- as

cancer is rare. On the other hand, in Holland ma- twenty-five years. Similar experiences are cited by laria and cancer are both common, and - we Behrens, Pfeiffer and others in different parts of shall see presently cancer is often found in low- Germany; Espine reporting that in the canton of lying marshy districts where one would expect to find Geneva in Switzerland there are villages where canmalaria. cer is extraordinarily prevalent, particularly cancer of the stomach.

This brings us to the study of localities in different countries, and we find that certain portions of many countries are much more favored by the disease than others. Haviland's work has been much quoted, but is worth repeating in this connection. A glance at his map shows that the southwest portion of England and Wales is a region where there is a low mortality from cancer. This section belongs geologically to the oldest formations, silurian and carboniferous, and includes the highest and best drained mountainous districts of the country. He found a low mortality from this disease in the chalk hills and the red sandstone districts; in other words, in the elevated districts of England which form the sources of the rivers which drain the country. The high mortality, on the other hand, is to be found near those portions of the rivers where they have reached their full formation in the low-lying level districts and regions liable to serious floods; and these regions are composed of more recent geological formations in which clays of different ages predominate. In a certain region where the river frequently overflows its banks, the mortality for women rose as high as 8.1 to every 10,000 living. In Liverpool the cancer death-rate at the same time was only 4.1 to every 10,000 females living. In Norway, on the other hand, the disease is more frequent on the highlands and less on the

coast.

I have already mentioned an example of a cancer street. Amaudet describes such a street in Corneilles in Normandy, in which out of fifty-four houses seventeen had contained cases of the disease. are near the middle of the street, and occupied both sides; many of them having 2 cases.

These houses

Examples of "cancer houses" could be given in great number, but one or two will suffice. The following case reported by Power, is perhaps as striking as any:

Mrs. A., forty-five years of age, lived in a certain house for thirteen years, and then died of cancer of the stomach. Mrs. B., forty-seven years of age, succeeded to her place, and occupied her bedroom. She lived in the house for twenty years and died of cancer of the liver. Mrs. C., sixty-seven years old, who had lived in the house for eight years, succeeded to the position previously held by the other two women, and to their bedroom, and died of cancer of the breast eight years after the death of Mrs. B.

Webb reports in the Birmingham Medical Review,2 several cases of cancer houses in the village near his residence. In two houses built as one building there were 6 cases following one another at regular intervals during a period of twenty-six years. None of the individuals were blood relations. Two were cases of cancer of the rectum; 2, cancer of the stomach; 1, cancer of the uterus, and 1, cancer of the breast. The drain and water supply were common to both. In another group of cottages there were 9 cases in fifteen years. All the inhabitants used water from a certain pump by the roadside and close to a very filthy hovel.

Mollier reports 4 cases of cancer occurring in ten years' time in a house in Lyons on the banks of the Saône. Three of these were cases of cancer of the stomach.

Coming now to the condition of certain localities, we find a state of things which might almost justify one in the assumption that cancer was endemic. D'Arcy Power describes a district in England, the condition of soil being identical with those described by Haviland, a flat country covering 60 square miles and consisting of gravel overlaying boulder clay. It has many streams and fens. The population is about 12,000. From 1872 to 1898 there were 173 cases of cancer under observation of the local physicians. In a village of 1,036 inhabitants in this district there. Fissinger lays stress upon solitude. A house near were 42 cases of cancer during the same period. a wood with bushes and swamps near the banks of a Many used water from the same well, but in many river are conditions which appear to be favorable for cases there was no common source of contagion of the development of the disease. Noel calls attention this kind. Seventy-one cases were cancers of the ali- to the fact that excise officers in England, whose duty mentary canal or organs suggesting water as an in- it is to traverse the woods, often suffer from cancer, fecting agent. Behla, a practising physician for as do also the country laborers who work in the twenty-two and one-half years in Luckau, a town in woods. Germany of 5,000 inhabitants, describes a remarkable increase of cancer in one of the suburbs of this town containing about 1,000 inhabitants, while in the adjacent district of the same size there was hardly a case of the disease. From October 1, 1875, to April 1, 1898, there were 663 deaths, of which 73 were cancer (mostly of the stomach and liver); that is, 1 in 9 deaths were from cancer; whereas in Prussia in general the rate is only 1 in 40 deaths. The majority of the houses in this district had had cancer cases in them, and on a certain side of a certain street every house had been infected, and in certain houses 3 or 4 cases of cancer had occurred. In a little over one year's time 10 men died of cancer in this district. Such a region seems fairly to have earned the name of "Cancer Village." In many of the neighboring villages there had been no deaths from cancer for

Coming now to the question of the increase of cancer, we find a pretty general expression of opinion that there has been a marked increase in the amount of the disease during the past fifty years, a period of time during which sufficiently careful statistics have been kept to enable an accurate estimate to be made.

