 1513-1516, 1934. For an abstract of this general review on embryonal tumors of the testicle and ovary, as it appeared elsewhere in German, see Am. J. Cancer 23: 920, 1935.

Nature of the Gonadotropic Hormone Found in the Urine of a Case of Teratoma Testis, R. J. MAINAND S. L. LEONARD.Endocrinology 18: 629-632, 1934. Concentrated specimens of urine from a man with a testicular teratoma were injected into immature female rats. Indefinite enlargement of the ovaries, increasing proportionately to the amount of urine injected, was not produced. In this the effect was similar to that observed following injections of urine from pregnant patients. It differed from that in pregnant patients in that follicular, but not corpus luteum, stimula- tion resulted. BENJAMINR. SHORE THE SUPRARENAL GLANDS 93 1

THE SUPRARENAL GLANDS Alteration of the Secondary Sentat Characteristics Associated with Cortical Adrenal Tumors, B. PITROLFFY-SZAB~.Uber die mit den Verlinderungen der sekundiiren Geschlechtsmerkmale zusammenhangenden Nebennierenrindengeschwtilste, Arch. f. klin. Chir. 181: 54g553, 1935. The author reports the case of a girl of three and a half years in whom deepening of the voice and an abnormal growth of body hair were the prominent clinical symptoms. She died following an exploratory laparotomy for a large inoperable tumor of the right adrenal gland. This growth, removed at autopsy, weighed 770 grams and measured 17 x 13 x 6 cm. Histologic study showed it to be a typical hypernephroma. The article is illustrated with photographs of the patient and gross specimen and a photomicrograph. BENJAMINR. SHORE

Successful Removal of Adrenal Cortical Tumor Causing Sexual Precocity in a Boy Five Years of Age, H. LISSER. Tr. A. Am. Physicians 48: 224-235, 1933. The author reports the case of a five-year-old boy in whom precocious development of the penis, testes, and scrotum were noticed at the age of eighteen months. Pubic hair appeared at three years of age. Roentgenographic study of the kidneys showed a marked deformity of the left upper pole which confirmed the clinical diagnosis of cortical adrenal tumor. At operation an encapsulated tumor of the left adrenal gland measuring 7.5 x 9 cm. and weighing 278 gm. was removed. Histologic study showed it to be a rapidly growing adenoma of the adrenal cortex. The boy was well eighteen months after operation but no marked transformation in regard to the development of the genitals had taken place. The axillary hair had vanished and the moustache and pubic hair had thinned somewhat. The article is illustrated with a photograph of the patient before operation and a photograph of the gross specimen. BENJAMINR. SHORE

Pluriglandular Syndrome Associated with Carcinoma of the Right Suprarenal Gland, I. F. VOLINIAND G. F. O’BRIEN. Med. Clin. North America 18: 1367-1‘376, 1935. A laborer of twenty-three entered the hoRpital complaining of pain in the back and weakness. Eight months before entry he had noticed a long reddish stria on the right side of the abdomen, just above the inguinal ligament. A month later the abdomen began to swell, and the chest and shoulders, as well as the face, began to fill out. More striae appeared and the face grew red. The pain in the back began six months before entry and gradually extended to the entire spine. The patient became very weak. Btriae appeared in the axillary regions, arms, and thighs. Examination showed cardiac enlargement, a blood pressure of 205/140, and a large retroperitoneal tumor in the right upper quadrant. Cystoscopy revealed a chronic cystitis; renal function was normal; pyelograms showed normal pelves with displacement downward of the right kidney by the tumor. The blood calcium was 12.2 mg., phosphorus 3 mg. There was decreased sugar tolerance. Roentgenograms showed marked osteoporosis of the vertebrae and calcification in the tumor mass. The patient was shorter and heavier than normal and gave a history of early hirsutism, having started to shave at the age of twelve. Erec- tions and libido were always subnormal. A suprarenal tumor measuring 12 x 12 x 5.5. cm. was removed at operation, during the course of which the patient died. Micro- scopically it was made up of cells resembling the cortical cells of the adrenal. The clinical picture is identical with that reported as occurring in basophilic adenomata of the pituitary. It has been shown to accompany adrenal tumors in seven cases reported from the Mayo Clinic. GRAYH. TWOMBLY

Paroxysmal Arterial Hypertension Associated with Tumors of the Suprarenal, M. LABBE. L’hypertension artbrielle paroxystique d’origine surrbnale, Bull. et m6m. SOC.m6d. d. h8p. de Paris 50: 1535-1537, 1934. The author summarizes three recent case reports on patients whom he had the opportunity of keeping under observation. In these cases, as in others found in the 932 ABSTRACTS literature, there were signs of arteriosclerosis and of renal lesions. It is pointed out that arterial hypertension may be associated with either cortical or medullary suprarenal tumors. Several other short papers follow this, in which the etiology of arterial hypertension in general is discussed. F. CAVERB THE NERVOUS SYSTEM

Clinical Consideration of Brain Tumors, R. G. SPURLINOAND F. JELSMA., Kentucky M. J. 32: 348-358, 1934. This is a general discussion of the diagnosis and treatment of brain tumors. The histories of nine patients are included. There are no illustrations. BENJAMINR. SHORE Euly Signs and Symptom of Brain Tumor, P. C. BUCY. Surg. Clin. North America 14: 909-918, 1934. The author reports the histories of four patients to illustrate the fact that certain symptoms should always arouse suspicion of an intracranial neoplasm. All patients presenting evidence of a progressively increasing defect of nervous function, all persons who experience a convulsive seiaure for the first time in adult life, and all individuals who suffer from unexplained vomiting, recurring headaches of increasing severity and frequency, or gradually failing vision should be suspected of harboring a brain tumor until thorough investigation establishes another cause for their complaints or definitely rules out the possibility of an intracranial neoplasm. BENJAMINR. SHOR'E Some Ophthalmological Aspects of Brain Tumors, F. H. NEWTON. Tri-State M. J. 5: 1164-1167, 1933. The writer reviews the course of the visual pathway from the retina to the occipital lobe. From the retina, the fibers pass back through the optic chiasm, at which point they partly cross; passing back from the chiasm they lead to the primary optic reception centers: the pulvinar of the thalamus, the superior colliculus or anterior quadrigeminal body, and the external geniculate body. Of these three stations, the external geniculate body is the great relay point. The great mass of optic fibers terminate in it and it gives rise to the optic radiation. It is divided into dorsal and ventral nuclei, the latter in tho course of phylogenesis dwindling almost to. insignificance. From the dorsal nucleus the fibers spread out to form the stalk of the optic radiation and sweep forward to form the temporal knee. They then extend dorsalward to be distributed in the area striata and calcarine region of the occipital cortex. The upper, outer, retinal quadrant is projected in the upper, outer segment of the optic nerve, upper part of the chiasm, medio-dorsal part of the optic tract, medial horn of the dorsal nucleus of the external (lateral) geniculate, the upper third of the optic radiation to the dorsal part of the area striata. The medial foveal fibers cross intermediately in the chiasm to seek homologous relationship with the temporal foveal fibers of the opposite side. Serial concentric aones of retina from the macula to the periphery are probably represented in order from behind forward in the visual cortex. It may be said that, although the general course and cortical representation of central connections of the visual pathways are known, most of the finer points regarding the neuro-anatomy of these connections are still surrounded with some uncertainty. Blurring of the optic nerve heads is usually first manifested on the upper and lower margins of the disc. The change later extends to the sides. With increased intracranial pressure the earliest objective finding is usually fullness and tortuosity of the retinal veins. When there is disturbance of vision, it is usually gradual in onset, the earliest complaint being blurring at intervals. Papilledema is due to a mechanical increase in the pressure of the cerebrospinal fluid which blocks the lymphatic channels surrounding the central artery of the retina. With increased intracranial pressure the venoua and lymph passages about the nerve are more or less obstructed. The nerve fibers at the disc are more loosely held together than those just beyond the disc, where the fibers of MUIler hold them more compactly together. This helps to explain why the edema THE NERVOUS SYSTEM 933

does not extend out into the retina. It is essential to distinguish between papilledema and papillitis. With papillitis vision is quickly reduced and out of proportion to the 8Welling. In papilledema veins are enlarged but arteries remain small. Enlargement of tbe blind spot occurs in either condition, but is always greater with papillitis. A central scotoma with diminution of light: sense is more characteristic of papillitis. The optic nerves are more often affected by toxic and inflammatory processes than by tumor. Neoplasm affecting the optic pathway is most commonly at the optic chiasm or in the temporal lobe. Chiasma1 tumors include pituitary adenomss, suprasellar Cysb, and meningiomas. The typical field defect is a bitemporal hemi8nOpSi8, but other changes are possible. Sparing of the fixation area in suprageniculate lesions is more marked the farther back the lesion. With basal frontal tumors there may be Ch8raCteriStiC eye findings. With a unilateral lesion there is a homolateral central scotoma. There may be optic atrophy or papilledema with contralateral normal vision and papilledema. Psychic disturbances with unilateral failure of vision and possibly exophthalmos suggest a frontal tumor. Meningioma arising from the anterior fossa may produce homolateral optic atrophy, contralateral papilledema, anosmia, and papil- ]edema of the opposite nerve head. With the suprasellar cyst there are bitemporal hemianopsia, optic atrophy, and an unchanged sells (roentgenographical~y). Tumor ansing from the sheath of the optic nerve may cause unilateral optic atrophy, central scotoma, and contralateral papilledema. Glioma of the chilrsm produces irregular vhual field defects and optic atrophy. The ocular syndrome caused by a temporal lobe tumor often consists of bilateral papilledema and homonymous quadrantic defects for form and color, but good visual acuity. Cushing believes that a temporal lobe tumor is more likely to produce homonymous quadrant defects, while lesions posterior to the temporal lobe are more likely to cause a complete vertical homonymous he- mianopia. In general, qualitative perimetry, with test objects of different size, is more valuable than quantitative or color perimetry. Visual hallucinations of formed type are most likely to be due to a lesion in the anterior part of the occipital lobe, Most occipital lobe tumors produce a contralateral homonymous visual field defect. Convulsive seizures are rather frequent in such cases, and in 10 per cent the seizures are preceded by a visual aura. Tumors involving the parietal lobes do not commonly produce visual symptoms, but rather, motor signs. Occeeionally, however, a low parietal lobe lesion may cause an homonymous field defeot varying from impairment of a quadrant to a complete hemianopsia. EDWINM. DEERY

Dhgnods of Intracranial Tumour, F. J. NATTRASS.Newcastle M. J. 14: 107-114, 1934. A general discussion, containing nothing new. F. CAVERE Dlynodr of Intracrd Tumour, H. G. GARLAND.Brit. M. J. 2: 346-348, 1934. In 3633 necropsies at the beds Infirmary in which the brain wss examined there were 264 cases (1.34 per cent) of intracranial, neoplasm. Analysis of this post-mortem material, covering two years, shows that a mass inside the skull (including sbsmsses, tuberculomaa, meningitis, etc., in addition to neoplasms) was almost as frequent as cancer of the stomach or the colon, and that 66 per cent of the intracranial masses were neoplaems. F. CAVERS Study of the Ventriculognms in Ninety-Seven Cases of Ved5ed Intrrcrlaial Tumors, C. PILCHERAND H. M. WILSON. Surg. Gynec. & Obst. 58: 995-1006, 1934. Ventriculograms in 97 cases of verified intracranial tumors have been studied with especial reference to the value of this diagnostic procedure in the localization of intracranial lesions. There were 26 tumors of the frontal, 12 of the parietal, 16 of the temporal lobes, 5 in the suprasellar region, 12 in the pineal region, and 26 in the posterior f0Ssa. In each case the region specified is that in which the greater portion of the tumor W8a located. The csses are classified as “ positive,” ‘‘ intermediate,” or “ misleading ” on the basis of interpretation of ventriculograms alone and without consideration of the 934 ABSTRACTS

clinical findings. By " positive '' is meant that the approximate location of the lesion could be definitely determined from the examination of the films alone; the term " intermediate " is applied to those cases in which the findings were abnormal but the location wan not definitely indicated; while under " misleading " are placed those cases in which the ventriculographic findings indicated an idcorrect location of the lesion or in which normal ventricular outlines were found even though a space-occupying lesion was subsequently proved to exist. Positive ventriculograms were obtained in 22 of the 26 frontal lobe cases, in 9 of the parietal lobe cases, in 14 of the temporal lobe cases, in 3 of the suprasellar cases, in 9 of the cases with tumors in the pineal region, and in 20 of the 26 cases with tumors in the posterior fossa. Of tho entire group of 97 cases, in 18 the ventriculograms failed to indicate the approximate location of the growth. How- ever, it cannot be emphasired too strongly that pneumoventriculography is only an adjunct to neurologic diagnosis, though as such it may prove of inestimable value. The article is illustrated by ventriculogams. BENJAMINR. SHORE Two Cases of Tumor Cerebri in Regio Thaldca, Diagnosed by Filling the Third Ventricle and the Aqueduct with Lipiodol, B. LINDBORQ.Acts psychiat. et neurol. 9: 67-84, 1934. (1) A girl of twenty-one had during the past four years shown symptoms of motor excitement and mental dullness, with general edema. She had never menstruated, and the genitalia were infantile. The temperature chart showed alternating hyper- and hypothermia. X-rays showed suprasellar calcification, but the positive symptoms and the absence of chiasmal disturbance suggested a diagnosis of calcified glioma of the hypothalamic region. This seemed to be favored by the observation of a filling defect in the anterior part of the third ventricle after lipiodol filling, but at operation no tumor was found. (2) In a boy of eleven there had developed, over a period of two years, hemi paresis and adiposogenital dystrophy. The sella was extremely small. Here also the lipiodol findings seemed to indicate the presence of an expansive process in the thalamic region, but, as in the first case, the diagnosis lacked confirmation, because the boy was discharged as inoperable, died at home two months later, and no necropsy was made. The interesting point in this report is that it represents one of the few applications of the lipiodol filling method so far made in Sweden in the diagnosis of intracranial tumors. Five roentgenograms are given. F. CAVESS

Arteriography and Encephalo-arteriography, W. LSHRAND W.JACOBI. Die Arteriog- raphie und die kombinierte Enzephalarteriographie, Fortschr. a. d. Geb. d. Riint- genstrahlen 40: 385-397, 1933. This is chiefly a review and discussion of the work of Egas Moniz in the radiographic demonstration of intracranial blood vessels by the use of thorotrast. Some 37 illustrations show the intracranisl blood vessels thus visualized in cases of cerebral arterin- sclerosis, blood vessel malformations, idiocy, hydrocephalus, purulent meningitis, abscess of the brain, and some of the intracranial tumors. Among the latter are cases of glioma, suprasellar cyst, congenital cysts of the third ventricle, spongioblastoma multiforme, sarcoma, meningioma, and cholesteatoma. Chief among the changes to be recognized in intracranial blood vessels by arteriography are reduction or increase in caliber and deviations from the normal course produced by direct or indirect pressure of a tumor. Some tumors, notably the meningiomas, have characteristically an unusually generous blood supply. This is shown radio- graphically by an increase and enlargement of the vessels in the immediate location of the lesion and in an increased blood supply to the adjacent dura and overlying bone. Blood vessel anomalies are usually readily recognized by arteriography. The abundant, abnormal vascular channels, when visualized by thorotrast, present a characteristic appearance. Such lesions not infrequently are partly thrombosed, partly calcified. EDWINM. DEERY THE NERVOUS SYSTEM 935

