MEDICINE 167 



combated. The combination of the results arrived at by microscopical investigation and 

 experimental study appears to complete the demonstration. A long step has thus been 

 taken in denning the direction in which the future investigation of cancer is alone likely 

 to be profitable." Out of the multitude of recent observations and doctrines concerning 

 cancer, we have to note the following, (i) Much attention has been given to the subject 

 of the biological characters of the " cancer cell," its place in nature, and what may be 

 called its natal and prenatal conditions. See, inter alia, the lectures by the late Sir Henry 

 Butlin on " Unicellula Cancri," Lancet, November 25 and December 2, 1911, and Mr. 

 C. J. Bond, Lancet, 1911, ii, 349. (2) H. C. Ross has published a book on " Induced 

 Cell-Reproduction and Cancer," describing his observations on leucocytes suspended in 

 citrate solution and examined in contact with a colloid film. (3) Carrel has succeeded 

 in cultivating particles of normal tissue, embryonic tissue, and cancer tissue, outside 

 the body, in vitro, on a medium of the blood-plasma of an animal of the same species, 

 and has been able to observe certain exchanges of influences between the plasma and 

 the still living tissue. (4) Wassermann has obtained results of considerable significance, 

 in mouse-cancer, by the intra- venous use of an eoain solution of selenium (See Brit. Med. 

 Journ., January 6, 1912). 



Diphtheria. Great attention has been given lately to the subject of diphtheria- 

 carriers. How long, after recovery from diphtheria, may the patient still be harbouring 

 the germs of the disease at the back of his throat? What is the risk of infection from such 

 cases? What measure of virulence is still present in these lingering germs? 

 How far are " carriers " responsible for the prevalence of diphtheria in Great 

 Britain? At the 1911 Annual Meeting of the British Medical Association, these ques- 

 tions were fully discussed. It appears that about 50 per cent, of all cases of diphtheria 

 are free from diphtheria-bacilli within three days of the disappearance of the diph- 

 theritic membrane; and a further 25 per cent are free within another week or ten days. 

 It is not improbable that the bacilli, in some of these cases, are of lowered virulence. 

 The risk of infection must depend, more or less, on the patient's age, surroundings, and 

 personal cleanliness. There seems to be, on the whole, a considerable weight of evidence 

 that, with such precautions as are suggested by common sense, and with bacteriological 

 examination of all especially suspicious cases, the chance of infection from diphtheria- 

 carriers is not a very grave danger to the community. . " In my opinion," says Dr. 

 Goodall, " one of the principal factors in the persistent prevalence of diphtheria is not 

 the carrier, but the mild, unrecognised case." 



As regards diphtheria antitoxin, the latest Report (1911) of the Metropolitan Asy- 

 lums Board states that " the amount of antitoxin supplied, the number of cases 

 treated, and the amount of antitoxin used for each patient, all show a considerable in- 

 crease." As compared with a death rate of 30 per cent before the introduction of 

 antitoxin, the death rate for 1910 was 7.7, the lowest on record: the death rate for 

 1911 was 8.5. 



There is no need here to praise diphtheria antitoxin. Securus judicat orbis terrarum. 

 But every serum-treatment has this imperfection, that the serum has other qualities of 

 its own, beside its antitoxic action: and some persons are abnormally sensitive to ill- 

 effects from the serum itself. We must not set the risk of these ill-effects against the 

 legions of lives which are saved: still, there the risk is, such as it is. With many patients, 

 the serum " disagrees " (if this word may be pardoned) : it gives them a rash, a high 

 temperature, and pains in the joints, for a few days. This is the so-called " serum sick- 

 ness." Much work has been done, of late years, in the hope of annulling these draw- 

 backs without impairing the antitoxic strength of the serum : see, inter alia, Dr. Bauzhaf 's 

 paper on " The Preparation of Antitoxin," Bull. Johns Hopkins Hasp., April, IQII. 

 In a very small minority of these cases of " serum-sickness," the effects of the serum are 

 more grave: and, in a few cases, they have even been disastrous. More than one 

 method has been devised against this very rare emergency. The remoteness of the 

 danger, in any given case, may be judged by the fact that millions of doses of antitoxin 

 have been given without harm of any kind (see Brit. Med. Journ., May 18, 1912). 