It is true that some have objected, like Payne and Neusholme, two able English observers, that these observations were fallacious. Payne attributes the increase of cancer to the diminished mortality from phthisis and other infectious diseases; a larger number of persons therefore surviving to become the victims of cancer later. Neusholme regards the increased figure as due to more accurate diagnosis and careful autopsy records. Andrews, of Chicago, shares these

2 No. 32, 1892, p. 342.

views. Nevertheless, the mass of evidence seems preventable diseases of early life will give rise to an strongly to favor a serious increase of cancer during artificial increase in the proportion of disease of later the period mentioned. For instance, Neusholme him- life which has not been prevented or cured, the charts self shows that in the period 1866 to 1868, there were do not show the result which should be expected from in England and Wales 25,567 deaths from cancer, this line of reasoning. If this argument were correct, and in the period 1894 to 1896 there were 67,888 the ratio of cancer deaths to the total deaths ought to deaths from the disease. In other words, during be greater than that compared with the living populatwenty years the deaths from cancer had more than tion, whereas the charts show this ratio is less in all doubled. Cancer is no new disease or one which has cases. The conviction is warranted, he says, that been set aside from a more comprehensive one, as ap- there is a widespread increase in the causes of this pendicitis from peritonitis, so that increased accuracy disease throughout the country. of diagnosis would probably eliminate as much as it added. Many cases of tuberculosis and syphilis formerly supposed to be cancer are now recognized not to be such, and would offset the additional cases of cancer now handed in in the reports of more accurate diagnosticians and pathologists.

The more recent studies of Haviland in Great Britain show an enormous increase of cancer in that country. In the period of 1857 to 1860 the death rate of England and Wales for males was 1.94 to 10,000 living, and for females 4.33 to 10,000. In 1881 to 1890, the death-rate for males was 4.30, and for females 7.38. In other words, during an interval of a little over twenty years, the rate has more than doubled for males, and not quite doubled for females.

Taking now two specimen low mortality areas, such as York and Gloucester, we find that the low mortality groups are still found in the same districts. although the standard death-rate has been raised from 4.3 to 7.4. The same may be said of the high mortality groups. In the Thames Valley district the death-rate for females above thirty-five years of age from 1851 to 1860 was 13, and from 1881 to 1890 was 23 to 10,000 living persons.

In other words, cancer is still comparatively low and still comparatively high under the conditions which existed in 1851 to 1860, but the rate in all these districts has been increased after the interval of twenty years.

The greatest increase has occurred in San Francisco. Here the ratio has crept from 1866 to 1898 from 16.5 to 103.6 cases to 100,000. Here we have the enormous increase of more than sixfold in thirtytwo years. In Boston the ratio has almost trebled between 1863 and 1887. After the latter date there was a temporary decrease followed by a tendency to increase up to the present time. In seven American cities in 1870 there were 999 deaths from cancer, or 35.4 per 100,000 living persons. In 1898 the deathrate was 66.4 per 100,000. The ratio has therefore almost doubled in twenty-eight years. At this rate in 1900 there would be an average of 80 deaths in each city to every 100,000 living persons. Massey calculates that there must have been about 49,800 deaths from cancer in the United States in 1898, and that there must be at the present time 100,000 victims of the disease within our borders. These figures give color to the startling statement made by Roswell Park a year or two ago that in 1909 there will probably be more deaths in the United States from cancer than from consumption, small-pox and typoid fever combined. This author shows that in New York State cancer is the only disease tabulated which shows a progressive and steady increment. In 1887 there were 2,363 deaths from cancer, and 11,609 deaths from consumption. In 1898 there were 4,456 deaths from cancer and 12,552 deaths from consumption. In Roswell Park's own city and neighborhood the deaths from this disease exceed in ratio that of almost any other section of the country. It is, as he justly says, a veritable "Tropic of Cancer." It is difficult, under these circumstances, to avoid asking one's self the question whether cancer is or is not an infectious dis

In Ireland in 1864 there were 1,498 deaths from cancer with a population of 5,678,307. In Ireland in 1884 there were 1,947 deaths with a population of 4,962,693. In Scotland in 1864 there were 1,300 deaths from cancer with a population of 3,118,701. | ease. In Scotland in 1884 there were 2,110 cases of cancer with a slight increase in population.