Diagnosis of Basd Brain Tumors, H. HOFF. Diagnostik der Tumoren der Hirnbasis, Wien. klin. Wchnschr. 47: 1176-1 177, 1934. This is a general discussion of the diagnosis of tumors situated at the base of the brain. No new material is contributed. BENJAMINR. SHORE

Neurinomas of the Base of the Brain, D. PAULIANAND J. BIBTRICEANO.Contribution B l’btude histo-pathologique des neurinomes de la base du cerveau, Ann. de mbd. 36: 147-156, 1934. Two cases of neurinoma at the base of the brain are reported, in which death occurred shortly after operation. The first patient, a woman of fifty-seven, had symptoms pointing to a right cerebellopontile angle tumor; on removal this was found to have no capsule. In the second patient, a man of twenty-four, with similar symptoms, the tumor found at operation occupied the right ‘I frontocerebellar ” region. In both instances the tumor had developed primarily in one or more of the cranial nerves (not specified in the second case) and had invaded the brain secondarily. The tumors consisted of dense cellular layers separated by collagenous fibers, and only a few gliocytes were found. The authors believe that these tumors are essentially derived from the sheaths of the cranial nerve roots and are most accurately described simply as neurinomas, according to the American usage, and not to be included in any subclass of the gliomas, as suggested by some French writers. Their findings favor the view that such tumors are neither true schwannomas nor astrocytomas, since the nerve sheaths from which they arise are composed of fibroblasts and not elements of neuro-ectodermal origin. There are ten illustrations. F CAVERE

Frontal Lobe Lesions with Cerebellar Manifestations, A. GORDON.J. Nerv. & Ment. Dis. 79: 411-422, 1934. The author reports the histories of five patients in whom cerebellar manifestions ,were evident but in whom the lesions at autopsy were found to be limited to the frontal lobes. - These cases indicate that the frontal region of the cerebrum contains a center for equilibrium and orientation and that when the cellular elements of this center are involved, even in a small degree, the fronto-ponto-cerebellar pathway originating here is functionally disturbed and ataxic manifestations simulating those of primary cerebellar disorders are produced. From the standpoint of differential diagnosis, a bilateral irregular distribution of cerebellar phenomena may be of considerable assistance in localiaing the original lesion in the frontal area of the brain. Strict unilaterality of mor- bid oerebellar manifestations is in favor of cerebellar lesions. The article is illustrated with photographs of gross specimens BENJAMINR. SHORE Thirty-five Cases of Cerebellopontile Angle Tumors; Pathologico-anatomical and Histological Examinations, P. WINDFELD.Acta path. et microbiol. Scandinav. 11 : 146-173, 1934. Five of the 35 cerebellopontine angle tumors reported by Windfeld were anatomically and histologically meningiomas, 3 being diagnosed as endotheliomas and 2 as psam- mosarcomas. The remaining 30 were anatomically acusticus tumors, the histologic diagnoses being as follows: gliomas or gliosarcomas 13, neurofibromas 8, fibrosarcomas 9. The author discusses the apparently irreconcilable divergences of interpretation which have recently arisen between the French and the American schools of neurology concerning the origin and nature of tumors in this region and of the meningeal tumors. The apparently simple question whether the schwannian sheath or, rather, the nuclei of Schwann, and the meninges are of neuro-ectodermal or of mesenchymal origin is one on which embryologists are not even yet in agreement. In any cases it seems fairly clear that neurinomas and meningiomas are closely related histologically, and the author prefers provisionally using the former term for all acusticus tumors and the latter for all meningeal tumors. There are eight good photomicrographs. F. CAVERE 936 ABSTRACTS

Further Remark8 on the Histopthology of Cerebral Gliomata, K. SCHAFFER.Weitere Bemerkungen iur Histopathologie des Hirnglioms, Beitr. a. path. Anat. u. 8. allg. Path. 92: 198-209, 1933. General remarks on the subject of gliomas of the brain and their classification, which for the most part reflect the generally accepted points of view. The writer urges that currently used clwifications are needlessly complicated. In his discussions of cell morphology he places considerable emphasis upon the nucleo-plasma relation and its significance. An excess activity on the part of the cell nucleus may result in neoplasia. An excess on the part of the cell body but not of the nucleus results in the formation of the mast glia. This is not a proliferative reaction but rather a response to irritation. The writer does not believe that the cells called microglia are of glial nature, and these elements should not be classified with neuroglia. EDWINM. DEMRY Tumors of the Brain from the Surgical Standpoint, W. McK. CRAIG. Minnesota Med. 17: 241-244, 1934. This is a general discussion concerning the surgical treatment of brain tumors. The histories of eight illustrative cases are included. There are no illustrations. BENJAMINR. SHORE

Operability of Brain Tumors, A. W. ADSON. Ann. Surg. 100: 241-265, 1934. The present study concerning the operability of brain tumors was undertaken to emphasize the fact that the surgical treatment of these lesions is far from a worthless procedure. During the eighteen months from April 1931 to September 1933, 220 patients with brain tumors were operated on at the Mayo Clinic. In 167 cases the situation of the tumor was verified, while in 53 cases it was unverified, even though the clinical and surgical findings suggested a subcortical tumor. The growth was removed completely in 19, or 8.6 per cent, and subtotally in 109, or 49.5 per cent, of the cases, the term subtotal removal being applied to all cases in which there remained any possibility of tumor cells having been left. This latter group included 32 pituitary tumors and 19 neuromas of the acoustic nerve. Seventy per cent of the tumors were situated above and 30 per cent below the tentorium. Forty-five per cent were encapsulated and 31 per cent were infiltrating tumors; 24 per cent remained unverified. Of the encapsulated tumors, 15 per cent were meningiomas, 8.6 per cent neuromas, and 14 per cent pituitary tumors. Although total and subtotal removal of the tumors was limited to 58.1 per cent of the cases, temporary relief of intracranial pressure by decompression, with supplementary relief from radiotherapy, diminished the symptoms and prolonged the life of additional patients with inoperable growths. The surgical technic for the removal of the various types of intracranial tumors is described in detail. Drawings and photographs illustrate the article. BENJAMINR. SHORE

Veri5ed Brain Tumors: End Results of 149 Cases Eight Years after Operation, W. P. VANWAGENEN. J. A. M. A. 102: 1454-1458, 1934. The author has studied the end-results obtained in 149 patients with histologically studied brain tumors eight years after the surgical removal of these growths. There were 80 gliomas, 26 pituitary adenomas, 16 cerebromeningiomas, 11 acoustic neuromas, 6 congenital cysts, 4 metastatic carcinomas, 4 blood vessel tumors, 1 pinealoma, and 1 heterotopia of the cerebellum. The 80 patients with the gliomas lived an average of 38.8 months after operation, while the period of useful activity of this group was estimated to be 24.4 months. In the group of 59 encapsulated growths and 4 cases of blood vessel tumors the average survival period was 76.4 months and the period of useful activity was 59.3 months. The 4 patients with metastatic brain tumors lived for an average of thirteen months after operation and the patient with a congenital heterotopia of the cerebellum has lived for eight years. BENJAMINR SHORE TEE NERVOUS SYSTEM 937 lstrtistics of 175 Operated htr.crmirl Tumor$. L. B~RIEL.L. DESGOUTTESAND A. RICARD. A pripos de 175 tumeurs c6r6brales opdrdes, Lyon m6d. 153: 373-380, 1934. Most of the authors’ 175 cases of intracranial neoplasms, all histologically examined, were operated upon during the period 1920 to 1932. Not until 1930 was ventriculography used in diagnosis. The great majority (136) of the series were gliomas, 17 were meningiomas, and the remainder comprised 14 cerebellopontile angle tumors, 3 adenomas of the hypophysis, and 6 tumors in other sites. Of the 138 gliomas, 94 were of rapidly growing and 42 of slow-growing types. The authors give no cure statistics, but state that they found the meningiomas the easiest to remove completely, while the slow- growing gliomas, especially those in the posterior fossa (chiefly astrocytomas and oligoden- drogliomss) gave the best postoperative results. F. CAVERS Four Cases of Successful Removal of Tumors of the Brain, F. C. GRANT. Burg. Clin. North America 14: 97-116, 1934. The author reports four cases in which successful surgical removal of intracranial tumors was accomplished. These included one meningioma, one cystic glioma of the right parietal lobe, one tumor arising in the pituitary fossa and involving the optic nerves, and one acoustic neuroma. The article is illustrated with photographs and roentgenograms. BENJAMINR. SHORE What is to be Learned from American Neurologic Surgeons? B. SCHLEBINQER.Was k6nnen wir von den amerikanischen Neurochirurgen lernen? Wien. klin. Wchnschr. 47: 970-976, 1934. This is a general deRcription of the methods of diagnosis and treatment formerly used by Cushing in his neurosurgical clinic in Boston. The writer believes that the methods of operating and the highly efficient technic there displayed could be profitably atudied by German neurosurgeons. BENJAMINR. SAORXO Brain Tumors, C. MAYER. Zur Klinik und Anatomie der Hirntumoren, Nervenarst 7: 105-112, 1934. The author reports the cases of two patients in whom parasagittal meningiomas were euoceesfully removed. In the third case reported an internal hydrocephalus was caused by an infiltrating tumor of the cerebellum. The article is illustrated with two photographs of cut sections of the brain from the last case. BENJAMINR. SHOREI Paradoxical Symptoms in Right Temporal Lobe Tumor, L. STONE. J. Nerv. & M8nt. Dis. 79: 1-13, 1934. A fifty-two-year-old man gave a history of homolateral visual hallucinations and aphasia in the presence of right handedness. Similar symptoms had been observed thirty years before the final illness. Death followed surgical removal of an encapsulated tumor situated in the substance of the right temporal lobe. The article is illustrated with roentgenograms and a photograph of a cut section of the brain. BENJAMINR. SHORE Central Brain Tumors, G. B. GRUBER. Zur Lehre von den sentralen Hirngeschwlilsten, Wien. med. Wchnschr. 84: 386-388, 1934. The author reports the autopsy findings of a nineteen-year-old patient who died with a central brain tumor of uncertain histologic classification. There are no illustra- tione. BENJAMINR. SHORE

Cue of Cerebellar Wedulloblastoma with Unusually Rapid Development of Symptom, B. POMM~AND H. GERMAIN.Tumeur c6r6belleuse. Manifestations oculaires et otitiques, Lyon m6d. 1%: 448-454, 1934. Three weeks before being brought to the authors’ clinic, a man of unstated age had vomiting and violent headache. At the hospital he attended there were detected only 938 ABSTRACTS slight nystagmus and slight disturbances of equilibrium; there was no papilledema. The patient was deeply somnolent, and the optic and vestibular nerve disturbances pointed to a diagnosis of tumor in the right half of the posterior fossa. This was confirmed by ventriculography, and operation was done at once. On raising an osteo- plastic flap the dura covering the right cerebellar lobe was found to be tense and bulging, and at this point the pulse and the arterial pressure became so low that further intervention was postponed. Next day high fever set in, and death occurred on the third day. Necropsy showed a tumor, the size of an orange, infiltrating the right cerebellar lobe; it was of gelatinous consistence and contained no cysts. The histologic diagnosis was medulloblastoma. There are no illustrations. F. CAVEHS

Cerebellar Metastasis from a Suprarenal Carcinoma, M. LAMY,G. ARNAUDAND E. BERTHET. A propos d’un cas de surrbnalome A symptomatologie cbrbbrale, Lyon mbd. 154: 205-209, 1934. A man of forty was admitted to the hospital in a feverish and somnolent condition. During the preceding two weeks he had complained of epigastric pain and violent headache and had frequently vomited. The urine contained no albumin or sugar, lumbar puncture revealed nothing abnormal, and neurologic examination was negative except for transient right nystagmus. Death occurred next day. At necropsy a brown friable tumor was found almost filling the right cerebellar hemisphere; the aqueduct and ventricles were dilated and contained brown fluid; there was a large mass replacing the left suprarenal, and similar nodules were present in the left kidney, pancreas, left lung, and tracheobronchial nodes. The left suprarenal mass showed no remains of normal tissue. It was largely necrotic; the tumor cells were mostly arranged irregularly but in places were disposed around the blood vessels. The nuclei were large and irregular, the cytoplasm abundant and vacuolated. The tumor gave the general impression of a cortical carcinoma; histologically the various metastases showed the 8ame structure. There is one illustration. F. CAVEHS

Cyotic Hemangioma of the Cerebellum, with Dislocation of Fragments of Cerebellar Tissue into the Spinal Subarachnoid, LAIQNEL-LAVASTINEAND A. F. LIBER. An- giome kystique du cervelet, ostbome de la faux du cerveau, masses cerbbelleuses juxta-spinales, Ann. d’anat. path. 11 : 929-936, 1934. A man of thirty-four was admitted to hospital with a clinical syndrome of intracranial hypertension of sudden onset. Before neurologic examination could be done the patient died suddenly. Necropsy revealed a large cavity in the right cerebellar hemisphere, with a nodular tumor in its floor showing the structure of hemangioblastoma and blocking the fourth ventricle. In front of this there was an osteoma of the falx cerebri. On the dorsal and lateral aspects of the spinal cord, from the third cervical to the tenth dorsal segment, were yellow friable subarachnoid nodules, thought at first to be multiple angiomas but found on histologic examination to consist of normal cortical cerebellar tissue. The authors consider that these had probably arisen by detachment and dissemination, via the liquor, of fragments of the distended and edem- atous cerebellum. This process had evidently been completed at an early stage, before the blockage of the fourth ventricle; the walls of the cerebellar cyst were now quite smooth, a point supporting this interpretation. There are two good illustrations; one could have wished for more, in view of the interesting findings described. F. CAVERS Diffuse Melanotic Tumor of the Meninges, H. JACOB. Diffus melanotische Gesch- wulstbildungen der weichen Hirnhaute, Deutsche Ztschr. f. Nervenh. 133: 167-187, 1934. The author reports the case of a forty-two-year-old patient in whom a diffuse melanosarcoma of the pleura, mediastinal lymph nodes, and meninges of the brain and spinal cord were found at autopsy. The ependyma of the brain also contained nodules of tumor. The primary site of the growth in this case could not be determined. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE THE NERVOUS SYSTEM 939

Case of Multiple Meningioms Combined with DMuse Miningiomntosis with Remarks on Some Combinations of Multiple Tumors, H. F. HARBITZ. Acta path. et microbiol. Scandinav. 12: 24-37, 1935. The author reports the case of a five and one-halt-yearald girl in whom multiple meningiomas situated over the left cerebral hemisphere were found at autopsy. There were 3 tumors; the smallest was 12 mm. in diameter and 2 mm. thick, and the largest was from 3 to 4 cm. in diameter and 13 mm. in its greatest thickness. Besides these isolated tumors, there was a diffuse thickening of the meninges. The article is illustrated with drawings and photomicrographs. BENJAMINR. SHORE

Meningioma in the Region of the Lesser Sphenoidal Wing, C. WESKAMP. MBning- oblastome de la petite aile du sphhoIde, Ann. d’ocul. 171: 579-587, 1934. In a man of fifty-three who had noticed gradually increasing left exophthalmos for several years, a solid tumor was felt in the orbit behind and above the globe. X-rays showed an irregular shadow in the region of the lesser wing of the sphenoid. The removed tumor was diagnosed as a meningoblastoma; the histologic description is brief and is not illustrated. Five good roentgenograms are given. F. CAVERS

