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THE TROPHOBLASTIC HYPOTHESIS OF CANCER.
1196
Pren.une in Tuberculous Women. At a recent meeting of the Medical Society in Jasy Dr. Rosianu gave a summary of the views held at present on the question of pregnancy in tuberculous If pregnancy has taken place the woman women. should be kept under careful medical observation, and if the tuberculous disease grows worse, abortion should be strongly recommended. During the later months of pregnancy the induction of premature labour does not offer any advantage over labour at full term, and is fraught with risk for a tuberculous patient. Moreover, as a tuberculous mother may give birth to a healthy child with fair chances of good health later on, it would be unfair to sacrifice needlessly the life of an infant. Dr. Rosianu does not believe in making a routine of interrupting the pregnancy, as advocated by Maragliano and
Hamburger. Phototherapy in Rachitis. Dr. Ranrsiceanu reports the results of ultra-violet treatment made with special arc lamps in 42 cases of rachitis. The patients ranged from 1 to 7 years of age. Every month comparative rontgenograms of the epiphyses of the right forearm were made on four children. In all cases that could be thus controlled there was an undoubted improvement in the clinical picture ; in most cases a complete cure was effected. At first the treatment was applied every second day, but of late he has given daily treatments. He begins with five minutes each to the abdomen and back at The time is lengthened by two minutes one sitting. at each sitting until 15 minutes each is reached. No No ill-effects following the treatment were noted. changes in diet were ordered and no medication was employed. The number of sittings was usually from 40 to 60. The rontgenograms established the fact that the bones were becoming harder and firmer. The initial softness of the bones should, of course, be taken advantage of to straighten curvatures and correct deformities, while irradiation is continued, so thatwhen the bones become firm they may be in the corrected position. Gastro-intestinal Disorders in Albania. There is an alarming increase of gastro-intestinal disorders in Albania ; thousands of working men are unemployed, and are compelled to live on a semistarvation diet. The sanitary conditions of the bakeries are very unsatisfactory ; the bread is bitter and made of inferior flour (chiefly maize) in a primitive manner. Another great source of gastro-intestinal disease is the enormous consumption of decayed vegetables, raw or in a half-cooked condition, and dried fruit, chiefly prunes, in partly decomposed state. ’The cases of gastro-intestinal disorders are for the most part mild, and recovery takes place without complication ; only a few fatal cases have as yet been
reported.
Correspondence. "Audi alteram
"
parted.
REPRESENTATION OF MEMBERS ON THE COUNCIL OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND. To the Editor of THE LANCET. SIR,-I gather from the President’s remarks at the annual meeting of Fellows and Members, held last week, that the Council of the College is to consider further the question of the representation of members Since that meeting, I have had before on that body. me the information regarding the history of this movement, which was put before the President by a deputation of the Society of Members of the College, and I am astounded to find that the right of representation on the College Council originally existed and was taken away from them, as I understand, surreptitiously and illegally, about half a century ago by the then
Fellows. In these circumstances, it is amazing to think that a body of gentlemen of the calibre of those who form the Council, and among whom, at the present time, I am proud to reckon many friends, could refuse to rectify such a gross injustice to the Members of the College, and one which has continued for over such a long period. Although the Society of Members have been the movers in this matter, the responsibility of the Council exists to far beyond their limited membership. Though I am not a member of this Society, I consider that the Council owes a sacred duty to the body corporate of the College to put this matter right. I had the pleasure of hearing Dr. Haden Guest’s address, and I think he made out a case which is beyond dispute. The Council now has the opportunity of rectifying the injustice of its predecessors, and I hope that it will proceed to do so quickly. Should the Council of the College refuse to do this, it seems to me that the logical course for it to pursue. in seeking a new charter, would be to have the members of the College degraded into a body of licentiates, such as exists in the sister college. I do not suppose for a moment that it would be allowed to do that; but to my mind it is the only logical alternative to the retention of the status of membership. I am quite sure that it would be to the advantage of the College and, indirectly, of the public, whom it serves, that it should agree to receive one or two members on its Governing Board. It appears to me to be very unfair that I, as a member of a university, should have a voice in the government of that university and a Parliamentary vote for its Member, while thousands of members of the College should not even have one representative on its College I am, Sir, yours faithfully, Council. LEWIS G. GLOVER, M.D., M.R.C.S., L.R.C.P.