The endemic character of cancer and the steady increase of the disease, and the fact that in certain localities there is a sudden invasion of this disease, all suggest strongly a local cause. To search for this requires special knowledge of the most diverse character. As Park suggests, a combination of the zoologist and the botanist and the veterinarian is needed for such an investigation.

Finkelnburg, in 1894, shows from a careful study of the distribution and frequency of cancer in Prussia that there has been a considerable increase in the mortality of carcinoma, although the general mortality rate was lowered during that period. The mortality was much greater in the cities than in the country, in large and well-cared-for cities especially. In The work of Behla again merits notice in this conBerlin the death-rate for cancer was 62.3 per 100,000 nection. After a careful study of the meteorological living persons. This increased mortality in the condition of his native town, of its water and other cities is attributed to the increased mortality among possible sources of infection, he turned his attention to the food supply - practically those forms which Although Andrews doubts the accuracy of our were eaten uncooked. The gardens containing letpopulation figures, Massey claims that our statistics tuce, radishes, berries, apples, etc., were watered with are sufficiently accurate to show that the ratio of water from the trench which surrounded the district. deaths from cancer to 100,000 living persons in the The water remaining in this trench was very foul and United States is on the increase. Massey's interest-contained quantities of vegetable and animal organing tables arranged for seven of our principal cities isms. The fresh lettuce was rinsed out in these dirty show also the ratio of deaths from cancer to each pools, and the water was also used to wash the 1,000 of all deaths in each city. He points out that, while kitchen utensils and the towels This stream did not it is evident that a lessened number of deaths from touch any other portion of the town. In many other

women.

villages of Germany where cancer prevails Behla was able to obtain the same history of the use of foul water for domestic purposes.

years of age, and it is well to remember that if ani-mals should be used for experimental purposes they should be taken at an age when they are more liable to cancer.

Of 49 cases of carcinoma collected by Fadyean, 25 were in the horse, 16 in the dog, 5 in the ox, 2 in the cat and 1 in the sheep. It appears to be extremely rare in pigs. Several cases of cancer of the stomach in horses are reported by this writer, although this is a very rare seat of the disease in animals. There are no statistics to show whether animals have cancer îm the specially infected districts. One observer has stated that cattle in low-lying pastures are more liable to cancer than those in higher and drier grazing country.

The data which have thus far been brought forward are in some cases strongly suggestive of the communicability of cancer from one individual to another. Is there any clinical evidence bearing upon this point? Cancer of the base of the tongue is reported by Scott in American trout transported to New Zealand. Roswell Park cites a number of interesting cases collected from literature. Thus Kuhn reports the case of a woman contracting an encephaloid cancer of the finger while caring for a cancerous cow. Jürgens reports the inoculation of an epithelioma from a fowl to the thumb. Budd reports the case of a pet dog contracting cancer of the tongue from licking the cancerous lip of his master. A London surgeon was affected with cancer of the tongue after having takem into his mouth some of the discharge from a cancerous breast. A physician inoculated an acne pustule om his face while scraping a cancerous uterus. Bucill mentions five French hospital surgeons who have died! of cancer, one eight months after receiving a wound! while operating on a cancerous patient.