Meningioma of the Fal. Cerebri, J. FROMENT,R. LERICHE AND R. FROMENT.Paralysie corticale du pied. Mhingiome de la faux du cerveau. Ablation, Lyon m6d. 153: 384-385, 1934. A meningioma, the size of an orange, was removed from the falx cerebri in a young female patient of unstated age, in whom there had developed during an unstated period paralysis of the left foot, with clonic convulsions and bilateral choked disc. Operation wea followed by transient aphasia; at the time of reporting, three months later, the right papilledema had disappeared and that of the left eye was much diminished. F. CAVERS Tumor of the Fourth Ventricle, F. MARCOLON~O.Tumore del IV ventricolo, Minerva med. 2: 177-187, 1933. In a woman of thirty there suddenly developed vertigo, headache, vomiting, and a fixed position of the head, symptoms which persisted with little change until death six months later. Some time after the onset pain occurred in the left side of the body and of the face and in the left arm and leg, and there were noises in the left ear. The heed was fixed and rotated toward the left, any attempted movement toward the right or baokward being accompanied by severe vertigo and vomiting. There were weakness of the corneal reflex and vestibular hypo-excitability on the left. Abdominal reflexes were absent, deep tendon reflexes present but weak. There was very slight equilibratory disturbance in Rtanding and walking, with hypotonia and dysmetria of both legs. Ophthalmoscopic examination showed the disks normal except for slight haainess of the borders on the left. Roentgenographically the skull showed no variation from the normal picture. The vestibular symptoms overshadowed the cerebellar findings throughout the life of the patient. At autopsy the ventricles were found much dilated, and a glioma was discovered arising from the vermis, infiltrating both hemispheres of the cerebellum, and filling the cavity of the fourth ventricle including the left lateral recess. The author discusses the apparent discordance between the clinical picture and necropsy findings. He helieves that the predominating vestibular symptoms are to be explained by early and persistent compression of the vestibular tracts. He notes that the patient showed many of the symptoms Lereboullet has described as the syndrome of the lateral recess of the fourth ventricle. JEANNETTBIMUNRO

Ependymomnta, H. W. RINK^. Zur Kenntnis der Ependymome, Ztschr. f. d. ges. Neurol. u. Psychiat. 148: 736-752, 1933. A woman of twenty-five years entered the hopsital in a psychotic state. For the past two years she had had considerable headache and, more recently, attacks of 940 ABSTRACTS

vertigo. Two weeks previous to her admission to the hospital she had gone through a normal confinement. Twenty-four hours after delivery, the psychotic symptoms developed, followed by motor restlessness, diplopia, ataxia, and frequent vomiting. Neurologic examination showed evidence of a marked increase in intracranial pressure and signs considered to be those of a parasellar tumor. Ventricular puncture was followed by death. At autopsy there was found an internal hydrocephalus caused by a tumor obstructing the fourth ventricle. The neoplasm appeared to originate from the tissues of the floor of the fourth ventricle, which it filled. There was an extension of the growth into the snbarfichnoid spaces of the cisterns with some herniation through the foramen magnum into the spinal canal. Histologically the tumor proved to be an ependymoma. Its probable source of origin was, therefore, from the ependymal elements of the fourth ventricle floor. [Dilation of the ventricular system, including the third ventricle, from cerebellar tumor, not infrequently simulates a chiasmal region tumor clinically, as it did in this case. The dilated third ventricle may even erode and greatly enlarge the bony sella turcica.] EDWINM. DEERY

Lipoma of the Corpus Callosum, I. HONDAAND S. SHIRAI. Trans. Japanese Path. Soc. 23: 603-605, 1933. A man twenty-two years of age committed suicide. Autopsy revealed a tumor of the corpus callosum, measuring 5 x 1 cm., soft, and of deep yellow color. The authors designate this a lipomn, though no mention is made of microscopic diagnosis. K. SUalUR.4 Large Cholesteatoma over the Left Hemisphere, G. HORRAX. Arch. Neurol. & Psychiat. 32: 667-668, 1934. Horrax reports the successful surgical removal of an intracranial cholesteatoma weighing 400 grams from a forty-three-year-old patient. The symptoms, which were of a mental character, were greatly relieved by the operation. The article is not illustrated. BENJAMINR. SHORE

Cysticercus Cyst of the Third Ventricle, J. A. BARRB. Kyste du 111" ventricule par cysticerque, Ann. de m6d. 36: 275-305, 1934. A man of fifty-five received a violent blow on the head which caused concussion and a hernatoma in the right parietal region. Three months later he had sudden dyspnea and vomiting, followed by an epileptiform attack with loss of consciousness. The physician called in tried to awaken him by moving his arms, but this was followed by clonic convulsions with tongue biting. Neurologic examination led to a diagnosis of third ventricle tumor. The patient was kept under observation until his death nearly two years later; during this period there were long intervals during which he was quite well and able to follow his occupation. He died in coma following an attack similar to that prior to his first admission to the hospital. Since there had been no progression of symptoms, the original diagnosis had been abandoned. Necropsy revealed a cysticercus cyst of the third ventricle. There are sixteen good illustrations, and an extensive bibliography of intracranial cysticercosis is appended. F. CAVERS

Cysticercosis Giving the Clinical Picture of a Brain Tumor, T. VON LEHOCZKY.Zy- stiserkose unter dem klinischen Rilde eines Gehirntumors, Deutsche Ztschr. f. Nervenh. 132: 193-211, 1933. The clinical history of a patient with signs and symptoms suggestive of an intracranial tumor. In addition to focal signs there was evidence of a marked increase in intracranial pressure, as shown by the presence of papilledema. The patient proved to have not a brain tumor, but cysticercosis. EDWINM. DEERY THE NERVOUS SYSTEM 94 1

Pituitary Adenomas: Roentgenographic Appearances of the Sella Turcica, P. PUECH AND L. STUHL. Adbnomes de l’hypophyse; aspects radi’ologiques schbmatiques de la selle turcique, Presse mbd. 42: 1131-1134, 1934. In this well illustrated paper the authors describe the differences between the roentgen appearances of chromophobe and acidophil adenomas of the pituitary. In the former there is a progressive spreading of the sella in an antero-posterior direction, with erosion and eventual destruction of the clinoids, the floor retaining its normal contour. In the acidophil group the clinoids do not become pushed apart; there is rather a ballooning of the sella downward, and a characteristic ‘‘ beak ” appears between the anterior clinoids, due to the sharing of the sella in the general acromegalic process. With the so-called transition adenomas the sella often shows this same “ beak.” The overgrowth of the anterior part of the sella may be so advanced as to make the tumor inaccessible to ordinary surgical approaches, but as a rule little difficulty is added to the procedure. In some cases this process may serve to protect the optic chiasm, permitting the development of a large tumor and advanced acromegaly without visual disturbance. The paper is illustrated with numerous drawings and roentgenograms. JOHNS. LOCKWOOD Roentgenographic Diagnosis of Hypophyseal Tumors, J. ERDELYI. Die Rontgen- diagnostik der Hypophysengeschwiilste, Fortschr. a. d. Geb. d. Riintgenstrahlen 51: 125-147, 1935. This is a detailed study of the radiologic evidences in tumors of and about the sella turcica. The article is well illustrated with roentgenograms of illustrative cases. BENJAMINR. SHORE Changes in the Sella Turcica in the Presence of Distant Intxacranial Tumors, M. LUDIN. Veranderungen der Sella turcica bei sellafernen intracraniellen Tumoren, Acta radiol. 16: 48-50, 1935. The author reports four cases of intracranial tumors located far from the sella, in which the latter showed pressure changes, a fairly common occurrence. Three of the tumors were diagnosed as dural endotheliomas, occupying respectively the right temporal, left parietal, and left temporofrontal regions; the fourth was a cystic glioma of the right cerebral hemisphere not more precisely indicated. There are four x-ray pictures. F. CAVERE Irradiation in the Treatment of Tumors of the Pituitary Gland, Report of Twenty- three Cases, C. W. RANDAND R. G. TAYLOR.Arch. Surg. 30: 103-150, 1935. The authors report in detail the histories of 23 patients with tumors of the pituitary gland who havc been treated by irradiation. Eight patients were operated on, either before or following the high-voltage therapy. Two patients with adenocarcinoma and one with a cystic adenoma showed no improvement after irradiation. Five patients with presumably chromophil tumors, all of whom had acromegalic symptoms, showed marked improvement in the visual fields. Twelve patient diagnosed as having chromophobe adenomas were given high-voltage therapy. The reaction was varied. In some instances slight improvement of vision was noticed for a short time; in others an un- looked for improvement occurred and was maintained. Again, not only was there no improvement, but the vision continued to fail; the tumor in the latter cases was, with few exceptions, found to be cystic at subsequent operation. The authors are unprepared to state what morphologic changes in the pituitary gland are to be expected following high-voltage irradiation. In one case of chrorno- phobe adenoma which came to autopsy no demonstrable changes were seen. However, the material was not obtained until a year after the irradiation had been discontinued and earlier demonstrable changes might easily have been missed. The technic and the amount of irradiation given in each case are described in detail. Numerous visual field charts are included. BENJAMINR. SHORE 942 ABSTRACTS

Pathogeneria of Mental Disturbances in Erdheim Tumors, A. ALMEIDADIM. Uber die Pathogenie der Ge?stestorungen bei Erdheimturnoren, Ztschr. f. d. ges. Neurol. u. Psychiat. 148: 250-262, 1933. A man of thirty-two years complained of generalized headaches, failing vision, increasing somnolence, and attacks of vomiting, these symptoms having been present for some two years, together with personality changes. He became irritable and quarrelsome, and more recently these changes had become so pronounced that he sought institutional care. Neurologic examination showed evidence of a marked increase in intracranial pressure, for which a decompression was carried out. At autopsy a fairly large Erdheim tumor, or craniophsryngioma, was found. Nerve elements of the ventricular wall and corpora mamillaria showed rather marked retrograde changes which the writer is willing to offer as the .organic basis of the mental symptoms. [For a description of tumors of the hypophyseal duct see Hassin: Histopathology of the Peripheral and Central Nervous System, p. 430.1 EDWINM. DEERY

Diabetes Inaipidus Associated with Pinealoma Transplant in the Tuber Cinersum, S. W. STRINGIER.Yale J. Biol. & Med. 6: 375-383, 1934. The author reports the case of a twenty-seven-year-old man whose clinical history was characterized by a progressive diabetes insipidus which terminated in hyperpyrexia. Autopsy showed a conical enlargement of the tuber cinereum and an enlarged pineal gland. The latter measured 2.1 x 1 x 1 cm. and weighed 845 mg. Histologic study showed the greater part of the pineal to be replaced by large epithelial cells whoae cytoplasm was abundant and deep-staining. A few bipolare spongioblasts were found among the epithelioid cells at the periphery of the growth. The neoplasm in the tuber cinereum was identical in structure with that of the pineal. Although the pituitary gland was definitely decreased in size, the individual component parts were morpho- logically normal. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE Intracradal Calciflcationa, T. DALE. Acts radiol. IS: 628-634, 1934. The author discusses two types of intracranial calcification: (1) physiologic calcification occurring mainly in the pineal body, choroid plexus, falx cerebri, the attachment of the tentorium, and the pacchionian granulations; (2) pathologic calcification occurring mostly in neoplasms. Of the former, the author reports one case each of echinococcal cyst and arteriovenous aneurysm, the other instances including pwt- traumatic calcification and calcified tuberculamas. The calcified tumors included 2 cases of hypophyseal duct cyst, 13 gliomas (9 histologically verified), and an angio- blastic meningioma. There are twenty illustrations. F. CAVERB

On the Localization of Calcified Pined Bodies under Normal and Pathological Condi- tions, B. LILJA. Acts radiol. IS: 659-667, 1934. Using Cushing’s extensive material, Vastine and Kinney (Am. J. Roentenol. 17: 320, 1927) and later C. G. Dyke (Ibid. 23: 598, 1930) studied the position of the pineal shadow, with special reference to changes associated with intracranial tumors. Al- though these writers found that displacements of the pineal body were fairly common in the presence of intracranial expansive processes, the very magnitude of their material [Dyke’s report was based on the examination of no fewer than 3000 skulls] precluded the application of detailed and statistically aesessed measurements upon which comparison between the normal and pathologic position of the pineal body can be reliably established. In 200 cases examined by Lilja there were no radiographic or clinical signs of any expansive procesa. The incidence of pineal calcification in this series was 34 per cent, rising to 40 per cent in subjects above twenty years of age. In anteroposterior and lateral roentgenograms in which the measurements were made to various points on the inner table of the cranium, the mean standard of error was found to vary from f 5.5 to f 7.9 per cent in different parts of the skull. Out of 60 cases of verified intracranial neoplasm definite displacement of the pineal body, after allowing for stand- THE NERVOUS SYSTEM 943

ard deviation, was found in 14 cases (23 per cent); this displacement was more frequent (35.8 per cent) in 39 cases where the tumor was located above the tentorium. On the other hand, no displacement beyond the normal limit (7.9 per cent) was found in 21 cases of tumor in the posterior fossa. The findings are set forth in diagrams and tables. F. CAVERS

Nyatagmus, Psychic Disturbances, Epilepsy, Calcification of the Pineal Body. Case for Diagnosis, J. EUZIBRE,H. VIALLEFONT,J. VIDALAND FASSIO. Crises OCulO- gyres, troubles psychiques, dtat de ma1 dpileptique, opacification de l’dpiphyse. Tumeur ou encdphalite, Arch. SOC.d. sc. mdd. et biol. de Montpellier 15: 21-24, 1934. A youth of seventeen was brought to the hospital in a state of stupor. While there he had several attacks which a relative said were like others that had occurred about once a week during the past two years. These began with deviation of the eyes and head upwards and to the right, rotation of the trunk to the right and backwards, and extension and hyperpronation of the upper extremities, and terminated in a fall. Conscious- ness was not lost, and for a variable time after the attack the patient could hear and understand but could not see or speak. During the attack the patient said he had feelings of great anguish and apprehension of impending calamity to various members of his family. The attacks became more frequent, being repeated at short intervals, as many as thirteen occurring within four hours, with clonic contractions of the right extremities and a terminal state of somnolence. Between attacks the patient seemed to be normal, and neurologic examination showed nothing of significance. X-ray studies revealed erosion of the clinoid processes, flattening of the frontal convolutions, and a rounded calcification about 4 mm. in diameter in the pineal region. There were no symptqms pointing to pineal tumor. At the time of the report the patient was still under observation. F. CAVBR~

