which are extraterrestrial and not of solar origin. The character of the soil may play a rôle in the accessibility of the organism to the cosmic rays. The absorption of the rays by the different kinds of soil has been extensively studied, and in certain of these the rays penetrate very deeply. Plastic argillaceous soil is a notably good conductor. The various minerals of the soil may in fact be divided into conductors and insulators. No hard and fast conclusions are reached, but the author's tabulations are filled with information. In France and nearby countries the lowest cancer incidence is at Geneva, Switzerland, with .50, and the highest at Nancy, with 1.95 cancer deaths per 1000. In the low death rate type of soil, we note, especially, gravels and sands, while in the opposite we see clays strongly predominate. The geological strata seem immaterial. The clays come under the head of conductors, the sandy soil, of insulators, of the cosmic rays.

CANCER: FORMS ET VARIÉTÉS DES CANCERS ET LEUR TRAITEMENT. Par P. Menetrier. 2me. ed. Paris. J. B. Baillière et fils. 1927.

This volume is the second part of the author's work on cancer, the first half of which has already been reviewed in CANCER. The author prefers to term it a "second edition" in place of the second section, which is confusing to the American reader. The volume begins with page 434, ending with page 2002 and covers the pathology and clinical manifestations, and finally there is a rather brief section on treatment. There are in the volume some 345 text-figures, beginning with Fig. 24, and ending with Fig. 345, the first twenty-three illustrations evidently in the first volume. In the pages, 1161 to 1181, we find a complete summary of all medicinal "modifying treatment" comprising anticancerous serum (prepared from cancerous tissues); ordinary sero-, bacterio-, and toxino-therapy, and similar resources prepared chiefly from alleged parasitic causal organisms; the Coley treatment; colloidotherapy; proteinotherapy; the use of various cancerotrope substances, irrespective of the colloids; opotherapy and vaccinotherapy. The author merely enumerates the claims of the various clinicians who have tested these substances, but

gives no summary, nor are there any general conclusions drawn nor comparisons made. This attitude comes about naturally, if we bear in mind that none is put forward as a cure of cancer, but merely at most, as able to modify, favorably, the course of the affection, under certain unknown conditions. Any benefit derived from salts of potassium, calcium, magnesium, etc., may be associated with actual defect of the tissues with radioactivity, with ionization, etc. The bulk of the testimony at the present time, is in favor of magnesium salts as a modifier of the cancerous soil. Since, in theory, potassium ought to stimulate cancer growth, its favorable action should be due to some other factor, doubtless radioactivity.

LES RÉSULTATS FOURNIS PAR LA RADIOTHÉRAPIE DANS LE TRAITEMENT DES CANCERS DU SEIN. Par Sophie Gliksman. Paris. Libraire Louis Arnette. 1927.

This work of 146 pages is a graduation thesis of the University of Paris written under the presidency of Prof. H. Hartmann, the well-known surgeon. It does not appear to have been in any way inspired by any of the exclusive Röntgenologists and is by no means a plea for irradiation. In the final paragraph of her conclusions the author frankly admits that exclusive surgery is not the ideal treatment and that postoperative irradiation so far from being an aid to or substitute for the knife, is not only useless at times but even harmful and the more intensive the irradiation the worse may be the results.

The book begins with a historical section which is followed by one on physics and physiological action with especial reference to the penetrating rays. Post-operative irradiation is first taken up and a large body of statistics analyzed with the conclusion that only rays of moderate intensity should be used because they are safe and give as good results as stronger ones. Next in order the author takes up preliminary or preoperative irradiation and publishes some original cases in her own practice and those of colleagues with the results of experience of leading surgeons and Röntgenologists. There is considerable want of standardization in this subject and no final conclusions are

reached, but many inoperable and doubtful cases have been rendered operable in this manner and permanent cures are not rare. Exclusive irradiation-naturally for the most part in inoperable cases-forms the final phase of the problem. The author concludes with the vexed questions of technic and of lack of uniformity of views and practice, with the possibility of stimulating natural defense by the rays and with the paradoxes of irradiation, such as the occasional efficacy of repeated weak rays.

TRAVAUX DE LA CLINIQUE CHIRURGICALE ET DU CENTRE ANTICANCÉREUX DE LA SALPÊTRIÈRE. Deuxième serié. Publiés par A. Gosset. Paris.

Masson et cie. 1927.

