VOL. XIII.

EDITORIAL.

CANCER.

Co-operating with the Cancer Prevention Society of the Pennsylvania State Medical Association, this issue of the JOURNAL is especially devoted to the consideration of the cancer problem with a special view to the prevention of the usual end results of this disease. It is now well recognized that there is a precancerous state in the development of practically all malignant growths, which if taken in time can be treated effectively. Remove all the warts and moles and superficial benign growths, as routine matter, on every patient who comes into the office, particularly if they are about the lips or on the face or neck or about the breasts. Make a careful examination of every woman immediately after labor, repair lacerations of the cervix and perineum, or if they come to you later, do or have done the secondary repair. Remember that bleeding is never a symptom of the change of life but is always a symptom of disease, usually cancer. Remember that blood in the stools and ulceration in the rectum is practically always malignant and can be cured only in the early stages. Many other most important matters are brought to your attention in the scientific editorials in this issue and we trust every thoughtful physician will read everyone of these splendid and especially prepared editorials. The JOURNAL. takes great pride in presenting them.

THE PROGRAM.

The attention of the membership is called to the preliminary program for the annual meeting of the Association which will be held in Louisville, September 21, 22 and 23. Dr. W. L. Rodman, President of the American Medical Association, formerly an honored

member of this Association, will deliver the annual address and Dr. John B. Murphy, of Chicago, will give a practical demonstration

No. 8

of the treatment of fractures, using both lantern slides and models in this demonstration. All the rest of the program will be contributed by our own membership. The committee hopes to report the complete program in the next issue with all the subjects properly arranged and classified. The present publication is made so that the members can begin to think along the lines which will be discussed and we will be particularly anxious to have as many of the members as possible write for any papers in which they are interested so they can better enable themselves to take part in the discussion.

Good railroad rates will be secured and everyone can make arrangements for attending the Louisville meeting with the promise that it will be the best one we have ever held both from a scientific and social standpoint.

THE HUNDRED PER CENT CLUB.

interested in the changes in the list of the The membership all over the State will be Hundred Per Cent Club of the State Association. It will be remembered that this consists of those county societies which have reported as many members in good standing as they had last year. Those marked with a star have increased their membership over last year and those marked with two stars have every eligible physician in the county. If your county is not on this list, please look into it and help your county officers to put it in there next month.

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*Adair. *Anderson, Ballard, *Boyd, Boyle. Bracken, "Breathitt, Breckinridge, Bullitt, Carlisle, Clark, Clay, Clinton, "Cumberland, Elliott, *Estell, Fayette, Fleming. Floyd, *Fulton, Gallatin, Garrard. *Grant, *Graves, Green, Hancock, *Hardin, "Harlan, Harrison, Henry, Hickman, Jessamne. *Knox, Lawrence, Lee, **Leslie. *Lewis, *Lincoln, *Livingston, *Lyon, *McCreary, *McLean, *Madison, Magoffin, Marion, Martin, Mason, *Meade,

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OFFICIAL ANNOUNCEMENTS.

The JOURNAL. desires to call the attention of the membership generally to the appointment of the following chairmen of sub-committees of the Committee on Arrangements for the approaching meeting of the Kentucky State Medical Association in Louisville, September 21, 22 and 23, with the House of Delegates meeting on September 20.

Dr. Charles Hibbitt is Chairman of the General Committee on Arrangements; Dr. Charles Lucas, Chairman of the Entertainment Committee; Dr. E. L. Henderson, Chairman of the Finance Committee; Dr. R. Lindsay Ireland, Chairman of the Committee on Transportation and Publicity; Dr. Lee Kahn, Chairman of the Committee on Hotels and Meeting Places, Mrs. Ap Morgan Vance, Chairman of the Ladies' Committee; and Dr. Ap Morgan Vance, President of the Jefferson County Medical Society was made an ex officio member of the General Committee on Arrangements.

AN EFFECTIVE OFFICIAL.

For the fourth time Dr. Samuel G. Dixon has been re-appointed Commissioner of Health of Pennsylvania. Under Dr. Dixon's leadership, Pennsylvania has developed probably the most effective health organization in the world. At the present time the Department has between three and four thousand employees and its activities reach into every precinct in the State.

In the campaign against tuberculosis, which ten years ago was the chief cause of death in Pennsylvania, one hundred and fifteen tuberculosis dispensaries have been established and three great sanitoria have been constructed. The death rate from tuberculosis is steadily declining year by year. Forty thousand cases of typhoid fever with a few over four thousand deaths was the annual toll exacted from Pennsylvania citizens ten years ago. This sick and death rate has been decreased more than seventy-five per cent. During the past year the death rate of 13.9 per thousand was the lowest in the history of the State. More than seventy-eight thousand people are thus shown to be alive in Pennsylvania to-day who would have died had the death rate of 1906 continued.