Tumor of the Spinal Cord, S. W. BOYCE. Tri-State M. J. 5: 1114-1117, 1933. The first spinal cord tumor was operated upon and removed about thirty-six years ago. In general, tumors of the spinal cord are less seriouR lesions than are intracranial tumors. Spinal tumors most frequently originate from the meninges and are therefore apt to be of benign nature. True intramedullary tumors arising from the substance of the cord give definite clinical signs, as there are no ‘I silent areas ’’ in the cord comparable with those of the brain. It is usually possible to distinguish between tumor and organio diseases of the spinal cord, on the basis of the neurological signs. Tumors of the spinal cord are conveniently subdivided into extramedullary and intramedullary lesions. Among the former group are sarcoma, fibroma, gumma, endothelioma, myxoma, parasitic cysts, lipoma and metastatic carcinoma. Of intramedullary tumors, gliomas are the most frequent. Such growths are apt to arise from the neuroglia about the central canal of the cord, particularly in the lower cervical region. Signs and symptoms of spinal tumor are due to pressure on the cord with its nerve tracts, motor cells, sensory cells, and ganglia. With extramedullary tumor pain is the earliest and most frequent symptom. The spinal fluid may show xanthochromia and increase of globulin. Dissociated anesthesia is characteristic of intramedullary tumor. When the clinical signs suggest the possibility of tumor, special tests will make it possible to arrive at a definite diagnosis. Such tests include cistern and lumbar punctures, the Queckenstedt test, lipiodol, and x-ray studies. In all cases where a reasonable suspicion of tumor exists, an exploratory laminectomy is justified. If the tumor proves to be an intramedullary glioma, the cord may be incised on its dorsal surface. A woman of thirty-five years had complained for some two years of pain in the back of the neck and upper dorsal region, radiating at times down both arms. The pain gradually disappeared and was followed by numbness of the back, chest;and right arm. Nausea and vomiting ensued and a complete motor and sensory paralysis of the body developed, with loss of sphincter control. Upon examination the patient showed a spastic quadriplegia and loss of sensation from below the breasts downward. The spinal fluid showed an increase of globulin and a pressure of 6 mm. Hg. Ascending lipiodol demonstrated a block at the second thoracic level, At operation an intramedul- 944 ARBTRACTS

lary tumor at the third and fourth ccrvical segments was found. The dorsal aspcct of the cord was incised and the spinal dura left open to encourage herniation of the tumor. At reoperation, six weeks later, brownish-red tumor tissue was removed, and the patient showed steady improvement. Microscopically the growth proved to be a gliosarcoma. A girl of ten years had pain in the right shoulder, considered for some days to be “ neuritis.” A progressive paralysis of the right arm and leg appeared, with varying parenthesia in these two extremities as well as some weakness in the left arm and leg. These symptoms gradually dieappeared but recurred some months later. A spinal manometric test revealed a subarachnoid block, and ascending lipiodol was arrested at the first thoracic level. A cervical laminectomy was carried out and an extramedullary lesion was found lying on the dorsal surface of the cord. This proved to be a cystic leHion formed by a “ pyogenic membrane.” Removal of the lesion was followed by an uncomplicated recovery. EDWINM. DEERY Early Symptoms of Extramedullary and Intradural Spinal Cord Tumors, M. PAPPEN- AEIM. Welches sind die Anfangssymptome extramedullilrer intraduraler Rucken- marksgeschwtilste, Wien. klin. Wchnschr. 47: 244-245, 1934. This is a general discuseion of the early diagnosis of spinal cord tumors. No ncw material is included. BENJAMINR. SHORE

Differentiation of Syringomyelia and Spinal Cord Tumor, L. VAN DER HORBTAND J. A. VAN HASBELT.Syringomyelie oder Tumor medullae? Deutsche Ztschr. f. Nervenh. 133: 129-135, 1934. The authors report the case of a twenty-six-year-old man in whom symptoms suggeRting syringomyelia were caused by an infiltrating intramedullary tumor situated in the eighth cervical segment of the spinal cord. The article is illustrated with a roentgenogram and photomicrographs. BENJAMINR. SHORP:

Operability of Tumors of the Spinal Cord, W. McK. CRAIG. Minnesota Med. 17: 110-113, 1934. A series of 392 tumors of the spinal cord which have been completely or partially removed at the Mayo Clinic and which have been verified histologically is reviewed. The segmental level of the tumors in this series was as follows: cervical, 18 per cent; thoracolumbar, 10 per cent; lumbar, 31 per cent; lumbosacral, 18 per cent; sacral, 1 per cent. For convenience the tumors are divided into extrameningeal, intrameningeal, and medullary types. Of the 392 tumors, 302 were extramedullary and involved the spinal cord only by compression. The operative mortality for the entire group was 4 per cent. Relief of symptoms after operation depends on the amount and duration of compression; clinical observation indicates that when loss of function is 25 per cent, it is usually recovered in three months; a 50 per cent loss requires from six to twelve months; a 75 per cent loss about eighteen months, while a total loss of function requires at lemt two years, and the injury to the cord may be so extensive that recovery will never take place. Recurrences followed the surgical removal of 4 neurofibromas and onc endothelioma. The article is not illustrated. BENJAMINR. SHORE

Spongioblastoma Multiforme of the Spinal Cord, Case Report, A. W. BRYAN. J. Nerv. & Ment. Dis. 79: 530-533, 1934. A forty-three-year-old man died two months after an exploratory laminectomy for a tumor in the cervical region. Autopsy showed a fusiform tumor involving the spinal cord at the level of the second cervical vertebra. Histologic study of the growth showed it to be a typical spongioblastoma multiforme. One photomicrograph of the tumor and several photographs of the sectioned spinal cord are included. BENJAMINR. SHORE THE NERVOUS SYSTEM 945

Multiple Neurinomas of the Spinal Roots and Peripheral Nerves, J. BARBIERAND BADINAND. Neurogliomes multiples sur les racines rachidiennes et lea nerfs phi- ph6riques, Lyon m6d. 153: 14-17, 1934. A woman of thirty-three had during the past four years become increasingly dull of hearing, and was now completely deaf. She had also during this period noticed failure of right vision and pain in the right orbit, the pain ceasing when sight was lost. More recently left vision had been failing. Her chief complaint now was of intense occipital headache causing insomnia. The findings included two subcutaneous nodules on the back of the left hand, muscular atrophy of all four extremities and slight increase of albumin and sugar in the cerebrospinal fluid. Biopsy of a nodule led to a diagnosis of neuroglioma (neurinoma). The authors attribute the ocular and auditory symptoms to tumors on the second and eighth nerves. They add that in another patient they observed similar symptoms plus compression of the spinal cord; necropsy revealed a spinal root neurinoma, and there were numerous similar peripheral tumors. There are no illustrations. F. CAVERB

Tumors of the Sympathetic Nervous System, D. LEWIS. Pennsylvania, M. J. 37: 715-720, 1934. Also in Virginia M. Month. 61: 377-383, 1934. This is a general discussion of tumors of the sympathetic nervous system. Included are neuroblastomas, paragangliogliomas, and ganglioneuromas. Aside from several case reports, no new material is added. The article is illustrated with photographs, roentgenograms, and photomicrographs. BENJAMINR. SHORD Nsurofibromatosia of the Sympathetic System with Involvement of the Spinal Cord, Brain and Pituitary, L. MARTZ. Neurofibromatose des Sympathicus mit unge- w6hnlicher Beteiligung des Riickenmarks, Gehirns und der Hypophyse, Frankfurt. Ztschr. f. Path. 46: 119-139, 1933. Brief clinical facts and a detailed report of the pathological findings in a case of extensive neurofibromatosis. The patient was a man of forty-nine with widespread skin lesions which the author believes took origin from the peripheral sympathetic nervous system. In addition the patient was an imbecile and had polydipsia. A complete account of the autopsy findings is given. There was an extensive neurofibromatosis of the skin and of the gastro-intestinal tract, including the appendix. The tongue contained an hemangioma. The vertebral bodies contained cavernomata, as did the subcutankous fatty tissue in several places. The brain showed a marked degree of dilatation of the ventricular system and there were many subependymal glial nodules. In the right occipital lobe was a spongioblastic glioma. The hypophysis showed extensive cystic degeneration. Brain and spinal cord showed a diffuse glioeis. EDWINM. DDERY

Bilateral Acusticus Tumors and Neuroflbromatosis, L. VAN BOGAERT.Tumeurs bilst6rales de l’acoustique et neuro-fibromatosis, Ann. d’anat. path. I1 : 353-369, 1934. The author reports three cases of vestibular nerve tumors showing the characteristic structure of schwannoma (neurinoma). In the first case there was evidence of familial neurofibromatosis, and the patient had skin pigmentation; in the second there were skin and retinal manifestations, and the patient’s parents both had skin pigmentation; in the third there were no other manifestations of neurofibromatosis nor was there a family history of the disease. The author believes that these acoustic tumors are of true ectodermal origin, chiefly on account of their finely fibrillar syncytial structure. There are ten good photomicrographs. F. CAVERS

Neuroflbroma of the Hypoglossal Nerve, L. FRIEDMANAND A. A. EIBENBERQ.Ann. Surg. 101: 834-838, 1935. The authors report the case of 8 thirty-year-old woman from whom a neurofibroma of the right hypoglossal nerve was surgically removed. The tumor occupied more than two-thirds of the proximal portion of the nerve as it emerged from the cranium and was 946 ABGTRACTS absolutely symptomlees E.O far as motor function disturbance was concerned. Boon after resection, however, motor function on that side was entirely interrupted and atrophy of the right side of the tongue was soon apparent. The article is illustrated by a drawing, photograph of the atrophied tongue, and photomicrographs. BENJAMINR. SRORKI

Cervical Neuroflbroma, C. W. MAYOAND K. W. BARBER.Burg. Gynec. t Obst. 59: 071-877, 1934. From July 1924 to January 1934, 17 patients with cervical neurofibromas were seen at the Mayo Clinic. The patients with these growths usually seek relief because of the disfigurement or the worry which the growth causes rather than because of discomfort. In 9 of the 17 cases there was no pain. The preservation of function of the affected nerve is rather remarkable; in none of these cases, eve0 in those in which the tumors were large, was there any evidence of impaired function. However, none of the tumors in this series arose from a large motor or sensory nerve. To be differentiated from these growths are various forms of lymph node enlargement, metastatic tumors, tumors of the salivary glands, branchial cysts, aberrant thyroid tissue, tuberculomas, and tumors of the carotid body. Prompt surgical removal of the tumor is the treatment of choice. Although these growths are potentially malignant, none in this series showed malignant characteristics. The results of treatment by roentgen rays or radium have not been satisfactory. The article is illustrated with two photographs and a photomicrograph. BIONJAMINR. SHORH

Radiosensitive Neuroblastoma, H. HAUSER. Am. J. Roentgenol. 31 : 234-237, 1934 The author reports the case of a five-year-old boy in whom intensive irradiation brought about local regression of a malignant neurobkstoma arising in the neck and disappearance of pulmonary metastases as shown roentgenographically. Subsequently destructive lesions were demonstrated roentgenographically in the $lvic bones, and extensive metastases reappeared in both lung fields. A mass appeared also in the cheek and the left parietal region of the scalp, and the child died three months after hospital admission and five months after the appearance of the original swelling in the neck. The technic was of the massive dose type. It is suggested that small divided doses extended over a period of several weeks with a greater total dosage might have brought about permanent regression if the treatment could have been started earlier in the course of the disease. As autopsy was not obtained, the original site of the tumor was undetermined, but it was assumed that it probably arose from the cervical sympathetic trunks. The article is illustrated with photographs, roentgenograms, and a photomicrograph. BENJAMINR. SHORE

Congenital Mesodermal Tumor of the Sciatic Nerve, K. E. GROTH. Kongenitale, teilweise maligne Geschwulstbildung im Nervus ischiadicus mit anschliessender Elephantiasis, Acts path. et microbiol. Scandinav. 11 : 44-90, 1934. A child was born with extreme cyanosis and died within an hour. In addition to marked elephantiasis of the right lower extremitity, there was a tumor involving the spinal origin and entire length of t.he right sciatic nerve. This had no capeule, and consisted of fibrous tissue evidently formed by proliferation of the perineurium and epineurium and containing scattered islands of immature cartilage and of fatty cells. In places there were numerous mitoses, suggesting a transition to sarcoma. References are given to four somewhat similar sciatic nerve tumors reported in the literature. There are nine good illustrations. F. CAVERS BONES AND JOINTS 947

BONES AND JOINTS ClasWation and Diagnosis of Bone Sarcomas, R. MATHEY-CORNAT.Sur la classi- fioation et le diagnostic radiologique des sarcomes osseux, Presse m6d 42: 1127- 1130, 1034. A review of the classification of bone sarcomas as published by Geschickter and Copeland (Tumors of Bone, published by Am. J. Cancer, 1931), with illustrative roentgenograms and a discussion of the x-ray signs characteristic of each type. JOHNS. LOCKWOOD Radiographic Characters of Osteogenic Sarcoma and Giant-cell Bone Tumor, E. SORREL.Des aspects radiologiques des sarcomes osseux et des tumeurs osseuses ti mybloplaxes, Bull. SOC.nat. de chir. 60: 1333-1334, 1934. In the author’s experience it is often extremely difficult to diagnose the nature of a bone tumor from its radiographic appearance alone, biopsy being required in addition. In a girl of fourteen years the x-ray pictures first made pointed to osteogenic sarcoma of the entire third left rib, but this wae thought to be an impossibility, and the case was reported as an example of congenital absence of this rib. Later, however, a swelling appeared on the rib (site not stated), and was found on biopsy to be a giant-cell tumor. Following x-ray treatment the rib became ossified and gave a normal x-ray image. F. CAVERS

Radiotherapy of Osteomas, L. CHEVRIER.A propos de la radiothbrapie des ost6omes, Bull. et m6m. SOC.nat. de chir. 60: 1182-1183, 1934. The author states that since 1917 he has successfully treated several cases of osteoma with x-rays.. He gives no details, but proceeds to express the view that in such cases the diminution in sire of the tumor, with complete or partial relief of the nerve compression due to its presence, is the result of decalcification of bone under the action of the x-rays. F. CAVERS Osteogenic Sarcoma at Point of Fracture, G. M. CANNATA.Sarcoma osteogenico sviluppato in un focolaio di frattura, Pathologica 25: 709-715, 1933. A man of twenty-five fractured the left femur in its lower third. Convalescence was stormy, a nephrostomy for renal calculus being performed shortly after the accident, and a phlebitis of the injured leg following. The point of fracture remained painful, and a swelling became apparent. X-ray showed a tumor at the point of fracture, invading the periosteum. Plates taken at the time of the accident had shown no evidence of tumor. At operation a typical osteogenic sarcoma was found. The histologic de- soription is given in detail. The author reviews the literature on osteogenic sarcoma, with particular refcrence to its relation to trauma. He suggests two theories, first that the trauma may cause modifications of the bony structure, wch as hematomas and localized necrotic areas, the repair of which, in individuals predisposed to tumor formation, results in a dis- orderly and atypical proliferation of elements which assume invasive characteristics. He also suggests that the structural changes at the point of fracture due to the injury may make the traumatized area peculiarly susceptible to some factor, parasitic or other, causing tumor formation. The necessity of frequent x-ray examinations is stressed, where any anomalous formation of callus occurs following bone injury; also the importance of using the x-ray for early diagnosis without waiting for the full clinical picture to develop. The article is illustrated by roentgenograms. JEANNETTEMUNRO Possible Ewing Sarcoma in a Child of Eighteen Months, A. R. MEYER. Ein Fall von Ewingsarkom bei einem 14-jllhrigen Kinde, Acta pdiat. 17: 142-155, 1934. A child of a year and 5 half was brought to the hospital. Six months before, it was noticed that his bones, especially the ribs, were painful on touch. The condition was diagnosed as rickets, and preparations of liver, calcium and iron were given. Soon 048 ABSTRACTS there appeared swelling of the left parietal region, then of the left mandible; both swellings were hard and insensitive to pressure. X-rays showed both condensations and rarefactions in these regions, also irregular rarefaction in nearly all the long bones, most marked in the femoral and tibia1 diaphyses. In twenty x-ray treatments five fields were given 760 r each. The patient’s temperature remained at 37-38”C., apart from a short period of high fever due to a spontaneously healing otitis media. Two months after the x-ray treatment no radiographic change in the bones could be detected, though the left parietal swelling had considerably diminished. The author admits that, owing to the absence of biopsy and to the apparent failure of x-ray treatment, the diagnosis has not been certainly established at the time of reporting, though the radiographic appearances agreed more closely with those of Ewing sarcoma than any other bone lesion. [Lack of radiation sensitiveness does not exclude a Ewing tumor, some of these growths having shown high radioresistance.] There are four illustrations. F. CAVERS Bone Tumor, L. RAMOND.NBoplasme osseux, Presse m6d. 42: 489-490, 1934. A discussion of a tumor of the upper end of the humerus in a woman of eighty-three years, which clinically and by x-ray resembled osteogenic sarcoma, but which Ramond declares must have been metastatic because of simultaneous involvement of the ac- romion, radius, and ulna. There are no illustrations. JOHNS. LOCKWOOD

