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THE intracavitary and interstitial use of radium usually requires some form of anesthesia. Local infiltrative and conductive (nerve block) anesthesia is frequently employed for the interstitial irradiation or surgical excision of intra-oral cancers. The surgical approach for radium therapy of cancers of the uterus, rectum, and urinary bladder is often done through the medium of spinal anesthesia. Local anesthesia is not suitable for the introduction of radium needles or radon seeds into bulky tumors of the trunk and extremities, or into the breast and axilla involved by mammary cancer. The majority of these treatments (i.e., the surgical implantation or placement of the radium) are given in less than ten minutes. It would seem that the technical difficulties, dangers, unpleasant sequelae and relatively long periods of recuperation from general and spinal anesthesia, as well as the apprehension and nervous shock of local anesthesia, might be avoided by the employment of an anesthetic with the following prop...

1. 1. A typical case of Gaucher's disease improved by splenectomy is described. 2. 2. The clinical features, morbid anatomy, diagnosis, pathogenesis, position in the general classification of medical diseases and treatment of Gaucher's disease are discussed.

THE reaction of the skin is a very important factor in external radiation therapy, since, in general, it limits the dose that can be administered. Consequently, any scheme which made possible the use of a larger amount of effective radiation without injury to the skin, would be of value. Recently some clinical evidence has been brought forward to show that when treatment is given by means of a combination of gamma and roentgen rays, the skin reaction is less marked than when only one type of radiation is used. It seems worth while to investigate this matter, to see whether this is really the case, or whether the idea is based on erroneous determinations of the magnitudes of the radium and roentgen-ray doses administered. If it is found to be true, there remains the further problem of whether this combined treatment is more effective from the point of view of tumor regression. That depends on the possible selective response of the tissues to the radiations employed, and is entirely outside the scope of the...

During the past decade, one of us (Brooks) has made extensive investigations of new methods for combating infections. In the course of this study, the following hypothesis was formulated:1 In the blood and blood-forming organs are found the various chemical structures, cellular or otherwise, which are responsible for the production of the antibodies, formed in the immunity response to infection. Consequently the blood should be good material from which to isolate immunifacient antigen bodies.Acting upon this theory, a protein was carefully prepared by shattering the fibrin of ox-blood with hydrochloric acid and pepsin. The residue was fractionated by precipitation with ammonium sulfate, retaining the lower secondary proteoses, which are the most active components. These proteoses, he found, were multiple in number and varied in nature, but their very complexity may explain their service in combating infections of different etiology.A host of workers has searched for a protein which would be efficient ther...

The chemical changes which occur in living matter are said to be profoundly influenced, and even may be said to be controlled by enzymes and their actions (1). Thus different enzymes in different parts of a living organism may produce different products from one and the same substrate supplied to the different parts. A systematic study of certain of the enzymes of various human and mammalian tumors as well as of normal tissues has shown that the enzyme actions of a definite material represent certain properties of that material (2). For the present study a large amount of pancreatic tumor was obtained from a specimen removed at operation. The tumor was of an unusual type in that it was a very large, solid, parenchymatous adenocarcinoma occupying the tail and much of the body of the pancreas (Figs. 1 and 2). Despite its large size the tumor was not necrotic and no metastases were found. This pancreatic tumor was studied from the physiological point of view and its enzyme content was compared with that of the normal human pancreas. For the latter purpose three normal organs, to be referred to as 1, 2, and 3, obtained at autopsy, were employed.

This presents a series of 267 patients given a total of 325 treatments of radioactive isotopes administered intracavum in the control of ascites and hydrothorax. The following radioactive isotopes were employed: Radioactive gold (Au198), radioactive chromic phosphate (CrP32O4), radioactive AU198 and CrP32O4 in combination and radioactive yttrium (Y90). The intracavitary instillation of radioactive Au198 and/or CrP32O4 afforded 54% of patients some degree of salutary benefit. Of 99 patients with hydrothorax 5.0% had an excellent response to treatment and 24% a good response; pleural effusion from a primary cancer of the breast, lung and lymphoma showed the most satisfactory response. Of 145 patients with cancerous ascites, 54% received benefit, 12% showing excellent response and 19% showing good response; ascites due to a primary cancer in the female genital tract (especially the ovary), the gastrointestinal tract and the lymphomas enjoyed the best palliation. Cancerous effusion carries an ominous prognosis; the average duration of life in our treated series was 6.3 months. In contrast, patients with effusion due to lymphoma survived an average period of 15 months. In half the patients treated, an undetermined restraint in fluid formation was noted with a probable resultant indeterminate prolongation of life. Complications were minimal.