Nov. 26th, 1925. DONATIONS AND BEQUESTS.-The Liverpool Hos** The subject is dealt with in another column. pital Sunday Fund this year-the fifty-fifth annual collection-amounted to .87752, being .8413 more than the amount - end. L. subscribed last year.-Princess Beatrice has given JB105 to start a .815,000 fund for the renovation of the Royal Isle of THE TROPHOBLASTIC HYPOTHESIS OF Wight County Hospita,l.-Lady Violet Charlotte Julia Maria CANCER. value of She of the 17,825. Watt, Brighton, left property left ;C500 each to the Royal Sussex County Hospital, the To the Editor of THE LANCET. Alexandra Hospital for Sick Children, Brighton, the Throat and Ear Hospital, the Hospital for Women, Brighton, the SIR,-It is surely unreasonable of anyone to expect Brighton, Hove, and Preston Dispensary, and 2250 to Our to find historical references to other theories in an Dumb Friends’ League, and the residue of the property to ’, address summarising the work of many years. After -
her executor for such charitable purposes as he may select. .what Dr. Murray has written, however, concerning my - Mr. David Levy, Brixton, left 216,440. After various want of knowledge on this matter, justice presumed he left the residue of the property in trust for his bequests wife for life, and then to King Edward’s Hospital Fund for demands that I comment severely upon his own London.-An anonymous donor has given 21000 to Crick- ignorance of the literature in respect of a previous howell Memorial Hospital in commemoration of the visit publication of mine in THE LANCET1 in which, when of the Prince of Wales to Glenark Park, Crickhowell.-Mr. dealing with the importance of chorion epithelioma John David Miller, Clifton, Bristol, left £ 00 each to the in relation to certain aspects of the aetiology of cancer, Bristol Royal Infirmary and the Bristol General Hospital; I acknowledged that, though I had arrived at a similar .8250 to Muller’s Orphanages, Ashley Down, Bristol; and conclusion independently, I subsequently discovered and the Bristol Hospital X150 each to the Bristol Eye Hospital 1 THE LANCET, 1924, i., 267. for Sick Women and Children.
1197 that I had been anticipated in this matter by Dr. Adami in a discussion on Cancer at the Chelsea Clinical Society in March, 1902 2-that is, prior to Dr. John Beard’s publication 3 to which Dr. Murray Of Dr. Adami’s paper Dr. Murray has referred. is also ignorant. to Marchand and a group of German workers, and not to Beard, the demonstration that chorion epithelioma is a malignant growth sui generis But all derived from the embryonic trophoblast. this is common knowledge, and it is hardly likely that anyone to-day would claim it as original ! If Dr. Murray will read, and read carefully, my address he will see that I state very definitely that our working hypothesis is based on known facts, as it should be. The difference between our views and Beard’s confused ideas is striking. Beard regarded the fertilised ovum as producing an alternate asexual generation ; on it is developed an individual, which for clearness we may term the blastula. From this there was now unfolded and developed the sexual individual-the embryo. His theory was that the asexual part (the chorion) might continue to exist after the sexual product had been destroyed or removed, and from this it followed that secondary growths in the lungs and elsewhere were to be considered asexual generations. Beard sums up his hypothesis in the last paragraph of the paper mentioned in the following words :Granted the facts of the origin, migrations, and history
presumably We
owe
of the of the thesis
germ-cells of vertebrates, and assuming the course life-cycle to be that previously indicated, by hypocancer is derived from vagrant primary germ-cells, which, instead of forming a more or less complete embryo or embryoma, skip this and give rise to a larva or phorozoon of indefinite unrestricted powers of
growth.
PROPHYLAXIS OF THE COMMON COLD. To the Editor of THE LANCET. Dr. Simey’s address with great interest. I would like to put forward the suggestion that a common source of infection is the dangerous practice of compelling adolescents to spend an hour or more in all weathers watching matches. The idea. that it is disloyal to the school not to appear to enjoy doing so compels many boys and girls to stand on wet ground in cold winds, thus lowering their vitality and resistance to infection. It is not necessary to go back to the classic experiment which produced anthrax in fowls to realise that it must be harmful in human beings. Would it be possible for medical officers of schools to arrange that only those who desire to watch matches should do so, and for the rest of the school to be occupied in keeping themselves warm, during the winter months, at any rate ? I am, Sir, yours faithfully, STELLA CHURCHILL. CHURCHILL
SIR,-I have read
Chiswick, W., Nov. 24th, 1925.