Bone Metastases from a Latent Renal Carcinoma Found at Necropsy, R. MESSIMYAND P. ISIDOR.Mbtastases osseuses multiples d’un Bpith6lioma renal latent ddcouvert ii l’autopsie, Ann. d’anat. path. 11: 957-959, 1934. A woman of sixty-two complained of increasingly severe pain in the right leg, which had begun about a year previously and had been relieved by salicylate of FO~H, given on a diagnosis of rheumatism. There was a swelling over the right hip joint, with pain on pressure in the ischiofemoral region, also a painless swelling of tho tenth rib. A roentgenogram showed considerable erosion of the right ilium and of the rib. The patient became increasingly cachectic and died about eighteen months after the onset of symptoms. Necropsy revealed a small, hard, white tumor in the cortex of the left kidney, diagnosed as carcinoma. Apart from deposits in the two bones, the only metastasis fouiid wa8 in the liver. In view of the smallness of the primary and secondary tumors and the abscnce of other pathologic findings, the rapidly fatal cachexia seemed difficult to explain. F. C:nv~as

Osteoehondroma of the Femur, G. A. CARILICCI.J. Bone dz Joint Surg. 17: 204-208, 1935. A sixty-four-year-old woman had the right leg amputated through the mid-thigh for an osteochondroma of the femur of twenty-five years’ duration. Although there were no histologic evidences of malignancy in the tumor, recurrences in the amputation stump were observed eight months after operation, and death from pulmonary metastases occurred two months later. Histologic study of the recurrent growth in the stump showed it to be a malignant osteogenic sarcoma. The article is illustrated with photographs of the gross specimens, a roentgenogram, and photomicrographs. BENJAMINR. SHORE Fibroma of the Popliteal Space, AUVRAY. Volumineux fibrome du creux poplit6, Bull. et m6m. Soc. nat. de chir. 60: 123tL1239, 1934. Fibroma of the Popliteal Space, F. M. CADENAT. Fibrome du creux poplit6, Ibid. 60: 130 1-1302, 1934. Auvray’s patient, a woman of forty-six, had first noticed about five years previously a hard movable lump behind the left knee, which grew steadily larger and caused increasing pain and limitation of knee movement. X-rays showed nothing amiss in the bones and joint. At operation the tumor was seen to be deeply grooved by the popliteal nervee, but was easily removed. It measured 11 cm. in length and 18 cm. in circumfer- ence, and was a pure fibroma. Cadenat reports the removal of a similar tumor from a ballet dancer of twenty-fivc. BONES AND JOINTS 949

Two years later there was recurrence (or re-occurrence) in the form of two separate tumors, one of which had a prolongation into the muscles. The invasive portion was not removed, as an attempt at extirpation might have endangered the lady’s livelihood. Histologically the tumor showed no signs of malignancy, and it was well encapsulated. F. CAVERS Rare Tumor of the Temporal Bone, D~DERLEIN.Seltene Knochengeschwulst des Schlafenbeines, Internat. Zentralbl. f. Ohrenh. 39: 86-87, 1934. A fifteen-year-old girl had a tumor about 5 em. in diameter behind the right ear. Histologic study of the excised growth showed numerous young connective-tissue cells, osteoblasts, and adult bone. The diagnosis of ossifying fibrosarcoma was made. There was no recurrence six months after operation. There are no illustrations. BENJAMINR. SHORE Treatment of Bone Tumor with Parathyroid Hormone, FILDERMAN.Tumeur osseuse traitbe par l’hemocrino-parathyroidienne, Bull. et m6m. SOC.de m6d. Paris 138: 378-382,1934. A primary tumor of the femur in a boy of fourteen appeared to be a benign osteoma on biopsy. Because of the continuing complaint of pain, parathyroid hormone was administered. This relieved the pain temporarily but produced no change in the local appearance of the tumor. JOHN5. LOCKWOOD

Vertebral Angiomas, J. A. LI~VRE.Les angiomes vert6braux, Presse m6d. 42: 1571- 1572, 1934. The author reports a case of vertebral angioma and includes a summary of the diagnostic and therapeutic features of such lesions. A woman of thirty-six years complained of severe lumbar backache with sciatic radiation. X-ray examination showed a widening of the body and loss of normal contour of the first lumbar vertebra, with ,replacement by mottled bone showing diminished opacity. The intervertebral discs and the laminae and pedicles appeared normal. The only physical sign was percussion tenderness over the affected vertebra. Seven years later the symptoms were only slightly more severe, and the x-ray picture had changed but little. X-ray treatment was employed, with striking relief of the pain, which on movement was excruciating, but without apparent change in the roentgenographic appearance of the tumor. This case is characteristic of the group, in that the symptoms are of long duration, with appearance of sensory changes quite early, followed only after a period of years by onset of paraplegia associated with cord compression. Histologically the tumors appear to be cavernous hemangiomas developing in bone. Attempts at surgical removal are likely to be disastrous because of the difficulty of controlling hemorrhage into the spinal canal. X-ray treatment usually brings temporary relief of symptoms, but laminectomy is neceesary in advanced cases. JOHN 5. LOCKWOOD

Bence-Jones Proteinemia in Multiple Myeloma, A. CANTAROW.Am. J. M. Sc. 189: 425-428, 1935. A case is reported of multiple myeloma (granulocytic type) with severe anemia and renal failure. Bence-Jones protein was present in the urine, and in the blood serum as well, where it was associated with hyperproteinemia. Such a combination is so unusual that even a single case is worth recording. The total serum protein concentration varied between 6.84 and 11.3 gm. per 100 c.c., the Bence-Jones protein being approximately 3 gm. when the total protein was 8.7 gm., and 5.2 gm. when the latter was 11.3 gm. per 100 C.C. Hypercalcemia (12.9 mg. per cent) was present at the time of admission. A deter- mination thirteen days later showed a fall to 9.2 mg. per cent, though the serum protein concentration had simultaneously increased from 8.7 to 11.3 gm. per 100 C.C. The diminution in serum calcium may have been due in part to an increase in serum in- organic phosphorus (from 5.8 to 12.5 mg. per 100 c.c.), but it cannot be satisfactorily explained solely on this basis. The blood creatinine rose from 6.1 to 13.6 mg. per 100 C.C. during the same period. 950 ABBTBACTS

The relatively rapid and distinct fluctuations in serum protein and serum calcium concentrations in those with multiple myeloma, and the variability of the several factors determining the characteristic precipitation reactions of Bence-Jones protein, emphasize the necessity for repeated studies in such patients. WM.H. WOGLOM

Multiple Myeloma (Plasmocytoma), SABADINI,MONTPELLIER AND CHECHAN.R6ti- culo-plasmocytome iliosacr6, Bull. et m6m. SOC.nat. de chir. 60: 1302-1305, 1934. A male Algerian native of about fifty-five came to the hospital complaining of severe pain in the lower extremities, especially the left. Over the sacro-iliac joint was a soft tumor, painful on pressure. X-rays showed decalcification of the underlying bone. incision of the tumor showed it to be a red mass, which was removed, leaving a cavity in the bone; this was curetted and two tibia1 grafts were inserted. Histologically thie material showed the characters of plasmocytoma, and the urine was found to contain abundant Bence-Jones albumose. Radiography of the skeleton revealed areas of rarefaction in the right parietal bone and the right and left humeri. X-ray treatment was given, but the patient became increasingly cachectic and left the hospital when the operation wound had healed. F. CAVERS

Hyperparathyroidism and Osteitis Fibrosa Cystica, A. RAWNAAND S. LYON. Hyper- parathyroidie et ost6ite fibro-kystique g6n6ralis6e, Presse m6d. 42: 1022-1024, 1934. This is an editorial r6sum6 wid a review of the newer knowledge accumulated on the clinico-pathological features of osteitis librosa cystica and its association with hyper- plastic parathyroid tissue. There is a bibliography of the outstanding contributions. JOHNS. LOCKWOOD

Case of Generalized Osteitis Fibrosa. Removal of a Parathyroid Tumor, A. S~RENSEN. Un cas d’ost6ite fibreuse g6n6ralis6e, t.rait4e par l’enlbvement d’une tumeur, para- thyroldienne, Acts chir. Scandinav. 74: 485-490, 1934. A woman of seventy-four suffered spontaneous fracture of the left femur. At the ’ site of fracture, and also in several other bones of the extremities, x-rays showed cysts of various sizes. The serum calcium was 13 mg. per 100 c.c., and the urinary calcium excretion in twenty-four hours was 433 mg. The thyroid region waa explored and a small tunior removed from the neighborhood of the left inferior parathyroid artery. This was diagnosed histologically as a cellular hyperplasia rather than a definite adenoma of the parathyroid. The day after operation right hemiplegia developed and the patient died with symptoms of cardiac insufficiency on the third day. There are no illustrations. F. CAVERR von ReckllnghPuBen’s Diaease of Bone Develqing During Course of Prolonged Administration of Powdered Thyroid Substance, MONIER-VINARD.Maladie osseuse de Recklinghauaen d6velopp4e au coups d’une absorption prolong6e de poudre de corps thyroide, Bull. et mem. SOC. m6d. d. h6p. de Paris S:379-382, 1934. A fifty-year-old woman complained of severe persistent neuralgic pain in the domain of the eleventh and twelfth thoracic nerves, of three years’ duration. Radiographs disclosed well-marked evidence of osteitis fibrosa cystica, involving particularly the dorsal and lumbar vertebrae. Careful questioning revealed that the woman, in an effort to avoid obesity, had taken from 5 to 40 cg. of powdered thyroid gland daily for ten years. Suspecting that the changes in the bones were brought about by the effect of the parathyroid substance present in the thyroid preparation, the author traced the particular product which the patient was still taking, and found that no effort was made to remove the parathyroid glands from the animal thyroid glands from which the desiccated thyroid was prepared. All thyroid medication waa stopped and after three months the pain was greatly diminished. The author believes that the condition was a result of excessive amounts of parathyroid hormone taken over a long period. WILLIAMJ. HOFFMAN BONES AND JOINTS 95 1

Malignant Synovioma of the Knee Joint, F. G. HODQSONAND E. L. BISHOP. J. Bone & Joint Surg. 17: 184-188, 1935. A twenty-eight-year-old man died of a malignant tumor which originated in the region of the left knee joint. Metastases to the inguinal lymph nodes occurred early in the course of the disease, and secondary nodules in the skin of the thigh were observed later. The tumor apparently did not respond to Coley’s toxins or to deep roentgen irradiation [amount unstated], and death occurred seven months after onset. Histologic study of the tissue in this case was limited to an involved inguinal oode. Most of the lymphatic structure had been obliterated by a cellular neoplastic mass of hyperchromatic cells which were of a somewhat epithelioid type, being more or less rounded, with relatively large nuclei. There were numerous mitoses. In other portions there was some relatively acellular fibrous stroma where the neoplastic cells were polyhedral in shape and very deep in their staining reaction. A few areas suggested a branching formation, with cells covering the pseudopapillae. The diagnosis ’of synovioma was made. The art.icle is illustrated with photographs and photomicrographs. BENJAMINR. SHORE Hemorrhagic Villous Synovitis of the Knee Joint Due to Xanthoma, Report of a Case, D. H. KLINOAND D. SA~HIN.Arch. Surg. 30: 52-61, 1935. The authors report the case of a twenty-three-year-old man with a diffuse, hemorrhagic, villous synovitis due to xanthoma of the left knee joint, successfully treated by synovectomy. Eighteen months after operation there were no eigns of recurrence. Repeated examinations of the blood, however, showed a persistent hypercholesteremia. Histologic study of the specimen showed old and recent hemorrhages, fibroblasts, and giant cells. The article is illustrated with photographe of the excised tiseue and photomicrographs. BENJAMINR. SHORE THE LEUKEMIAS, HODGKIN’S DISEASE, LYMPHOSARCOMA Morbidity of Leukemia in Elderly Persons, H. CURBCHMANN.Zur Morbiditilt der Leukilmien, insbesondere auch im htiheren Alter, Deutsche med. Wchnschr. 61 : 285-288, 1935. Among 100 patients with leukemia obeerved during the past nine years there were !27 from sixty-one to seventy-fivo years of age. Of these 27, 12 had chronic leukemic lymphadenosis, 3 acute lymphatic leukemia, 9 chronic leukemic myelosis, and 3 acuttt myeloblsstio leukemia. From .this study it is concluded that leukemia in elderly persons is not rare. BENJAMINR. SHORE Teleroentgentherapy in Leukemia and Hodgkin’s Disease, GEOR~ESMARCHAL, ‘ LUCIEN MALLET,P. COTTENOTAND J. M. LEMOINE. La t616roentgenth6rapie totale dans le traitement des leucemies et de la maladie de Hodgkin, Presse m6d. 42: 1763-1766, 1934. Seven cases of chronic leukemia and 17 cases of Hodgkin’s disease have been subjected to teleroentgentherapy by the author5 during the past two years (see Abst. il: Am. J. Cancer 20: 783, 1934, for report of previous work). The theoretical objective was the irradiation of the entire hematopoietic system with very small doses. The tube distance was 1.7 to 3.5 meters with 200-300 kv. and 3 ma. The dosage averaged about 25t per treatment, only about half that used in previous work, and the total dosage varied from 300 to 600 t. In some the cases supplementary localized irradiation of the spleen and groups of enlarged nodes was employed. In the 7 cases of leukemia temporary remission was observed in 4, but in 2 of these localized irradiation was used. These results are not as encouraging as those reported in the previous paper. Of tho 17 cases of Hodgkin’s disease, 5 were restored to normal activity by teleroentgentherapy alone and 4 others by teleroentgentherapy and localized treatment. In the other 8 cases the improvement was too transient to be of significance. The advantages of teleroentgentherapy are said to be relief of pruritus (in 11 of the 12 oases in which it occurred); an increased sense of well-being; diminution in size of the 952 ABSTRACTS spleen and of node masses, usually after a latent period, and reduction of the white blood cell levels. There is frequently, however, inhibition of erythropoiesis which compels cessation of treatment, with resort to blood transfusions. X-ray sickness is often severe, and the multiplicity of treatments is objectionable to many patients. The final conclusion of the authors is that the data are not sufficiently encouraging to warrant t.he exclusive use of teleroentgentherapy, though it may be a useful adjunct to localized irradiation, particularly in the absence of localized manifestations. JOHNS. LOCKWOOD Radioresistance of Lymphatic Leukemia with Endothelial (Rieder) Cells in the Lymph Nodes and Blood, P. IhLE-Weil AND IACH-WALL.Radio-rbsistance de la leucbmie B rellules de Rieder, Sang 8: 454-458, 1034. The authors recall that while the majority of cases of lymphoid and myeloid leukemia show a6 any rate slight remissions under x-ray treatment, though more or less rapidly becoming reeistant, some cases are radioresistant from the first. A man of forty-five was treated for intestinal trouble due to ascaris infection, and his physician noticed bilateral axillary and inguinal adenopathy and sent him to the authors' clinic. There wae at this time swelling of the left lids with exophthalmos, which disappeared spontaneously after about two weeks. A blood count showed 3,680,000 erythrocytes and 11,900 leukocytes (polymorphonuclears 28 per cent, lymphocytes 67, monocytes 5). The liver and spleen were moderately enlarged. Biopsy of the nodes showed replacement of normal structure by densely packed lymphocytes, among which there were numerous larger cells with large ovoid nuclei, frequently in mitosis, and neutrophil cytoplasm. These large cells were most abundant in the peripheral sinuses and appeared to be of endothelial origin (Rieder cells). About four months after the first blood examination, the left eye again became painful and swollen and a retrobulbar tumor was palpable. The blood now showed 15,000 leukocytes, of which 35 per cent were polymorphonuclears and 65 per cent " mononuclears " (including 24 per cent Rieder cells). There next appeared three subcutaneous nodes in the infraxiphoid region nnd a hard swelling 6 cm. long on the seventh rib. X-ray treatment was given to the epigastrium and the orbit, the total dosages being 2200 and 3500 r respectively. The orbital mass showed slight diminution. In the next blood count the total leukocytes numbered 12,000, and the differential count was as follows: polymorphonuclears 30 per cent, monocytes 20, Rieder cells 14, stem cells 6, myelocytes 2, metamyelocytes 8; the nature of the remaining 20 per cent was unstated. The patient died from intestinal obstruction five months after the detection of adenopathy, and necropsy was not permitted. The authors suggest that the almost complete radioresistance observed in this case was in some way associated with the presence of the Rieder cells in the lymph nodes and the circulating blood. F. CAVERS Radium Treatment of Leukemia, L. ARZT. Das Radium in der Therapie der LeukB- mien, Wien. klin. Wchnschr. 48: 166-169, 1935. The author reports three cases in which satisfactory local results were obtained after the treatment of subcutaneous leukemic nodules by radium. Photographs of one patient before and after treatment are included. BENJAMINR. SHORE Therapeutic Failure with Certain Organic Substances in Leukemia, 0. 0. MEYER, W. 5. MIDDLETONAXD E. W. THEWLIS.Folis haemat. 53: 166-171, 1935. The authors postulated the existence of a maturing substance for leukocytes whose absence might be a cauee of leukemia in a manner analogous to that in which absence of the maturing substance for erythrocytes causes pernicious anemia. Beef lymph nodes, beef duodenum, hog spleen and beef bone marrow were given by mouth, and various extracts of these substances were given intramuscularly to six leukemic patients. There was no evidence that these materials contained the postulated maturing factor. H. Q. WOODARD THE LEUKEMIAS, H0I)QKIN'S I)ISEASE, LYMPHOSAHCOMA 953

