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The injection of moderately large doses of diphtheria toxins into animals is followed by no change in arterial blood pressure until after the elapse of a certain latent period, varying from 24 hours in the rabbit to 2-4 days in the dog, when it begins to fall. The fall in blood pressure, having once occurred, rapidly proceeds, so that within a very short time the animal is dead (30 minutes in the rabbit). Both vasomotor paralysis and cardiac failure are responsible for the fall, although it is evident that the cardiac failure is the more important as the immediate cause of death, since mere isolation of the vasomotor center — as after spinal transection — is not followed by such rapid cardiac failure. The vasomotor paralysis of course accelerates the cardiac failure.1Roily further found that isolation by Hering's method of the heart of a rabbit just dying as a result of diphtheria inoculation and its perfusion with blood from a healthy animal did not in the slightest degree delay the failure.Although a certain amount of histological change seems always to be present in the myocardium after death from the inoculation of diphtheria toxins, yet it has been considered by Rolly and others as scarcely of sufficient intensity to account for the sudden failure. Furthermore, addition of diphtheria toxins even in very large dosage to the fluid perfused through a Langen-dorff heart preparation does not influence the beat; nor does its perfusion with the blood of a moribund animal (from diphtheria inoculation).It has been suggested, therefore, (by Rolly, et al.) that the cardiac failure is due to a functional change resulting from the gradual assimilation of toxin by the cardiac muscle until so much had been taken up as to paralyze the muscle. Hence, the long latent period and the rapid course of the failure.

To the Editor.—I have read with interest Dr Laforet's scholarly communication on informed consent, and I agree that it is possible to carry its principle to absurd lengths. However, I do stand firmly behind the lines he quoted from my article on "Breast Cancer and Informed Consent."There is a vast difference between not informing a patient of all possible complications that could occur after a standard operation, eg, repair of a hernia, and not informing a patient about the various alternatives for treating a clinical stage I cancer of the breast. Since there is no agreement among authorities in the field of breast cancer, I think it is imperative that the patient be so informed. Only if she knows this can she participate in the making of the decision.The same principles apply to the treatment of small, low-lying rectal cancers. The patient should be informed that many

This note is based on a study of fifty-two cases. Blood from three normal individuals is used for each test. With each there is a control heated to 55° C. for ten minutes and also a salt control. A hemolytic reaction in one or more tubes is counted as a positive test. Of the cases offering a fair surgical risk, 82 per cent. showed a positive reaction; of the advanced cases 39 per cent, showed reaction. Of these all but one showed reverse hemolysis. These results conform with my former tables. The total number thus far observed is three hundred and one. In a large number of observations upon surgical patients other than those with cancer or tuberculosis, there is rarely a hemolytic reaction. In tuberculosis the reaction, when present, is always reverse. In chronic infection there is, in about ten per cent., a direct hemolysis. Among apparently normal individuals, hemolysis occurs in about two per cent.We conclude that hemolysis occurs rarely in normal individuals, occasionally in routine surgical patients excepting those with tuberculosis and cancer. In active tuberculosis it is the rule and is always of the reverse type. In advanced cancer there is hemolysis in about two out of five patients and in these the hemolysis is usually reverse. In the operable stage of cancer among about four out of five patients direct hemolysis occurs. Hemolysis is therefore additional evidence of cancer, but in no sense specific.

Spontaneous rupture of a visceral vessel into the peritoneum or between the leaves of the mesentery has occasionally been reported in the literature, but it has usually been associated with trauma, intra-abdominal disease or malignant growth. Spontaneous rupture of a visceral vessel due to arteriosclerosis and hypertension is an extremely rare occurrence as judged by the reports in the literature, although most of the authors express their surprise that this phenomenon does not occur more frequently. The case presented here apparently belongs to the latter group of rare cases of abdominal apoplexy caused by marked arteriosclerosis and hypertension. We use the word "apparently" because in this case the exact site of rupture was not located.In reviewing the literature we found that ten previous cases of abdominal apoplexy associated with arteriosclerosis and hypertension have been reported: (1) Hilliard's1 case in 1918, (2) Starcke's2 case in 1923, (3) Green

All cases of tuberculosis showed reverse hemolysis, i. e., normal serum hemolyzed the patient's corpuscles. In all cases serum heated to 55° C. for ten minutes prevented hemolysis. Sudden chilling of the blood according to the method of Hoover and Stone caused a marked increase in the hemolytic action. Plasma obtained by immediately centrifugalizing the serum caused little or no hemolysis in hemolytic cases.The hemolytic property reaches its maximum about 24 hours after the blood is drawn.In the cancer group the cases in which the disease was entirely removed lost their hemolytic property in from 12 to 21 days after operation.In cases in which an incomplete operation was performed the hemolysins continued indefinitely.Our conclusion is that hemolysis occurs in a number of diseases. It occurs in great frequency in cancer and tuberculosis. The reaction in tuberculosis is the reverse of that of cancer. From the clinical standpoint hemolysis offers additional evidence which may be used in the diagnosis of cancer and tuberculosis. This evidence is not as yet specific.