It is of special interest to know that the people of Pennsylvania through their General

Assembly at its session which adjourned on May 20, appropriated $4,632,387.00 for public health work in that state for the next two years.

This is a wonderful tribute to a great commonwealth in that it has recognized the practical possibility and value of health work and has paid so splendid a tribute to so efficient an officer.

GRAVES COUNTY.

In the society columns we are publishing a report of the recent meeting of the Graves County Medical Society at Farmington. The JOURNAL feels that it has been a little relax in not more frequently calling attention to the excellence of this Society. Dr. Hunt has been the secretary for many years and gives this work the sort of attention that is bound to win. They have a splendid lot of doctors in the county and everyone of them are willing to subordinate their individual feelings for the common good and whenever there is a difference of opinion they thresh it out in the society and arrive at a just conclusion and then to business. Our hats are off to the members of the Graves County Medical Society and especially to its very effective secretary.

THE FRACTURE COURSE.

One of the most creditable things that has ever been undertaken by the Kentucky State Medical Association was the co-operative postgraduate Course in Fractures given under its auspices during the recent commencement week at the University of Louisville. The conception of this course and its successful inauguration are due to the broad view of professional conditions and needs gained through his years of experience as chairman of our Medico-Legal Committee by Dr. John J. Moren, and the practical course provided was due to Dr. Henry E. Tuley, the Dean of the University of Louisville and its effective faculty. Neither Dr. Moren nor Dr. Tuley were completely satisfied with this course. The attendance and the response by the profession of the State as shown in its attendance on the course was far greater than was expected. Next year it is the purpose of both the Association and the University of Louisville to work out a far more practical course that will be a lot more worth while. The JOURNAL is sure it voices the gratitude of everyone who was present, to Drs. Moren and Tuley and their associates and it is with considerable pride that we call the attention of other associations to this new step indicating the practical results that can be brought about by the state societies in improving professional conditions. No better post-graduate course has ever been held than this and no state so

ciety has ever done more for its membership in the inauguration of this departure from older methods. It is of passing interest that the attendance on this course was more than twice that we used to have at the annual meetings of the Association before its reorganization along democratic lines.

GOOD TEETH ESSENTIAL TO GOOD HEALTH.

The following will be of interest to our readers:

"According to the United States Public Health Service there will be a falling off in the sale of store teeth in the future, and plates and toothless gums will be seen less frequently than formerly. This is due to the epochmaking discovery of the cause and method of treating what is known to the scientist as pyorrhea dentalis and alveolaris and to the layman as Rigg's disease. This is a suppuration around the roots of the teeth and causes an inflammation which produces loosening and loss of the teeth. At one time or another practically everybody has Rigg's disease. It is caused by a minute single celled animal called the endamoeba buccalis. This malevolent parasite does its work in combination with the pus-producing bacteria or germs. The skillful teamwork between these two destroys the delicate membrane which surrounds the roots of the teeth and causes them to fall out.

"The necessity of good teeth in order to have good health has been recognized a long time, but the scientists of our country have only recently worked out the relationship between decay of the teeth and Rigg's disease on the one hand, and rheumatism, serious heart disease and high blood pressure on the other. So firmly have these facts been proven that the modern up-to-date physician begins the treatment of such diseases by an inquiry into the condition of the teeth and their sockets. If these are found to be diseased, the condition is cured before the treatment goes further. The discovery of the cause of Rigg's disease is, therefore, of the very greatest importance.

"Just as soon as the cause of Rigg's disease was found out, the search for the cure began in earnest. It has been previously discovered that the use of ipecac would cure the diseases which are caused by infection of the intestine with endamoeba. From this it was deduced that a similar treatment would cause the destruction of endamoeba in the mouth. This was found to be the case, and emetin, the form of the drug used, is now administered by physicians for the cure and prevention of the disease. It sometimes takes a considerable time to get rid of all of the malignant germs in this way but the results which have been ob

tained have been remarkably good. The treatment is both local and general.

"In the matter of preventing much disease, it is important that the mouth be cleaned several times a day, and that a dentist be visited frequently to remove tartar and the yellowish matter which accumulates along the inner edges of the teeth and between the teeth. This is particularly important in the case of children, because it has been found that many a child is apparently dull who is in reality suffering from a chronic poisoning produced by a mouth full of decaying teeth."

DAMAGES FOR WATER-BORNE TYPHOID FEVER.

