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them through the public in order to call the peoples attention to the great menace of cancer, and the need of having it recognized early and promptly treated. First of all it should be understood.


sion and two of the cases seemed much brighter the following two days. Potassium iodide was administered in moderate doses and urotropin in large doses. The urine was examined frequently to observe any urotropin irritation should it occur. Narcotics were given for restlessness.

('onclusions.-A careful study of cases I and II, one is impressed with the fact that case II probably contracted the disease from case I, the onset similar and course similar but a lowergrade temperature in case II, and that the incubation period was from three to three and one-half weeks. (2) Whether or not this disease is a type of poliomyelitis seems quite a puzzle. In poliomyelitis the appearance of the disease is more rapid and pronounced as contrast to epidemic encephalitis. All three cases have had a grad ual onset. I have been unable to trace any evidence of presence of any cases of acute anterior poliomyelitis in this section of Michigan. (3) None of the three cases had suffered a preceding attack of influenza. (4) MacNalty thinks the relationship between poliomyelitis and encephalitis might be comparable to that existing between typhoid fever and paratyphoid.

Although it may occur in the same family, this only shows that there may be a lack of resistance to cancer in that family, but it is not transmitted from parent to child.

IT IS NOT CONTAGIOUS. People living in the same house, doctors and nurses who handle these cases a great deal, never get it that way. I know of no case where a husband or wife both had the disease.

But, I want to qualify this remark myself. The experiments of Gaylord of Buffalo with cancer in fishes seems to indicate that it is contagious. In the Bronx Zoological Garden it has been shown that snakes are peculiarly liable to cancer, and if one snake gets it, all the snakes in that cage die of cancer in a short time, unless the first case is early recognized, and promptly removed.



von Economo: Wien. Klin. Woch., May 10, 1917. Netter: Medical Society Hospital of Paris. Harris: Lancet, April 20, 1918. Hall: Brit. Med. Jour., Oct. 26, 1918. von Wiesener: Lancet, July 6, 1918, Wien. Klin. Woch., July

26, 1917. Melntosh : Lancet, Nov. 2. 1918. Hancock & Pearse: Lancet. Nov. 2. 1918. Wilson: Lancet, July 6, 1918. Picken: Lancet. July 13, 1918. Breinl: Medical Jour. of Australia, March 23, 1918. Marinesco: Brit. Med. Jour., Jan. 11, 1919. Hamer: Lancet, Nov. 2, 1918. Noel: Lancet, Jan. 25, 1919. Buzzard: Lancet. Dec. 21, 1918, Box: Lancet, Nov. 23, 1918. MacNalty: Brit. Med. Jour., Jan. 11, 1919. James: Lancet, Dec. 21, 1918, Nov. 2, 1918. Vaidaya: Lancet, Sept. 7, 1918. Crookshank: Lancet, July 13, 1918, May 4 and 18, 1918. Crookshank: Lancet, Nov. 9, 1918. Broadbent: Lancet, May 4, 1918. Marshall: Brit. Med. Jour., July 6, 1918. Pothier: Jour. A.M.A., March 8, 1919, Camp Lee. Findlay: Lethargic Ensephalitis, Glasgow M. J., Oct., 1918.

Cancer occurs especially after the fortieth year. Although cases are frequently reported even younger, as early as twenty, and children especially are subjected to a form of cancer called, sarcoma. Nevertheless, it has been universally recognized that from thirty-five to forty, and over, is the so-called cancer age, and that at this time people must be especially on the lookout for such trouble.





J. H. CARSTENS, M.D. Professor of Abdominal and Pelvic Surgery, Detroit College of Medicine and Surgery, Detroit, Michigan.