Leukemic Tumors of the Head, Cf. CLAUS. Leukamische Tumoren am Kopf, Internat. Zentralbl. f. Ohrenh. 39: 84-85, 1934. The author reports the case of a seventy-year-old woman with extensive leukemic nodules situatad on the nose, lips, forehead, cheeks, scalp, and right ear. There was also marked leukemic thickening of the buccal mucosa, tongue, tonsils, and uvula. Histologic study of a biopsy specimen from one of the skin tumors showed a diffuse lymphocytic infiltration throughout the tissues. Marked decrease in the size of the nodules followed the administration of arsenic and intensive irradiation. There are no illustrations. BENJAMINR. SHORE

Acute Leukemia with Primary Symptoms in the Rectum. A Rapid Increase in White Cells and a Fatal Outcome, G. WALBHAND C. S. STICKLDY.South. Med. & Surg. 96: t348-649, 1934. A case of acute leukemia with rapidly fatal outcome is reported. The immediate cause for admission to the hospital was the presence of thrombosed hemorrhoids. Apparently this is regarded as a primary manifestation of the systemic disease, but one finds it hard to believe, especially since the patient had suffered from hemorrhoids for over twenty years. The case is not unusual. There are no illustrations. THEODORE5. RAIFORD

Case of Undifferentiated Leukemia with Superacute Course in a Tuberculous Patient Treated by Gold Salts, M. COSTE. Un cas de leucBmie B cellules indiffBrenci6es et B Bvolution suraigue ohservBe chez un tuberculeux pulmonaire trait6 par les sels d'or, Bull. et mem. SOC.mdd. d. h8p. de Paris 50: 456-466, 1934. A thirty-seven-year-old man with pulmonary tuberculosis, with cavitation and positive sputum, was treated by intravenous injections of a double salt of gold and sodium thiosulphate. This was administered twice a week in amounts which were gradually increased from 10 grains to 50 gains, until a total of 3 grams had been given. Examination revealed a purpuric eruption over the skin of the entire body, desquamative erythrodermia of the face, stomatitis, and fever. The liver and spleen were normal in size. Clinically, the case appeared to be one of agranulocytic angina caused by administration of the gold salt. The patient was profoundly ill and died eighteen hours after admission to the hospital. Blood smears showed an extremely acute leukemia with predominance of undifferentiated stem cells, constituting 68 per cent of the total. The author recalls cases of agranulocytic angina resulting from metallic poisons, but is unable to report any other case wherein the acute leukemia appeared to have been precipitated by administration of gold salts. WILLIAMJ. HOFFMAN

Acute Leukemia Appearing After a Septic Infection, M. BRUL~,P. HILLEMAND,J. COTTETAND F. SIGKJIER.LeucBmie aigue apparue spree une inoculation septique, Bull. et mem. SOC.mBd. d. h8p. de Paris 50: 314-317, 1934. A thirty-five-year-old woman sustained an injury to the left hand while dressing a septic wound. Soon afterward an abscess developed at the site. Two weeks later a similar infection appeared on the right hand, accompanied by chills, fever, and the blood picture of acute lymphatic leukemia, terminating fatally six weeks after onset. The author discusses the possibility that the infection incited the acute leukemia, or that the infection was the obvious expression of a severe anemia and lowered resistance, accompanying a previously established acute lymphatic leukemia. WILLIAMJ. HOFFMAN

Case of Acute Leukemia in a Child, C. CISI. A proposito di un caso di leucemia acuta in una bambina, Pathologica 25: 474-486, 1933. A girl of nine had sore throat, fever, and abdominal p+n, of abrupt onset, followed by an ulcero-gangrenous stomatitis, petechiae, slight enlargement of lymph nodes and spleen and melena. The blood showed a secondary anemia, 300,000 white blood cells, 954 ABGTRACTS many immature red and white cells, monocytes, hietiocytes, and monocytoid celh. There were many Auer’s bodies, some of which appeared to be in the process of separating from the nuclei, suggesting a definite nuclear origin. Death occurred twenty-six days after the appearance of symptoms. Discussing this case as a mixed type of leukemia, the author goes into the question of the origin of the monocytes, favoring the unitarian theory of origin of the hematopoietic system. He suggests a common trunk with three branches, the trunk itself being affected in such mixed cases. The article is illustrated by colored microscopic drawing. JEANNETTEMUNRO Pernicious Anemia and Subsequent Lymphatic Leukemia in a Three-year-old Child, B. WEILL-HALL&A. ABAZA AND M. PENEY.Anbmie pernicieuse et leucbmie lymphotde consecutive chez une enfant de trois ans, Bull. SOC.de pediat. de Paris, 31: 397-405, 1933. The authors report a case of pernicious anemia in a three-year-old girl. The red cell count was 680,000; white cell count 6,000; hemoglobin 15 per cent; color index 1.1. Following two blood transfusions and administration of liver extract, the child improved steadily, but within one month the blood picture shifted to that of lymphatic leukemia, with eplenomegaly, generalized lymphadenopathy, and a white cell count of 42,800 (96 per cent lymphocytes). A sudden leukopenia developed, with hemorrhagic phenomena, and death occurred within two months of the onset of symptoms. WILLIAMJ. HOFFMAN

Lymphatic Leukemia with Splenomegaly Associated with Malaria, A. RIVOALENAND S. POPOFF.Leucbmie lymphoIde avec splbnomegalie chez un paludben, Bull. SOC. path. exot. 27: 281-283, 1934. The authors describe a case of lymphatic leukemia in a fifty-year-old farmer whose blood showed the presence of malaria parasites. The special features of the case, in addition to the coexistent malaria, included a severe anemia and an unusual degree of splenomegaly . WILLIAMJ. HOFFMAN Some New Observations on Auer Bodies in Acute Myelogenous Leukemia, ALBERT F. GOODWIN.Folia haemat. 51: 359-366, 1934. Coodwin reports a case of acute myelogenous leukemia in a man seventy-four years of age. When the patient was first seen, the white cell count was 9,400, rising to 63,850 per cubic millimeter four days before death, one month later. The Auer bodies appeared as rod-like forms, the ends being round, tapered, or blunt; they varied in size up to X micra in length and from 1 to 2 micra in width. They were observed in hemohistio- blasts, myeloblasts, myelocytes, neutrophilic polymorphonuclear leukocytes, and in the degenerating cells of the myelogenous series. They were found in 25 per cent of all the white blood cells. By application of a technic by which the red blood cells were overstained, and the white blood cells were understained, the Auer bodies were found more frequently on the nucleus. They were observed on the nucleue in 48 per cent, and at the nuclear indentation in 38 per cent of the total myeloblast count. A point of interest in this case was that the Auer body persisted as the final cellular structural element, preserving its staining and morphological properties even in myeloblasts which had been reduced to a necrotic mass. It was then evidently set free from these basket cells into the blood plasma. Coodwin noted, in his study of the liberated Auer body, that it retained its normal appearance as observed in the cells, and never presented signs of degeneration or necrosis. WILLIAMJ. HOFFMAN Traumatic Leukemia and Priapism, 0. R~LEIR.Traumatische Leukiimie und Pri- apismus, Miinchen. med. Wchnschr. 82: 217-218, 1935. The author reports the case of a thirtyeight-year-old man who sought medical treatment for a persistent priapism which began thirty-six hours after moderate trauma to the base of the penis. Twenty days after this injury the patient suffered acute pain in the left hypochondrium and for the first time an enlarged spleen could be felt. Studies THE LEUKEMIAS, HODOKIN 'S DIBEASE, LYMPHOSARCOMA 955

of the blood showed the changes typical of myelogenous leukemia. Since there was no indication of leukemia in this patient's clinical history before the accident, a definite cause and effect relation betwoen the trauma and the development of the myelogenous leukemia is assumed. [Inasmuch as priapism is a text-book symptom of myelogenous leukemia, and as the leukemia was unquestionably present hefore the injury, the latter could have had nothing to do with the leukemia.] BENJAMINR. SHORE Case of Subacute Myeloid Leukemia with Gangrenous Skin Eruption, J. PAVIOT,A. GUICHARD,AND M. DAMEZ. Gangrene cutanbe en plaques au cours d'une leuc6mie my6loIde evolution subaigue chea un homme de 78 ans, Lyon m6d. 154: 508-572, 1934. A man of seventy-eight had six weeks previously noticed edema of the lower extremities and a red patchy eruption on the left thigh. One patch grew rapidly larger and underwent ulceration. It now showed a central dry black scar about 5 cm. in diameter, surrounded by a wide ecchymotic aone. The spleen was considerably enlarged, and a blood count showed 2,780,000 erythrocytes and 102,000 leukocytes (polymorphonuclears 22 per cent, myelocytes 25, myeloblasts 46, monocytes 5, lymphocytes 2). Within three weeks the total leukocyte count had risen to 387,500, and the percentages of myelocytes and myeloblasts to 30 and 50 respectively, while nucleated red cells had appeared (10 per 100 leukocytes). During this period also there occurred for the first time nose- bleeds, hemoptyses, and purpura. The patient was taken home in a dying condition. The authors report the case because of the unusual skin manifestations, the rapid terminal progress of the disease, and the apparent absence of sepsis during the period of observation. F. CAVER~

Negafive Results of Treatment of Chronic Myelogenous Leukemia as a Deficiency Disease, WILLIAMB. CASTLE,OVID 0. MEYERAND WILLIAMB. CHEW,Proc. SOC. Exper. Biol. & Med. 32: 680-063, 1935. There is no obvious reason for supposing chronic myelogenous leukemia to be a dietary disease; yet the abnormal proliferation of primitive white blood cells in the bone-marrow might conceivably have a physiological analogy in the maturation arrest 'of the primitive red blood cells crowding the marrow of pernicious anemia in relapse. Although gastric anacidity is only occasionally present in myelogenous leukemia, the Bimultaneous advent of two patihts with chronic myelogenous leukemia, one of whom waa in a leukopenic phase and both of whom had gastric achlorhydria, provided the stimulus for the experiments here reported. The oral adminietration of desiccated mucosa of the stomach, small intestine, and pancreas of the hog, or mixtures of most of the fresh organs from newly born rabbits, proved to be without effect. Daily transfusions of the plasma and whole blood from normal persons were also devoid of value. No support for the idea that chronic myelogenous leukemia is a deficiency disease was obtained from these observations. WM. H. WOQLOM

The Porphyrins in Chloroma and Myeloid Leukemia, J. THOMASAND E. J. BIQWOOD. Etude des porphyrines qui apparaissent dans le chlorome et dans la leuc6mie mybldde, Compt. rend. SOC.de biol. 118: 381-383, 1936. The green color characteristic of chloroma is regarded by some investigators as parenchymal, ascribed by others to a pigment of the lipochrome group, and referred by still others to a degradation product of hemoglobin. Examination of a specimen with the microspectroscope and the fluorescence spectroscope showed large amounts of free porphyrin. This, when extracted, proved to have the properties of protoporphyrin, but the amount of available material wm small and the authors are not sure but that some coproporphyrin may have been present as well. Coneiderable amounts of free porphyrin were found, also, in distinctly green nodes from a patient with myeloid leukemia, and traces in other nodes from the same patient 956 ABSTRACTS

that were quite free of green coloration. None could be detected in spleen, liver, or a fragment of rib. That extracted from the green nodes resembled the protoporphyrin isolated from the chloroma. On the other hand, no free porphyrin could be found in greenish nodes from another patient with myeloid leukemia; the kidney, also, was free. Degradation products of blood pigment may be dismissed as a source of the protoporphyrin in the chloroma and in the lymph nodes of the first of the two patients with myeloid leukemia, for it seems more probable that this parent substance accumulated in consequence of its failure to develop into the other porphyrins, free or combined, that are now thought to be derived from it. WM. H. WOGLOM

