786 INTERNAL SECRETIONS AND PRESERVATION OF LIFE. 



or another, relatively impaired, may become the seat of this 

 malignant growth, or rather of a local accumulation of the ab- 

 errant or worn-out cells which enter into its formation. The 

 great vascularity of these growths suggests an effort of Nature 

 to cause their elimination, but mitotic proliferation is alone in- 

 duced, the blood being deficient in the four constituents which 

 should insure destruction of the morbid cellular elements. 



Apart, from the marked vascularization peculiar to sar- 

 coma, the same pathological process obtains, it seems to us, in 

 cancer, although here we are dealing with a localized accumu- 

 lation, retention, and proliferation of epithelial cells. Their 

 multiplication in situ occurs (as in sarcoma) partly in virtue of 

 the fact that they "cannot fully utilize the assimilated material 

 in. the performance of [their] specific functions" ( Adami 119 ) and 

 partly because the potential energy of their nuclei becomes con- 

 verted into sufficient heat-energy (with what oxidizing sub- 

 stance reaches them) to induce proliferative activity, fitter 120 

 found the nuclear chromatin to be precisely that of normal 

 tissue and the cellular karyokinesis to differ in no way from 

 that observed in the normal physiological process. 



Adrenal insufficiency also accounts for the complications 

 witnessed. As the accumulated elements degenerate, toxic 

 products of decomposition enter the blood and, by lowering the 

 functional activity of the anterior pituitary body, finally bring 

 on the cachectic stage. The foci of retained cellular elements 

 becomes also more numerous: i.e., "metastasis" occurs in one or 

 more regions. That the adrenal system is primarily at fault 

 is also suggested by the predilection of the aged to malignant 

 growths, the recognized influence of "general debility," local- 

 ized malnutrition as a result of trauma, cicatrices, etc., and by 

 the fact that the only internal remedies that have proven of 

 any value whatever are powerful adrenal stimulants: erysipelas 

 toxins (Fehleisen), erysipelas and bacillus prodigiosus toxin? 

 (Coley), thyroid extract (Borland), lysol and iodine (Behle- 

 Luckau), sodium cacodylate (Benoit), and the better known ar- 

 senic, quinine, etc. 



Owing to the adrenal stimulation induced, the four con- 



u J. George Adami: British Medical Journal, March 16,1901. 

 120 Ritter: Deutsche med. Wochenschrift, June, 1901. 