DETROIT, MICH. The State Board of Health of Michigan deserves the credit of being the first to issue a circular for public distribution on the cancer question in 1909, and another one in 1915. These were distributed to physicians, and by

WHAT WOMEN SHOULD KNOW. A malignant disease affects women especially in the generative organs, of which the breast is

Any lump, swelling, hardening in the breast during the cancer age is potentially can

It may be only a cystic or fibroid growth at the time, but ultimately a cancerous condition will be planted on it. Hence, every swelling, hardening, or tumor, which does not disappear in a few weeks must be promptly removed, not only removed, but no woman can afford to take the chance, but must have the whole breast removed, including the glands in the axilla, because not enough tissue is removed by simply taking out the tumor, and if an effort is made to remove half of the breast, or something like it, the whole breast might just as well be removed. No use talking to me about esthetic appearance, and preventing the wearing of low-necked dresses, when the woman has

such a trouble it is too serious, and all vanity gerous whatsoever, and the malignant growth must disappear. . It is simply a question of


may be on the posterior part of the abdomen, life and death.

where it is difficult to make the diagnosis, with CHANGE OF LIFE AND FLOWING,

the present means in our hands, but where the The vicious notion still persists that when

surgeon with a small opening can clear the case,

and easily remove the trouble, if it is not too a woman approaches the change of life, she

far advanced. Everything depends on the early must and does flow a great deal, kind of anticipating the after stoppage. This is entirely

diagnosis. When a man in the cancer age has

an irritable bladder, trouble in urinating, he wrong. When a woman approaches the change of life she flows no more, if healthy, than at

should promptly seek medical aid. Men are any other time.. In fact, it generally becomes

also especially liable to cancer of the rectum,

and when there is troublesome or painful descantier, runs over times, skips a month here

fecation, he should not listen to his friends who and there, and finally ceases. If a woman at this time flows longer than usual, and it recurs

sav, “Oh, you have got the piles," but should earlier than her normal period, or a discharge

seek the aid of a careful physician, who will makes its appearance, or if she has a discharge,

make a thorough investigation, and he must and that changes in character, becomes irritat

insist on that, and not be given some pile salve

or suppositories. ing or odorous, the probabilities are she is developing a cancer.

IRRITATION DOES NOT CAUSE CANCER. She must promptly consult a physician, not one who gives her some medicine, as that does

It is stated in nearly every article you read no good, but one who thoroughly examines her

about irritation causing cancer.

I thought I

had repeatedly shown up that this is not the case. If the physician does not examine her,

cause. If irritation would cause it, everybody simply gives her some medicine, he is absolutely no good. She must go to a scientific up-to-date

would have it. If there is any irritation, it is man, who will thoroughly investigate her case

on the nose by wearing glasses. Has anybody and act promptly, as this is the most important

ever seen a cancer start at that place? I never

found a physician who would admit it. There thing of all

are five, or perhaps ten million people in this WHAT MEN SHOULD KNOW.

country wearing trusses, it is claimed. If there Men are more liable to cancer on the face, is any irritation anywhere, it is where the pad the nose, ear, lips, eyelids, and any sore, pimple, of the truss presses. The skin there is thickand wart that develops and does not disappear ened, there is a deposit of pigment, and a conin ten to fifteen days is liable to be the begin- stant irritation. Has anybody ever ning of a cancer, and a 'physician should be case of cancer develop at that spot? But more promptly consulted. Men are most liable to than that, with the silly shoes worn by women, cancer of the abdominal organs, stomach, liver, as a rule all women have corns. There is irriand intestines, as well as the bladder and pros- tation with every step dar in and dav out, vear tate. A man who has always had good diges

after year.

Has anybody ever seen a cancer tion, and then has trouble with it, who de- Nevelop where a corn was, where the irritation velops flatulency and constipation, with pain has existed for years and vears? No, it takes in the abdomen, who is inclined to be easily more than irritation to produce cancer. nauseated, and above all, who looses weight

THE CAUSE OF CANCER IS NOT KNOWN. rapidly is very liable to have cancer develop somewhere in the abdomen. He should prompt- It has been suggested that some prenatal ly seek medical aid and diagnosis. If the phy- cells have been misplaced in the body, and in sician just treats him with simple remedies, the course of time being irritated, there decathartics, etc., that physician is no good. He velops what we call cancer. Some think it is should be dismissed; he is not up-to-date. A a micro-organism. I certainly do not know, physician should analyze his gastric juice after but I belong to those who believe that the giving him a test meal. He should have his whole history and course of cancer would instomach and abdominal organs carefully X- dicate some kind of infection, that has a very raved, and a diagnosis made. The latter is slow lengthy period of incubation. We all do sometimes difficult, and where prompt improve- see, how bacteria circulating in the blood, ment does not take place, an exploratory ab- sometimes escape from the the blood vessels in dominal section should be made. This in the the surrounding tissue and there multiply, and hands of an experienced surgeon is not dan- develop an abscess, be that streptococcus or



