not lessen the terror, does not keep us from shivering as did Kipling's little Jungleman, from fear, a primitive instinct we can never shake off. And these cases are as a rule found more among well to do, the so-called better classes, than those proverty-stricken, and it is in such people, with their fuller knowledge of cancer states that we find them living in a well founded dread of cancer, because it "runs in my family."

This has been the problem of the ages. It's very name, the word itself sounds sinister. Think of it. The world over, one woman in every seven and one man in every eleven has to die of cancer. Who is it to be? No one knows. A far more humane method would be to draw lots, and let the victim die peacefully under an anesthetic or some other form of euthanasia. But it is even worse than that; every year that you live increases your chances for malignancy. Terrible, is it not? Here, then is a spectre, grim and determined, that stalks and persistently dogs the tracks of those who have passed the meridian or middle period of life. By care and the observing of hygienic laws, you can escape tuberculosis, typhoid, typhus, plague, yellow fever and a host of diseases; by care you can avoid and if attacked, have a reasonable chance for recovery. But not so with cancer. At every age, increasing with each year, becoming a greater and greater menace day by day, year by year, decade by decade, the nearer you approach the serc and yellow period of life. And you can do nothing to prevent it. It is not due to dirt; it is not contagious and infectious in the ordinary sense of the word. No particular diet, habit or hygiene provokes it; it comes with prosperity, hygienic surroundings, good food and nutrition, more often than in dirt and poverty. It is a disease of the upper classes.

Here then, we have a disease, a growth, a tissue change that we know physically, that we name, classify and study; upon which we operate when we can, and when all is told, lose four out of every five of our cases in a manner simply too horrible to contemplate. With all our knowledge, with all the noble work surgery has done and the results aecomplished, in its presence, we can feel a mystery and instinctively sense the sorrow and hopelessness of our cause. Summed up in six words, our ordinary surgical methods "gives the patient the best chance." That is mighty little for the undergoing of one of the longest, severest, most mutilating of operations and seemingly the greater the mutilation, the better chance. We give a part in the hope not certainty, of escaping a horrible death, and even then in the horrible gamble, the odds are against us. Will this terrible sphinx open her mouth, tell the secret of the ages and permit

the pigmy man a chance against the giant, David against Goliath? It would seem as though such was the case. To talk of a cure for cancer, to talk of specific medication for cancer, is to run the risk of being tabooed by your own profession. How queer. You would think that every medical man would at once kow-tow to the man who could even produce the slightest impression upon or stay the progress of cancer. Of course, we would expect as a condition precedent that the man so speaking, really had a right to speak upon the subject. Of course, where a group of men are well known; who are scientific; who are known to have worked for years along this line, speak in the cautious, careful tones of science, who demonstrate their work, in other words "make good," then We should and must give heed and faith especially when my ears have heard and my eyes seen those things that constitute the faith in me." Such is a little group of men composed of Drs. Alex Horowitz, S. P. Beebe (of exophthalmic goitre fame), J. Wallace Beveridge, A. Judson Quimby, men holding high position and just fame in the medical world, who believe they have solved this riddle and who seem to be performing the hitherto impossible, the apparent relief and disappearance of the cancer growth.

This is not the result of chance, but of many years of constant, steady research by Horowitz, assisted by Beebe, Beveridge and their conferes. It is based on the following grounds tersely stated; cancer cells are protein compounds; that under certain conditions, the blood of a healthy person will digest cancer cells; that the power to digest cancer cells or prevent their formation, is due to certain properties of the blood and tissues; that the absence or immunity secured by their presence, is interfered with in order that cancer may develop. Based on the idea that the green pigment chlorophyll, was the synthetic agent in the upbuilding of plant life, this was extracted from Cannabis Indica (Hashish) chromophyll, an alkaloid not of the ordinary type, extracted from the nuclei of the pentaphylii, bearing an intricate relation to the process of cell growth and division, was likewise used in combination with other biologic products It is interesting to note here in passing that we know little of chlorophyll, save that it is closely associated with the conversion of inorganic into organic matter, and that chromophyll is closely associated with the generative activities of every cell of living matter. The final outcome and combination of these delicate substances is a transparent, greenish or greenish-brown fluid, possessing the power of autolysis. that is to say, the power of stimulating the cells of the host and weakening the cells of the growth until

they undergo dissolution or self digestion. It is administered hypodermically and if reports and demonstrations are to be accepted, the problem is much nearer of solution. Every medical well-wisher should say "God speed the day." Think of it. The word of eminent honest, scientists, backed by the actual clinical work, to the effect that hopeless, inoperable and unquestioned cancers have yielded to the remedy with results far beyond the dreams of belief. restoring men and women temporarily to the bosoms of their families, destroying the growths, giving hope for the future and adding to the sum total of human happiness. Think what it will mean to the three and a half million cancer sufferers. Not only will the ban of death be lifted, but suffering and terror will have fled. As to the permanency of the relief, no one can as yet say, but even if the treatment had to be repeated this would be a tremendous advance. We can only hope that this sand will pan out pure gold, and that the laurel wreath will crown their brows. Peans of praise; of thankfulness, should rise like incense and our hearts warm with the feeling that the Golden Gate of Hope has, at last, been opened.

