scourged by cancer, and this phylogenetic fact shows that the most highly organized of the tissues is naturally the first to give way. Insufficiency of trophic nerve influence seems able on the one hand to set free energy of cellular growth and at the same time cause degeneration of the cells.-Les Neoplasmes, May-June, 1927.

Biology of Cancer of the Uterus.-Tesauro, an Italian laboratory man quoted in the Münchener medizinische Wochenschrift for Aug. 5, 1927, has made many studies of the blood in this affection. There is a pronounced constant hyperglykemia and the blood contains on an average 25 mgms. of lactic acid per 100 cc. After extirpation this value sinks to the normalabout one-half that figure. The facility of the blood to bind carbon dioxide is down to the lowest normal level, and the carbon dioxide tension is constantly depressed, but after removal of the tumor rises again to normal. Therapeutic doses of Röntgen rays diminish the CO, tension and increase the blood sugar and lactic acid and therefore would in theory be contraindicated in treatment, while for the same reason removal of the mass would tend to restore the blood to the normal composition. The author makes no allusion to the use of insulin in these cases, which, in theory at least, seems indicated, in as far as it reduces the amount of blood sugar.

Resistance of Cancer Cells to Glycerine.—Arthur Compton has made an accidental discovery in connection with the transplantation of ulcerated mouse cancer which may have far reaching effects in some directions. In attempting to disinfect infected transplants by exposing them to glycerine over various intervals, he was led to make control studies of other tissues and also with low forms of animal and vegetable life. The use of glycerine in this connection seems to have been akin to that in the conservation of vaccine. He found first that epithelium has unusual resistance to glycerine in comparison with microorganisms and other tissue elements, cancer cells agreeing in this respect with other epithelia. The resistance was much greater than that of leucocytes and other formed elements and far greater than that of bacteria. Half an hour immersion in pure glycerine does not in any way injure the vitality of cancer cells, which are enabled to grow and proliferate as usual, although after this limit is exceeded the vitality begins to suffer. The author does not mention the dehydrating action of glycerine in this connection, but merely speaks of its devitalizing action as toxic. At first sight the only gain appears to lie in the freeing of cancer transplants from infectious germs, for many mice implanted with infected grafts die of septicemia, but the use of glycerine may be extended to plastic surgery and grafting in man. The author does not mention the possibility of using glycerine in dressing ulcerated cancers with the immediate effect of cleansing them, and the ultimate possibility of devitalizing the cancer cell by prolonged application.-The Lancet, Aug. 13, 1927.

TREATMENT

Treatment of Superficial Malignant Lesions by Combined Measures.-At a meeting of the Medical Association of Georgia, Dr. J. W. Landham, Atlanta, gave it as his opinion that the best results in the treatment of these growths would not be obtained except by a combination of methods. He made mention of a series of malignant lesions of the larynx, lip, tonsil, mouth, penis and pigmented lesions in which he used a combination treatment of diathermy and irradiation. The mortality statistics of this series of malignancies were: face, 6 2/3 per cent; lips, 16 2/3 per cent; nose, 3 4/7 per cent; pharynx, 66 2/3 per cent; penis, 50 per cent; antrum, 33 1/3 per cent; tongue, 66 2/3 per cent and mouth, 30 per cent. He recommends that the education of the public with reference to malignancy be pushed relentlessly. Prophylaxis should be stressed by the physician to the patient. Biopsies are condemned. He considers it better to overtreat superficial malignant tumors than to undertreat them in an effort to obtain better cosmetic results.-Journal American Medical Association, July 16, 1927.

Uterine Cancer Treated with Radium.-In a meeting of the Tennessee State Medical Association at Chattanooga, Dr. E. Dunbar, Newell, Chattanooga, stated that radium alone will cure 50 to 75 per cent of the cases of cervical cancer if given in the distinctly operable stage. In the border-line cases, radium, alone, or, with deep X-ray, will cure from 20 to 25 per cent. In the distinctly inoperable cases, radium, plus deep X-ray, will cure from 10 to 20 per cent. In the apparently hopeless stage, an occasional life may be saved. In cancer of the uterine body, panhysterectomy should be performed if there are no contraindications; if there are such contraindications, radium and deep X-ray should be used.

