social heredity. In broad lines it appears to correspond to pure social dihybridism, that is to say with segregation independent of its so-called "genes" without notable overlapping and lethal accidents. In addition to the technical difficulties of the subject the author reaches his conclusions through mathematical computations which he states demonstrate beyond doubt that all tumors are by nature hereditary, with distribution in a given generation along strictly Mendelian lines. This subject has nothing in common with the appearance of tumors in families in Mendelian distribution.

Is Cancer a Local or Constitutional Disease?-Kotzareff and Morsier attempt to answer this question in Les Neoplasmes for January-February, 1927. It is an important question, for upon its answer depends our treatment; if cancer is local we must use the knife and cautery and direct radiation—if general, we must use chemotherapy, vaccinotherapy, intravenous radium, etc. It is of course true that early local treatment sometimes suffices for a clinical cure and we know that cancer can be implanted from without; but it is often possible to explain such facts away. Predisposition of some sort at present unknown plays a great rôle in all local cancer, whether spontaneous or experimental. In any general disease we see a place of least resistance to local irritation. The possibility that cancer is originally a general disease is complicated by the fact that an apparently localized cancer can rapidly infect the body at large and this fact may be understood from two quite dissimilar viewpoints, as upholding either the local or the constitutional theory. The authors regard the entire subject as most difficult to visualize. Cancerization of the body as the disease progresses is at present beyond explanation. The existence of numerous seroreactions appears to show that this cancerization can take place at a very early moment. We may also make use of the term cancerization to indicate the transformation of so-called precancerous lesions into malignant growths. Local cancerization is believed to be, at least oftentimes, a very slow process which may require many years and the factors which determine it are both local and general, external and internal. The presence of these internal factors allows us to think in terms of constitutional origin.

Cancer Contagion.—A paper, read in the New York Academy of Medicine, by Dr. Hartmann, discussed cancer with regard to the element of possible contagion, as well as to whether it is hereditary or not, and it evoked quite a bit of discussion among several in the audience. In the paper, Dr. Hartmann announced that in his study of the disease, he had found seventy-nine cases of family cancer. Also it was brought out in the debate afterward that there seemed to be evidence that in at least twentyfive cases there had been cancer occurring in both husband and wife. (It seems to us that only such a small proportion being presented as pointing toward an hereditary tendency out of the almost countless amount of cancer

material there is at hand, that it is too meagre evidence on which to base any such conclusion. We certainly have never heard of any preponderance of such evidence as would be required to lead us to any such conclusion. We do believe, however, that people in families, living under the same circumstances and partaking of the same kinds of food, prepared in the same manner, might be simultaneously afflicted with cancer, especially if both are possessed of any predisposition to a carcinotic condition of the system. Editors.)

New Views on the Causes of Cancer.-Koose read a paper on this subject before the Silesian Society for National Culture last January, an abstract of which appears in the Klinische Wochenschrift for April 23, 1927. The heredity of a part of human cancer has now been placed beyond doubt while the irritation theory originally put forth by Virchow has been rendered prominent by animal experiment. The parasitic theory has at the same time receded. Studies based on the Rous fowl sarcoma may be interpreted against as well as for the existence of a parasite and Carrel seems to have shown that something like the bacteriophage may be responsible for these and other growths. Erdmann has found that in addition to cancer cells and stroma cells a third unknown structural element is requisite for the production of mammalian cancer and herein we see analogies with fowl sarcoma as well. In discussion Prausnitz held that if the cause of cancer was akin to the bacteriophage, the parasitic theory was upheld. Henke refers to the view that a part of cancer is of parasitic origin but thinks that at present the parasitic theory as a whole is without scientific basis. Koose in closing is in favor of keeping this theory active as a working hypothesis.

