Subscription Price, $1.00 Per Year, in Advance, Postpaid. The writers of original articles, who wish to avail themselves of reprints, will please notify the managing editor at the time of presentation of paper; otherwise, full price will have to be charged as the type will have to be reset. ADDRESS ALL COMMUNICATIONS TO THE AMERICAN PRACTITIONER AND NEWS PUBLISHING CO., The Cancer Editorial. Cancer must to-day be recognized as possibly the greatest scourge with which mankind is afflicted. We recognize that tuberculosis is now within the possibilities of human effort in its cure, for in reality we are in possession of such facts as its cause, methods of invasion, to now place it second to cancer. It is estimated by Cryle in drawing his conclusions from the British Isles that there are in the United States about 80,000 cases of cancer, and according to statistics one woman in eight reaching her thirty-fifth year dies of cancer; and hospital records with post-mortem evidences show cancer in every twelve autopsies. He farther states which is known to be true, that not only does cancer destroy countless lives, but destroys them by the most merciless torture. That to die from cancer is not a matter of a short period, but the distress of months and possibly by years-suffering not alone the pain but suffering without hope-the cruel work of a species of celular cannibalism. But cancer still remains a mystery in its causation. Any definite cure is as yet attained by mutilation, the re'sults are far from satisfactory in strictly surgical treat ment. Until the cause has been made known in both sarcoma as well as carcinoma, we can only look to surgery, which is yet uncertain. Dr. Cryle does not regard cancer as on the increase. In his opinion it is only a relative one. He emphasizes the fact that cancer may always be eradicated if it could be operated on early enough. In other words a very large per cent. of favorably situated cancers would show a three years cure if operated on by the surgical standard of to-day. The discovery of immunity opens up the road, however, eventually to success in the treatment of cancer. The experiments by Cryle and Beebe upon sarcoma in dogs by transfusion of blood of an immune dog, holds out a therapeutic promise of wonderful range. The trials upon man while recent, give great promise. His results with hemolysis as an early test for malignancy are indeed most encouraging, and the utilizing of immunity for the cure through transfusion will open up the way for much investigation. This problem so long unsolved begins to come with the range of surgical endeavor, and may as he says "banish despair" and give us hope. EDITORAL NOTES. FOCAL SYMPTOMS IN DIFFUSE BRAIN AFFECTIONS. Focal symptoms are usually looked upon by the surgeons as indication of local disease of the brain; their character and site guide him in choosing the spot for opening the skull in order to reach the portion of the brain involved in the disease. It is, however, to be remembered that focal symptoms may appear in diffuse disease where operation is not indicated. Saenger, (Munchener Medizinische Wochenschrift, May 12, 1908) reports several cases in which a mistaken diagnosis of local disease was thus made. An especially frequent cause for such focal signs seems to have been tuberculous meningitis. Other cases were those of diffuse sarcomatosis, diffuse leptomeningitis, chronic hydrocephalus, and arteriosclerosis of the cerebral vessels. The surgeon must therefore be on his guard against too hasty an assumption that in the presence of focal symptoms local disease of the brain alone exists. In many cases, of course, an explanaatory operation is advisable, even when the diagnosis is very doubtful; lumbar puncture, however, ought to be frequently performed, for it may reveal the existence of a general infection of the brain or the meninges, and this contraindicates operative interference.-Medical Record, June 1, 1908. The following conclusions are drawn by Harry C. Parker in a recent article in the A. M. A. Journal: I. The calmette ocular tuberculin test is a great diagnostic importance as any other single test. II. A positive reaction is indicative of a tubercular focus, somewhere in the body. III. The test is uncertain in patients under two years of age, in whom the cutaneous test of Von Pirquet is most certain. IV. The test fails in advanced cases of tuberculosis but there is little need of it here. V. The initial instillation should be preferably under one per cent. strength in order that severe inflammatory conditions may not follow. If necessary to make the second and stronger test, the eye not previously used should be selected. VI. The concensus of opinion seems to be against using the test in an eye not wholly normal. VII. After complications have occured from its use but have entirely cleared up in a varying length of time and are not so frequent when the initial test is made with a solution under one per cent., recent