stokes-adams disease and cardiac arrhythmia

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only reasonable and just, as in this instance. I most sincerelyhope the local authorities of St. Moritz will see their wayto clear this matter up before the discontent makes itselfmanifest by appearing in the columns of the daily press.

I am. Sirs, vours faithfully,T. W. PARKINSON, M.D. Edin.

Stoane-street, S.W., Nov. 21st, 1906.

MORAU AND JENSEN’S TUMOUR.To the Editors of THE LANCET.

SIRS,-No one disputes that in Morau’s experimentstumours developed in mice inoculated or fed with tumours.In the inoculation experiments the tumours developed notonly at the site of inoculation, but also, and apparently quiteas frequently, they developed remote from it, although insites corresponding to the anatomical distribution of themammas in the mouse. Tumours developed from threemonths to more than a year after inoculation had beenpractised on mice no longer young at the time. In the feed-ing experiments large multiple tumours developed in themammav of an old female, and a small tumour in the axillaof an old male nine months after the commencement of theircancerous dietary. Morau expresses no surprise at theirregular distribution of the tumours developing after inocula-tion ; it was in agreement with the inference that somecausative agent (virus néoplasique) capable of disseminationfrom the alimentary canal was responsible for the positiveresults of the feeding experiments, for what is described asgeneral dissemination of the tumours, as well as for thecachexia.The histological character of Morau’s tumours varied, but

none had the features of Jensen’s tumour. The tumour

serving as the starting point of Morau’s experiments was a hasmorrhagic adeno-carcinoma of the mamma-one of thecommonest forms of tumour of this organ, but of a typewhich is very difficult to transplant, and has only beentransplanted by Morau and ourselves. There is no evidenceto prove that even when the tumours developed at the site ofinoculation some of them did not arise spontaneously. I am,however, far from asserting that all his inoculation experi-ments were negative, for obviously many were positive.The two facts-(1) that many tumours arose at a distance

from the site of inoculation ; and (2) in animals fed withtumour material-prove that every tumour developing asdescribed, arose spontaneously-i.e., independently of the

experimental procedures-for in successful transplantationexperiments tumours invariably develop at the site ofinoculation and never develop as the result of feeding. In

short, the process of the transmission of carcinoma experi-mentally, as we understand it, owing to the work of Jensenand of the Imperial Cancer Research was utterly unsus-pected by Morau and to-day is not comprehended by Mr. W.Roger Williams. What Morau describes as dissemination isalso contrary to the facts as we now know them, and in

reality supports the view that the spontaneous developmentof new tumours in other parts of the mammary apparatusconfused the results of the experiments.

I have shown with Murray that young mice are moresuitable for the transplantation of carcinoma than old andthat mammary tumours develop spontaneously in mice withgreatest frequency in the last third of their existence whichrarely extends to three years. Morau specially states thathe selected mice large enough and old enough to withstandhis experimental procedures ; it is therefore not smprisingthat some of his positive observations were obtained inanimals 18 months after birth, and others in animals whichhad attained the extreme limit of life. The long time themajority of the tumours took to develop, the use of animalsno longer young, the varied sites of development, the natureof the so-called dissemination, and the differences in thehistology recorded by Morau all point to his havingobserved many spontaneous tumours in a number of agedmice. Certain of his observations are in this respectparallel to some by Borrel on mice kept in "cancer-

cages" and to others by Murray and myself on the possi-bility of inherited susceptibility to cancer. The naturalincidence of cancer in old age requires to be allowedfor in interpreting the positive results of all three sets ofexperiments. Evidence for the continuity of the growth ofMorau’s original tumour through the four consecutive trans-ferences of his 17 series of experiments is entirely wanting,because Morau regarded it as a matter of indifferenl e

whether the sub-inoculations were made from tumours whichhad developed at the site of inoculation or elsewhere. Theclaim Mr. Williams makes is groundless.

It seems needless to point out that Jensen’s tumour is onlyone of 50 mammary tumours of the mouse studied in thelaboratories of the Imperial Cancer Research Fund and onlyone of 26 transplantable mammary tumours. These tumoursform a graduated series, from adenomata, with a closeresemblance and direct anatomical relation to normalmamma, to others typically carcinomatous and undis-tinguishable from Jensen’s tumour. The papers publishedfrom the laboratory of the Imperial Cancer Research Fundhave in no case been based solely on observations on Jensen’stumour, although prominence has invariably been given tothe value of Jensen’s work once the nature of his tumourwas determined. Four of the 26 transplantable tumoursgive constantly from 80 to 100 per cent. of successfulinoculations.

Mr. Williams’s comment can only be explained bya want of personal knowledge of the anatomy and thehistology of the mouse’s mamma, of the benign and themalignant new growths to which it is liable, as well as ofthe fundamental truths on which the experimental study ofcancer has been founded.

I need hardly reaffirm what the President of the RoyalCollege of Surgeons has already stated in your columns, thatcareful consideration has been given to Morau’s work in thedeliberations of the Executive Committee of the ImperialCancer Research, that Mr. Henry Morris himself paid tributeto the value of his work in the Bradshaw Lecture of 1903,and that his work has been referred to, whenever opportune,in the official reports and other papers published from thislaboratory.

It is entirely unfortunate that such a misconception ofMorau’s position in the development of the experimentalstudy of cancer on the part of Mr. Williams has necessitatedthese criticisms which do not detract from the appreciationI have for the pioneer work of the distinguished French in-vestigator who unfortunately was not spared to interpret hisexperiments in the light of subsequent investigations. Hewas dead before Jensen’s papers appeared.

I am. Sirs. vours faithfully.E. F. BASHFORD.

Imperial Cancer Research Fund, Examination Hall, London, W.C.,Nov. 26th, 1906.

STOKES-ADAMS DISEASE AND CARDIACARRHYTHMIA.

To the Editors of THE LANCET.

SIRS,-In the interesting paper by Dr. J. Hay and Dr. S. A.Moore in THE LANCET of Nov. 10th on a case of this descrip-tion one remark, casually introduced, seems to me to call forfurther information which they may be able to give. At thecommencement of the article under the head ‘‘ History of thecase" they say : ’-After the patient’s discharge from

hospital on Dec. 8tb, 1905, he took great care of himself,exercised caution in bis diet, ceased to indulge even

moderately in alcohol, and kept his bowels open." Herethere is one conspicuous omission-his habits as to tobaoco.Further on in the paper, in a description of a series of fitswhich occurred on one day more than a month after hissecond admission to hospital and during a lengthy period ofrepeated " syncopal seizure?," come the significant words:"He askedfor his pipe." Are we to understand from thisthat, throughout this severe illness in hospital, the patientaas habitually smoking tobacco, and if so in what amounts ? I am making no suggestion as to the causation ; I am onlyasking for information on what seems to me a point at leastof equal importance with the alcohol habit.

I am, Sirs, yours faithfully,Hendon, Nov. 20th, 1906. HENRY BAZETT.

A NEW ASPECT OF THE PATHOLOGYAND TREATMENT OF LEPROSY.

To Me Aditors of THE LANCET.

SIRS,-I have just read with great interest the article inTHE LANCET of Oct. 20th, p. 1064, by Dr. R. ’. Black of CapeTown under this title, in which he brings forward some valu-able facts with reference to the part played by the initiallesions of the nose in leprosy and advances the theory thathere we have the starting point of th’s di&ease—the bacilli