normal temperature and weak pulse, and was ordered digalen, to be used freely and repeatedly, as needed.

Of course, the end is not yet, and it is difficult to say what the end will be. But instead of the predicted and expected one month to live, the patient is still alive over four months. Instead of screaming with pain, only controlled by large morphine injections, she has been reasonably comfortable for three months, with no morphine or opiate. She takes the prescribed diet and medicines, and sits up, often in a chair. It would seem that the constitutional disease, which produced the first tumor and the metastases, is largely overcome, and instead of increased metastases those already formed appear to have diminished. When, by two changes of nurses, the treatment has been more or less interfered with, matters have not gone so well, and there have been some slight set-backs, matters have been improved when everything has been rigidly enforced. The whole history illustrates well what can be done, even in apparently hopeless cases, by the strictest, wise medical adjustment of proper measures, rigidly carried out. Since writing the above she has passed peacefully away, presumably from her weak heart, which caused her fainting attacks.

President Coolidge, in addressing 3000 members of the American Association for the Advancement of Science, recently said:

"It has taken endless ages to create in men the courage that will accept the truth simply because it is the truth," and it seems ages to get the medical profession to find the truth in regard to cancer. The laity seem to have partially learned it first, and to realize that the knife is not able to really cure the disease. Emerson has said "No truth is trivial today but it may be sublime tomorrow, in the light of new ideas."

Iodine As a Palliative.-Iodine is commonly spoken of as the most unquestionable among tumoraffin substances. Botelho, well known for his serodiagnostic reaction, recommended at one time a compress saturated every 10 minutes with a mixture of saline solution, glycerine, purified tannin, potassium iodide, and iodine. Mild as this formula seems, it is said to cause the cancer to slough. Some of its efficacy is thought to be due to the formation of precipitates in the blood vessels, with shutting off of the circulation. The remedy is mentioned in Science for June 12, 1925, but we have seen no subsequent allusion to it. It was evidently intended particularly for mammary cancer.

The Journal Cancer.-Unfortunately through a gross and false misrepresentation by a former associate in practice, whom I had named as Associate Editor of Cancer, an impression has gone abroad that the Journal has changed hands and is to appear under different management. To correct this error a definite statement must be made.

The Journal was started in October, 1923, under the auspices of the American Association for the Prevention and Cure of Cancer, and has appeared quarterly under the present Editor, with a corps of collaborators. There have been three assistant Editors in succession, the late office assistant of the Editor being the third, and Dr. J. Lyman Bulkley, his present office assistant, recently appointed, as the fourth Associate Editor of CANCER.

It has cost many thousands of dollars and very much hard work to bring the Journal to its present recognized position as an exponent of the constitutional nature of cancer and its non-surgical treatment, and there never has been any thought of giving it up, or of changing editors. The Supreme Court of New York has issued an injunction against any further attempt in this direction, and it is hoped that the arrogant action of the former Associate Editor will be forgotten, and the spurious issue of the October number will disappear. As the original articles in that issue were sent to the Cancer Publishing Company, and removed from my desk and printed and circulated without my knowledge, they are reprinted in the January issue.

L. Duncan Bulkley, M. D.,

Owner, Editor and Publisher of CANCER.

In the Footsteps of Louis Sambon.—In an article in the London Morning Post of November 30, 1926, mention is made of a letter written them emphasizing the importance of pursuing cancer research on biological and epidemiological lines. The letter is signed by such imposing medical investigators as Lord Aberconway, Major E. E. Austin, Sir G. Lenthal Cheatle, Sir James Crichton-Browne, Dr. F. G. Clemow, Professor Winifred Cullis (M.D.), Dr. E. T. Jensen, Major Gen'l Sir John Moore and Sir D'arcy Power. They argue that while study of cancer in the ward and the pathological laboratory may advance ideas of the curative treatment, it does not give insight into its causation nor means of prevention. It further recounts the results of Dr. L. W. Sambon's investigations in Italy which map out the different localities where cancer is prevalent, including such places as what he terms "Cancer houses," "Cancer streets" and even "Cancer villages," suggesting that by means of such a census a causative factor in cancer production may be found to be an unequal distribution of some element or elements in the environment, and through this means enable some method of prevention to be carried out. The letter concludes with an appeal for money to enable such a census as that of Sambon's to be instituted in England.

A PSYCHOLOGICAL STUDY OF CANCER, By Elida Evans

Dodd Mead & Co., New York

The first comment I have to make on this scientific book is, that the pages are not cut. It is a nuisance to the reader and disturbs the line of thought to have to stop and cut the leaves. I wonder at Dodd, Mead & Company accepting any book with the pages uncut.

This book is interesting because it presents quite a new view to the profession and the laity in regard to a psychological study of Cancer. It is very hard reading, but every word has been read and many pages marked for further consideration.