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staphylococcus, or any other kind of microbe. scopically to see if it is cancer, and then leisSo I can see how a cancer germ circulating in urely remove it at some later day is a most the blood can strike some part of the body were vicious practice, and should be condemned on the blood vessels are aberrant, irritated or every occasion. The only correct treatment is weakened, like they would be in an irritated or that I have above indicated in talking of canlacerated part of the body, or where there was cer of the breast. a naevus, or a wart, or scar. How a germ cir- Another thing that makes me perfectly disculating in such weakened part of the arterial

gusted is to see physicians curetting a uterus, or venous system could more easily pass through

and every general practitioner does that now the blood vessels at this locality, and then mul

days, or sewing up a lacerated cervix, throwing tiply and develop into what we call a cancer.

away the curettings, or the tissues removed Hence, I for one would say, that irritation does

from the cervix. This to me is most vicious. not cause cancer, it may be predisposition, but

Every tissue removed from a lacerated cervix, that the cause of is

or when curetting, should be carefully examined LACK OF RESISTANCE, IRRITATION, PLUS—? microscopically, and many cases of cancer in However, I want to especially appeal to the

the very earliest stages can be detected, and medical profession.

the parts then promptly removed, and the pa

tient's life saved. This you might say, is also WHAT DOCTORS OUGHT TO KNOW ABOUT CANCER. a kind of biopsy, but the danger of implantaDoctors should know, and I think all good

tion from curetting the parts does not seem doctors do know, all that is known about it, but to me great, and I have records on hand of that is not enough, for he should have what I

patients operated upon many years ago, who have called attention to heretofore, and what I are still perfectly well. In fact, I go further, call “Cancer on the Brain.” They often forget a woman who has a badly lacerated or diseased that one woman out of eight dies of cancer,

uterus in the cancer age, who has passed the and one man out of thirteen dies of cancer.

child bearing period, instead of trying to patch They are busy, sometimes very busy, and they

up that diseased and absolutely useless organ, are careless. They do not examine the patient

I urge a complete removal of the uterus, and as thoroughly as they should. It makes me

take no chance of the development of cancer, tired, as the high school girl would say, to

and in some of these cases, I have found canhave patients come to me with cancer who have

cer cells. In cases of cancer of the fundus, had it for a year or two, and have been doctor

where the cervix seems perfectly healthy, it is ing all the time. It certainly is a crime and a

difficult to make the diagnosis. Where a woman sin to neglect patients like that. Every person

flows and flows with an apparently healthy in the cancer age should be suspected of having

uterus, I do not hesitate to remove the organ the trouble, and no physician has a right to jog

if she is in the cancer age. these patients along without a most thorough For years I have advocated the question of and systematic investigation of the case. The educating the public on the cancer question. doctor may be very busy, and have to hurry In fact, I have suggested that we have a cancer to some emergency case when a patient calls

day designated every year, wḥen the ministers upon him with the troubles that are suspicious. should preach in the churches, and the doctors He may give that patient some simply remedy, in the different societies and clubs, and the and make an appointment for a thorough in- newspapers publish articles on the great menace vestigation in a day or two, and then he should of cancer. It is apparently getting worse than take his time, and thoroughly investigate the the question of tuberculosis. I do not know case, and if he cannot positively make up his whether it increases, according to statistics it. mind what the trouble is, he should call in does, but it is more frequently diagnosed than council, and get all the help he can to make a formerly, and it may not be more common than correct diagnosis. For every doctor should it was years ago, still I firmly believe it is inknow, that in the present state of our knowledge creasing. that only the early diagnosis, and the prompt

In summing up, I would say. and thorough removal of the diseased parts,

First Educate the people by lectures and will give the patient any chance.

by talks on every occasion about the danger of BIOPSY.

cancer. The former vicious practice of removing some Secondly. Teach the people what the susof the diseased tissues and examining it micro- picious symptoms are.