Ora et labora.

CURRAN POPE.

A NEW SOCIETY OF ANESTHETISTS. That anesthesia administration is at last coming into its own as a highly developed specialty-recognized, honored, and accorded the same dignity that the older specialists have long enjoyed, is obvious to any one who has kept in touch with the progress made in the past few years. To many who were present during the organization meeting of the InterState Association of Anesthetists in Cincinnati in May, the attendance, the enthusiasm, and principally the scope and quality of the scientific program, was a revelation. Essays -many illustrated by stereopticon, covering practically all that is recent in scientific anesthesia and analgesia; free discussions, and an interesting demonstration of intra-tracheal anesthesia; exhibiting a simplified portable apparatus; made up the two days' program. Social features were not over-looked, the members enjoying a dinner the evening of the first day, at which the permanent organization was effected. and after which the anesthetists were the guests of the Ohio State Medical Association, at a smoker. The ladies were charmingly taken care of by a committee headed by Dr. Nora Crotty of Cincinnati, and their diversions included a theatre party and an auto trip through the beauty spots of the city.

Following closely the organization of the American Association of Anesthetists,

and the the establishment of the Anesthesia Supplement; a journal published quarterly within the covers of the American Journal of Surgery, but with its own distinct editorial staff, devoted exclusively to anesthesia and analgesia, and acting as official organ for the American Association of Anesthetists, the Scottish Society of Anesthetists, and other such bodies; those of us who have long worked for the better recognition of this specialty have reason to feel singularly gratified.

The Inter-State Association of Anesthetists was organized with the idea of bringing together those physicians and dentists in the Middle West who are actively engaged in this work, or sufficiently interested in it to become members of such an organization. Naturally composed principally of anesthetists, the membership is not limited. On the contrary it is the plan of the officers and Executive Committee to interest surgeons and others, that all aspects of anesthesia may be touched upon, and that a proper relation may be better established and maintained-good "team work"-between the operator and his anesthetist. "To advance the science and practice of anesthesia and analgesia and to conserve the interests of anesthetists:" This, broadly, is the object of the organization.

The Association will meet annually, preferably in conjunction with the State Society of one of the States in this section. Its present officers are: W. Hamilton Long, Louisville, President; Isabelle Herb. Chicago, Vice President; F. Hoeffer McMechan, Cincinnati, Secretary and Treasurer.

W. HAMILTON LONG.

Standardizing Bacterins-A review of the principal methods used to standardize bacterins (bacterial vaccines) is given by C. P. Fitch, Ithaca, N. Y., (Journal A. M. A., March 13, 1915.) These include Wright's method, the nephelometer method first used by Mallory and Wright. All of these are described and their defects and advantages shown, and summed up as follows: “1. Some method employing the hemocytometer offers the most accurate technic for standardizing vaccines. 2. Comparisons of different counts made of the same suspension by Wright's method showed an average variation of 15 per cent. 3.

Comparisons of different counts made of the same suspension by the 0.02 mm. hemocytometer showed an average variation of 5 per cent. 4. Comparisons of counts of the same suspension made by Wright method, Allen's modification, and the chamber method (0.02 mm.) showed that the former two gave a much less number of bacteria. 5. A less degree of uniformity of counts has been obtained with the 0.01 mm. chamber than with the 0.02 mm. 6. Callison's diluting fluid seems to be the best of any so far used

38.

(Subject to be announced).-Dr. B. E. Gianinni, Straight Creek.

Rabies. Dr. L. H. South, Bowling Green.