Acute Monocytic Leukemia or Leukemic Reticulo-EndotheUosis3 T. LUCHERINI. Leucemia acuta monocitica o reticoloendoteliosi leucemica? Minerva med. 2: 188- 194, 1933. A man of seventy-seven had pain of sudden onset in the left upper jaw, burning of the tongue, fever of a septic type, and great prostration. A severe ulcero-necrotic stomatitis developed, and a profound anemia. Eight days after the onset the submaxillary nodes were enlarged and tender and fluid full of monocytic cells was present in the pleural cavity. A papulo-vesicular eruption appeared on the abdomen and back. The blood showed from 40,000 to 60,000 white blood cells, with 80 per cent monocytic elements. There was a granulopenia, but never a disappearance of the neutrophils. No lymphoblasts, myeloblasts, or hemocytoblasts were found. Blood cultures were sterile. No hemorrhagic phenomena were observed except for a small amount of blood in the stool. Autopsy three weeks after the onset showed an intense proliferation of the reticulo-endothelial elements of the liver, spleen and lymph nodes. Section of a rib showed the marrow composed almost exclusively of large monocytes. The differential diagnosis between acute monocytic leukemia and leukemic reticulo- endotheliosis is discussed. The clinical picture in the cue presented was that of an acute leukemia The predominant cells of the blood as observed for sixteen days before death were typical monocytes. Histological study showed the picture of a leukemic reticulo-endotheliosis. The author believes that a differentiation between the two conditions is impossible in this case and suggests that the monocyte and the reticulo- endotheliocyte may be transitional morphological phases of the same cell or that both cells may be derived from a common ancestor. Where the clinical picture and the underlying pathology of the two conditions are so nearly identical, Lucherini believes that the term monocytic leukemia might be used for-both JEANNETTEMUNRO

Acute Monocytic Leukemia, J. MORQANAND Y. T. Hsu. Chinese M. J. 48: 1113-1125, 1934. A case is reported of acute monocytic leukemia of rather abrupt onset and rapid course, the patient dying in three and one half weeks. The autopsy findings are given in detail. A terminal septicemia of Streptococcus viridans hastened death. The total white cell count was 21,200 on admission and 338,050 nine days later. The percentage of monocytes (97-99 per cent) was unusually high, with complete absence of polymorphonuclear cells. W. 5. MACCOMB Acute Monocytic Leukemia, with Hypertrophy of the Thymus, G. MARCHAL,C. BRUN AND C. GRUPPMR.Hypertrophie du thymus. Leucemie monocytaire aigue, Bull. ct m6m. SOC. m6d. d. h8p. de Paris SO: 1715-1721, 1934. A man of thirty had bilateral quinsy. After incision the fever rapidly subeidedt but three weeks later there WBB enlargement of the submandibular lymph nodes on both sides, with increasingly high fever. The first blood count showed 2,100,000 erythrocytes, but is said to have been otherwise normal. During the next two months there appeared ulueronecrotic angina, extensive adenopathy, dyspnea, and enlargement of the spleen and liver. Repeated blood transfusions were given, but the patient died five months after the onset of the quinsy. A week before death a blood count showed 1,380,000erythrocytes, 6,000 normoblasts, and 35,400 leukocytes per c.mm. (monocytes 80 per cent, monoblasts 11, lymphocytes 7, myelocytes 2). At necropsy the thymus THE LEUKEMIAS, HODQKLN ’S DISEASE, LYMPHOSARCOMA 957

showed considerable hyperplasia, which the authors believe played some part in the etiology of the leukemia. Nothing is said about histologic examination of the lymph nodes, liver, spleen, and bone marrow. F. CAVPRS Chronic Monocytic Leukemia Without Enlargement of Spleen or Lymph Nodes, G. MARCHAL,J. LEMOINDAND R. BLOCH-MICHEL.Leuc6mie chronique B monocytes sans spl6nom6galie, ni ad6nom6galieJ Sang 8: 694-700, 1934. In the authors’ experience, monocytic leukemia is accompanied by either splenomegaly or adenopathy or both. In the case here reported neither of these manifestations was present, and the diagnosis was made from routine blood examination. A man of seventy-three was found to have advanced mitral insufficiency, with dyspnea, enlargement of the liver, and edema of the lower extremities. Nearly two years previously, when he was first seen, a blood count showed 10,500 leukocytes with 52 per cent monocytes (remainder of count not given). The blood on this second admission contained 35,800 leukocytes with 83 per cent monocytes, and a count made four weeks later, two days before death, showed a rise in the monocytes to 91 per cent of the total 65,600 leukocytes. Necropsy revealed no adenopathy except for three elightly enlarged tracheobronchial nodes. The spleen pulp showed moderate hyperplasia, with lymphoid cells aggregated around the blood vessels and monocytes at the periphery of the mal- pighian corpuscles. The marrow of the ribs showed mainly lymphoid proliferation, with a fair number of monocytes. There were infiltrations in the liver, heart, and lungs, in which the monocytes were about as abundant as the lymphocytes. From their histologic observations on five cases of chronic monocytic leukemia coming to necropsy, the authors have adopted an eclectic attitude regarding the histogenesis of monocytes, which they believe may be derived either from special stem cells leading through monoblasts, or from transformation of lymphocytes, or from reticulo- endothelial elements, especially in the spleen. F. CAVERS

Plasma Cell Leukemia, E. E. OSGOODAND W.C. HUNTER. Folia haemat. 52: 369-383, 1934. The authors’ patient was a forty-nine-year-old man with symptoms applicable to any form of leukemia. Physical findinge and blood studies were not specifically diagnostic until late in the course of the disease, when the terminal entrance of the plasma cells into the blood stream made possible the diagnosis. Multiple myeloma was ruled out by the absence of typical bone changes. Necropsy findings demonstrated a marked plasma-cell hyperplasia, especially in the bone marrow, spleen, liver, and lymph nodes. The authors could find in the literature only one similar case (Piney: Folia haemat. 30: 174, 1924). The case here reported offered an excellent opportunity for the study of the morphology and histogenesis of plasma cells. From detailed study of the blood and pathological findings the authors conclude that the plasma cell is not derived from the lymphocyte or any of the other precursors previously suggested. On the contrary it is suggested that they are normal constituents of the blood and bone marrow, entities just as distinct as any other leukocytes, which they resemble in their potentialities for infiltration, leukocytoeis, tumor formation, and leukemic proliferation. Finally the occurrence of plasma cells with Ttirck cells and the recognition of intermediate stages between them suggest the probability of two stages in a common histogenetic scale. There are five photomicrographs and one colored plate depicting various forms of the plasma cell. There is a short but comprehensive bibliography, THEODORES. RAIFORD Subleukemic Lymphadenosis Associated with Tuberculosis of the Lymph Nodes and Spleen, EMILE-WEIL,P. ISCH-WALLAND R. LEHMANN.Un cas de lymphomatose eplhoganglionnaire subleuc6mique avec tuberculose suppur6e localist5e aux ganglions et 8- la rate, Sang 8: 709-714, 1934. About six weeks before hospital admission a man of seventy-four had attacks of left hypochondria1 pain and noticed lumps in both groins. There was also bilateral enlarge- 958 ABSTRACTS ment of the suprac~avicular,axillary, and epitrochlear nodes. The spleen was considerably enlarged, the liver of normal sice. A blood count showed 4,850,000 erythro- cytee and 6200 leukocytes (polymorphonuclears 54 per cent, lymphocytes 31, monocytes 15). Splenic puncture showed mainly lymphoblasts, and biopsy of a node revealed replacement by these cells. Successive blood c0unt.s showed reduction of erythrocytes, slight increase of total leukocytes, and increase of lymphocytes at the expense of poly- nuclears. After x-rays twice a week to the spleen and the axillary and inguinal nodes, the total leukocyte count fell to 3400 (polymorphonuclears 72 per cent, lymphocytes 12, monocytes 14, myelocytes 2), but the patient became dyspneic, owing to left pleural effusion. Paracentesis yielded 3.3 liters of blood-stained fluid, containing a preponderance of monocytes. The spleen and nodes now became much smaller, but nine days later the patient died, four months after the appearance of the first symptoms. Necropsy revealed numerous enlarged mesenteric and mediastinal nodes, all of which were soft and contained purulent caseous material. Similar nodules were disseminated in the spleen. In these internal lymph nodes and in the spleen there was lymphobleetic infiltration 8SSOCi8ted with purulent caseous foci, but no tubercle bacilli were found in emears or cultures. An emulsion of the mesenteric nodes was injected into a guinea-pig, which when killed, three months later, showed tuberculous follicles with giant cells but no tubercle bacilli. The authors interpret the c88e as one of lymphadenosis, perhaps better termed lymphomatosis, in which the young lymphoid cells formed in the spleen and the internal lymph nodes failed to reach the general blood stream, but they leave the etiologic relation, if any, between the leukotic and tubercular processes an open question. F. CAVERS

Case of Subacute Ateukemic Myeloblastic Leukosis, N. I. NISSEN. Et tilfselde af subakut aleuksemisk myeloblastleukose, Ugeskr. f. Lseger 96: 165-166, 1934. A woman of fifty died four months after admission to hospital. The first symptoms, noticed a month before admission, were fever, ulceration of the mouth and lips, and heniorrhages in the skin. The course of the disease gave the clinical picture of pernicious anemia combined with purpura. During the period of observation the erythrocytes sank from 3,700,000 to 2,000,000, the hemoglobin percentage from 72 to 29, the thrombocytes from 120,000 to 30,000. The total leukocytes remained very constant, the extreme counts being 2400 and 4500; the myelocytes rose from 20 per cent, and the myeloblasts from 45 to 77 per cent, while the po~ymorphonuclearsfell from 45 to 3 per cent and the lymphocytes from 6 to 0 per cent. F. CAVERS Hodgkin’s Disease, G. BASSI. Linfogranulomatosi cervico-axillo-mediastinica, Gior. med. d. Alto Adige 6: 241-250. 1934. In this clinical lecture the author reports a typical case of malignant lymphogranulomatosis, which serves for a general discussion of the chief features of this disease and its differential diagnosis. Remission occurred after x-ray treatment. At the time of the report the patient had developed osteoarthropathy of the digits of the hands and feet. There are no illustrations. F. CAVERS Hodgkin’s Disease with Ulcerated Skin Lesions Necereitating Amputation of One Foot, 5. CZEZOWSKAAND H. MIERZECKI.Manifestations cutankes diffuses dans Is ~ymphogranulomatosemaligne, Act8 derm.-venereol. 1s: 501-513, 1934. A woman of forty-two had for several weeks had pruritus, cough, and difficulty in breathing. These symptoms rapidly became more intense, and lumps appeared in the right supraclavicular fossa and right axilla. The neck was swollen and the jugular veins distended. X-rays showed a dense right hilar shadow, and biopsy of a node confirmed the diagnosis of Hodgkin’s disease. Under x-ray treatment the general condition rapidly improved and the mediastinal shadow almost disappeared. About Rix weeks after leaving the hospital the patient was brought back, with high fever, intense dyspnea, cyanosis, and edema of the face, neck, and right hemithorax. There was right pleural effusion. After repeated paracentesis and x-rays to the chest, the dyspnea and edema cleared, but there suddenly appeared, all over the body, small THE LEUKEMIAS, HOWKIN ’8 DISEASE, LYMPHOSARCOMA 959 papules which rapidly underwent ulceration. The individual lesions disappeared in a few days, without treatment, leaving a brown patch, while new lesions appeared in successive crops. The patient also complained of ,a burning sensation in the mouth, with dysphagia, and innumerable similar lesions were found in the buccal and pharyngeal mucosa. Over the right tibiotarsal joint numerous skin lesions became confluent, and a large deep ulcer. was formed, with infection by staphylococci and streptococci. As this ulcer became wider and deeper despite local treatment, and profuse hemorrhage set in, amputation was done above the joint. The ulcer contained typical Hodgkin tissue with numerous Sternberg cells. Following operation the patient rapidly improved and left the hospital. She did not return for further treatment. The authors stress the advisability of careful antiseptic treatment of the skin lesions in lymphogranulomatosis. They give three good illustrations. F. CAVXRB

Acute Lymphogranulomatosis, A. JEZLERAND 8. SCHEIDEGGER.Akuter Verlauf bei Lymphogranulomatose, Schweis. med. Wchnschr. 16: 7-10, 1935. The authors report the case of a thirty-three-year-old woman whose death from lymphogranulomatosis involving the spleen, bone marrow, and intra-abdominal lymph nodes, occurred about three months after the onset of the disease. The striking clinical features were hyperpyrexia and marked leukopenia. At times the total white cell count was as low as 400 per cubic millimeter, the greatest reduction being in the number of the neutrophils. There was a corresponding anemia. An interesting feature of the case was the fact that an intravenous injection of uroselectan for diagnostic purposes seemed to aggravate all the symptoms of the disease so as to cause a fatal outcome four weeks later. The typical lesions of lymphogranulomatosis were found in the spleen, liver, bone marrow, and lymph nodes at autopsy. BENJAMINR. SHORE Didlorentid Diagnosis Between Siderotic Granuloma and Lymphogranulomatosis of the Spleen, B. BERGQVISTAND E. CRIPWALL.Beitritge aur Kenntnis der Differen- tiddiagnose swischen splenogranulomatosis eiderotica (Nanta) und Lympho- granulomatose, Acta path. et microbiol. Scandinav. 12: 79-1 14, 1935. The authors report the case of a man from whom an enlarged spleen was surgically removed in February 1932. Histologic study of thie organ showed nodules of granulomatous tissue in which were deposited large quantities of iron-containing pigment. Besides this there were areas in which a mycelium-like network was found. These latter structures were interpreted as representing altered connective tissue. The patient died twenty-one months after the splenectomy. Autopsy disclosed an enlarged liver and enlarged retroperitoneal lymph nodes which had the histologic characteristics of lymphogranulomatosis. It is concluded from the study of this case that siderotic nodules and mycelium-like connective tissue in the spleen are compatible with a diagnosis of lymphogranulomatosis. The article is well illustrated with photomicrographs. BENJAMINR. SHORID Hodgldn’e Disease of the Skeleton without Glandular Involvement: A Case Report Roved by Autopsy, 8. K. LIVINGSTON.J. Bone & Joint Surg. 17: 189-194, 1935. The author reports the case of a forty-one-year-old man in whom the lesions of Hodgkin’s disease were found in the ribs, skull, pelvic bones, lumbar vertebrae, and liver at autopsy. There was no involvement of the lymph nodes. The article is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHORID

Metastatic Lymphogranulomatosis of the Skeleton, M. BRANDT. Beitrag zur metasta- tischen Knochenlymphogranulomatose, Frankfurter Ztschr. f. Path. 46: 508-512, 1934. The author reports the case of a forty-year-old woman in whom typical lesione of lymphogranulomatosis of the lymph nodes and metastatic tumors in the bones of the pelvis and skull, the left femur, and left humerus were found at autopsy. There were also atypical lesions in the right tonsil, liver, left adrenal gland, and nasopharynx. From the distribution of the skeletal lesions it was thought that they represented metas- 960 ABSTRACTS tases by way of the blood stream. Photographs of several of the skeletal growths are included. BENJAMINR. SHORE