The whole basis of the study is, as might be imagined, that psychological mental strain causes a derangement of cells and that cancer necessarily occurs from neurotic causes. We have long known from statements made in books, old and new, and from personal experience, that great worry and extensive distress etc., induce the tendency to the disease, but I think that very few are willing to accept the claim that they are the single or main cause of the cancer.

Writer gives 12 or more cases which are interesting in one way, in which cancer followed a great strain or disappointment. While we all realize that these causes do act upon the tissues of the body, and can provoke certain cells to the wrong action seen in cancer, we note the error of concluding that psychological disturbances are alone the effective cause of the lesion.

Many of us who see much of cancer find many metabolic changes in the system, which may often be produced from psychological disturbances in certain cases, but it is too much to say that neurotic disturbances are the real cause of cancer, in every instance.

The book emphasizes the aid which good surgery may exert toward the cure of the disease, although in many instances it perverts or deranges the psychology and tends to make cancer worse, and too often causes a fatal issue.

The book is well worth reading, studying, and remembering, and we trust that many of the physicians and surgeons, especially the latter, will read, understand and act upon it.

The author is evidently a woman having much to do with neurotic cases of all kinds, and who has seen some cancer, and therefore is a very appropriate person to develop such a line of thought as is here found. Its perusal and acceptation will aid many physicians in understanding this terrible disease, and in giving relief to it.

DIE KREBSKRANKHEIT. The official handbook of the Austrian Society for the Study of and Warfare Against Cancer. 1925.

This work, which consists of a large number of individual essays by different authors on some of the varied aspects of cancer, is not well suited for reviewing. In glancing through it a few passages are of interest concerning the constitutional nature and medical treatment of cancer. The volume is almost silent on prophylaxis, other than early surgical removal of actual cancer and precancer, and there is only a reference to the feasibility of prophylactic raying of localities like the female breast and cervix uteri in the hope of destroying the germ of the future malignant growth. It is suggested that these treatments be given to women in general after the age of 35. Whether one or a series of exposures is necessary is left undecided.

Under the head of medical treatment the hope is expressed that at some future period it will be possible to combine some form of active immunization with chemotherapy, organotherapy, and some form of radiant energy into a practical method of cure. It is suggested that this will be facilitated as soon as we can find a dependable method of early diagnosis.

Under cancer as a constitutional disease we have at present only such knowledge as can be gleaned from cancer families, and even with this limitation we know little enough about prospective victims as to their physique, metabolism, etc. There are two views which may or may not be opposed, of which one refers to a general or systemic disposition to neoplasms of all kinds, and the other to organ predisposition, in which some particular portion of the body represents a vulnerable spot for cancer development.

REVIEW OF LITERATURE

STATISTICS AND INCIDENCE

Percentage of Cancer in Cancer Suspects.-It is now over two years ago since the experiment was made in Detroit of examining the public gratis over a brief period. The free diagnostic clinics were held Feb. 17-20 inclusive, 1924, at the different Detroit hospitals and under the auspices of the Wayne County Medical Society. The publicity was secured in the usual way, through the press chiefly. The expenses were met through the Chase Cancer Fund of the Harper Hospital, and Dr. F. T. Murphy. Over 1100 individuals applied at eight hospitals and another hundred wrote to the Society. The number actually examined and who may be loosely spoken of as suspects was 874 and of this number 42 actually were found suffering from the disease or 4.8 per cent, while 75 presented precancerous conditions which might or might not develop into cancer, and in whom conceivably prophylactic measures were recommended. The crusade proved well worth while from another standpoint for at least 60 per cent of those examined were suffering from some ailment other than malignancy-chronic appendicitis, cholelithiasis, peptic ulcer, etc. The number of hypochondriacs does not seem to have been unduly large and most of these seem to have complained of digestive disturbances of functional nature. There is no computation as to how many patients with incipient cancer failed to present themselves, yet it ought not be difficult to arrive approximately at this number from the annual cancer deathrate of Detroit and environs.

Cancer Among the Hindus.-The vexed question of the frequency of cancer among the Hindus is obscured because the social status and the local forms of the disease are often disregarded. When one observer mentions cancer frequency he is probably referring to betel chewers' epithelioma or to cancer among the higher castes and Anglo-Indians. In a letter written to the Indian Medical Gazette for January, 1925, Dr. Halliday has reason to believe that the cultured and upper classes enjoy no immunity. Some of the officers and civil service men are poorly situated for daily and complete evacuations of the bowels, whether through pressure of duties, inadequate diet or other reason. Some men contribute to their own constipation by neglect of the call of nature because it upsets their routine. In the Punjab where the author can speak from experience, the agricultural people appear to be immune from an entire group of diseases common to civilization, and the diet is of the simplest, while defecation is a most natural function. They never have to inconvenience themselves to find a latrine. The immunity extends to appendicitis, gastric and duodenal ulcer, gall stones and cancer, as well as visceroptosis. Diet consists chiefly of fruits and vegetables. The upper class Punjabi living in cities and towns, eat steel rollered wheat flour made in Delhi and in habits and diet do not differ essentially from the