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581 organic compounds were studied for their spermicidal activity by a modified Brown and Gamble method. Of 55 compounds that were considered highly effective in aqueous solutions of .5% or less 31 were surfactant substances. A new class of polyhydric phenols bismonohydroxy and bisdihydroxyphenyl derivatives of methane were discovered to have strong spermicidal activity. Low molecular weight sodium dialkyldithiocarbamates had the highest spermicidal activity of any material studied. Alkylxanthate salts were effective at .5% concentrations. 9 Class I spermicides were found in alkylphenoxypolyoxyethylene ethanols. Certain alykl derivatives of diphenyliodonium also showed strong spermicidal activity. Several of the materials notably the alkylthiopolyoxyethylene ethylene ethanols have not been previously reported as spermicides.

Twenty-eight cases of carcinoma of the cervix associated with pregnancy are reviewed. Analysis of the results suggests that patients whose carcinomas are diagnosed in early pregnancy fare better than patients with carcinomas of comparable clinical stages which are diagnosed in late pregnancy or the postpartum period.

Summary The success of the program depends in turn upon the approach with which it is undertaken. 1. Voluntary. Involvement by the physician concerned produces the greatest educational benefits. 2. Local. The only persons really qualified to evaluate cases of perinatal mortality are those who are entirely familiar with the local conditions. 3. Current. The extreme brevity of most newborn records demands the investigation of the caes of a current basis for accuracy.

Cancer of the cervix in 251 patients has been treated externally by theratron and betatron. Central therapy, when given, is applied by colpostat and tandem containing radioactive cobalt-60. Minimal side reactions have occurred. Cure rates and complications encountered are discussed. Projected 5 year cure rates by clinical staging are as follows: Stage I, 54 patients, 86 per cent; Stage II, 79 patients, 50.5 per cent; Stage III, 73 patients, 31.0 per cent; Stage IV, 45 patients, 25.0 per cent. The 12 per cent complication rate was more that of the disease than the therapy. Megavoltage therapy used in the manner outlined has proved effective and safe.

The evidence directly relating vitamin C with the process of reproduction is constantly accumulating. The recent papers of Lardy, Casida and Phillips, 1 as well as of Korenchevsky and Hall 2 summarize much of this work. With respect to the fetal-maternal relationship, McDevitt and co-workers 3 and Lund and Kimble 4 have postulated a selective retention of vitamin C by the placenta. The extensive study of Lund and Kimble 4 bears consideration. They confirmed the observation that in a fasting or near-fasting state the fetal ascorbic acid level is always greater than the maternal. Subsequent to the administration of vitamin C, both the fetal and maternal plasma levels rise, followed in a few hours by a drop in the maternal level, while the fetal plasma ascorbic acid remains higher. Their tentative hypothesis, that the placenta permits free maternal-fetal passage of ascorbic acid, while limiting fetal-maternal passage, must be examined closely in view of Needham's observation that electrolytes of low molecular weight pass freely and equally in both directions across the placental barrier. 5 These significant observations led us to undertake a study of the placental metabolism of vitamin C. The present report has the purpose of (a) extending the observations of the maternal-fetal plasma ascorbic acid relationship to whole blood, (b) correlating these levels with placental assays of vitamin C, (c) ruling out the possibility of ascorbic acid synthesis by the placenta, and (d) determining whether or not such selective retention is a nonspecific nutritional function of the placenta which applies to all vitamins.

A rabbit vaginal-irritation test described in this article is recommended as a reliable procedure for the evaluation of vaginal jellies and creams. The importance in a drug evaluation test of procedure, type of tissue involved, and method of interpreting the results are discussed.