The first article, which is devoted to the organization and functioning of the Surgical Clinic and Anti-cancerous Centre, may be passed over. It is by Gosset, who is also responsible for the next article, finely illustrated, on the surgical treatment of cancer of the breast. There is but one conclusion-operate early and widely. The total number operated to date is 102 and the final results are known in 84. The number to survive to date is 47 with 13, 5-year cures and 25, 3-year cures. If we limit the figures to the 5-year cures 13 are known to be living out of 102 operated, which is not an imposing percentage. Of 35 who succumbed to recurrence 3 were 5-year cures until the relapse set in. The third article is jointly by Gosset and Charrier on the two-stage intervention in tumors of the right colon. Six cases are published, beautifully illustrated. Several articles now intervene on surgical subjects other than cancer, which are passed over, the seventh being by Monod on the results of surgery and radium on 75 cases of cancer of the cervix. The number of patients followed up is 68 with 44 cures, only 9 of which are 5-year cures, the 3-year cures amounting to 28. Nine 5-year cures in 75 patients do not form an imposing salvage of life. A brief article on plant cancer by Magrou is followed by a technical paper by R. Bernard on the surgical removal of enlarged cervical glands.

DYSCYTOGENÈSE OU CANCER. Par Docteur Naamé. Paris. A Maloine et fils. 1919.

This little pamphlet, which first appeared some years ago, has been edited by the author in manuscript, certain passages being omitted, while others are stressed. It is, therefore, virtually, a new and amended edition. The author is a student of endocrinology and opotherapy, and experience has taught him that cancer originates from too great demands upon the endocrine glands, and that it may be prevented and at times cured, by opotherapy, along with a diet of fruit, vegetables and milk. In cancer of the breast he gives mammary gland substance and thyroid, and the cases of favorable result which he appends were all examples of breast cancer. As the author has contributed an original paper, which appears in a current number of CANCER, in which his latest views of cancer are discussed, we need not enter more fully into the contents of the present volume.

CARCINOMA OF THE ESOPHAGUS

Carcinoma of the oesophagus, although of slightly less incidence than cancer of the stomach, is by no means rare. Males are more often afflicted than females in the proportion of five to one.

The position of election in the lumen are those sites of physiological narrowing abraded by the passage of the food bolus. The entrance to the œsophagus, the aortic, bronchial and diaphragmatic. The squamous-celled epitheliomata and adenocarcinoma represent 90 per cent of all carcinoma of the œsophagus. According to Friedenwald, the early symptomatology is indefinite and the premonitory signs vague and inconstant. Sensation of difficulty in swallowing with lump rising in the throat is one of the earliest symptoms felt by the patient. Dysphagia and regurgitation of particles of food may be observed at this stage, also small amounts of blood. Esophagoscopy and Roentgen ray are the best agencies for detecting the condition. Surgery is seldom resorted to because of the great danger of radically removing the growth. Gastrostomy is resorted to for temporary relief. Vinson recommends dilating with bougies and treating with radium, procedures apparently of doubtful utility.

REVIEW OF LITERATURE

STATISTICS AND INCIDENCE

In the Journal of the American Medical Association, issue of Sept. 3, 1927, in a letter from its regular Paris correspondent, under date of Aug. 3, 1927, appears the following:

"The Rôle of Chance in Cancer Statistics

“Auguste Lumière has presented to the Academy of Sciences a critical analysis of statistics pertaining to the hereditary transmission of cancer, the mode of contagion and its peculiar frequency in certain conditions. Viewing the matter from the point of view of pure mathematics, and applying the mode of reckoning by probabilities, he finds that the chances of both husband and wife being affected with cancer are as 1 to 225. Lumière concludes that statistics on cases of this kind are of no value unless they reveal a proportion much higher than 1 to 225, which represents the part played by chance. Likewise with regard to so-called "cancer houses," from one to three deaths from cancer in a given house of a city is no more than would be expected from the calculation of the probabilities. A high degree of conservatism is therefore indicated in dealing with statistics of that kind. Moreover, Lumière, in agreement with Quénu, thinks that the hereditability of cancer, if there is such a thing, is based on a hereditability of the soil, which is subject to modifications due to many changing circumstances, and not on a direct transmission of the virus or a micro-organism.”

Genitourinary Cancer.-Dr. Walther analyzes one hundred and sixteen cases of cancer of the bladder, prostate, penis and testicle and calls attention to the incidence of genitourinary cancer in the negro. There were fifteen that were apparently well, and twenty-seven were recorded as improved. In three of the cases, the growth was shown to be unaffected, not even being arrested. This analysis shows the significant fact that thirtyone different methods of technic were employed in attempting to destroy malignant growths in four organs. Journal of Urology, Baltimore, February, 1927.

Incidence of Primary Carcinoma in India.—In about six thousand cases examined during a period of fifty years, Dr. P. V. Gharpure succeeded in finding only thirty-six cases of primary carcinoma of the liver, stomach, pancreas and gallbladder.-Indian Medical Gazette, Calcutta, June, 1927.