malignant the growths were reduced in size, persisting in this state, while in the "wild" growths there was an initial aggravation which soon gave way to complete cure. Intermediate between these two were subtypes which for the most part appeared like Type I to be transformed to benign tumors. The full treatment is made up of the preliminary immunizing use of the drug, the treatment proper and the after-treatment.-Klinische Wochenschrift, July 16, 1927.

Latest Report on the Blair Bell Lead Treatment.-The report was made at the fourth session of the Liverpool Medical Research Organization in November, 1926. Bell himself made an opening address after which Professor Glynn showed slides of cancer tissue as affected by the lead treatment. It was apparent that to have any kind of injected remedy reach the cancer cells the blood and lymph circulations must have been in excellent functional condition. Professor Dilling described the toxic effects of various suspensions of lead. In malignant tissues there are certain alterations as demonstrated by Lewis comprising increased permeability. Brooks showed that the injected lead ultimately became lead phosphate. Certain cases were shown, one in particular of a complete cure of a cancer of the rectum after an artificial anus had been formed, while in another there was permanent cure of an inoperable recurrent cancer of the breast. Cunningham, who exhibited a number of cases, pointed out that one should give from 15 to 20 cc. of a 0.5 per cent suspension twice weekly with complete control of the kidneys and blood during treatment and keep up treatment for a time after disappearance of the tumor. Bell showed 7 cases treated since 1920 which are still free from recurrence. The treatment has been taken up in various parts of the world aside from England and the total material treated to date is now over 600 cases.-Deutsche medizinische Wochenschrift, June 24, 1927.

Choice of Operation.-Dr. L. P. Bell, Woodland, Cal., concludes that the operation of choice with him is the two-stage abdomino-perineal operation when the grade of malignancy is high, or when the physical condition of the patient is such that there is no appreciable operative risk. Surgery, Gynecology and Obstetrics, Chicago, April, 1927. Part 1.

Postoperative Irradiation of Carcinoma of the Breast.-Dr. A. Anschütz affirms that, from his observations, postoperative irradiation of carcinoma is seen to be of value only in a selected group of cases. He gave the statistics of the Kiel University clinic. Small, frequent doses-two-thirds of the erythema dose, three fields, ten or eleven irradiations distributed over two years have proved more efficacious than Wintz's intensive method.Beitrage zur klinischen Chirurgie, Berlin.

Heat and Cancer Growth.-Konsuloff comes to the conclusion that if cancer patients were treated with malaria virus to secure artificial fever the results might be encouraging, independent of the nature of the disease. Thus far the diseases which have responded to such treatment have been due to microorganisms but it is not essential that this causal factor be present. It may be shown that the action of unusual degrees of heat varies greatly with the character of the cells and tissues thus treated. The first effect of the warmth is to stimulate cell vitality and in some tissues this effect may be persistent as in the case of normal connective tissue; in other words, the defensive forces resident in the latter are activated. But in regard to the cancer cell the effect is quite reversed. At the outset there may be some stimulation but this is soon followed by coagulation which is at first recoverable but later fatal, the cancer cells being paralyzed. Cancer tissues are rich in mitoses and this implies a change in the colloidal condition of the protoplasm-in the viscosity, which renders them particularly sensitive to the action of heat. The author does not in this connection allude to diathermy which might be made to supplement the action of the malaria virus but he does speak of irradiation in the sense of a synergist.—Zeitschrift f. Krebsforschung, May 18, 1927.

Drinking Water and Cancer.-Goldstein first gives the relative incidence of cancer death in numerous districts of Prussia and notes that in three of these the rate is abnormally low. Thus far he has had opportunity of studying but one of these-Daun. He prefaces his remarks by calling attention to the greater death rate from cancer in cities although from the greater per cent of people of the cancer age in the rural districts we should expect the reverse. In choosing some one factor which might throw light on the relatively low incidence in Daun, he singled out the drinking water. In the cities, of course, there is used a central water supply in which the water is filtered, while in the rural districts well water and other individual supply is used without any preparation. After having shown that the water from the springs agreed in analysis with the ordinary ground water, containing both soda and lithia, he had some tests made on Berlin cancer patients in the hospitals and made a rather surprising find that this water disagreed with the latter (urinary irritation) although tolerated well by healthy subjects. He sees in this reaction a connection between the drinking water and cancer. Experimenting on rats which had been inoculated with cancer he found that those who used the water underwent a partial arrest of the disease as compared with controls. He is now in the midst of these experiments and is not ready for a final report.-Zeitschrift f. Krebsforschung, May 18, 1927.

