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tonsils as established by the study of the injected specimens is as follows:
"The lymph vessels pass from the external portion of the tonsil through the peritonsillar connective tissue, the pharyngeal aponeurosis, and the superior constrictor of the pharynx, and one, two or more fine vessels run obliquely in a downward, posterior, and outward course, passing below the facial artery. Bending more posteriorly the lymph vessels next run between the internal jugular vein and the stylohyoid muscle, reaching finally the superior surface of an enlarged lymph gland, placed just beneath the anterior border of the sterno-cleido-mastoid muscle, where it is crossed by the posterior belly of the digastric muscle. The efferent vessels from this gland are generally two or three in number, and pass into the neighboring glands of the internal jugular group. Further anastomoses which connect the lower glands of the internal jugular group with those receiving the tonsillar drainage form a complete lymph channel, through which tonsillar lymph finally empties into the jugular lymph trunk."
The author gives the name "tonsillar lymph gland" to the gland placed external and slightly anterior to the internal jugular vein, and is embedded in loose areolar tissue containing more or less fat. This gland is especialy involved in infections from the tonsil.
BY WILLIAM FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.
CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.
ON THE INFLUENCE OF LIGHT IN THE PRODUCTION OF CANCER OF THE SKIN.
DOCTOR JAMES NEVINS HYDE, of Chicago, Professor of Diseases of the Skin in Rush Medical College, read a paper on this subject before the Ann Arbor Medical Club, November 8, 1905. The entire article is published in the American Journal of the Medical Sciences for January, 1906, but the following abstract presents the salient points thereof.
The paper was a comprehensive discussion of the pathology, etiology, prevalence, and mortality resulting from conditions beginning as cancer of the skin, particularly with reference to the damaging effects of solar light and r-rays under certain conditions, and radiotherapy in general; also to the lesser prevalence and death rate from cancer in the colored races and inhabitants of warmer countries, attributed to the protection against ill effects of excessive light, afforded by the greater pigmentation of the skin.
It is impossible to give, in the limits available, an adequate abstract. of the scope and value of the paper, illustrated with several paintings and maps, supported by statistics, and presented in the interesting and
forcible style of the distinguished author. It should be read in full to be appreciated.
Discussing the various forms of epitheliomata, "these all represent variations of a single morbid process an invasion of neighboring tissues through the avenue of the lymphatic spaces by epithelial cells." Considering the causes of this change, which may reach a point when destruction of life results, and noting the recent research work on the subject conducted by scientific men in laboratories equipped and maintained by generous private and public benefactions, "as yet, however, agreement has not been reached respecting the essential factors in the genesis of this scourge of the human family."
"The chief causes of cancer heretofore assigned by writers on the subject may be classed as follows: First, proliferation of the epidermis proceeding from stray bits of the germinal layer separated in the embryo from their proper attachments and included in the growing tissues (Cohnheim); second, loss of equilibrium-pressure and counterpressure between the epidermis and the corium; third, disturbance of equilibrium between waste and repair; fourth, congenital tendency to reversion of epidermal cells to a simpler and undifferentiated type; fifth, parasitism." There are many and seductive reasons for searching for a parasite as the cause of cancer. . . . . It is difficult to conceive that the human body in so large a proportion of cases, without introduction of a foreign element, can evolve a growth of such malignant potency.. A decided reaction, however, seems to have set in against the tide which bore in the direction of parasitism of cancer. Many of the bodies which it was once believed would prove to be parasites are now known to be irregular cell inclusions. Various considerations, which need not be cited in full, have for the time lessened the belief of scientific men in the hypothesis of parasitism in cancer.
"Carcinoma of the sailor's skin," also described by Unna, in which cases the ears, the cheeks, the temples, the backs of the hands, and of the fingers first become mottled and pigmented, nonpigmented islands of skin later developing between the freckles, with thickening, roughening, and cornification of the horny layer follow, and eventually, as in xeroderma pigmentosum, the sebaceous glands become hypertrophied and indolent cancerous growths of the "rodent ulcer" type form. There is both hyperkeratosis and acanthosis, and conical horny taps push downward into the corium; the lymph spaces of the latter become largely dilated; the mast cells multiply, fissures form, and finally papillary cancerous growths furnish flabby ulcers which refuse to heal.