A group of 20 patients with pelvic malignancies were treated with intraarterial nitrogen mustard with a one- or two-injection technique to administer the entire dosage. The patients had cervical, fundal, and ovarian carcinomas but in each instance the lesion had spread beyond the confines of the organ of origin. Fifteen of these patients had been treated “to tolerance” and had evidences of active recurrence, giving them an exceedingly limited prognosis initially. Five patients were selected for treatment prior to the administration initially. Five patients were selected for treatment prior to the administration of the radiation. With 3 of the patients still living—2 without evidence of disease and one with evidence of disease—the average survival for the entire group is approximately twelve months. The posttreatment morbidity was considerably more marked, however, in the patients whose radiation had preceded the administration of the HN2. The animal studies using rabbits failed to indicate an increased mortality rate when sublethal doses of radiation and mustard were used together without regard for the sequence of administration or the time interval. Clinically, it is not felt that this particular technique of mustard administration yields enough benefit, even in the far-advanced pelvic malignancies, to merit the risk of morbidity which it entails.

The sites of metastases of 136 cases of uterine carcinoma have been indicated in graphic form. The spread to primary and secondary node groups has been broken down to specific anatomic sites. In addition, the spread of carcinoma to distant sites of metastases has been analyzed in 64 treated cases of cervical carcinoma as compared with 43 nontreated cases of carcinoma. Significant is the relationship of treatment to the spread of carcinoma. In the treated cases the primary nodes were involved in 73.2 per cent of the cases as compared with a 95.2 per cent involvement in the untreated cases. The secondary nodes were involved in 48.4 per cent of the treated cases and in 65.0 per cent of the nontreated cases. This would indicate local destruction of the carcinoma in a significant number of treated cases. When death ensued in these same cases, there were more distant metastases in the treated group than in the nontreated group. The incidence of metastases was 57.8 per cent in the treated, as compared with 51.1 per cent in the nontreated. This bears out the fact that therapy can destroy local growth, but the untreated distant metastases go on to kill the host. The assigned cause of death in cervical carcinoma was directly due to carcinoma in 88 per cent of the 107 cases. In the cases of endometrial carcinoma, death was attributable to carcinoma in 18 of the 22 cases. In the 7 cases of uterine sarcoma, 6 of the 7 deaths were caused by tumor growth. The remaining 24 of the 136 patients died of causes other than carcinoma. The diagnosis of carcinoma should not mislead the clinician into overlooking other disease entities in the individual patient. Conversely, carcinoma can simulate many other disease types.

0 N c o L Y T I c viruses demonstrate the ability to invade and to destroy tumor cells. Continuing experiments with oncolytic viruses have been carried out in the laboratories of the Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, since March, 1953. Prior reports have been made on the results of treatment of heterologous tumor transplants with APC, virus,l i.e., the strain of adenopharyngoconjunctival virus. The oncolytic effect of the APC, virus was first noticed by Rowe and associates2 These workers found that the virus was cytopathogenic to the HeLa cells, the base of the culture, which were originally derived from epidermoid carcinoma of the cervix as described by Ryan.3 Rowe? also reported the isolation of this adenopharyngoconjunctival virus. In tissue cultures containing both epithelial cells and fibroblasts, the virus affected the epithelial cells first. The nuclei became indistinguishable in the granular cytoplasm of the cells. The cells finally became pyknotic and fell into the wall of the tube. In turn, then, the fibroblasts were attacked. On the basis of this evidence, APC, virus was obtained from Dr. Ted Suie of the Ohio State University, Department of Ophthalmology, for injection into the H.Ee,. hosts in order to study the effect of the carcinoma.

A combination of irradiation therapy followed by radical hysterectomy (Wertheim's operation) was used in 140 cases of stage 1 or stage II carcinoma of the cervix. The results indicate that it is superior to irradiation alone. Five year survival rates for the patients with stage I and stage II lesions were 87.5 per cent and 70.3 per cent, respectively.

A study demonstrating the importance of the rabbit-irritation test in evaluating the therapeutic indices of spermicidal jellies for contraceptive use is presented. 8 spermicides discovered by a modified Brown and Gamble method were tested for irritating properties. The therapeutic index of a spermicide was indicated by the ratio of the maximum nonirritating concentration in the rabbit-irritation test to the minimal spermicidal concentration. It is demonstrated that bis-iodonium chloride is 5 times as effective a spermicide as tridecoxypoly ethanol but the therapeutic index of the former is considerably lower than that of the latter (1:16).