Pituitary Extract. The results of a study of the treatment of hemorrhage in operations on the nose and throat by hypodermic injections of pituitary extract are reported by H. Kahn and L. E. Gordon, Chicago (Journal A. M. A., Jan. 23, 1915) They made a study of the blood-pressure before and after the administration of the drug in the hope of adding something to our knowledge on the blood-pressure in children and the effects of the drug. The coagulation time was also studied. All but three of the patients were children aged between 4 and 12 years and the dose was 12 minims hypodermically in children and 15 minims in adults, not less than fifteen minutes before and after the fifteen-minute interval and the same was the case with the bloodpressure. In the early cases the Brodie and Russell coagulometer was used and in the later ones the "drop on the slide" method. The authors' conclusions are given as follows: 1. The coagulation time of the blood is materally reduced by the hypodermic administration of pituitary extract. 2. The hemorrhage following nasa! and throat operations is much reduced, especially operations on the turbinals. 3. The effect on the blood-pressure of children is variable. as follows: Systolic pressure was increased in 55.31 per cent. of the cases, reduced in 36 per cent. and unchanged in 8.5 per cent.

ORIGINAL ARTICLES

MALIGNANT GROWTHS OF THE PROSTATE.*

By CLAUDE G. HUFFMAN, Louisville No organ nor tissue embraced within the human economy enjoys the distinction of being entirely exempt from the ravages of cancer; and why certain portions of the body are attacked with greater frequency than others, has never been definitely determined. "Cancer has been a constant subject of constant subject of study in all ages and in all nations, but the mystery of its origin has yet been unsolved, resistance to its progress has yet proved unsuccessful, and the symbolic crab continues to sink its claws slowly but relentlessly into the flesh of its victim. The disease, at first local, becomes regional and constitutional; recurring when removed, disseminating when lett; undergoing degeneration, intractable ulceration, deep spreading excavation, and is usually followed by cachexia and death."

"It must be confessed that in spite of the time, brains, energy, and money, which have been expended during the past few years in the attempt to solve the problem of cancer in almost all parts of the civilized world, little or no apparent progress has been made."

Since the scope of this dissertation is limited to consideration of the prostate gland. it would be inappropriate to discuss the numerous so-called varieties of malignant growths, to review details concerning the multitudinous fanciful theories hitherto advanced in attempted explanation of the presumed etiological factors, to describe in extenso the intricate histo-pathological characteristics, or to elaborate the diversified symptomatology, there being abundant available authority to substantiate or discredit the most extravagant statements which one might desire to make concerning every phase of cancer regardless of the anatomical region attacked, and the prostate is no exception to the rule. However, certain brief histo-pathologie outlines may be permissible.

The normal acinus of the prostate is lined with a single or an imperfect double-layer of columnar epithelial cells. These are the differential or specific functional cells of the gland. In examination of pathologic specimens, these functional cells are seen frequently in a state of excessive proliferation, forming projections in and bridges across the acini. There is observed also partial or complete exfoliation of the same cells with the formation of cysts, which are empty or con

*Let it be understood that where not otherwise specified, "malignant growth" as utilized in this paper. may be interpreted to signify any variety of cancerous tumor.

tain accumulations of the cells in varying degrees of degeneration. Some fields are noted in which the acini present not only the proliferated functional cells, but also outside these and immediately adjoining the stroma, another row of cells, which are morphologically dissimilar to the inner row of differential cells. Other fields contain acini with functional cells present, exfoliated or absent, and the lumina partially or completely filled with the hyperplastic undifferentiated cells of the outer row. Still other fields are seen in which these hyperplastic cells of the outer row are both intra-acinic and extra-acinic, consequently presenting epithelial invasion of tissue, the accepted picture of cancer. Furthermore, what is impressive, the three conditions just described have been observed together in the same microscopic field. (MeGrath).

Some authors maintain that cancer does not begin in a hypertrophic portion of the gland, that its presence here is an invasion from a focus situated elsewhere in the organ, usually in the posterior lobe. Others state that cancer occurs as an almost imperceptible transition from benign adenoma. Still others, disregarding as unessential the consideration whether the associated process be one of general hypertrophy, adenoma or other pathological condition, view, apart from its causation, the pathogenesis of prostatic cancer, likewise of cancer in general, as fundamentally a question of the histogenesis of epithelial cells. (McGrath).

Malignant growths involving the prostate may be either sarcomatous or carcinomatous, the latter being more frequently observed than the former. Experience demonstrates that neither can be considered as uncommon as hitherto believed. The prostatic tumor is usually primary, but may be secondary or metastatic. Inflammatory changes, prolonged congestion from any cause, cause, and simple glandular hypertrophy, sometimes appear to favor malignant development. Prostatic invasion may also occur secondarily by extension from adjacent organs.

Prostatic sarcoma is most frequently encountered in individuals less than ten years of age, next in those more than fifty; instances have been recorded between ten and fifty, a few between thirty and fifty. Statisties show that about fifty per cent. develop before the age of ten; twenty-five per cent. between ten and thirty; five per cent between thirty and fifty; twenty per cent. beyond fifty years. Metastasis is not uncommon, especially in small round-celled sarcoma. Carcinoma of the prostate, on the other hand, is pre-eminently a lesion of advanced life, few examples having been recorded in patients less than sixty years of age. Metastasis and extension to

adjacent structures occur with greater frequency in carcinomata than in sarcomata.