These instances of malignant cancer occurring obviously as a result. of exposure to light justify the inquiry whether all cutaneous cancers. are not influenced in their origin and career by the actinic rays. It would be venturesome without strong proof to make a broadly affirmative answer to such a question; but the condition of skin which makes epithelioma more than possible certainly predisposes to its occurrence.
The question can be better put by asking whether actinic rays of light unfavorably influence, not all, but certain sensitive skins at definite. ages of the body in the direction of the epitheliomatous metamorphoses?
It is to be remembered that pigmentation, especially hyperpigmentation, admittedly furnishes a valuable protective screen for the body. The dark skins of the Asiatic and the African possess for them a great protective value against heat and light. The Albino, without trace of pigment either in the skin or the choroid coat of the eye, is notoriously feeble of body and short-lived. Hektoen states that black rats are more resistant than gray, and gray rats than white to anthrax. In this connection it is interesting to note that Gaylord and his colleagues in studying Jensen's adenocarcinoma obtained their remarkable results after experimentation with white mice only. The researches of Loeb, Gruber, Dubois and others on the orientation of plants and animals throw some light on this question. They indicate that heliotropism is influenced largely by the more refrangible rays of light; . . . that at a constant intensity light operates as a continuous source of stimulation; chemical rays playing upon the sensitive and unprotected skin produce in order-first, hyperemia; second, pigmentation; third, atrophy; fourth, cancerosis. The first two changes are obviously protective in character.
The action of the Finsen light upon the skin produces a reactive hyperemia, though the technique of its application requires that the area to be treated should be made as exsanguine as possible to permit the passage of rays to the skin. The action of the r-rays upon the cutaneous surface is similar to that of the ultraviolet frequencies. The hyperemia is followed by well-marked pigmentation, more conspicuous in some cases than in others. Later, in the results of actinic ray bombardment, atrophy may result, the overstimulated protoplasm losing its vitality, the cells and their nuclei shrinking while phagocytosis, as in other cases, disposes of the epithelial cells. But hyperkeratosis, and finally cancerosis may occur. The r-ray production of cancer of the skin reported by Mendes, Da Costa, White, Bowen, Pusey and others is established by other incontrovertible evidence. Fortunately the beneficent use of the rays far outranks the exceptional catastrophe in which a disastrous result is produced. Doctor Ormsby has noticed that patients who burn in sunlight are burned by x-rays. The beneficial effects of all these rays occur when the stimulation is pushed to the point of cell shrinkage and not farther. The doctrine that light is capable of exciting in animal tissue a series of changes which may terminate fatally is not inconsistent with the facts of science. Beneficent as they are shown to be in much that relates to both the genesis and conservation of life, heat, light, and electricity, interchangeable modes of motion have each a stroke wherewith slowly or swiftly they may destroy that life.”
Following are the doctor's conclusons:
(1) The skin of the human body in a certain proportion of indi
viduals, and in those only, is hypersensitive to the action of the actinic rays of the spectrum.
(2) This hypersensitiveness may be exhibited in the production of either hyperemia, pigmentation, telangiectasis, atrophy, hyperkeratosis, or cancerosis of the skin, or by all at times in a determined order of succession.
(3) In the form of childhood cancerosis, known as xeroderma pigmentosum, pigmentation, telangiectasis, atrophy, hyperkeratosis, and cancerosis of the skin resulting from exposure to rays of light, are exhibited early in life, instances of this disorder being exceedingly rare.
(4) Pigmentation, telangiectasis, atrophy, hyperkeratosis, and cancerosis of the skin occur in adults much more frequently than in childhood, reaction to the play of actinic rays of light upon the surface being chiefly determined after the middle periods of life have been reached.
