vidual. Behla has collected 118 cases of cancer transmitted between husband and wife. (Deutsch. Med. Woch., 1901, 427 et seq.) He also mentions the cases of 8 physicians who died from infection from patients and 4 cases traced to cancers of animals. He further cites the cancer epidemic among the white mice in the pathologic institute at Freiburg i. B. The rather usual local recurrences after operative removal may be due to infection of exposed surfaces by the surgeon's knife. Cases of family cancer are mentioned in Senn's "Pathology and Treatment of Tumors" and other textbooks.

A multiple etiology is, in my opinion, not excluded. As to sarcoma, some of the results of successful inoculations of carcinomata were a crossing over to the mesoblastic form-another blow to the homologous doctrine. Sarcoma is merely a connective tissue cancer. The second portion of the title need not detain us long. I presume the Secretary meant histology instead of pathology, as the latter would refer to changes which are not peculiar-viz., degeneration, cyst formation, atrophy, secondary infection, and ulceration. The histology is closely connected with diagnosis. The questions, "What is the exact line of demarcation between benign and malignant?" "Is there any metaplasia from one into the other?" and "What constitutes malignancy?" can only be answered with qualifications. This histologic diagnosis of carcinoma depends upon various factors, none of which are either recognizably constant or always pathognomonic. For instance, Hansemann's atypic mitosis is not only not pathognomonic, but generally not recognizable in the tissues, as we get them improperly or not at all fixed. The invasion of the basement membrane may be a misleading picture, and many malignant adenomata have well-formed basement membranes. The embryonic character of the epithelia is frequently not to be made out, and in adeno-carcinomata and papillo-carcinomata the cells may appear quite mature. My photograph, No. 1, shows mature, functionating cells. From granulation tissue and bacterial granulomata the distinction is frequently difficult, consequent upon inflammatory displacement. My photographs, Nos. 5 and 6, from a tongue granulation, bear upon this point. No. 5 is only a few sections above the other, and in it we have ulceration-an area of epithelioid cells badly vacuolated, as from mucoid degeneration, surrounded by round-cell infiltration; and we

would be justified in regarding it as a syphilitic granuloma.

In No. 6, however, we find the characteristic advancing plugs of epithelia from the germinal layer so typic of rodent ulcer. The most perplexing tissues to analyze are uterine curettings. Here we have to work over a vast amount of material which may be absolutely non-committal, although overlying a virulent cancer which is not represented in the scrapings; and, on the other hand, there may be distortion, inflammation, and lymphoid infiltration, which would give a picture in a benign tissue justifying a diagnosis of malignancy. This is no argument against attempting a diagnosis with the microscope, but a plea for greater care in selecting material for examination.

Generally speaking, a multiple layer of cells in a gland formation, with immature cells, irregularly arranged, and invasion of basement membrane, is positively diagnostic of carcinoma. Squamous celled growths must be differentiated from lupus, granuloma, and papilloma. Here we generally find pearls, absence of giant cells, and ingrowth instead of outgrowth as the diagnostic features. Even the most thoroughly trained histologist may err in forming an opinion in some cases, and it is hoped that Gaylord's bodies will do for the diagnosis and treatment of cancer what Laveran's discovery has done for malaria. A definite proof of the protozoan nature of cancer will open a new era in parasitology, as many diseases of unknown pathology may finally come under this head.

MORE EXPERIENCE WITH SUPRARENAL LIQUID
WITH CHLORETONE IN DISEASES OF
THE EAR AND NOSE.

BY J. T. HERRON, M.D., JACKSON, TENN.

Mr. President and Gentlemen of the State Society:

At the West Tennessee Medical Society last May I reported a few cases of ear troubles successfully treated by the use of suprarenal liquid with chloretone. As my experience at that time was somewhat limited, I have decided to reread a portion of that paper, also add another year's experience with this preparation, which, in my opinion, is destined to become valuable in the treatment of ear troubles.

*Read at meeting of Med. Society of the State of Tennessee, April 9, 1902.

squamous epithelia

PLATE V.

squamous epithelia

Section from ulcer of tongue (Rogers & Smythe)-x240. (Hæmatoxylin and congo red, congo and orange gray filter.)

supr

Le m

paper

chi

of ex

1902

Section from ulcer of tongue (Rogers & Smythe)-cancer simulating granuloma; almost no connective-tissue growth, the epithelia being in full possession. This section is about 1 mm. deeper than Plate V. Plates V. and VI. are to illustrate difficulties (errors) in diagnosis from insufficient material.