ovarian cyst and a fibroma of the uterus. One speaks here familiarly of a tumor diathesis. In an analysis of nearly 250 cases of double neoplasm, there were 83 cancers and 13 sarcomata (96 malignant), 49 cases of goitre, 38 of uterine fibroid, 19 of hypertrophied prostate, 18 of miscellaneous polypi, etc.

Cancer in China.—In the China Medical Journal, Shanghai, for January, 1927, are two articles on cancer incidence which are abstracted in the Journal of the American Medical Association for May 8. The first refers to the material of a single large hospital for a period of three years. There were 4799 total admissions among which were 144 patients with cancer, 86 being males. Among the men there were 20 cases of cancer of the stomach or stomach and liver jointly, and 14 of cancer of the œsophagus. Other localities mentioned are the penis with 17 cases and the skin with 13. Among the women there were 37 cases of cancer of the breast and but 8 of the generative organs. (The reader is at a disadvantage in his ignorance of the status of the patients, whether native Chinese or foreigners and whether the Chinese were of the upper or lower strata. Cancer of the skin and penis is common in the relatively primitive races while cancer of the stomach and oesophagus is rare. One wonders to what extent the 34 cases of œsophageal and gastric cancer could have been due to drinking boiling hot tea. The great predominance of breast over uterine cancer is difficult to understand. Ed.) The other article deals with 40 cases of cancer of the breast in women and 5 of sarcoma of the breast (2 males) seen in the Peking Union Medical College Hospital during four years. Thirty-five cases of cancer of the breast were treated with surgery alone or surgery plus radiation. Ten patients are deceased and fourteen survive over limits of two months to more than five years, but the abstract does not mention recurrences. Of eleven cases ignored the patients have probably dropped out of sight, which was the case with four of the five sarcoma patients, the fifth dying on the table.

Incidence of Carcinoma of Uterus in Jewish Women.-As reported by Dr. A. Horwitz, of 1237 cases of primary carcinoma of the uterus seen at the Mayo Clinic between 1920 and 1925, inclusive, 1227 were among Gentiles and ten were among Jewesses. From data obtained by Horwitz at the Curie Hospital, where two-thirds of the patients were treated for carcinoma by X-rays or radium, the incidence of carcinoma was slightly less for the Jewish patient (62 per cent), as compared with carcinoma in the Gentiles (66 per cent). Carcinoma is comparatively infrequent among Jewesses, being about one-fourth as frequent as in the Gentile women (3.9 per cent as compared with 16.5 per cent). Carcinoma of the breast in the female is common among Jewesses, almost equalling that of Gentile women, the incidence being 26.4 and 28.3 per cent, respectively. Carcinoma of the di

gestive tract, including the liver and pancreas, was almost twice as frequent in the Jew as in the Gentile, being 30.2 and 17.1 per cent, respectively. Surg., Gyn. and Obst., Chicago, March, 1927.

Mule Spinner's Cancer.-The recognition that cancer of the scrotum and adjacent skin is associated with the occupation of mule spinning in cotton mills, is only within a short period of time. Dr. A. H. Southam found recorded 667 cases, 570 in spinners and 97 in ex-spinners who had gone into some other employment. The important factor in the etiology of this form of malignancy is undoubtedly the susceptibility of the skin to the effects of the mineral oil used in this occupation.-British Med. Jour., Feb. 26, 1927.

Cancer and Race.-Deelman's paper which was read at the Lake Mohonk Congress appears in full in Surgery, Gynecology and Obstetrics for May, 1927. It is certain, he states, that no race of mankind is entirely exempt from cancer and it is also certain that when we have been in long and intimate contact with these primitive people we find more cancer than is at first sight apparent. But it is not necessary to go out of our way to study relative racial and geographical immunity for we can do this equally well at home. Thus in the speaker's country, Holland, the death rates from cancer show a wide range, the maximum being 41.85 in Friesland, the minimum 29.52 in Limburg. In Denmark we find a maximum of 52.41 and a minimum of 33.54. In Switzerland the range is still greater-60.8 to 20.3. In all of the European countries we see this contrast repeated. How can this be explained? For certain reasons these very low figures do not seem trustworthy. There is often a marked relationship between a backward and unintelligent community and a small cancer rate, which simply means that it is difficult to obtain trustworthy figures. But if the figures are right there must be another factor to accuse. Is it race? Both race and religion seem to be involved to some extent and the Nordic Protestants seem to suffer more than the Alpine and Mediterranean Catholics. The differences, however, seem too slight to carry much weight. Another element sooner or later comes to the front. If we go back many years and compare the statistics then with those of today, we do not find the same differences. Provinces with a high figure may show a much lower one in the past and vice versa. In other words, single year statistics are notably deceptive and in determining incidence by geographic or political subdivisions we should always seek averages over many years.