investigations have shown a greater number of opthalmic affections due to tuberculosis than formerly supposed. And in the calmette reaction we have a simple means of differential diagnosis, which should be thoroughly tried. VIII. The ocular reaction is especially valuable for ascertaining the tuberculous nature of cases of phlyctenular keratitis. and conjunctivitis, episcleritis and scleritis, chronic iritis, iridocyclitis, interstitial keratitis and chorioidities. IX. A one per cent. solution of Koch's Old Tuberculin is nearly as good as the calmette solution for diagnostic purposes. X. The test in the hands of various observers has given such uniformally excellent results that its value is practically assured. The Second Annual Meeting of the Kentucky State Associa-tion of Graduate Nurses was held at the Woman's Club, Fourth Avenue, Louisville, Ky., June 9, 10, 11, 1908. The following officers were elected: President, Miss L. A. Willson; First Vice President, Miss Marie Lustnauer; Second Vice President,. Miss S. E. Dock; Recording Secretary, Miss Lula Evans; Corresponding Secretary, Miss Viola J. Bines; Treasurer, Mr. J. J. Telford. Committees: Ways and Means, Miss Louise Weisenger; Credentials, Miss Edith Bush; Nomination, Miss Katherine Arnold; Press and Publication, Miss Patty McPherson. DR. WILLIAM J. SCHLOSSER, graduate of the Louisville College of Dentistry, 1895, begs to announce that he is now located at the Southeast corner of Second and Chestnut Streets. Recent Progress in Medical Science. E. S. ALLEN, M. D., Professor of Pathology, Kentucky School of Medicine. PATHOLOGY. Clotting of Blood.—(Journal A. M. A.) by Drs. Robertson, Ullman & Duncan, Philadelphia, Pa. The above gentlemen have given us in a most excellent article the result of an exhaustive research as to the relative effects of calcium salts and citric acid on the coagulability of the blood. Their investigations were for the purpose of confirming Wright's statements along these lines, but they were unable to agree with Wright as to calcium salts lessening the coagulation of blood. This work by Wright, Morowitz, McClintock and Vaughn,. and others, is becoming of unusual interest for they are upsetting our text book statements as to fibrinogen acting on paroglobulin. and thrombosis in the presence of calcium, forms a new substance fibrin which entangles corpuscles by mechanical and possibly some chemotactic action. Some of us have long been of the opinion that the fluidity of the blood, while intravascular is dependent upon the vitality of the endothelial cells, that when the endothelial cell was in- jured or devitalized from mechanical, chemical, or nutritional changes, a ferment was liberated which activated the chemical elements of the fibrin forming substances and at once a positive chematosis was generated between the fibrinogen elements which resulted in the formation of fibrin. Now we are told that fibrin has very little to do with intravascular clotting, for hemophilia possesses the normal amount of fibrin. It has been demonstrated that hemorrhages increase the coagulativity of blood. Vierordt explains this by certain juices that are absorbed from the tissues at large to fill up the liquid element and the incorporated in the fluid from the cells is a substance that plays some specific part in the coagulating tendency of the blood. The skin is supposed to give some ferment or fluid with some specific coagulation qualities, for the serum of blisters especially lessen the coagulation of blood. It is agreed that in pneumonia there is an increased amount of fibrin and no unusual tendency to thrombosis, while in typhoid fever and anemia where fibrin is diminished, thrombosis is comparatively common. Post Operative Thrombosis.-The gentlemen explain that post operative thrombosis probably is caused by the juices absorbed from the tissues which give up their fluid to fill up the blood current; probably a contributing cause are bacteria acting as hemolytic agents and foreign bodies, but Wright states that foreign bodies do not lessen the coagulation tendency. And as to bacteria, the frequent opportunity furnished in medical and surgical cases for the entrance of micro-organism must demonstrate that some other factor must be at work other than the mechanical and hemolytic action of micro-organism. These investigators have concluded that in some way coagulation within the vessels differs in some way from extra vascular coagulation. For outside the body many factors determine the coagulation tendency, such as volume, rate of flow, nature of vessel in which blood is received, temperature (cold retards, heat hastens), duration of contact with tissues. Free blood from a deep incision is longer in clotting than blood from a superficial wound. Pressure on a part, probably by increasing tissue juices, hastens clotting. The first drop of blood has a longer clotting time; a drop removed from different parts of the body has different clotting times. |