Effect of Light on Transplanted Neoplasm.-Drs. L. Pearce and C. M. Van Allen report an experiment in which constant and continuous light, excluding the shorter ultraviolet rays, also a condition of continuous darkness, have influenced the course of a malignant condition in rabbits induced by means of a transplantable neoplasm. Under the influence of constant light, the level of malignancy was low; under the influence of constant darkness, the level was somewhat lower than that of control animals living in ordinary indoor light but not as low as in the animals in the constant light. This seems to show that there is a correlation between light and the manifestations of an experimental malignancy.-Journal of Experimental Medicine, Baltimore, March, 1927.

Radiotherapy of Nasopharyngeal Lymphosarcoma.-Dr. H. A. Colwall reports a case in which an extensive nasopharyngeal lymphosarcoma disappeared under irradiation treatment, without any operative procedure except that necessary for the implantation of the radium, and in which there has been no recurrence during a period of six and one-half years.-Lancet, London, Feb., 1927.

Surgical Treatment of Cancer of the Penis.-Dr. A. Astraldi, in his article, gives a series of twenty-two cases. He recommends that radiotherapy be not employed but surgery resorted to at once. Nor does he recommend extirpation of the glands in either partial or total amputation. In the only case he attempted to extirpate the glands, recurrence occurred eight years later. He asserts that advocates of gland removal in cancer of the penis do not apply their own principle to superficial growths on the face.— Boletín del Instituto de Med. Experimental, Buenos Aires, Nov., 1926.

Conservative Treatment of Bone Sarcoma.-Dr. F. Gentil, twenty-four years ago, in his first case of bone sarcoma, simply removed the diseased portion, the head of the humerus. She remained well and free from recurrences for more than five years. In another case (tibial sarcoma), a pedunculated bone graft was inserted after the resection of the diseased bone. This patient remained well and free from recurrences for twenty years. Of 1508 cases of malignancy in one of the Lisbon surgical clinics, there were only twenty-eight of bone sarcoma. Of these there were eight cures or about 26 per cent. If the tumor is separated from the soft parts by periosteum, excision is recommended, followed by irradiation and a bone graft. Giant cell tumor, being benign, permits almost any measure to be tried. The X-rays not only locate the tumor but reveal if it be of the giant cell variety.-Lisboa Médica, Lisbon, Oct., 1926.

Surgical Treatment of Epithelioma of the Lip.-Dr. W. M. Shedden, Boston, says that the "radical" neck dissection described will give 3-year cures in 76 per cent of the cases. This "radical" dissection will give 42 per cent cures, he asserts, even when cancer is present in the glands. It is not necessary to excise chronic ulcers and tumors of the lip even though there be a possibility of cancer, and to have a microscopical examination of the tissue excised. The position of the growth on the lip should determine whether the neck dissection is to be bilateral or unilateral. Syphilis is not commonly seen with cancer of the lip, and its presence should not delay adequate operative procedures.-Boston Medical and Surgical Journal, Feb. 17, 1927.

Treatment of Rodent Ulcers.-Dr. H. Leslie-Roberts asserts that the efficacy of trichloracetic acid in the treatment of rodent ulcers lies in the fact that its action causes complete coagulation of the cell contents. The compounds formed between the cell contents and the acid are nonhydrophil, and therefore do not tend to draw lymph out of the capillaries. Thus the acid converts the neoplasm into a solid block of dead tissue, which is gradually thrust out by the undergrowth of the healthy living cell of the epidermis.— British Medical Journal, London, April 30, 1927.

Curability of Cancer: Spontaneous Cure of a Cancer of the Lip.-Avramovici of Bucharest writes at great length on this subject in the Lyon Chirurgical for May-June, 1927. Spontaneous cure is so rare that Werner in nearly 15,000 cases of cancer never has seen an example, and the author places the number of recorded cases as in the vicinity of fifty only. There are many more alleged cases which cannot be placed in this group and some authors like Strauss are inclined to regard even the positive cases as fallacious. The author's patient was a man of 45, first seen in 1923, always vigorous and without history of any ailment. There seems to have been a slight family disposition to malignancy, for the father died of cancer of the frontal bone, while a brother died of some neoplasm of the stomach at the early age of 15.