As is well known to the profession and people of Kentucky, the State Board of Health has been taking very active steps toward securing pure water supplies for the various cities and towns in the State for the past several years. Sometimes the public service corporations which supply water have doubtless felt that the Board was perniciously active in interfering with their commercial rights, but we feel sure that in the long run they will find that the Board has been acting in their interest as well as in the public interest. The courts everywhere are inclined to hold that private water companies are responsible for infected water supplies. Special attention is called to the decision rendered this year by the State Supreme Court of New Jersey in an appeal from a verdict of $750 awarded B. Henry Jones against the Mt. Holly Water Company to recover expenses and loss of time due to the illness of three of the plaintiff's children from typhoid fever or paratyphoid, beginning in January, 1912, during an outbreak of typhoid in Mt. Holly. The plaintiff had paid the Company $29.50 in advance for a year's water supply, covering the period during which the illness occurred.

The court, in reviewing the testimony and law of the subject, held that there was evidence that the water supply was polluted with sewage and that the company had known of the evidence for three and a half years prior to the epidemic. It also held that there was a contractual duty on the part of the company to supply the plaintiff with pure, wholesome water. Two paragraphs expressing this view may be quoted from the decision as follows:

"It must be borne in mind that the defendant company was in the water-supply business for profit. The plaintiff had paid for the supply which he was to receive in advance. Hence, it became the duty of the defendant company to give the plaintiff water fit for domestic purposes, including fitness for drinking.

Water is a necessity of life and one who undertakes to trade in it and supply customers stands in no different position to those with whom he deals than does a dealer in food stuffs. He is bound to use reasonable care that whatever is supplied for food or drink shall be ordinarily and reasonably pure and wholesome."

The court cites with approval a clause in the contract which provides that the water delivered to the city shall be pure and wholesome and free from pollution for drinking and domestic purposes. The court also cites with approval a declaration "that pure and wholesome water necessarily means such as is reasonably free from bacteria and coli, or any other infection or contamination which renders water unfit for domestic use and unsafe and dangerous to individuals." Moreover, it was necessary for the plaintiff to do no more than make it "reasonably appear that the drinking water was the probable efficient cause of the typhoid fever."

Water-borne typhoid fever should not occur in cities and towns with a public water supply. If it does, it is due to negligence on the part of the company supplying it and the State Board of Health is glad to assist either the public or the company in the prevention

of this disease.

THE HAZELWOOD SANITARIUM.

The Hazelwood Sanitarium has been opened since April first. It will be remembered by the profession of the State that this Institu tion is conducted by the Louisville Anti-Tuberculosis Association. Letters addressed to it at Station E. R. F. D. No. 2, Louisville, Kentucky, will receive prompt attention. Special arrangements have been made for persons with incipient tuberculosis who are in moderate circumstances, at this splendid Institution. It is in charge of Dr. O. O. Miller, recently of Asheville, North Carolina. An experienced physician is in charge of the Sanitarium and our members are urged to visit it or correspond with him whenever they are called upon to visit patients in regard to sanitarium treatment for tuberculosis.

Gas Gangrene in War.-The worst septic complication of wounds that has been seen frequently during the present war is the so-called gas gangrene. There are a series of forms of this, and not all the cases are by any means necessarily identical with acute emphysematous gangrene. The cases as a rule begin as a cellulitis with much gas formation and rapid sloughing of tissues, and then gangrene eventually develops, running a rapid course. It is not always the same organism. Pus is not produced in the early stages, but only sloughing and gas formation.

SCIENTIFIC EDITORIALS.

SKIN CANCER: ITS PREVENTION AND TREATMENT.

The dictum of Austerlitz concerning psoriasis can be applied to cancer: "What cancer is, no man knows." For, while a great amount of clinical experience and scientific research has in the course of time put us in possession of a number of facts bearing upon the mode of origin of malignant growths, no plausible theory can be found that agrees with all that we know and that is not refuted by other facts to account for the cause of cancer. Yet, while no satisfactory theory has yet been advanced, sufficient is known to prove that the disease is not of a parasitic nature. The supporters of the parasitic theory argue that proliferation of cancer cells is, in a way, as foreign to the adjacent normal cells as a bac terial or protozoal parasite would be. From time to time there has even been claims made that a definite parasite cause of cancer has been discovered, but such claims have never received general acceptance, since further investigation has failed to verify them, or the discovered bodies have been proved to be harmless or unimportant. In recent publications Cantamine and Bose have stated that they believe they have discovered a protozoal cause of cancer, which can be cultured and transplanted. However, after following up. the work done along this line, we have not been convinced that they have been successful. A strong argument against the parasitic nature of the disease is the fact that epitheliomata often develops after exposure to sunlight, X-rays, radium, and chemical and mechanical irritation. Moreover persons living with or in attendance on cancer patients do not develop the disease more frequently than others.