(5) Physiological pigmentation of the skin in the colored races. seems to furnish relative immunity against cancerosis of that organ.
(6) The colored races apparently suffer less than the whites from cancer of other organs than the skin. This relative immunity may be due to the protection from actinic rays of light furnished by the pigment of the integument.
BY DAVID INGLIS, M. D., DETROIT, MICHIGAN.
PROFESSOR of NERVOUS AND MENTAL DISEASES IN THE Detroit College of MEDICINE.
IRWIN HOFFMAN NEFF, M. D., PONTIAC, MICHIGAN.
ASSISTANT PHYSICIAN AT THE EASTERN MICHIGAN ASYLUM.
THE DIET IN EPILEPSY.
ROSANOFF (Journal of Nervous and Mental Disease, December, 1905, Volume XXXII, Number XII). The writer quotes authorities in proof that certain articles of diet may cause a material change in the syndrome of epilepsy. The paper is founded on eleven cases. The results were obtained from five experiments, a definite number of epileptics being placed on a prescribed diet, and accurate clinical observations taken.
His results are summed up as follows: "Experiments one and two proved that the effect of a mixed diet in epilepsy differs in no way from that of a vegetable diet containing the same quantities of proximate principles. Consequently any lingering belief that animal food. has any effect as such is to be definitely discarded. Experiments three and four prove that the quantity of proteids in the diet has a decided influence on the manifestations of epilepsy. If it is either above or below the indispensable minimum the severity of the disease is increased. Experiment five shows that if the diet of an epileptic is made to contain a large excess of proteid and practically no carbohy
drates, so that the organism is compelled to use proteid material in place of carbohydrate material, the number of convulsions increases enormously and there is a general aggravation in the physical and mental condition of the patient."
In conclusion the author advances a theory as follows: "That just as the organism of the diabetic is unable to properly utilize carbohydrates, so the organism of the epileptic cannot take care of proteid. material as it is taken care of by the normal organism.”
The therapeutic indication, he believes, is clear, and he expresses it as follows: "Carbohydrates and fats are to a certain extent capable of replacing the proteids in the diet. The epileptic patient, then, should receive the largest amount of carbohydrates and fats that he can assimilate without inconvenience, and the smallest amount of proteids which is compatible with the preservation of the nitrogenous equilibrium; that is to say, the amount of nitrogen ingested with the food must not be allowed to fall below the amount excreted, for then the thing is overdone, a condition of proteid starvation is established, the general health of the patient suffers, and his disease becomes aggravated."
I. H. N.
BY DELOS LEONARD PARKER, PH. B., M. D., DETROIT, MICHIGAN.
LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE OF MEDICINE.
THE PRESENT STATUS OF SERUM THERAPY.
EZRA READ LARNED, M. D., in The Therapeutic Gazette for September, 1905, discusses the subject of serum therapy. He first separates the different sera into two groups as follows: Curative sera and diagnostic sera. He further classifies sera according to their efficacy as curative agents.
In the first group he places those whose efficacy has been demonstrated beyond reasonable doubt, such as antidiphtheric, antitetanic, antiplague, antistreptococci and serum for exophthalmic goitre.
In the second group are sera whose value appears likely or possible, but in support of which there is not yet sufficient evidence to warrant their inclusion in Class I. These contemplate hay-fever, antityphoid, antitubercle, antirabic, and antivenene sera, and tuberculin.
In the third group are those sera whose value is questioned by a majority of observers. These are antipneumococcic sera, antiscarlatina sera, antidysenteric sera, antivarioloid sera, antitoxin for cerebrospinal meningitis, serum for rheumatism, serum for syphilis, and sera for anthrax, cancer, and leprosy.
Of the curative sera Doctor Larned states that antidiphtheric serum justly holds the highest place, and if used early and in sufficient quantities can be counted on to overcome every case of the disease.
Of antistreptococcic serum not so much can be said. On the whole