MALARIA AS A THERAPEUTIC AGENT. To the Editor of THE LANCET. connexion with the malaria treatment of SIR,-In general paralysis, it is interesting to learn from a recent article by Dr. Cabanes 1 that in the Middle Ages it was believed that quartan ague cured epilepsy. Dr. Cabanes quotes Louis XI. as begging the Prior of Notre-Dame des Salles, at Bourges, to pray " incessamment Dieu et Notre-Dame des Salles pour moy, a ce que leur plaisir soit de m’envoyer la iievre quarte, car j’ay une maladie dont les physiciens disent que je ne puis etre guery sans l’avoir." According to Dr. Cabanes, Louis XI. was an epileptic. It appears he also suffered from leprosy, and the fact. throws light on the king’s strange behaviour. Notwithstanding such drawbacks, he yet managed to weld a disunited country into a kingdom. I am, Sir, yours faithfully, GEORGE PERNET. London, W., Nov. 29th, 1925.
Adami and I havehad no such ideas. Our conception has been that the chorionic epithelium grows and penetrates the uterine tissue in performance of a special function-that is, to secure nourishment for itself and the growing embryo ; that through it foodstuffs are absorbed from the maternal blood, and the other interchanges are made ; that if the foetus die or become aborted this normal function ceases to be required, and that now, to employ Adami’s expression, the habit of work being interrupted, the habit of growth may continue, or as I expressed it, the embryonic restraint being removed the chorionic PRECANCEROUS STATES. epithelium may multiply and become excessively malignant. This is totally different from John Beard’s To the Editor of THE LANCET. hypothesis’, which I agree could not be fruitful. ’ in SiR,-My experience of tropical granulomata With this statement, which should have been throw light, however slight, on " preCalcutta may I to must leave readers your entirely unnecessary, cancerous " states in general. Tropical granulomata judge Dr. Murray’s letter. Speaking not only for are subjected to irritation to such degrees myself but also for the whole staff of the Liverpool thatfrequently it is remarkable they do not undergo malignant Cancer Research Fund, I wish to say that we most cordially invite criticism of our work on its scientific changes more often than they do. The histological merits. We do not want opinions, pious or impious; changes observed during the transition of granulomata to malignancy are interesting. There is a varying we, like all other honest workers, want the truth. degree of leucocytic infiltration with a relative I am, Sir, yours faithfully, preponderance of lymphocytes. This may be due to W. BLAIR BELL. Liverpool, Nov. 30th, 1925. irritation caused by a specific virus or some changes PS.-Will you allow me to say that the following produced in the invading epithelium. The epithelial paragraph was omitted by accident from my Toronto cells proliferate and extend both in the longitudinal address in THE LANCET of Nov. 14th, but will appear and vertical planes in the granulation tissue, its in the reprints. It should follow the first paragraph towards the periphery being at first in the left-hand column on p. 1005. Those interested proliferation slow. Side by side, there is connective tissue reaction. will be able to read it into the rest of the argument :- The perilymphatic and endolymphatic distribution " Here it seems proper to call attention to a point of the epithelial proliferation and invasion and cells, of interest that affords considerable support to the cellular reaction vary according to the type of explanations I have given of certain pathological granuloma, the irritation, and the stage of transphenomena; this obvious point appears to have formation. In a few cases in which a malignantly escaped description, and even notice, at the hands of transformed granuloma tends to revert to nonpathologists-at least, I am not aware of any state- malignancy, the connective tissue proliferation seems ment on the matter. It is this : chorion epithelioma to result in fibrosis which pervade the growth, the .-the most malignant of malignant diseases-is not rate and extent of epithelial proliferation become a dedifferentiated growth as is every other malignant reduced and the cells themselves become more and neoplasm ; it is a simple hyperplasia of the chorionic more normal in character. epithelial elements. Dedifferentiation cannot occur I am, Sir. yours faithfully, for the chorionic epithelium is normally malignant, K. K. ;K. CHATTERJI, F.R.C.S.I. and is itself the ancestral type." Southwell-ga.rdeus, London. S.W., Nov. 30th, 1925. 2 Clinical Journal, June 18th, 1902. 3 THE LANCET, 1902, i., 1758.