Lymphosarcoma, MAXCUTLER. Arch. Surg. 30: 405-441, 1935. Cutler reports thirty cases of lymphosarcoma, which he divides on a clinical basis into the following groups: I. Lymphosarcoma with generalized adenopathy, but no other special localization: Nine cases of this type were studied, but the details are not included. 2. Lymphosarcoma with localization in the tonsil, the pharynx, or the base of the tongue: There were 6 cases in this group. One patient was free of evidence of disease an unstated length of time after radium treatment of a lymphosarcoma of the base of the tongue. Four of the other patients were dead, and in one of these the lesion did not respond at all to radiation. One of the patients, who had a primary lymphosarcoma of the nasopharynx which recurred after radiation in the accessory sinuses, was autopsied and no distant metastases were found. 3. Lymphosarcoma with retroperitonal lymph nodes: There was only one case in Cutler’s series in which the disease was localized in the retroperitoneal lymph nodes. No radiation treatment was given, and death occurred following exploratory laparotomy done two years after the onset of symptoms. 4. Lymphosarcoma associated with lesions of the rectum: Three patients with localized tumors of the rectum diagnosed as lymphosarcoma are included. One treated by surgical excision followed by roentgen treatment was well three years later. The 2 others, treated with radium, were free of evidence of disease thirteen and fourteen months, respectively, after treatment. 5. Lymphadcnoma: Cutler includes 3 cases of generalized enlargement of lymph nodes in which his histological diagnosis was ’’ lymphadenoma.” He includes photomicrographs of poor quality to illustrate the morphology of the lesions in two of the patients, but fails to present a careful histological description of the lesions. The reader is thus left in doubt as to the exact nature of the condition in these patients. All three were alive when the report was written, which was about three years after their symptoms had begun. 6. Thymic tUmOr8: Although Cutler places 8 of his cases in this category, and uses the loose term “ thymoma ” to describe them, he presents anatomical evidence gained from autopsy which might support the diagnosis of a thymic tumor in only 2 cases. All of the patients received radiation treatment, and in all but 2 a degree of primary response was obtained. Two of the patients were alive six and two years, respectively, after treatment. Cutler is able to present, from his series of 30 cases, 2 who were alive and free from disease for more than five years after treatment with radiation. The average survival period in the patients who died was sixteen months. He believes that the localized forms of lymphosarcoma should be treated by intensive local radiation, but that the generalized forms may be given smaller doses. A bibliography is included. C. D. HAAGENSEN

Lymphosarcoma, A. L. WINGFIELD.Proc. Roy. SOC.Med. 28: 762, 1935. A man of fifty-seven had painless swellings in the neck for “ many years ” and had recently begun to have cough with thick sputum. There was also bilateral suprascapular and axillary adenopathy; the liver and spleen were not palpable; the lungs and heart were clinically normal. Biopsy of a node showed replacement of normal structure by infiltration with lymphocytes; a few mitoses were seen, and lymphosarcoma was diagnosed. X-ray showed increased density at the roots of both lungs. F. CAVERS

Lymphosarcoma with Metastases in the Skin, F. LANGMEADAND G. B. HEG~S.Proc. Roy. SOC.Med. 28: 736, 1935. A man of fifty-four had a month before hospital admission noticed swellings in both preauricular regions and later in the groins and axillae. There were now also enlarged nodes in the neck and the popliteal spaces, Biopsy led to the diagnosis of lymphosar- STATISTICS 961 coma. Radiography of the thorax was negative. During the next few weeks cutaneous nodules appeared, histologically resembling the enlarged nodes but showing fewer mitoses. After x-ray treatment the skin nodules regressed, while the enlarged nodes soon resumed growth after temporary diminution. F. CAVERS

STATISTICS Vienna Registry for Cancer, F. KRUTINA.Der Wiener Krebskataster, Wien. klin. Wchnschr. 47: 1481-1482, 1934. In 1933,2001 cases of cancer in women and 1484 in men were registered in Vienna. The tumors in 901 of the 2001 women were situated in the urogenital tract and 327 additional ones arose in the breast. Among the men the largest group, numbering 291 cases, was made up of tumors of the oral cavity, pharynx, and esophagus. Mortality statistics are not included. BENJAMINR. SHORE

Frequency of Cancer in the City of Jassy. Contribution to Local Cancer Statistics, I. GEEORGHIUAND N. VORNICESCU.La fr6quence du cancer dam la ville de Jassy. Contribution de statistique locale B la recherche du cancer, Bull. Assoc. franc. p. 1’6tude de cancer 24: 73-78, 1935. The authors admit at the outset that their findings have but a relative value, since in very few instances was the diagnosis established by autopsy. To show how unreliable such unverified returns may be they recall how, in Germany, the general statistics suggest that 3.6 per cent of the total deaths are caused by cancer, whereas autopsy and microscopic examination raise this figure to 9.2 per cent. After recording the familiar predominance of cancer in the fourth and fifth decades, the vulnerability of the female genital system, etc., the authors take up the question of “ cancer houses,’’ the existence of which they seem more or less inclined to admit; nor are they entirely hostile to the hypothesis of contagion. They discount the idea that soil is an influence in etiology, for that underlying the city is everywhere the 8ame, yet the number of reported cases varies considerably from one district to another. Most of the patients come from damp, over-populated, badly constructed, and poorly maintained houses in the slums. WM. H. WOGLOM Cancer in the Maori Population of New Zealand, FREDERICKL. HOFFMAN. Acta Cancrologica 1: 279-283, 1935. The difference in age distribution between Maoris and Europeans is not sufficiently pronounced to affect seriously the corresponding cancer statistics. As with other races, carcinoma of the female genital organs and mammary gland is common among the Maoris. The predominating neoplasm is cancer of the stomach and liver [included under the one heading]. The general cancer death rate is 33.7 per 100,000. WM. H. WOGLOM

Mortality Statistics, M. J. HOLMEa. J. Cancer Res. Comm. Univ. of Sydney, 6: 29-34, 1934. Mortality statistics for Australia show a constantly rising cancer death rate-from 629 per 10,000 deaths in 1908 to 1,211 in 1932. An analysis of the figures indicates the unsoundness of the impression that cancer mortality is not a serious factor except at comparatively late ages. In middle age (forty-five to fifty-nine) cancer is steadily taking a heavy toll of life, and the proportion of cancer deaths to total deaths is at its highest in these age groups: it was found to be the principal cause of death in middle age in females, while in males it came second only to the diseases of the heart and circulation. Although the cancer mortality rate in most regions of the body has been steadily increasing, exceptions being noted in the case of cancer of the tongue and cancer of the skin in males, the rate of increase has been much more marked in some sites than in others. The region in which the most rapid increase has occurred is the digestive tract. 962 ABBTBACTS

EDUCATION

The Phydcianb Relation to Cancer, K. F. KESMODEL.J. M. A. Alabama 4: 129-133, 1934. Since SO little is known about the origin of cancer, prevention occupies a less important place than cure. Since the succe8s or failure of curative measures depends largely upon the stage in which the disease is attacked, the physician who has the first contact with the patient must bear a large part of the responsibility. Patients may be divided into four groups, of which the first includes those presenting precancerous lesions, i.e. lesions which experience has taught may develop into malignant disease. These the physician should be able to recognire and to treat before malignant change takes place. The second group presents obvious cancer. These individuals usually ask for medical advice on account of some lump or sore spot which they regard as abnormal. The character and extent of the condition should be ascertained, and the patient should be referred to a consultant or special clinic where the lesion can be adequately treated. Above all the use of irritating topical applications should be avoided. A third group presents symptoms suggestive of cancer. Here again it is the duty of the physician to determine if there is a pathological reason for the symptoms. In this he may need modern diagnostic methods and should have the patient competently examined. The fourth group includes those patients in whom a malignant growth gives no obvious or characteristic manifestations. The symptoms suah as they are may easily be referable to some other cause and the malignant disease pass entirely unnoticed. In patients of this type, the utmost in discrimination is needed if a correct diagnosis is to be made and treatment instituted in a curable stage. There are no illustrations or bibliography. THEODORE8. RAIFORD Education and Researcb in the Field of Inheritance of Disease, M. T. MACKLIN. Canadian M. A. J. 32: 80-82, 1935. Starting from Lord Horder’s recent plea for the incorporation in the medical school curriculum of instruction in genetics, with special reference to the inheritance of disease, the author urges with unaontestable logic and good sense that there should be established institutes for the collection and analysis of statistics conaerning the familial incidence of disease, in particular of cancer. She states that many of the family records taken in private and hospital practice are inadequate or useless, and are often unjustifi- ably employed as evidenoe against the inheritance of cancer. She also points out that a large amount of money might be obtainable for the purpose of the campaign against cancer by the simple expedient of sacking I’ a large percentage of the officials by whom Canada [and many another country] is I’ tremendously over-governed.” [The reader of this joyously trenchant paper might be inclined to a more merciful use of the cru- sader’s mace. Why not offer these “ sacked ” officials, instead of the unemployment dole, the opportunity of learning some arithmetic and the elements of genetics, and on their passing an examination in these subjects and in general intelligence, give them work on the staffs oE t4heproposed health record institutes, and of the follow-up depart- ments of the hospitals?] F. CAVERB Cancer Instruction and Control in the U. S. A. BRUNOCEBHARD. Krebsaufklarung und Krebsbekilmpfung in USA, Deutsche med. Wchnschr. 61 : 268-269, 1935. The American program for cancer instruction and control has three aspects-publicity, support of research, and improvements in diagnosis and treatment. With 153,000 deaths annually, cancer now occupies second place in the tables of mortality. The rate at present is 12.3 per 10,000 as compared with 6.3 in 1900. In other words, every tenth death is caused by cancer. Organized effort began in 1913 with the founding of the American Society for the Control of Cancer, whose program is mainly the education of both phyeician and layman. Practical results are being achieved. Thus, in Pennsylvania, for example, the time between the patient’s first suspicion and his consultation with a phyeician has been decreased by 50 per cent, while the period elapsing before the physician institutes appropriate treatment has been shortened by 75 per cent. EDUOATION 963

Diagnostic clinics and therapeutic centers are being organized on a large scale 88 8 result of inquiries which uncovered a general operative mortality of 45 per cent or more among 75 hospitals in 19 large cities, as contrasted with the 10 per cent of recognized specialists. Failure of the general practitioner to refer the patient to a surgeon in time, inadequate radiotherapeutic apparatus, and the lack of beds for incurable patients were found to be the conditions most urgently calling for improvement. Here the American College of Surgeons has done invaluable work in tecommending a minimum standard for a cancer service in a general hospital. The requirements include the presence of 8 surgeon, a gynecologist, a radiotherapeutist, a pathologist, an x-ray apparatus of not less than 200,000 volts, a minimum of 200 mg. of radium, and regular staff conferences. This “ group practice,” the most typical feature of modern American medicine, is too often condemned in Germany as over-specialization. The activities of certain health officers have been a mode1 which others might well follow. Thus George H. Bigelow, in his valuable monograph on “ Cancer and Other Chronic Diseases in Massachusetts ” said that as a result of an organized campaign in that state the number of patients coming for advice had increased in six years bY.50 per cent, in consequence of which the number of still operable cases discovered was rising year by year. Special attention had been given to obtaining the cooperation of the general practitioner, who bears the responsibility of first making the diagnosis. His difficulties are well shown by the calculation that in Massachusetts he may be expected to encounter, on the average, only two cancer patients yearly; yet he is severely censured if he fails to make the diagnosis immediately. WM.H. WoGLOM

Organization of the Cancer Campaign in the United States of America, A. SOILAND. Radiology 23: 446448, 1934. Boiland reviews the organizations and institutions in the United States through which attempts are being made to lessen the mortality from malignant dkiease. State controlled institutions for research and treatment are maintained in only two states, New York and Massachusetts, but in several others cancer commissions under the control of state medical aocieties are carrying out active investigative work. The privately endowed American Society for the Control of Cancer with headquarters in New York plays an active part in the education of both the medical and lay public. The American College of Surgeons has aided in standardizing the diagnosis and treatment of neoplastic disease in many hospitals over the country. Further educational work is being done by the American Medical Association through the medium of the radio and press, and one of the major life insurance companies calls attention to the necessity of cancer con- fro1 through its published statistics. THEODOREs. RAIFORD

FhtYear’s Operation of the Tumor Clinic at Fulton State Hospital, F. H. SPENCER,D. A. ROBNETTAND E. FISCHEL.J. Missouri M. A. 32: 59-61, 1935. From September 1933 to September 1934 70 patients with cancer were treated at the Fulton State Hospital, Missouri. In 54 of these a cure appeared possible. The sites were as follows: lip 5; tongue 2; skin 59; breast 11; uterus 5; testicle 1; osteoma 1; larynx 1 (papilloma); pharynx 1. GRAYH. TWOMBLY

The Khg George V Silver Jubilee Cancer Fund for Canada, J. S. EACHWRNET AL. Canadian M. A. J. 32: 117-118, 1935. It has been wisely decided that the opportunity afforded to the people of Canada of 8 permanent commemoration of the 25th anniversary of the King’s accession is to take the form of a voluntary fund for the study and control of cancer. In their an- nouncements of thie decision, the President of the Canadian Medical Association, the Chairman of its Cancer Committee and the Editor of its Journa.1 stress the urgent need of making the most of this opportunity, since hitherto there has never been a public appeal in Canada for the relief of cancer or a voluntary association in the country having this for its sole object. F. CAVERS 964 ABSTRACTS

The Organization of Cancer Campaigns, MAX GENTZEN.Organisatorisches zur Frage der Krebsbekampfung, Deutsche med. Wchnschr. 60: 1353-1354, 1934. The necessity for undertaking a serious campaign against cancer in East Prussia is shoyn by the fact that it destroys every year about 1000 persons under the age of sixty-a group which is of particular value as most of its members are still industrially active. The annual number of deaths among those above sixty is in the neighborhood of 2000. The problem has not changed since Winter began his campaign of instruction by the printed word thirty years ago, but aupplementary methods will be required for its solution. Personal contact with all classes of the population through public lectures and the oral instruction of nurses and midwives is now indispensable. Here women should receive first consideration, as the danger is greater for them than for men, and each one should be advised to submit to an examination once a year. Though reliable statistics on cancer morbidity would no doubt be of value, this is perhaps the least important aspect of the problem at the present time. Such material, if desired, could best be collected by making cancer, actual or suspected, a reportable disease. WM. H. WOQLOM Progress of the Anticancer Campaign in France. Les progr6s de la lutte anticancbreuse en France, EMILEFORQUE. Gaz. d. hbp. 108: 141-143. 1935. This lecture, delivered at the opening of a new cancer center, contains no fresh material. WM.H. WOQLOM

Review of Developments in Coxmexion with Cancer Control in Australia, 1933, M. J. HOLMES. J. Cancer Res. Comm. Univ. Sydney 6: 14-28, 1934. A report by the Senior Medical Officer of the Commonwealth Department of Health on the facilities for cancer treatment, especially by radiotherapeutic methods, in Australia.

Laboratory Research in New Zealand, A. M. BEQQ. J. Cancer Res. Comm. Univ. Sydney 6: 35-38, 1934. A report of investigations in progress in New Zealand on thc causation of cancer and on therapeutic and diagnostic procedures. The Jugo-Slavian Cancer Campaign, 5. TASSOVATZ.L’organisation de la lutte contre le cancer en Yougoslavie, Presse mbd. 42: 1475-1477, 1934. ThiF is an outline of the cancer-campaign which has been conducted in Yugoslavia during the past seven years in an attempt to organize and give coherent direction in this regard to the work of clinical, laboratory, statistical and publicity agencies. JOHNS. LOCKWOOD

Advertised Cures for Cancer, P. R. PEACOCK.Brit. M. J. 1: 680-681, 1935. The author draws attention to an advertisement by a cancer quack which appeared in a Glusgow newspaper, and considers that the medical authorities might instigate legielation to penalize this sort of thing. F. CAVEHS

The Study of Malignancy, A. H. B. KIRKMAN.Brit. M J. 1: 230, 1935. The Study of Malignancy, M. ROBERTS. Ibid. 1: 279, 1935. These two letters are examples of discussion about cancer which add nothing to our knowledge of the disease. F. CAVERH