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Introduction In view of the development of interest in the use of insulin in the supplemental treatment of malignant disease, briefly reported by one of us (S. M. B.),1 it has seemed advisable to obtain definite scientific data on which to base conclusions. It was felt that the most satisfactory method of evaluating treatment would be to run carefully controlled experiments on mice with transplantable tumors. Animals were chosen having a high susceptibility to tumor, and a tumor well adapted to that particular strain of mice was chosen, so that the incidence of spontaneous regression would be as low as possible. The experiments were carried out over a period of seven months. Material and Methods Tumor: The tumor used was a transmissible mammary gland adenocarcinoma of the domestic mouse, of the strain designated dBrB.2 This tumor was fairly rapidly growing, definitely invasive, but non-metastasizing on subcutaneous transplantation. Previous experience had shown that the percentage of successful transplants was high (90–95 per cent) and had established a norm for its behavior. Mice: The mice were of the dilute brown (dBr) strain, inbred for heightened susceptibility to the strain of tumor employed, which originally arose spontaneously in this strain. The essential part of the experiment involved the use of 400 mice, approximately 75 days old when inoculated and so distributed that experimental and control animals of each group were always litter mates. In addition to these 400 animals, 140 non-litter mates of assorted ages, averaging six to seven months of age, were utilized. Procedure The stock tumor was carried in adult mice and transplanted every twenty days. For inoculation into control and experimental animals, a tumor of appropriate size (about 3 c.c. by volume) was excised from a mouse killed with chloroform, and was cut into small fragments of about 0.03 gm. This was carried out in sterile normal salt solution, and necrotic areas of tumor were avoided, in order to insure a high percentage of “takes.” These fragments were taken up in a trocar and implanted subcutaneously. The trocar was inserted in the right inguinal region and carried along subcutaneously to the right axillary region, where the tumor fragment was deposited by pushing home the plunger. As a rule, the mice were inoculated in groups of 40—a number which could easily be inoculated from a single excised tumor nodule—and successive groups were inoculated at intervals of about ten days.

IN A comprehensive review of 127 extramedullary plasmacytomas in 1943, Hellwig1 found only 4 cases in which plasmacytoma appeared to originate in lymph nodes. Search of the subsequent literature reveals only a single additional example.2 Because plasmacytoma of lymph nodes may be associated with grave prognostic significance, the case presented below, which was followed for three and a half years, is considered worthy of comment. Case Report A 52-year-old man entered the hospital on June 27, 1946, because of a painless swelling in the right inguinal region of 4 weeks' duration. Except for a history of phlebitis of the right . . .

Presentation of Case A two-year-old girl was brought to the hospital because of fever. Two months previously a furuncle in the right inguinal region was incised and drained. Subsequently, there were elevations of the temperature to 101 to 103°F., and another furuncle in the same region was incised and drained one month before admission. Despite antibiotic therapy the white-cell count, which was 23,800, with 69 per cent neutrophils, remained elevated, as did the temperature. The patient constantly flexed the right hip and resisted attempts to extend the right knee. Tenderness was present in the right inguinal region. Splinting in the . . .

The author1 has reported the occurrence of sporadic bacillemia in 17 of 20 dogs infected experimentally with virulent human tubercle bacilli (H 37). This report represents a further study of some factors in the time relationships of bacillemia in tuberculous dogs, including some of the animals included in the previous report.Dogs were injected intravenously or subcutaneously with virulent human tubercle bacilli (H 37) in a suspension of Kaolan, mineral oil, and normal saline, the doses ranging from 3 to 20 mg. Femoral arterial punctures were performed daily on all dogs, and 3 to 5 cc of arterial blood withdrawn, under sterile precautions and injected directly into guinea pigs, usually subcutaneously in the right inguinal region. Endermal tuberculin tests were done on all guinea pigs before inoculation with the dogs' blood, and at intervals up to 3 months after inoculation, when all were sacrificed and necropsied.The presence of tuberculosis was established on the basis of the characteristic pathology of i...