A hermaphrodite pig, grown to maturity, weighing one hundred and eighty pounds, was reported to us by the meat inspector at the local abattoir. The general appearance of this animal resembled that of a sow, but there was one noticeable external genital malformation namely, the ventral labial commissure, which pointed upward rather than downward. The meat was condemned because of its boarish odor. Fortunately we were able to secure the external and internal genitalia intact. Protruding from the vulva is a clitoris, which, when unsheathed, is two inches long. It is spiral in shape and in size and configuration resembles a rudimentary penis. The vagina and urethra are in common for two inches, the common channel beginning at the cervix uteri and ending in the urogenital orifice.

The first accredited mention of melanoma was by Hippocrates in the fifth century, B.C. The legendary rumor that this tumor was described in the Ebers Papyrus is apocryphal. A number of references to “fatal black tumors with metastases and black fluid in the body” are encountered in European literature between 1650 and 1760. Laennec discussed “la melanose” in 1806 and Robert Carswell, in 1838, first employed the word melanoma. During the eighteenth century moles—either natural or as appliques (“mouches pour Bal”)—were popular as beauty marks. Later, in addition to being considered beautiful, they had religious implications. In the early 1930's moles on the upper part of the trunk—consonant with an ancient ritualistic qualification—played a significant role in the incarnation of the fourteenth Dalai Lama. Most interesting testimony to the antiquity of this tumor is exhibited in several mummies of pre-Colombian Incas of Peru, some estimated to be 2,400 years old, which show diffuse metastases to bones, particularly of the skull and extremities.

1. 1. A case report is given of cancer of the gallbladder of high-grade histologic malignancy with regional lymph node metastases. The patient has survived cholecystectomy and dissection of the cystic nodes for nearly eight years. 2. 2. Despite marked anaplasia and regional node metastases, cancer of the gall-bladder is a curable disease and an attempt to control this cancer is always in order.

1. 1. Roentgen rays were applied first in the human to a gastric cancer by Depeignes in 1896. 2. 2. Because of its inaccessibility for external and interstitial irradiation, the frequency of obstruction of an orifice, and the advanced stage of the disease when diagnosed, irradiation of gastric cancer is extremely difficult. 3. 3. Radiosensitive gastric tumors are rare and usually occur in the proximal half of the stomach. 4. 4. Gastric lymphosarcoma has been found to be radiosensitive. 5. 5. Radium in the 4-gram radium element pack, radon in gold seed, roentgen rays and combinations of these radiotherapeutic agents have been applied in definitely measured doses to 60 cases of gastric cancer. For external irradiation the radium element pack seems preferable to roentgen rays. 6. 6. Roentgen irradiation in fractionated doses to several portals with a crossfiring effect in the tumor provides greater tissue dosage. 7. 7. Preoperative irradiation of operable gastric carcinoma is not advised. In cases where two stage resection is elected, irradiation may be used in the interval. 8. 8. Interstitial radiation with gold radon seeds of gastric cardia cancer has been performed through a gastrostomy stoma or by exposure of the tumor by a costochondral rib flap. This method is supplemental to external radiation. 9. 9. Exclusion of inoperable carcinomas of the distal segment is desirable before radiation therapy is instituted. 10. 10. Prophylactic irradiation of radically resected cases is not a routine procedure in this clinic. 11. 11. Serious complications which may follow radiotherapy include tumor necrosis with fistula formation, peritonitis and hemorrhage from the stomach. Radiation sickness occurs frequently. 12. 12. Palliation has been obtained in some inoperable gastric cancers.

IT is axiomatic in radiation therapy that the amount of radiation which can be delivered to a given point through one skin portal is strictly limited by the amount the skin will tolerate. With a realization of the need in many cases for larger doses of radiation, have come various efforts to increase this tolerance limit. These have taken two forms: (1) An attempt to find something which could be applied to the skin to “toughen” it, or decrease its sensitivity, and (2) an attempt to vary the dosage technic in some manner so that the skin would permit the use of more radiation. One method of this kind which seemed to give some satisfactory results was to use combinations of different types of radiation in the treatment of the case, rather than to rely on a single type. Clinically it seemed that such combinations were at times more effective, but it is difficult to draw definite conclusions with regard to such a question from clinical evidence alone. In order to obtain an evaluation of the advantage of such...