Foul and stagnant water, sluggish streams with wooded banks which are often overflowed appear thus to be favorable conditions. It is well known that trees are subject to xylomata, or wood tumors, which are destructive. These affections of trees appear to be contagious, as neighboring trees are usually affected. A form of ameba (plasmodiophora Wassica) grows on certain cabbages and other vegetables, forming large tumors. It is possible that the seeds of disease shed from trees or plants may float upon the water used for washing and drinking purposes, and thus be conveyed to the human organism. Pfeiffer has suggested that the micro organisms may be conveyed by an intermediate host, and has carefully studied the sporozoa and other protozoa forms found in insects with the hope of discovering the cause of the disease. We have but recently been made familiar with the mosquito as an active agent in the spread of malaria, and in a like manner wasps have been suggested as the carriers of disease from tree to tree and plant to plant, as on these insects both protozoa and fungi abound, and perhaps also to human food. It can readily be seen that if such articles of food and drink were infectious, they would, if handled by man, convey the poison to the nose, lips or tongue, and if swallowed could transport the disease to the stomach, intestines or internal organs. We can easily imagine that a micro-organism could, under the circumstances, attach itself to a break in the epidermal or epithelial coverings of the body, or when these cells were by age or a blow or chronic irritation rendered less resistant to morbid influences. In this way a single cell may become the point of entrance of the disease into the body. Behla suggests that summer is the season of The situation of cancer in the human body certainly the year when infection is more likely to occur, but is suggestive of inoculation. Thus Andrews has studunfortunately there is no known period to guide us. ied the locality of 7,881 cases of cancer and endeavors It is interesting to note in this connection that the to show that primary cancer is more common on exdog, an animal which comes in contact with earth and posed surfaces, such as the lip, the face and the hands, water so freely, does not have cancer in the regions so and in such situations in the digestive tract where a often found diseased in man, but more upon the sur-microbe would lodge easily and not be swept awayface of the body, as on the ears, the tail, the scrotum, Estimating according to area and placing the intestine,, prepuce, vulva and anus. Observations on the food which has a large area but small percentage of cancer,, of man have not as yet brought out any suggestive as one, we find the lip stands at the head of the list; data. Bencke has noted that cancer is rare in pris- the other portions of the digestive tract follow in the ons where animal food is not freely furnished and order we might expect, as the tongue, the stomach, work is hard. Certain monk orders are said to be rectum, mouth, esophagus, etc. exempt from cancer, but there are no facts to show that vegetarians as a class are less liable than meat eaters, although Paget thinks that meat eaters are more liable.

In Normandy the cider made from very foul water has been blamed for the increase of cancer. Those addicted to alcohol have been said to be more liable. These are probably only predisposing causes which favor irritation of the stomach or intestines.

A study of the health of a locality before and after the introduction of a pure water supply might throw light upon this question.

So far as animals are concerned, the disease is found in herbivorous as well as carnivorous. It is more common among mammals and is rare in birds. In cold-blooded animals it is not seen. The disease is rare in the digestive tract, but, as we have already seen, is more common on the outer skin and urogenital tracts. Cancer is not observed in dogs under two

Now that attention is being brought to the possibility of contagion, practitioners will doubtless begin to report examples which they have observed in their practice. We all remember how improbable the theory of the contagiousness of tubercle seemed when it was first brought forward. In my own experience, particularly with cancer of the breast, I have noticed of late years the frequency with which the husband is affected with keratosis senilis or the early stages of rodent ulcer. The milder forms of this affection often pass unnoticed, but may be none the less a possible source of contagion. Coming as they do on exposed parts of the body, they could easily be communicated from husband to wife and find a lodgment in an organ which is susceptible to the disease.

Cases of inoculation are so striking when they do occur as not to pass unnoticed. I have seen cancer of the prepuce clearly communicated from the glans penis by contact and not by extension. In the same way

cancer has been known to jump from the tongue to the cheek. Cancer has followed the track of the trocar, the punch, or of the exploratory operating wound. It is my habit in operations for cancer of the breast to avoid touching the disease with the knife blade and to keep all portions of the wound carefully protected with gauze held in place by catch forceps until the last trace of cancer has been removed.

Coming now to experimental inoculation, we find that well authenticated cases are exceedingly rare even in animals. Cornil reports a case of sarcoma of the breast in which the surgeons inserted a small fragment of the growth beneath the skin of the breast of the opposite side. The small wound healed by first intention, but two months later a nodule of sarcoma formed at the site of the inoculation. Hahn reports a similar case. Bose cites 3 cases of inoculation of cancer from man to man. Alibert, who derided the theory of contagion, is said to have inoculated himself with cancer juice and subsequently to have died of

carcinoma.

Inoculations have been made into dogs, cats and rats from carcinoma of man; various organs have been inoculated, and also the peritoneum and the circulating blood. In very few cases has there been any result, and these have been regarded rather as transplantations and independent growths of the inoculated or grafted tissues rather than as growths of the local tissue as the result of an infection.

an infiltration of the diaphragm. Cancer is an extremely rare disease in rabbits; hence Lock concluded that his operation produced the disease.

Moran was able to transmit cancer in white mice in 8 out of 10 cases. He also performed an experiment which is interesting as suggesting the possibility of the theory of an intermediate host as the carrier of the virus. Placing healthy mice in cages over a vapor of turpentine and camphor to protect them from insects, they remained in perfect health. In other cages he placed mice with bed bugs taken from the cages of cancerous mice, and observed after a few months that all the animals infested by these insects were suffering from cancer.

Irritation seems to play an important rôle in the production of cancer; cancer of the breast, lip and scrotum often have a history which suggests irritation or a traumatic origin, but attempts to produce cancer by trauma in animals have not succeeded.