Chemotherapy with Ferment Poisons.-Karczag and Németh of Professor Koranyi's internist clinic of the University of Budapest refer first to the discovery of Warburg and his pupils of the anoxemic metabolism of malig

nancy as the midpoint of the cancer problem. This can be selectively influenced by certain poisons which have a ferment killing action and are not protoplasmic poisons. One such substance is potassium cyanide and the authors tested it in mouse cancer but the toxic dose and maximum active dose are very nearly the same, so that this combination could not at first be made to answer. Even oxygen inhalations with various antidotal drugs were unable to damp the destructive action. Later it was found that a dose sufficient to produce convulsions and coma for over an hour or so could be employed with positive results and without resort to antidotes. Further research showed that the animals could be habituated to the destructive action of cyanide by giving them small repeated doses so that eventually it became possible to give the convulsive dose daily with practically no unpleasant or deleterious action. No fixation had occurred for analyses showed that the cyanide persists in the tissues in a free state. Cumulation of action was never in evidence.

After the above results had been obtained on normal animals the treatment was transferred to cancer bearing mice. The theory being that if a ferment is responsible for cancer it should be possible to arrest the disease by destroying the ferment. Thus far the theory seems in accord with the facts elicited. Regressive changes are set up in the mouse cancers which are not so much suggestive of a caseous-necrotic as a gummous degeneration. At present the research has only begun and much time will be required to carry it to completion.—Klinische Wochenschrift June 4, 1927.

The Biologic Treatment of Cancer.-Theilhaber, the well-known gynecologist of Münich, read a paper on this subject before the recently held German Gynecological Congress which appears in the July 1 number of the Münchener medizinische Wochenschrift. For millenia we have had for the most part only a mechanical treatment of cancer-the knife, actual or chemical cautery. In not more than a fifth of all cases and these the least advanced has this treatment proved successful. Since 31 years we have had the Röntgen ray and more recently radium and mesothorium but by these methods 80 per cent still remain uncured.

Another method is left, at least in theory, that of arousing the natural defences of the organism against cancer. The idea that the use of blood might be a step in this direction is as old as Hippocrates, who writes of drinking goose blood, but the principle for the most part has remained inactive. Bier has been testing injections of blood in the vicinity of the tumor for many years but the favorable results were not sufficient to prolong life. Eighteen years ago the author reached the conclusion that the roborant treatment of the disease must be general as well as local and that the hemolymphatic system must be stimulated to produce more blood while lymphocytic tissues should be added to the body of the patient. There is a cumulation of evidence now that the thymus is able to immunize the body against cancer although this reposes chiefly on a basis of animal experiment. Thymus extract can destroy cancer cells in vitro.

Injections of organ extracts form another step in this roborant or immunizing treatment as well as the transplantation of organs outright. Most of the hormones have shown some anticancerous property. The plan of the author has comprised the transfusion of blood and injection of foreign protein and lipoids or better the actual implantation of certain organs. Since the beginning of last winter he has carried out numerous transplantations in advanced cancer with multiple metastases and generally of the most inoperable type. He has transplanted the thymus and spleen of young rabbits and of freshly slaughtered calves. The former tissues healed in perfectly but those of the calf were more refractory although in the majority there was success. But the sloughing away of the implant does not mean an entire failure for absorption may take place before this comes about. Clinically favorable effects are seen in these as well as in the completely successful cases. Some remarkable results were seen, for example in the case of a recurrent cancer of the rectovaginal septum which has been mentioned elsewhere. It is possible that injections of malarial blood may be advantageously incorporated into the author's general plan of treatment, which he believes also to possess like value in tuberculosis and syphilis.