1 Mercure de France, May 15th, 1925, p. 197.
Pren.une in Tuberculous Women. At a recent meeting of the Medical Society in Jasy Dr. Rosianu gave a summary of the views held at present on the question of pregnancy in tuberculous If pregnancy has taken place the woman women. should be kept under careful medical observation, and if the tuberculous disease grows worse, abortion should be strongly recommended. During the later months of pregnancy the induction of premature labour does not offer any advantage over labour at full term, and is fraught with risk for a tuberculous patient. Moreover, as a tuberculous mother may give birth to a healthy child with fair chances of good health later on, it would be unfair to sacrifice needlessly the life of an infant. Dr. Rosianu does not believe in making a routine of interrupting the pregnancy, as advocated by Maragliano and
Hamburger. Phototherapy in Rachitis. Dr. Ranrsiceanu reports the results of ultra-violet treatment made with special arc lamps in 42 cases of rachitis. The patients ranged from 1 to 7 years of age. Every month comparative rontgenograms of the epiphyses of the right forearm were made on four children. In all cases that could be thus controlled there was an undoubted improvement in the clinical picture ; in most cases a complete cure was effected. At first the treatment was applied every second day, but of late he has given daily treatments. He begins with five minutes each to the abdomen and back at The time is lengthened by two minutes one sitting. at each sitting until 15 minutes each is reached. No No ill-effects following the treatment were noted. changes in diet were ordered and no medication was employed. The number of sittings was usually from 40 to 60. The rontgenograms established the fact that the bones were becoming harder and firmer. The initial softness of the bones should, of course, be taken advantage of to straighten curvatures and correct deformities, while irradiation is continued, so thatwhen the bones become firm they may be in the corrected position. Gastro-intestinal Disorders in Albania. There is an alarming increase of gastro-intestinal disorders in Albania ; thousands of working men are unemployed, and are compelled to live on a semistarvation diet. The sanitary conditions of the bakeries are very unsatisfactory ; the bread is bitter and made of inferior flour (chiefly maize) in a primitive manner. Another great source of gastro-intestinal disease is the enormous consumption of decayed vegetables, raw or in a half-cooked condition, and dried fruit, chiefly prunes, in partly decomposed state. ’The cases of gastro-intestinal disorders are for the most part mild, and recovery takes place without complication ; only a few fatal cases have as yet been
reported.
Correspondence. "Audi alteram
"
parted.
REPRESENTATION OF MEMBERS ON THE COUNCIL OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND. To the Editor of THE LANCET. SIR,-I gather from the President’s remarks at the annual meeting of Fellows and Members, held last week, that the Council of the College is to consider further the question of the representation of members Since that meeting, I have had before on that body. me the information regarding the history of this movement, which was put before the President by a deputation of the Society of Members of the College, and I am astounded to find that the right of representation on the College Council originally existed and was taken away from them, as I understand, surreptitiously and illegally, about half a century ago by the then
Fellows. In these circumstances, it is amazing to think that a body of gentlemen of the calibre of those who form the Council, and among whom, at the present time, I am proud to reckon many friends, could refuse to rectify such a gross injustice to the Members of the College, and one which has continued for over such a long period. Although the Society of Members have been the movers in this matter, the responsibility of the Council exists to far beyond their limited membership. Though I am not a member of this Society, I consider that the Council owes a sacred duty to the body corporate of the College to put this matter right. I had the pleasure of hearing Dr. Haden Guest’s address, and I think he made out a case which is beyond dispute. The Council now has the opportunity of rectifying the injustice of its predecessors, and I hope that it will proceed to do so quickly. Should the Council of the College refuse to do this, it seems to me that the logical course for it to pursue. in seeking a new charter, would be to have the members of the College degraded into a body of licentiates, such as exists in the sister college. I do not suppose for a moment that it would be allowed to do that; but to my mind it is the only logical alternative to the retention of the status of membership. I am quite sure that it would be to the advantage of the College and, indirectly, of the public, whom it serves, that it should agree to receive one or two members on its Governing Board. It appears to me to be very unfair that I, as a member of a university, should have a voice in the government of that university and a Parliamentary vote for its Member, while thousands of members of the College should not even have one representative on its College I am, Sir, yours faithfully, Council. LEWIS G. GLOVER, M.D., M.R.C.S., L.R.C.P.