The question of heredity, as a factor in the causation of the disease, is one about which statisticians differ greatly; it has been placed below 10% by some and as high as 30% by others. How often do we hear a patient exclaim, when informed of the diagnosis, that they have never heard of an instance of the disease in the family for generations. Yet, in some instances, we hear of very striking examples of family susceptibility to the disease. Space does not permit me to cite more than one, which I have selected as showing at the same time a remarkable susceptibility of a certain organ. Power reports a case of cancer of the breast with the following family history: The father died at forty-six with cancer of the breast; a brother died at sixty-five with cancer of the throat; a second brother died at twenty-five with cancer under left arm. First sister died at sixty-three with cancer of the breast;

8

breasts; third sister died at forty with cancer of both breasts; fourth sister died at fifty-four with cancer of breast; fifth and sixth sisters now living with cancer of the breast.

This does not prove by any means that the cancer germ, if there be such, is not inoculable. Doubtless nature fails continually to infect the human organism. It is possible that there may be a certain stage in the life history of the micro-organism in which it is capable of being inoculated and other periods in which it is inert. One of the earliest of the modern attempts at ex-second sister died at forty-six with cancer of both perimental inoculation was by Langenbeck, who made an emulsion of an encephaloid cancer and mixed it with the defibrinated blood of a dog and injected it into the femoral vein of a dog. Two months later nodules were found in the lung. In 1888 Hanau transplanted into the tunica vaginalis of the testicle of two rats materials derived from non-ulcerated metastatic glands following a cancer of the vulva. One of the rats died seven weeks later with nodular cancer involving the peritoneum. As the inguinal canal in the rat is not obliterated, this appears to be a direct extension of the disease from the point of inoculation. The inoculation was also successful in the second rat and material taken from this rat and inoculated into a third rat also proved to be successful.

Inoculation from animals into animals of the same species seems to be more successful than into animals of a different species.

A consideration of the so-called parasites of cancer brings us to a new and the latest phase of the question of the nature and origin of carcinoma.

When the anatomical nature of the disease was better understood and the scientific world realized the active part played in the development of the growth of epithelial cells, attempts were made to recognize a specific cell, by Lebert and others, which could be regarded as the typical cancer cell. The attention of investigators being concentrated on the behavior of the epithelium brought out theories like those of Tiersch and Conheim. Tiersch assumed that an antagonism was brought about between the epithelium and the surrounding connective tissue and, the resisting power of the latter having been weakened, an ingrowth of epithelium had to follow.

Wehr has implanted malignant tumors of the prepuce and vagina of dogs and has succeeded in producing a fatal carcinomatosis. Klencke has also succeeded Conheim's ingenious theory of the isolation of in transmitting melanosarcomata of horses. In this fragments of embryonic tissue, which for a time connection the most interesting experiment of Lock remained latent and subsequently developed into cannot be passed by. This investigator believes that tumors, aroused great interest by the skilful manner cancer is due to the entrance of normal epithelium in which it was presented. It accounted, undoubtedly, into the lymph vessels with continuation of growth. for certain forms of growth, but did not succeed in Hence he opened the peritoneum of a rabbit and maintaining its ground as a potent factor in the scraped the epithelium of the ovaries. The animal development of cancer. Rippert believes that the was killed after fourteen months. The animal showed first change takes place in the connective tissue as cancerous nodules in the mesentery; white areas in the result of some chronic inflammatory process, and the liver; a small mass on the wall of the uterus and

British Medical Journal, 1898, vol. i, p. 154.

Hansemann's theory places the primary change in the epithelium itself. As a result of this new influence the epithelium undergoes a change known as anaplasia, or an increase in reproductive and regenerative power and a loss of differentiation for the function for which it was originally intended. It is a change backward toward the embryonic state.

Many of these theories receive an apparent justification in the experiment of Lock in the epithelium of the ovary above described.