Injections of Cancerous Autolysates in the Treatment of Cancer.J. Thomas, in an article which appeared in the Comptes rendus des Séances de l'Académie des Sciences, June 20, 1927, gives credit for the introduction of anticancerous serotherapy to Charles Richet, the physiologist, before the Academy in 1895. This was a very brief communication for which Richet does not seem to have received credit from the historians of our knowledge of cancer. Naturally there are two separate aspects—the serotherapy of experimental cancer and that of human cancer in the clinic. Since 1895 many attempts have been recorded to cure cancer by serums and vaccines, not without numerous partial successes, such as amelioration of the general condition, retrogression and the making of inoperable cancers operable. The present author once made use of an antiserum in a case of cancer of the breast and although both local and general improvement were in evidence serious anaphylaxis developed and influenced the author to substitute autolysates of cancer without regard to any specific quality. Mature cancer tissue yields the most efficacious preparation or otherwise stated no tissue under 3 months of age should be employed. Lean patients give better results than fat ones, and it is better to dispense with the use of Röntgen rays before or during the autolysate treatment. Injections may be practised anywhere on the surface of the body. The pains should diminish, the tumor and enlarged lymph nodes should show retrogression, the discharge, if one is present, should become less and free from fetor and the general condition show improvement. The author has one patient with cancer of the tongue who maintains improvement after 16 months, and one of the stomach improving after 3 years, which will be worthy of a special report.

Radium in Gynecology.—In the opinion of Dr. Frank C. Benson, Jr., Philadelphia, the greatest need for the use of radio-therapy is as follows: (1) superficial cases, properly classed as dermatological; (2) gynecological; (3) urological, and (4) surgical. He believes that this classification will change in the next five years when the surgical cases will be classed first. Among the contraindications for the use of radium is mentioned marked anemia, either primary or secondary, on account of unsatisfactory and even dangerous results; acute or chronic inflammation. There are very meager if any good results in syphilitic or tuberculous lesions.

He recommends its use in cervical and fundal polyposis, as appearance of cells about their base are indicative of adenocarcinoma, although he considers the change in the endometrium rather than in the polyp itself which has pushed its way through the endometrium. Also he considers its use as almost a panacea in selected cases of myofibroma and myopathic hemorrhage. The use of radium is indicated in both cellular and connective tissue types of uterine malignancy and the technique is the same in both types. In cancer of the uterine body, the dissemination is slow, but in the squamous cell type of the lower cervix, the dissemination is very early, and surgical measures are not indicated, radium being used instead. Dr. Benson describes briefly but very satisfactorily the technique used.— Journal of the Institute of Homeopathy, Chicago, July, 1927.

Roentgen Rays in Treatment of Tumors of the Spinal Cord.-Drs. R. Ledoux-Lebard and E. Piot stress the value of X-rays in the diagnosis and treatment of tumors of the spinal cord. X-ray examination, preceded by injection of lipiodol, has proved to be a sure means of locating the site of the lesion. And after operation the rays are used for the after treatment, the irradiation field, however, extending well beyond the operation field. The irradiations, employing from 500 to 1000 Behnkin units of deeply penetrating rays each time, are repeated at one or two day intervals for three to four weeks. A second series of this treatment may be given after a three month interval. With this method there have been no complications observed Three patients with sarcoma, lymphosarcoma and glioma respectively recovered after operation and irradiation as outlined above, one of the recoveries being at the present time of three years' standing.-Presse Médicale, Paris, April 13, 1927.

Insulin Treatment of Cancer.-Drs. Silberstein, Freud and Revesz, after much experimentation, have come to the conclusion that treatment of cancer with insulin may cause the disease to come to a standstill, and even in inoperable cases, may cause a retrogression, whereby the tumor may become amenable to operation. In the smaller tumors, they found that local injections of insulin exerted a decidedly beneficial influence.-Zeitschrift f. d. yes. Experimentelle Medizin, Berlin, April 28, 1927.