Skin Reaction in Carcinoma. 



93 



variety of diseases, such as nephritis, tuberculosis of lungs, 

 bladder, kidneys (7 cases), leukemia, syphilis (2 cases), benign 

 tumors, acute and chronic inflammatory affections, etc. In all 

 but three cases, the reaction was negative. One patient with a 

 septic endocarditis gave a suspicious, but not a positive reaction. 

 Two other injections made in this patient were negative. This 

 case was among the earliest of our series, and therefore must be 

 accepted with caution. A patient who had been operated on for 

 a large rapidly growing lymphangioma of the suprapubic region 

 and had several large angiomata of the thigh with a large post" 

 operative hematoma of the scrotum, gave a marked positive 

 reaction. A patient with gastric symptoms, absence of hydro- 

 chloric acid and presence of lactic acid, with a loss of thirty 

 pounds in weight, gave a positive reaction. The operation failed 

 to show any carcinoma. I obtained no reaction in several patients 

 in whom malignant disease was suspected but in whom no 

 malignant disease was found at operation or at autopsy, and have 

 obtained positive reactions in several patients in whom carcinoma 

 was not suspected, but in whom carcinomatous disease was found 

 at operation. Jaundice seemed to have no influence upon the 

 appearance of the reaction. 



In order to gain a more definite idea of the causation of the 

 skin changes, normal defibrinated blood was laked with distilled 

 water, and, after the tubes had been centrifuged, the supernatant 

 fluid was injected into a number of patients. For purposes of con- 

 trol, hypodermic injections of sterile distilled water were given. 

 All of the patients, whether suffering from malignant disease or 

 not, who received hypodermic injections of laked blood, presented 

 a skin lesion similar to that which was observed in carcinoma 

 patients after the injection of washed red blood cells. This seemed 

 to show that in the patients with carcinoma the reaction from the 

 blood cell injection was due to a local hemolysis. In the normal 

 individual or one suffering from some other disease, on the other 

 hand, there was no hemolysis and therefore no reaction. When, 

 however, the hemolyzable substances extracted from the red cells 

 by laking were injected, the characteristic local lesion was ob- 

 served. I have not yet been able to obtain pure human hemo- 

 globin for injection purposes. 