Mortara and Saito1reported recently that streptomycin was effective in treatment for experimental infections of rabbits with Hemophilus ducreyi. Their work suggested a clinical trial of this antibiotic in cases of chancroid. Recently 3 patients suffering from typical chancroid were treated with streptomycin at the United States Marine Hospital in San Francisco. The results of this treatment were so striking as to justify a brief report. REPORT OF CASES Case 1.— A. S., a 34 year old Negro merchant seaman, entered the hospital with a penile chancre and a tender swelling in the right inguinal region of eighteen days' duration. The patient had always been healthy except for three attacks of gonorrheal urethritis, the last two of which had been treated with "sulfa." The patient remembered that fever and a cutaneous rash appeared when he took "sulfa pills" for the second time. His present illness began with a penile lesion

Long before the pathology of appendicitis was so well pointed out by Fitz in his classical paper in 1886, the profession understood that there was a disease in or around the cecum that had a large mortality. Even the ancients recognized a fatal swelling in the right inguinal region. The appendix was recognized anatomically in the sixteenth century. The early half of the nineteenth century saw an increasing interest in the disease now called appendicitis. John Burne published two interesting articles in the 30's (1837 and 1839), and, while he was hampered by the unsurgical methods then in vogue, he shows much ready knowledge of the subject and speaks of the disease as of "frequent occurrence, always dangerous, often fatal and characterized by a train of symptoms so peculiar and marked as to render the recognition of them certain and not difficult." His first paper records eight cases, of which

T. K., male, white, set. 34 years, consulted me at my office on the evening of November 15, 1888. He complained of general malaise, with localized pain in the lower part of the abdomen towards the right side. He had a short, harassing cough. His bowels had been freely moved from some purgative pills taken the previous night. His pulse was 100, temperature 102.6°. I ordered him home and to bed at once and prescribed codeia and quinine, together with- a strict liquid diet. On the following morning (November 16), I found that he had passed a very comfortable night. A thorough examination revealed a tumor in the right inguinal region. The pulse was 80 and the temperature 100° F. Poultices were ordered. When I saw the patient again in the evening his pulse was 100 and his temperature 102°. On the morning of the 17th Dr. J. Ford Thompson

A case is described of a patient who presented initially with localized retriculum cell sarcoma which was treated by radiotherapy with complete resolution, and who has subsequently developed chronic myeloid leukaemia. The patient is an unmarried female whose only previous illnesses were episodes of pneumonia and tonsillitis in childhood. She first presented in June, 1963 at the age of 17 years with a four-week history of pain in the right groin. Clinical examination revealed a mass in the right inguinal region and this was explored surgically, four enlarged lymph nodes being found, and one of these was biopsied.

Hernia of the bladder through the inguinal canal, while rare, is a condition that must be borne in mind when operating on any hernia, either femoral or inguinal. Failure to recognize this rarity has led to disastrous results. Cooley, in Keen's "System of Surgery," says that but three cases of hernia of the bladder were encountered in a series of over 1,900 cases of hernia in patients operated on at the Hospital for Ruptured and Crippled. History. —Miss H., aged 20, first noticed a small bunch in the right inguinal region last April. This did not disappear and was painful at times, but she continued teaching school. The mass felt like a fatty growth. At times it was thought that an impulse on coughing could be felt and at other examinations no impulse on coughing could be detected

History. —R. T. was born March 31, 1908, six weeks before the end of a carefully computed term of pregnancy. He was the third child of a physician. His mother and one of his brothers had been operated on for appendicitis. Two weeks after birth his weight was five pounds and four ounces. Considering the circumstances, the child seemed normal and gained satisfactorily in weight. Thus on April 7 his weight was five pounds and two ounces and on April 11 five pounds and eight ounces. Shortly after birth a. small reducible tumor was noted in the right inguinal region, the enlargement gradually extending into the scrotum. When the child was three weeks and three days old the father called in a physician, who applied a truss with a small wooden pad, the hernia being apparently thoroughly reduced. The truss was put on about 5 o'clock in the afternoon, and

In January of the year 1598, Guilielmus Fabricius 6 treated the "noble matron Margarita a Gleresse" for a hernia with "intestinal erosion." He stated that there was gangrene in the right inguinal region and that bloody, purulent material escaped periodically from this area. However, normal bowel function continued in this patient and the fistula closed by itself after about two months' duration. Much later, in 1785, August Gottlieb Richter 17 described accurately the type of small hernia now bearing his name "which does not involve the whole canal, but only one side of the gut." At that time he admonished physicians "that since often no external protrusion appears, those ruptures may not be discovered and errors in diagnosis will result in the loss of the patients' health and possibly their lives." The question of priority of description between Littre and Richter seems to have been resolved in the English literature

Repeka, a virgin, 15 years of age, of Armenian parentage, was brought to me, July 8, 1887, from Adana, with the following history: From the first appearance of her menses till five months previous to her visit to me, the menstruation had been free and regular, and with but little discomfort. At that time she was confined to her bed with neuralgic pain in the right ovarian region. After several days of a scanty flow of menses the pain left, but returned with the menses, after forty days, at which time she noticed a swelling in the right inguinal region, which was only slightly less in size than at present. Since then her menses have been very irregular and scant, and the pain which is present, more or less, all the time is greatly increased at the menstrual period, radiating from the swelling over the whole abdomen. Three months ago