Malignant tumors of the prostate may be either intra-capsular or extra-capsular, i. e., in the former the neoplasm is limited by the prostatic capsule, whereas from extension the latter may become diffused throughout the entire pelvic cavity. In intra-capsular neoplasms examination generally reveals the prostatic surface hard, smooth, irregular in contour, and one or more lobes or the entire gland may be implicated. The vesical trigone is usually elevated, and the urethral curve altered by the lobular deformity. In extra capsular growths the prostate in some instances retains its normal size and contour, in others pressure may cause reduction resembling atrophy. More frequently, however, considerable enlargement and deformity of the gland are noted, with extension of the neoplasm ramifications in various directions. In some instances the neoplasm attains the size of a lemon, in others from contiguity of structure the entire pelvic contents may become involved. It has been shown that more often than otherwise malignant growths begin in the posterior prostatic lobe.

The clinical picture presented is practically identical regardless of the variety of the neoplasm. In the majority of instances disturbances of micturition, due to pressure with consequent narrowing and tortuosity of the urethral lumen, are the clinical manifestations first noted. Considerable straining may be necessary to enable the patient to completely empty the bladder; the urinary stream. becomes smaller, and the act more prolonged than in simple hypertrophy; dribbling of the urine generally supervenes within a short time; finally partia! or complete retention ensues. Hematuria is inconstant and may therefore be misleading. As a rule hemorrhage occurs as a late manifestation, and generally indicates trigonal involvement. So-called "cancer cells,' blood, prostatic and connective tissue cells, are usually demonstrable in the urine. Pain in the prostate radiating toward the lumbar region, simulating lumbago; pain in the legs, resembling sciatica; painful defecation and tenesmus, are common accompanying manifestations. A sanguinolent rectal discharge may be rarely observed.

While the foregoing clinical symptoms are recognized as important, the pertinent fact must not be permitted to pass unobserved that early differential diagnosis between a malignant growth and hypertrophied prostate may be practically impossible. In young subjects the symptoms may not be pronouneed until the neoplasm attains considerable size, when dysuria and varying degrees of retention are likely to suddenly ensue. malignant growth be present, however, phys

If a

ical examination usually reveals more or less hypertrophy of the glandular structure. Rectal investigation discloses a hard, smooth, nodular tumor. Cystoscopy shows nodules about the vesical trigone and the internal meatus. Ulceration in these situations is indicative of carcinoma rather than sarcoma.

Like malignant neoplasms in other anatomical situations, the histo-pathological characteristics of prostatic growths are represented by abundant cellular proliferation, the character of the predominating cells depending upon the variety of the tumor. As already suggested carcinomata are most frequently encountered, next large and small round-celled and spindle-celled sarcomata, the lympho-, myxo,- and angio-sarcomata being less common.

According to Wolfe (as quoted by Guiteras) the course of malignant tumors of the prostate is exceedingly variable. For instance, in sarcoma the so-called latent stage may last for several years, and in very malignant cases the duration is from a few months to three years. "These growths (sarcomata) are probably developed from embryonic tissue remnants, rather than from from the prostate gland itself. Some have been described as containing striped muscle fibres." (Guiteras).

The association of prostatic hypertrophy and malignant growths, of malignant degeneration of an hypertrophied prostate," is not uncommon in their examination of onehundred prostates giving a picture of benign adenomatous hypertrophy, Albarran and Halle found typical epithelial proliferation, i.e., carcinomatous degeneration, in fourteen. Many other examples have been described where examination after removal revealed adenomatous prostatic hypertrophy with areas of distinct carcinomatous changes. Young noted malignancy in 28 per cent; Albarran 14 per cent; Walker 16.5 per cent; Wilson and McGrath 15.5 per cent; Freyer 13.4 per cent; Moullin 25 per cent; Binney believes malignancy supervenes in 15 to 20 per cent of all so-called hypertrophied prostates.

The treatment of malignant growths of the prostate constitutes one of the darkest chapters in surgery of the urogenital tract. Despite the tremendous advancing strides toward the acme of perfection in the surgical treatment of other lesions, the wisdom exhibited by the venerable Father of Medicine (Hippocrates) who wrote concerning the treatment of cancer twenty-four centuries ago, that "the deep-seated forms are best untreated, for if treated the patient soon dies, other wise he might live a long time," is emphasized by the disastrous failures which sometimes follow the application of modern accepted methods of procedure.