Thirdly. That it is the most solemn duty diers in camp, and especially to our returning of every physician to make the most sytematic soldiers. investigation in every case, showing suspicious It is now becoming recognized that many symptoms.

of the crimes committed by juveniles and 1447 David Whitney Bldg.

adults are committed as a result of mental defects. For example it has recently been proven

that chronic drunkenness is a result, in a large REPORT OF THE WORK DONE FOR

number of cases, of feeble mindedness or insan. THE MICHIGAN STATE BOARD OF

ity. Dr. Bowers in his pamphlet “The Relation HEALTH ON THE MENTAL CON

of Insanity to Crime,” states: "A study coverDITIONS OF CASES UNDER

ing more than 3,000 prisoners has led me to TREATMENT FOR VENE

believe that there are a comparatively small REAL DISEASE.*

number of criminals who deliberately, wilfully, G. F. INCH, M.D.

and in a manner wholly responsible, practice

crime. On the other hand, I am convinced that KALAMAZ00, MICH.

there is a very much larger group of more or Prostitution, with its resulting diseases, has less mentally defective individuals who are occupied the attention of society for centuries. such by the never-changing laws of heredity All of you are more or less familiar with the or through some biological caprice or through different methods employed to attempt to solve the acquisition of disease and who are defined this very difficult problem. In the past we have as being anti-social and dangerous elements in blamed economical conditions, such as poor society in spite of all the efforts to reform them wages, starvation, over-crowding, and other and this belief has its basis in, and is supported factors closely related to the life of the individ- by, clinical facts.” In short, we are becoming ual, but have failed to recognize that often more and more convinced that vices and crimes the fundamental cause is in the individual men- are the results of mental aberrations, and we tal makeup and that in a large percentage of have come, of late years, to look upon prostituthe prostitutes we find women of normal phys

tion from the same viewpoint. The Massachuical development and normal instincts combined

setts Commission for the investigation of the with intellects incapable of properly compre

white slave traffic found that 51 per cent. of hending and forming correct judgments and the prostitutes examined were feeble minded. acting accordingly. In fact, a large percentage The Chicago Moral Court found in six hundred have intelligences far below the average normal and thirty-nine prostitutes examined that the standard and as a result are suggestible and proportion of feeble minded was about 85 per easily led astray.

cent, and of the one hundred and four sexually We have no means of knowing the exact num

immoral girls tested in the Illinois Training ber of confirmed prostitutes in the United

School for Girls, 97 per cent. reacted as feeble States. In 1911 the Vice Commission of Chi

minded. The New York Probation and Procago reported 5,000 identified prostitutes in

tective Association examined five hundred dethat city and the large cities of the seaboard linquent girls and found 37 per cent, mentally had a proportionately larger number and of

defective. Dr. Catherine Brannick reports that course these figures would be greatly augmented

of the one hundred forty-nine women commitby the addition of those unknown to the author

ted for prostitution to the Massachusetts Reities. No doubt the number is very large and

formatory, 42 per cent. were considered feeble will be found to have increased astonishingly

minded. Tredgold says "My experience is that during the past two years. The mobilization of about half of the girls admitted into Magdalen the great armies has naturally been attended

Homes on account of 'first fall' are of this feeble with marked psychological changes in the

minded type.” These figures should be sufficvouths of the nation—the emotions have been

ient to convince any doubting person as to the heightened and this has had its effect upon

mental states of the majority of these women girls of weakened mentality, many of whom,

under consideration. under normal conditions, would have remained “The reason the feeble minded tend so strongnormal. This increase in the number of pros- ly to become delinquent is that morality detitutes is a distinct menace to the State, sol- pends on two things, ability to foresee and

weigh possible consequences for self and others, *Rogil before the Kalamazoo Academy of Medicine, February

of different kinds of behavior; and second, on

11. 1919.