PROPHYLAXIS

American Cancer Propaganda as Viewed in Germany.-It should be borne in mind that wholesale prophylaxis of cancer by propaganda was extensively tried out years ago for Prussia. In an abstract from a paper originally published by the Hamburg Medical Union which appears in the Klinische Wochenschrift for April 16, 1927, the author, Bierich, who attended the Mohonk Congress, commends the effort and the intent but his hearers seem skeptical of the result attainable. Phillipson states that these do not come up to the propaganda. Winter of Prussia tested the idea on all women of the climacteric years. Holm was opposed to medical specialization as carried out in the United States and once in vogue in Germany, stating that the present aim in the latter country is a good general training. Inferentially he opposes, as do others, the idea of cancer specialists trained for that especial work. He also believes that the idea of a propaganda for the laity is a blunder. Much more could be accomplished, in Germany at least, by examination and instruction of the thousands who

pass annually through the hospitals and dispensaries. Examinations can be made without alarming the community and a propaganda makes thousands of hypochondriacs. Wolffson would put the matter up to the insurance companies as a form of relatively silent propaganda. Emden believes the American propaganda will partly fail because of the latency of much cancer; by the time the patient recognizes the symptoms the case may have advanced too far. Bierich, closing the discussion, denied being a partisan; he simply related his experience for what it was worth.

TREATMENT

Remote Results of Gastrectomy for Cancer.-The statistics for this report of Drs. Delore, Mallet-Guy and Burlet are based on 239 cases of gastrectomy for cancer. The operative mortality was between 16 and 17 per cent. The percentage of deaths within the first year after operation was 21; within the second and third years, 33 and 17 per cent, respectively. Recurrences were observed three and even six years after the operation. Those who survived six years, which number is 14, are considered as probably cured. Two feel well and are carrying on their normal occupations thirteen and fourteen years after the operation. The prognosis in colloid cancer is considerably less favorable than in typical cancer.-Lyon Chirurgical, November-December, 1926.

Combating Cancer.-Dr. B. Moynihan calls particular attention to the points which in his opinion are essential on which to concentrate in the fight against cancer: (1) To make the very utmost of present methods which are applicable to all cases of accessible growths. (2) To undertake research so that the cause or causes of the disease may be discovered and something be done for the prevention of the disease or for its cure by methods other than those of surgery.-Lancet, London, Jan. 29, 1927.

Implantation of Cystadenoma Following Nephrectomy.-Dr. W. A. Frontz reports an unusual case in which, following nephrectomy for renal papillary cystadenoma, there developed, in the abdominal muscles, a tumor which was identical, histologically, with the tumor removed with the kidney. The condition was considered to be due to the implantation of cell of the original tumor during the operation, in spite of the fact that the kidney was removed without contamination of the operative field.-Jour. of Urology, Baltimore, February, 1927.

Malignant Papillary Cystadenoma of the Kidney.-Dr. W. C. Stirling reports a case of primary malignant papillary cystadenoma of kidney with fungating growth in pelvis in a girl aged 18 years. The kidney was extirpated in September, 1925, and there has been no recurrence of symptoms up to the present time. However, as he remarks, this type of malignancy of the kidney is usually of slow growth and of a low grade of malignancy

and offers the best prognosis of any of the groups of renal carcinoma.Jour. of Urol., Baltimore, February, 1927.

Injury to Kidneys from X-Ray.-Dr. G. Domagk, in 1921, observed the case of a child who died from nephritis, about six months after X-ray treatment for tuberculosis of the mesenteric lymph nodes. He attributed the kidney trouble to the effect of the X-ray on the kidney. In order to verify his deductions, he experimented with irradiation on animals (rabbits) and found that it caused the tubules to atrophy, while the glomeruli apparently were but little affected. The epithelial changes were more marked in well fed animals than in those that were underfed. Three more cases in the human came under his observation, also, which had been irradiated for abdominal tumors, and he concluded, from certain peculiar scars on the kidneys, that they probably had been injured by the treatment.-Medicinische Klinik, Berlin, March 11, 1927.