The patient, a young clerk 31 years of age, was referred for treatment of a granuloma of both inguinal regions. The groins were occupied by a mass of exuberant granulating tissue, with a foul smelling exudate. The lesions extended laterally to the wings of the ilia. In 1915 the patient had a bilateral inguinal adenitis. At this time a biopsy was performed. The lymph node showed chronic inflammation due to some infection. Between 1916 and 1920 the patient resided in Shanghai, China. In 1921, he developed a rather severe backache, for which he received orthopedic treatment, which consisted chiefly in wearing a steel brace for a year. The past history is irrelevant. The patient is married and has one child, who is perfectly healthy. The lesion began a year and a half ago as a hard, painless verrucous plaque in the right inguinal region. This began to break down centrally and a similar condition developed on the left side. Physical examination showed a rather pale young man. The general physical examination w...

To the Editor.— Skin pigmentation resulting from therapy with amiodarone hydrochloride (cordarone [Belgium]) has become well known during the last few years. 1.2 We will describe what we believe to be the first case of proliferative papillomatosis (ioderma) due to amiodarone hydrochloride therapy. A 67-year-old woman with an aortic stenosis had been treated for two years with amiodarone hydrochloride (usually in daily doses of 400 mg) and with various digitalis preparations. In October 1974, the patient came to the surgical department of Katholieke Universiteit (Nijmegen, the Netherlands) with a necrotic tumor in the left inguinal region. The tumor was removed surgically because it was suspected that it might be malignant; however, only nonspecific, granular tissue was found. Two months later, new tumors appeared—first, in the left inguinal region, at the site of the excision, and later, in the right inguinal region. The tumor in the right inguinal region slowly

In the August American Journal of Obstetrics is an article by Palmer Findley on "Foreign Bodies Left in the Abdominal Cavity." He discusses various results following the leaving of sponges in the abdominal cavity and the method by which they are eventually extruded. After relating many cases he closes with an admonition to the surgeon by all means to avoid publicity to the laity concerning these things. In this connection I report the following interesting case: On August 8, 1908, I was called to Albany, Ore., in consultation with Dr. Booth of Lebanon, Ore., and Dr. Davis of Albany, to see a case of intestinal obstruction. The patient had had a hysterectomy performed thirteen months before. There was a palpable enlargement in the right inguinal region. We all agreed that the probable condition was strangulation of a knuckle of intestine, due to postoperative adhesions. In the abdomen we found practically

S. B., a Negro, aged 24, was admitted, April 14, 1930, to the surgical services of the Cook County Hospital, Chicago, because of a swelling in the right inguinal region, vomiting, and severe abdominal cramps for the past twenty-four hours. The patient stated that he had had a right inguinal hernia for the past two years. The day before, about 2 p. m., he suddenly developed a sharp, colicky pain in the right inguinal region. An hour later he noticed a round, hard and tender mass in the same area. The pain was followed soon by nausea and vomiting, the vomitus consisting of food material and mucus. About 3 o'clock the pain had spread over the entire abdomen and was especially marked around the umbilicus. He vomited again at 5 and at 6 a considerable amount of grayish material. He tried to go to sleep but was awakened again by

THE CASE to be described is the first in the literature in which the development of carcinoma of the vulva secondary to granuloma inguinale is without doubt. There are in the literature, however, case reports of squamous cell carcinoma of the genitalia that developed at sites previously involved by granuloma inguinale, but none in which this sequence of events can go unquestioned with regard to the vulva itself. REPORT OF A CASE W. G. (No. 38-901), a 16-year-old Negro girl, was admitted to the clinic on Oct. 14, 1938, because of multiple lesions of the vulva of approximately six months' duration. The lesions were granulomatous, beefy red, and covered with a serosanguineous exudate; they involved the fourchette of the vagina, a part of the right vaginal wall, the right labium minus and labium majus, the right genitocrural fold, and in great part the right inguinal region. There were

Primary solid tumors of the epididymis are rare, Among those of malignant type carcinoma is particularly infrequent, there being comparatively few verified cases of this kind reported in the literature. Having recently seen a case of the latter type, I thought that it might be of interest to put it on record. The particulars of this case are as follows: REPORT OF CASE History. —A man, aged 22, came for relief of pain in the right inguinal region and because of swelling of the right testis. Fourteen months before the right testis had been severely injured while he was playing football. Eleven months previously he had developed a pain in the region of the right inguinal ring. This pain was dull and fairly constant, and did not radiate except to the scrotum. Six months before the right side of the scrotum started to swell, increasing gradually in size until at