the willingness and capacity to exercise self re- they came in close contact with the public; as, straint. Every feeble minded woman is a po- for example, in hotels and restaurants; and, tential prostitute. Moral judgment, like any second, women detained on account of quesother form of judgment, is the function of in- tionable character. All those found to be intelligence.”

fected were cared for locally or were sent to The medical profession has labored under hospitals in Detroit, Bay City, Ann Arbor, difficulties in the past because of lack of proper

Grand Rapids, Kalamazoo, and other places. methods of determining who is, and who is not, The out clinic department of the Kalamazoo feeble minded. The general public, and to State Hospital undertook, at the request of the some extent the medical profession have as- State Board of Health, the mental examination sumed that a feeble minded person is one whose of those women who were sent for treatment for condition is plainly evident. As a county offic- venereal diseases to the Devore Hospital of ial recently said "I don't know anything about Grand Rapids and the Fairmount Hospital of vour Binet tests or intelligence quotients but I Kalamazoo. Not all women, of course, examcan determine in a few minutes if a girl is ined in these two clinics should be considered feeble minded.” This official would be undoubt- prostitutes, the majority of them, however, were edly able to pick out the low grade imbecile undoubtedly such. I was assisted in this work or idiot but these are not the ones dangerous by Dr. Eva Rawlings of the Kalamazoo State to society. They are not so prone to commit Hospital, Professor. Renshaw, Professor of Psycrimes and a large proportion of them do not chology at the Western State Normal; Mrs. marry or reproduce. So often the higher grade Cordelia Creswell, Miss Pauline Camp, Miss morons and borderline cases are passed by with Alice H. Campbell and Miss Louise Sullivan the remark that they are only ignorant and no of the Board of Education of Grand Rapids. consideration is given to the question as to why We obtained as complete a family history as they are ignorant. It is unnecessary for me possible from each woman and this was suppleto say here that if we decide on a standard of mented by reports from the probate judges and normal intelligence there will be all grades organized charities and in a number of cases downward from this standard to zero, and up. from the patient's former school teachers, phyward to the highest mentality obtainable. In sicians, etc. One would, of course, be inclined the downward scale, theoretically at least, there to question the reliability of the histories obwill be reached a point where the individual tained from these women and no doubt in some shows such lack of intellect that he becomes instances the information is misleading but on legally irresponsible and is termed defective. the whole I believe it quite reliable. A rather Between this point and the normal will be found superficial neurological examination was made cases which we designate as borderline cases. consisting of testing the special and general Individuals of this class, and of the higher senses, the reflexes and the neuromuscular congrade defectives, are the ones who really become dition. The condition of the mentality was a menace to the community and a danger to based on the family history, ability to get along future generations.

in school, success in places of employment and During the past ten or twelve years various the general reaction to environment, as pecutests have been devised for estimating the ap

liar mental attitudes, delusions or hallucinaproximate mental level of an individual. Binet tions, etc., and lastly by estimating the native and Simon of Paris were among the first to put mental capacity by means of either the Terman forth such tests. Since that time various im- or Yerkes-Bridges tests and various performprovements and additions have been made, the ance tests as devised by Healy, Pintner-Pattertwo most important being the Stanford revision son and others. by Terman and the Yerkes-Bridges test.

There were 139 cases in all. In the beginning of the war our Federal varied from 16 to 46, the majority of the womGovernment saw the necessity of taking active en being in their early twenties. Of this nummeasures to prevent the spread of venereal dis- her two were undoubtedly cases of Dementia eases among the troops, and to aid in this work, Praecox; two were Psychopathic; thirty-two called upon the Health Departments, of the mentally dull; fourteen were borderline cases ; various State Governments for assistance. Our fifty-seven were morons or imbeciles; thirty State Board of Health, with the assistance of were normal and two were not diagnosed. Three the local boards, took upon itself the duties of of the morons had general paresis also and examining, first girls emploved in places where three had epilepsy. This shows 41 per cent. of

Their ages

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