Nov. 26th, 1925. DONATIONS AND BEQUESTS.-The Liverpool Hos** The subject is dealt with in another column. pital Sunday Fund this year-the fifty-fifth annual collection-amounted to .87752, being .8413 more than the amount - end. L. subscribed last year.-Princess Beatrice has given JB105 to start a .815,000 fund for the renovation of the Royal Isle of THE TROPHOBLASTIC HYPOTHESIS OF Wight County Hospita,l.-Lady Violet Charlotte Julia Maria CANCER. value of She of the 17,825. Watt, Brighton, left property left ;C500 each to the Royal Sussex County Hospital, the To the Editor of THE LANCET. Alexandra Hospital for Sick Children, Brighton, the Throat and Ear Hospital, the Hospital for Women, Brighton, the SIR,-It is surely unreasonable of anyone to expect Brighton, Hove, and Preston Dispensary, and 2250 to Our to find historical references to other theories in an Dumb Friends’ League, and the residue of the property to ’, address summarising the work of many years. After -
her executor for such charitable purposes as he may select. .what Dr. Murray has written, however, concerning my - Mr. David Levy, Brixton, left 216,440. After various want of knowledge on this matter, justice presumed he left the residue of the property in trust for his bequests wife for life, and then to King Edward’s Hospital Fund for demands that I comment severely upon his own London.-An anonymous donor has given 21000 to Crick- ignorance of the literature in respect of a previous howell Memorial Hospital in commemoration of the visit publication of mine in THE LANCET1 in which, when of the Prince of Wales to Glenark Park, Crickhowell.-Mr. dealing with the importance of chorion epithelioma John David Miller, Clifton, Bristol, left £ 00 each to the in relation to certain aspects of the aetiology of cancer, Bristol Royal Infirmary and the Bristol General Hospital; I acknowledged that, though I had arrived at a similar .8250 to Muller’s Orphanages, Ashley Down, Bristol; and conclusion independently, I subsequently discovered and the Bristol Hospital X150 each to the Bristol Eye Hospital 1 THE LANCET, 1924, i., 267. for Sick Women and Children.
1197 that I had been anticipated in this matter by Dr. Adami in a discussion on Cancer at the Chelsea Clinical Society in March, 1902 2-that is, prior to Dr. John Beard’s publication 3 to which Dr. Murray Of Dr. Adami’s paper Dr. Murray has referred. is also ignorant. to Marchand and a group of German workers, and not to Beard, the demonstration that chorion epithelioma is a malignant growth sui generis But all derived from the embryonic trophoblast. this is common knowledge, and it is hardly likely that anyone to-day would claim it as original ! If Dr. Murray will read, and read carefully, my address he will see that I state very definitely that our working hypothesis is based on known facts, as it should be. The difference between our views and Beard’s confused ideas is striking. Beard regarded the fertilised ovum as producing an alternate asexual generation ; on it is developed an individual, which for clearness we may term the blastula. From this there was now unfolded and developed the sexual individual-the embryo. His theory was that the asexual part (the chorion) might continue to exist after the sexual product had been destroyed or removed, and from this it followed that secondary growths in the lungs and elsewhere were to be considered asexual generations. Beard sums up his hypothesis in the last paragraph of the paper mentioned in the following words :Granted the facts of the origin, migrations, and history
presumably We
owe
of the of the thesis
germ-cells of vertebrates, and assuming the course life-cycle to be that previously indicated, by hypocancer is derived from vagrant primary germ-cells, which, instead of forming a more or less complete embryo or embryoma, skip this and give rise to a larva or phorozoon of indefinite unrestricted powers of
growth.
PROPHYLAXIS OF THE COMMON COLD. To the Editor of THE LANCET. Dr. Simey’s address with great interest. I would like to put forward the suggestion that a common source of infection is the dangerous practice of compelling adolescents to spend an hour or more in all weathers watching matches. The idea. that it is disloyal to the school not to appear to enjoy doing so compels many boys and girls to stand on wet ground in cold winds, thus lowering their vitality and resistance to infection. It is not necessary to go back to the classic experiment which produced anthrax in fowls to realise that it must be harmful in human beings. Would it be possible for medical officers of schools to arrange that only those who desire to watch matches should do so, and for the rest of the school to be occupied in keeping themselves warm, during the winter months, at any rate ? I am, Sir, yours faithfully, STELLA CHURCHILL. CHURCHILL
SIR,-I have read
Chiswick, W., Nov. 24th, 1925.