a portion of the epithelial tissue is thus isolated from ordinary cell formations seen in neoplasms. I quote its surroundings. When thus put under abnormal Plimmer's description, as he has studied them with. conditions the epithelial cell acquires great productive Ruffer and has reported having examined 1,278 cases power, which is characteristic of cancer. of cancer and found these bodies in 1,130. He found them at the growing edge and not in the degenerated parts. In ordinary cancers they are found only in small numbers, but in very malignant growths they are exceedingly numerous. Ruffer and Plimmer believe that the parasite can be seen alive if teased in salt solution, and changes in the shape of the nucleus have been observed. They are now generally recognized as a frequent occurrence in the cells of a growing carcinoma. Dean, however, shows that they sometimes take a nuclear stain, which he thinks throws Virchow was the first to call attention to the change some doubt upon the parasitic theory. When kept in the interior of the cell and the presence of bodies under cover-glass their reproduction by budding has having a well-defined outline; he called them physa- been observed. These structures have none of the lides. It was in 1889 that Thoma first ascribed a reaction of any known degeneration. The organism, parasitic origin to the nucleated bodies found in as it appears in culture, differs materially from that cancer. Darier also about this time observed or- observed in the tissues. Many of these appearances ganisms in a disease described simultaneously by are simply degenerated forms of the organism and it Podwyssosski as psorospermose folliculaire vegetante, is undoubtedly the case that other cell degenerations and by White as keratosis follicularis, and assumed have been mistaken for it, thus giving rise to much that they belonged to the family of coccidia. This confusion. organism consists of a granular mass of protoplasm, I have endeavored to describe these organisms with a nucleus not easily seen and without an envelop- under the varying conditions under which they are ing membrane during its period of growth, while it examined by the pathologist, as they seem to have inhabits an epithelial cell. It finally breaks away the property shared by many bacteria, to which they from its host and segmentation and sporulation take stand next in the scale of plant life, of changing their place. These organisms are very common in the character in accordance with the nutrient material in livers of rabbits an animal, by the way, in which which they happen to grow, and this may account for cancer is extremely rare. A more careful study of the varying appearance in cell inclusions which these cell inclusions with fuchsin gave to Russell we find in carcinoma. They have a chemistry of the suggestion that they might be vegetable organisms their own and they are capable, though harmless belonging to the family of yeasts, but the general at first, of being raised in virulence by cultivation opinion prevailing at that time was that they were from one animal to another until they become exsome form of protozoa. Opinion has now veered tremely pathogenic to the same species of animal. round to the view that they are vegetable rather than Their classification is quite unsettled, some, apparanimal organisms and belong to a class of fungi, ently, being only stages in the life history of higher known as blastomycetes, or a variety of yeast. It fungi. was not then known that this plant produced lesions very similar to the so-called protozoa; that is, that it produced inflammatory reaction in the tissues into which cultures of this organism were injected. When examined under suitable staining all these so-called protozoa forms can be simulated by the blastomyces. When inoculated into guinea-pigs this organism has its proper membrane, which is filled with protoplasm and contains a body resembling a nucleus. The cell averages 8 to 10 in diameter. μ

Busse was one of the first observers to recognize the blastomyces as a pathogenic organism and succeeded in obtaining a culture of it from the sarcoma of the tibia in a woman. Romer, in 1891, first studied experimentally its pathogenic qualities. Attempts were now made by Sanfelice, Plimmer and others to obtain cultures from human cancers, but great difficulty has been found in accomplishing this. Kahane obtained the organism from a cancer of It grows by budding the uterus. Curtis obtained it from a tumor of the and in the process the parent cell may give rise to back. Corselli and Frioco isolated blastomyces and several buds. Under certain circumstances spore for- found the organisms thus obtained pathogenic in mation may also take place. It grows in strongly animals. Bonomé cultivated the organisms 7 times acid media and can thus be separated from many of from malignant growths, in 1 case of sarcoma and 6 the forms of bacteria. cases of cancer, out of 26 cases.

The parasitic bodies seen in the tissues and cells of Sanfelice succeeded in isolating an organism, but a growing carcinoma are thus described by Plimmer: could make it live but a short time, and got no They are from .004 to .04 millimetre in diameter. satisfactory pathogenic action in animals. He then There is a central portion which represents a nucleus, took an organism obtained from the skin of a lemon, around which is a protoplasm surrounded by a cap-cultivated it on vegetable culture media, and succeeded sule. The nucleus differs in its reaction from the in obtaining a distinctly pathogenic action in guineaordinary cell nucleus. The protoplasm is generally pigs and other animals. He was able to produce inhomogeneous and the capsule is very strongly marked flammatory reaction in the shape of tumor-like growths in outline. It multiplies by division into two by and infection of the lymphatic glands. Busse and budding, or the nucleus divides first and the proto- other investigators have also succeeded in producing plasm afterwards undergoes segmentation. These organisms stain usually with protoplasm and not with nuclear stains and thus distinguish themselves from

there inflammatory growths and even septicemia. Investigations now began to follow two general lines. Systematic attempts were made to isolate and culti