Cancer in the Jews.-Horwitz of the Mayo Clinic reports some statistics on this subject in Surgery, Gynecology and Obstetrics for March, 1927. Whereas but 4 per cent of the patients treated by operative methods were Jews, the ratio for cancer of the uterus was far smaller than even this low

figure would indicate. Thus, of 1237 cases in this locality seen during the six year period 1920-1925 inclusive only 10 of these women were Jewesses. On the other hand the statistics of the Curie Hospital show that Gentiles and Jewesses were about equally represented in regard to cancer of this organ. A study of older figures shows a certain relative immunity to Jewesses in comparison with Gentiles. From figures worked out by the author it would appear that Jewesses suffer only one-fourth of the morbidity of cancer of the uterus of the Gentile. However, this does not extend to cancer elsewhere, for there is hardly any difference between the incidence of cancer of the breast in the two large groups. And when we reach cancer of the digestive apparatus we find that the Jews independent of sex have nearly double the incidence of the Gentile, which goes far to offset the advantage of the Jew in cancer of the uterus. No attempt is made to account for these group differences in cancer incidence.

Analysis of Genito-Urinary Cancer.-Dr. H. W. E. Walther, of New Orleans, analyzes one hundred sixteen cases of cancer occurring in the bladder, prostate, penis and testis. The attention is directed to the incidence of genito-urinary cancer in the negro. Fifty-two patients, or 44.8 per cent, are dead; twenty-seven are said to be improved and fifteen are apparently, at this time, well. The growths were not arrested in three cases. report apparently shows that in the treatment of the four organs operated on there were employed thirty-one different methods in technique.

This

Cancer of Gastro-Intestinal Tract.-In a survey of deaths from cancer, compiled by Dr. A. H. Burgess, there was found to be 26,670 deaths from cancer in England and Wales in 1923 and 1924 due to cancer of the alimentary canal, exclusive of the buccal cavity, out of a total of 50,389

Malignant Tumors of Breast in Peking.-A report by Dr. R. H. Meade, Jr., is made of forty-five cases of malignant disease observed by him in the Peking Union Medical College Hospital. During a four year period, forty cases of carcinoma and five of sarcoma occurred. In thirty-five cases of carcinoma that were treated, fourteen patients were living at the time this report was rendered, and they had been living for periods of time varying from two months to five years and four months. Ten had died. Treatment had combined surgery and radiotherapy, or surgery alone. Of the five cases of sarcoma (breast), one had died during the operation, and the others could not be traced after leaving the hospital. Of these cases, there were two males.-China Medical Journal, Jan., 1927.

Carcinoma in China.-Of 4,799 inpatients in one hospital (Shantung Christian University Hospital, Tsinan) observed by Dr. L. H. Braafladt during a period of three years, 144 had cancer, an incidence of 3.1 per cent. Eighty-six were males; fifty-eight were females. Among the males, there were twenty cases of cancer of the stomach and liver; seventeen cases of cancer of the penis; fourteen of the esophagus and thirteen of skin cancer. Among the women, the breast, with thirty-seven cases or 63.7 per cent, was most often the seat of the cancer; there were but eight cases of cancer of the generative organs.-China Medical Journal, Shanghai, Jan., 1927.