Results of Surgical Treatment of Cervical Carcinoma.-Dr. F. C. Wille says that the radical operation of Wertheim is by choice used at the Charité women's clinic. In a series of 308 cases between 1916 and 1920, 45.8 per cent showed a five-year freedom from symptoms. For patients in the early stage, a percentage of 76; for "borderline" cases, 25 per cent. Dr. Franz seems to extend the limits of operability farther than most; does not consider infiltration of the parametrium a contraindication unless bone is involved, nor vaginal wall involvement, slight motility of the uterus, complicating myoma nor adnexal changes. But considers carcinomatous bladder involvement a contraindication and will not operate on women over 65 years of age.-Zentralblatt f. Gyn., Leipzig, January, 1927.

Blood Changes in Experimental Lead Poisoning. Dr. K. Fujita produced an experimental lead poisoning by feeding rabbits acetate of lead. He found the result on the blood to be a lessening of the number of erythrocytes and an increase of the leucocytes. Fibrinogen in the blood plasma and in the hemoglobin was diminished in quantity. There was but little change in the erythrocyte resistance against hypotonic salt solution.-Acta Dermatologica, Kyoto, Japan, January, 1927.

The Blood After Roentgen Irradiation.-Drs. A. Gigon and M. Lüdin discovered that food affects the reaction of rabbits to X-ray irradiation. The total carbon and nitrogen of the whole blood become lower and the blood sugar higher on an ordinary diet, on oats or during fasting, regardless of the dosage of the rays applied. Rabbits fed on green fodder react with a marked increase in the total carbon (up to sixty times more than could be accounted for by the hyperglycemia), without a proportionately large increase in nitrogen.-Schweizerische Med. Woch., Basel, March 5, 1927.

On a Possible Gas Treatment of Cancer-Andersen and Fischer discuss this subject in the Zeitschrift f. Krebsforschung for April 8, 1927 (xxiv, 2). At the present time the only gas therapy which is being investigated is oxygen therapy, not in the sense of a specific action, of oxidation, but as a matter of chemical potential. According to Wieland oxidation in biology is not at the outset an oxidation at all but a dehydration which may be due not to chemical affinity but to the mere tension of the gas. If in place of oxygen, hydrogen were employed a difference might be found in the reaction to it of normal and malignant cells. If a mixture of the two gases were used it would be notably unstable, and if the mutual attraction were accelerated by catalysators a vast amount of energy should be set free. At present almost nothing is known of increased gas tension in its relationship to cell activity and the subject will have to be studied in an elementary manner with cultures of living cells. Increased oxygen tension has recently been studied on mouse cancer, mostly as an accessory to the injection of colloidal metals and other cancerotrope substances.

Cure of Mouse Cancer with Drugs and Oxygen Overpressure.-Professor Fischer, the well-known cancer student of Copenhagen, with three assistants, has been at work on this subject and at present appears to be on the staff of the Kaiser Wilhelm Institute of Biology at Berlin. The article appears in the Zeitschrift für Krebsforschung, April 8, 1927, volume xxiv, No. 6. The plan consists in combining two different principles in one, of which the older consists in the use of cancerotrope substances like the colloid metals, dyestuffs, etc., such as have long been believed to devitalize the malignant cells. These have been combined with various sugars which are likewise regarded as cancerotrope and made into solutions for intravenous use. The metals used have been principally copper, also platinum and selenium. Methylene blue and nonspecific protein have also been tested. The other element of the treatment is the use of an oxygen atmosphere of from 1.6 to 2 atmosphere concentration. The mice must become accustomed to it and the optimum was found to be as above with sojourn in the gas chamber of from 14 to 22 hours. The theory of the oxygen treatment doubtless originated in the action of the gas on cancer cells, but it is by no means certain that the gas acts by ordinary oxidation and it is not impossible that the benefit is due to the tension of the gas and that other gases might have a like result. The authors, however, speak of the possible influence of the cell oxidases which have usually been held to facilitate oxidation by their catalytic effect. They have implanted more than 1000 cases of mouse cancer and have never seen a spontaneous cure. Over 500 animals received the treatment with the net result of 15 cures and 27 improvements, while in 114 the result was in doubt and in 395 quite negative. One case yielded to oxygen alone. The positive results were in a way striking, but the authors cherish no illusions of a cure of human cancer.