To prevent cancer or to treat it after it has started one must be well-posted on the pathology and histology of pre-cancerous phenomena, as well as able to recognize all the different forms of malignant tumors. It is largely on the ability to detect the pre-cancerous stage that our hopes of prevention or cure at an early stage depends. Even the smallest and least malignant of cancers will in time become inoperable and hopeless, if effective treatment is not instituted, while in other forms a few weeks delay may mean that the death-warrant has been signed. Early diagnosis and early treatment is the key-note in our fight with cancer. In skin-cancers especially should an early diagnosis be made, since the lesion is visible, and can be studied much more easily than cancer of the internal or

ance in skin-cancer, and it is upon the recognition of these phases that the prognosis must be made. If the recognition is made early in the course of the disease the prognosis is good and the treatment is simple, but if not made until later the prognosis is bad and the treatment is difficult and often useless. Therefore a clear understanding of the pathology of skin-cancers, the rapid changes and the peculiar characteristics, are of the greatest importance. The three phases that are met with in skin-cancers can be classified as follows: I. True scirrhus carcinoma, often secondary to carcinoma of other organs. more especially of the female breast; easily recognizable;

II. Superficial epithelioma or rodent ulcer, usually begins as a small papule which grows slowly into the characteristic ulcer:

III. Deeply infiltrated epithelioma, beginning as one or more deeply-seated hard tubercules, changing into a crateriform uleer.

Since the success of prevention and treatment of skin cancer depends upon the recognition of its precancerous state, we must always bear in mind that prolonged irritation of seborrheic localities may provoke epithelial neoplasms or cancer. These precancerous influences may be brought about by congenital or hereditary conditions, inflammatory

are at

changes, whether by chemical or mechanical irritation, or by actinic influence or even old age. Different types of naevi, small tumors, moles and warts are prone to become cancers. Particularly dangerous are the pigmented naevi, which when injured by knife or razor, may turn malignant, and often cause metastases in the neighboring glands in the form of melano-carcinomata. These pigmented naevi disappear quickly after being thorough ly cauterized. Certain dermatoses times inclined to take on a malignant character, as we see in stubborn cases of psoria sis where too much arsenic has been administered promiscuously, thereby causing a keratosic condition. Benign cystic epitheliomas and particularly, xeroderma pigmentosum Kaposi may often assume a malignant type. Chronic inflammatory processes, such lupus vulgaris and lupus erythematosus, eczemas, burns, old syphilitic sores (particularly about the nose and mouth), scars, leukoplakias of the tongue and mouth, chronic inflammation of the glands, and other pathological conditions may suddenly assume malignancy.

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'That trauma, whether mechanical or chemical, has been a very important factor in producing cancerous processes, and that this fact alone speaks against parasitic origin of cancer, is vouched for by many prominent authorities. Pipe and cigar smokers, betelnut and tobacco chewers, chimney sweeps,

sailors exposed to the sun and wind, X-ray operators and workers in tar and parafin products often suffer from cancer. The sharp edge of a broken tooth may be the cause of a cancer. According to Neve, of 1189 cases of epithelioma, 848 of them were of the thighs and abdomen, and resulted from friction by the kangri, a portable fire-box, used by the natives. Tattooing and scarring of the cheeks with a sharp instrument as practiced by African women also cause many cancers.

Since no single aetiological factor can account for development of cancer, we must always be on the lookout for pathological conditions of the skin. To prevent and to treat cancer we must eradicate the precancerous changes noticed in the skin. Where practicable thorough cauterization (actual or electric) currettage with or without subsequent cauterization, and application of massive doses. of X-ray. Where these are inadvisable the knife seems at present the most hopeful remedy we have at our command.

Radium therapy, which was revived two years ago, has been found wanting. Some of its enthusiastic followers made unusual claims, but statistics have shown different results.

Of the newest therapeutic measures, injection of benzol is highly recommended by Geza Kiralyfi. The injections of benzol in quantities of 0.1-0.5 in the tumor leads to destruction of cancer cells; a necrotic place is formed which increases from day to day until the whole tumor is sloughed out. These injections, according to Kiralyfi, improves the general health. The only drawback, it is only a purely local remedy and does not penetrate deep enough and absorb all the cancer nod

ules and cells.

We have not tried this remedy, as it is not so active as other well-tried agents. It would be better to leave a malignant growth alone than to subject it to irritation by unknown remedies. M. L. RAVITCH.

W. W. Bissell and E. R. Le Count, Chicago, (Journal A. M. A., March 27, 1915), give a study illustrated by charts, of 200 cases of fatal coma or semi-consciousness in the Cook County Hospital during a period of about three and one-half years. Brief accounts are given of the cases correctly and incorrectly diagnosed as uremia. The list of cases analyzed is, as they say, imperfect as not including some of the coma cases which offered no problem, the explanation being well verified accounts of morphine poisoning, illuminating gas poisoning, etc.