DIAGNOSIS

Kahn's Method of Serodiagnosis.-Two years ago H. Kahn first announced a new method of serodiagnosis and publishes his latest technic in the Klinische Wochenschrift for March 5, 1927. He terms it now the "modified Albumin A reaction" and the instrument through which the reaction is revealed is known as the opalometer. It is not specific, for other ingredients of the blood serum may cause opalescence, so that its value is only relative. The nature of the so-called Albumin A is unknown. After a complete description of the method and apparatus the author, Kahn, leaves to a clinician, Fregonneau, the practical significance of the reaction. In the local clinic at Karlsruhe 440 patients were tested during the past year and in 121 with malignant tumors the positives numbered 89.3 per cent with only 6.6 per cent actually negative. The other patients tested who were free from malignancy gave 87.5 per cent negative and but 4.6 per cent positive. Since the latest modification by Kahn 61 other patients have been tested. Of 19 cases with cancer 17 gave a positive reaction with the other two in doubt. Two patients with sarcoma reacted positively, so that the score for malignant disease comprised no frankly negative reactions. Of 31 patients with absence of malignancy only two gave positive reactions-one case each of bilateral pyelitis and pernicious anemia. There were a few other positives, one in a case of hepatic cirrhosis and one of pregnancy. It is apparent that with improvements in the technic much good may come of this reaction. The latest modification does away with a subjective factor involved in interpreting the opalescence for this is now possible by objective criteria. Kahn affirms that in cancer patients who react properly the method is of value in checking up the results of treatment, of operation, etc., and in the diagnosis of recurrence.

Early Symptoms of Brain Tumor.-Dr. C. L. Carlisle points out that the tendency seems to indicate that the patient's first symptoms for which he should be hospitalized may strongly suggest a psychoneurosis of a neurasthenic type—namely, “stomach trouble"; a generalized complaint of malaise

or "failing health," vague disturbances of vision usually diagnosed as errors of refraction, and complaints of rather mild headaches and a feeling of inability to go on working as usual. Any such patients with psychoneurosis of the neurasthenic type, with symptoms relating to the eye and stomach, and with head sensations, including visual hallucinations (especially when on a non-toxic basis), should receive sufficient observation and later reexaminations to exclude or include the triad: choked disk, the vomiting due to an organic brain lesion, and headaches from organic brain lesions (with or without an actual psychosis). Among the earliest symptoms which may make a definite impression on an examiner is that of a visual hallucinosis.-U. S. Veterans' Bureau Medical Bulletin, April, 1927.

Embolic Forms of Secondary Carcinomatosis of Lungs.-Drs. M. Loper and R. Turpin describe a case in a man, aged 45, in which the disease started with symptoms of ulcer of the stomach, developing gradually into those of cancer. Symptoms referable to the lungs developed six years later. The association of obliterating phlebitis with signs of recurring pulmonary infarction suggested the diagnosis of embolism of the lungs. The patient died and on necropsy there were found miliary and nodular carcinomas in the lungs and no trace of infarction. The coexisting edema and congestion were probably a factor in the pathogenesis of the pulmonary symptoms. Undoubtedly, the phlebitis was the result of the primary tumor.-Archives Med.-Chir. de l'App. Respiratoire, Paris, Oct., 1926.

Early Diagnostic Point in Breast Cancer.-Dr. E. Liek has apparently observed a point in diagnosis that seems to be quite important and which he records as follows: If there is severe pain in the lumbar region that does not seem to yield to persistent treatment, suspect cancer of the breast, for pain in the above-mentioned region is sometimes one of the very earliest symptoms of cancer of the breast, and a very thorough examination of the breasts and neighboring lymphatic structures is indicated.Zentralblatt f. Chir.

Tumors of the Pancreas.-In cases reported by Einhorn, the most prominent symptoms appear to be anorexia, frequent eructations and a feeling of heaviness in the epigastrium. Pain, if any, was experienced mostly in the hypochondrium, radiating posteriorly. In some cases, patients experienced more pain in the dorsal posture which was mitigated by sitting up or lying on the right side. In the malignant cases, the disease advanced without remissions; in the cases of benign trouble, there were intervals when the patients felt better and were more free from pain. It was demonstrated through test capsules that digestive power was much impaired, especially in the malignant cases, proven by undigested portions in the