MALARIA AS A THERAPEUTIC AGENT. To the Editor of THE LANCET. connexion with the malaria treatment of SIR,-In general paralysis, it is interesting to learn from a recent article by Dr. Cabanes 1 that in the Middle Ages it was believed that quartan ague cured epilepsy. Dr. Cabanes quotes Louis XI. as begging the Prior of Notre-Dame des Salles, at Bourges, to pray " incessamment Dieu et Notre-Dame des Salles pour moy, a ce que leur plaisir soit de m’envoyer la iievre quarte, car j’ay une maladie dont les physiciens disent que je ne puis etre guery sans l’avoir." According to Dr. Cabanes, Louis XI. was an epileptic. It appears he also suffered from leprosy, and the fact. throws light on the king’s strange behaviour. Notwithstanding such drawbacks, he yet managed to weld a disunited country into a kingdom. I am, Sir, yours faithfully, GEORGE PERNET. London, W., Nov. 29th, 1925.
Adami and I havehad no such ideas. Our conception has been that the chorionic epithelium grows and penetrates the uterine tissue in performance of a special function-that is, to secure nourishment for itself and the growing embryo ; that through it foodstuffs are absorbed from the maternal blood, and the other interchanges are made ; that if the foetus die or become aborted this normal function ceases to be required, and that now, to employ Adami’s expression, the habit of work being interrupted, the habit of growth may continue, or as I expressed it, the embryonic restraint being removed the chorionic PRECANCEROUS STATES. epithelium may multiply and become excessively malignant. This is totally different from John Beard’s To the Editor of THE LANCET. hypothesis’, which I agree could not be fruitful. ’ in SiR,-My experience of tropical granulomata With this statement, which should have been throw light, however slight, on " preCalcutta may I to must leave readers your entirely unnecessary, cancerous " states in general. Tropical granulomata judge Dr. Murray’s letter. Speaking not only for are subjected to irritation to such degrees myself but also for the whole staff of the Liverpool thatfrequently it is remarkable they do not undergo malignant Cancer Research Fund, I wish to say that we most cordially invite criticism of our work on its scientific changes more often than they do. The histological merits. We do not want opinions, pious or impious; changes observed during the transition of granulomata to malignancy are interesting. There is a varying we, like all other honest workers, want the truth. degree of leucocytic infiltration with a relative I am, Sir, yours faithfully, preponderance of lymphocytes. This may be due to W. BLAIR BELL. Liverpool, Nov. 30th, 1925. irritation caused by a specific virus or some changes PS.-Will you allow me to say that the following produced in the invading epithelium. The epithelial paragraph was omitted by accident from my Toronto cells proliferate and extend both in the longitudinal address in THE LANCET of Nov. 14th, but will appear and vertical planes in the granulation tissue, its in the reprints. It should follow the first paragraph towards the periphery being at first in the left-hand column on p. 1005. Those interested proliferation slow. Side by side, there is connective tissue reaction. will be able to read it into the rest of the argument :- The perilymphatic and endolymphatic distribution " Here it seems proper to call attention to a point of the epithelial proliferation and invasion and cells, of interest that affords considerable support to the cellular reaction vary according to the type of explanations I have given of certain pathological granuloma, the irritation, and the stage of transphenomena; this obvious point appears to have formation. In a few cases in which a malignantly escaped description, and even notice, at the hands of transformed granuloma tends to revert to nonpathologists-at least, I am not aware of any state- malignancy, the connective tissue proliferation seems ment on the matter. It is this : chorion epithelioma to result in fibrosis which pervade the growth, the .-the most malignant of malignant diseases-is not rate and extent of epithelial proliferation become a dedifferentiated growth as is every other malignant reduced and the cells themselves become more and neoplasm ; it is a simple hyperplasia of the chorionic more normal in character. epithelial elements. Dedifferentiation cannot occur I am, Sir. yours faithfully, for the chorionic epithelium is normally malignant, K. K. ;K. CHATTERJI, F.R.C.S.I. and is itself the ancestral type." Southwell-ga.rdeus, London. S.W., Nov. 30th, 1925. 2 Clinical Journal, June 18th, 1902. 3 THE LANCET, 1902, i., 1758.
1 Mercure de France, May 15th, 1925, p. 197.