The lesion on the lip began two months before consultation as a wart-like formation in the middle line of the lower lip which on picking tended to bleed and passed on to a sight hemorrhagic ulcer which mild local applications failed to influence. Not long after the debut the patient developed a fever which was clearly malarial in origin with very high temperatures in the accesses. For this he received quinine from the village doctor, who also cauterized the lip sore with great aggravation of symptoms. He was advised then to have the growth excised and came to Bucharest to consult the author, who found an indolent excavated ulcer with hard base and tendency to bleed easily. The lesion tended to invade the outlying tissues but there was only a slight reaction in the regional lymphnodes. Professor Gerota, who was called in consultation, advised a biopsy and one was made by Professor Babès, who pronounced the growth a spino-cellular epithelioma of medium malignancy and advised extirpation.

Professor Gerota was to have operated radically on the man, but after requesting a few days of grace for the purpose of going home to settle his affairs, he astounded the medical men by returning at the end of 12 days almost cured. The only directions which he had received were to use hydrogen peroxide and refrain from picking the lesion, with quinine daily to ward off a malarial access (15 grain doses).

This man has been seen repeatedly over a period of three years and there has been no evidence of recurrence. The healing process had gone on to complete recovery. What could have cured this patient? The thermocautery of the country practitioner, the malarial fever, the quinine, the biopsy? The author admits that the high temperature of the paludic fever may have contributed. What was the mechanism of the cure? Stimulation of the body resistance? If so, by what mechanism? We do not know how high temperatures such as are occasionally seen to inhibit the growth of cancer, are able to exert this favorable influence. The Coley serum, however, has not had much success in the treatment of true cancer. The author can only suggest a test of malaria treatment in other cases of cancer.

Colloidal Gold in Inoperable Cancer.-E. H. Ochsner has been using this remedy for this affection for about 6 years and has influenced other surgeons in the same direction. Recently he published statistics of 309 cases treated by 182 medical men. In following up radiation treatment of cancer for the past thirty years he has reached the conclusion that it is of no real value and he has never seen an inoperable case cured by this means; not only that, but he has tried in vain to find such a cure in the practice of others. Indeed, he believes that the treatment lowers the natural resistance to the disease. He therefore differs radically from the consensus of opinion at the Lake Mohonk meeting when it states that radium and Röntgen rays with surgery represent the only trustworthy treatment for the disease as a whole. Having once arrived at his unfavorable opinion of radiation in cancer he has sought to find a substitute which promises better. This he believes he has discovered in colloidal gold given by the mouth, local application and intravenous injection (in inaccessible cases). He believes that the gold inhibits the growth of cancer, and improves the general nutrition. The number of cures thus far is small but the remedy becomes of value when we are confronted either with inoperable accessible cases and inaccessible cases. He recommends the knife or cautery in all operable cases. Six case histories are appended, all from the practice of others lest the author show unconscious bias. The seat of the disease was the rectum, stomach, breast (2) and abdominal cavity (2), the site of the primary formation unmentioned, the cavity containing many metastatic growths. The cases are unselected and comprise complete recoveries, arrest, improvement and prolongation of life. In some cases there is freedom from pain, no morphine required.-International Journal of Medicine and Surgery, March, 1927.

Chemotherapy of Mouse Carcinoma.-Karczag of Professor Koranyi's clinic for internal medicine at Budapest University refers to the therapeutic use of ferment destroying poisons, upon which subject he had already published something. The only poisonous substance of this sort thus far tested is potassium cyanide, which spares protoplasm although able to inhibit the ferment activity of cancer cells. Naturally the mice must first be made to tolerate the action of the cyanide, which can be done without injury. The strain of animal tested was the Ehrlich cancer mouse. Two sets of these animals presenting the growths were tested of which one served as control. The cyanide was found to affect profoundly the biological properties of the tumors and when given in sufficient doses was able to cure them despite the rapidly malignant character. But the same animals when subsequently placed on minute doses of the cyanide underwent a recurrence of malignancy which again subsided when the dose was duly increased. The cure of the growths did not necessitate ulceration and softening. The gain in longevity of the mice thus treated was two to three fold. A difference in behavior was noted in two tumor types. In the less