Patient. —A Chinaman; aged 64, a laborer, for the past fifteen years had been troubled by a rupture which had gradually increased in size. On several occasions there had been difficulty in reducing the contents, but he had always finally succeeded. He had never used a truss. Four days previous to his admittance to the hospital, the swelling had increased in size and he had been unable to reduce it. He had suffered considerable pain. The bowels had moved once. According to the patient's statement, which was corroborated by that of his friends and relatives, he had not vomited at all. Physical Examination. —The patient was a fairly well-nourished man; pulse was 120; temperature 101; respiration embarrassed. The abdomen was greatly distended and tympanitic. The right inguinal region showed a tense, tender swelling involving the right side of the scrotum. The skin over the swelling was reddened and edematous. There

This case is reported to call attention to a condition which sometimes confronts the surgeon at the time of operation. Inguinal hernia is spoken of as either single or double, the latter term meaning bilateral. I think the term "bilateral" is preferable to "double" because in this case the hernia was unilateral, being on the right side, but at the same time it was both direct and indirect, and hence, in one sense, it was double. The patient was a man about 48, and was first seen May 24, 1915. His occupation was engineering, principally drafting. He was thin, and had a very nervous disposition; otherwise he had been fairly well. About six weeks prior he had noticed a bulging in the right inguinal region. This bulging had increased in size following an afternoon of unusual effort in lifting. No general symptoms followed the occurrence of the bulging except that

It is not surprising to find tinea circinata in one or several adult members of the families of children suffering from tinea capitis caused by the genus Microsporum. The following case is reported because of the unusual site of an infection with Microsporum audouini in an adolescent, presumably contracted from her young brother, who had tinea capitis. REPORT OF CASE D. M., a 17-year-old girl, was first seen by us on March 17, 1953. She presented circinate to imbricate lesions on the mons veneris. There were satellite lesions on the lower abdomen with a tendency to spread toward the right inguinal region (Figure). The disease was of three months' duration and had been unsuccessfully treated with various ointments. Examination under filtered ultraviolet light revealed bright-green fluorescence of the pubic hair. The scalp, axillae, and the rest of the body were free of infection. Microscopically, hairs from the pubic region showed

TORSION of the testis in a case of intersexuality is of sufficiently rare occurrence to warrant publication. The present case may fit the category of male pseudohermaphroiditism labeled by Howard1as adenoma tubulare and most recently described by Schneider and co-workers2in familial form, or it may be an example of true hermaphroiditism. REPORT OF CASE A 50-year-old female farmer was sent to the hospital with the diagnosis of incarcerated hernia. She had never menstruated but had married and had intercourse, without sexual desire. Of great significance is the fact that the patient had three sisters who never menstruated and had not married. Since childhood the patient had been suffering from a "small hernia" in the right inguinal region, which once, 12 years previously, had become incarcerated, with severe pain, and which subsided after manipulation. In the morning of the day of hospitalization, while hard at work in

History. —J. T., aged 17, had had an undescended testicle in the lower end of the right inguinal canal since a baby without producing any symptoms. On July 13, while walking along a railroad track he stumbled and fell forward. In attempting to catch himself he felt something give way in the right inguinal region, but after resting for a few minutes, during which time he vomited once, he was able to walk to his home half a mile away. During the next two hours he vomited several times and had a great deal of pain in the region of the undescended testicle which had increased to twice its normal size. When seen three hours after the injury a diagnosis of strangulated hernia was made and an unsuccessful attempt made to reduce it under anesthesia. Immediate operation was then performed.

Patient, aged 28, married for seven years, came to the hospital for treatment for hypospadias and the removal of a mass in the right inguinal region. He said he had never had intercourse but had had sexual desire with erections and emissions. Facial hair was entirely lacking (not so remarkable, however, as the Koreans have very scanty beards as a rule) and the expression of the face was as much that of a woman as a man. He had a strong muscular frame, being accustomed to doing ordinary coolie labor. The breasts were as large as those of a young virgin and the hips were broad. Examination revealed a penis about 2 inches long with well-developed glans and corona and loose foreskin and a penile hypospadias with the meatus about 1 inch back of the tip of the glans. The scrotum was normal. On the left side was a normal

Dr. A. W. Miller, Aug. 1, 1923, referred for examination to me a boy, aged 2 years, who had a large swelling in the scrotum and right inguinal region. The child appeared to be very sick and was vomiting frequently. The pulse was rapid and of good volume, the temperature was normal, and the abdomen was slightly distended. An attempt to reduce the hernia was unsuccessful. The mother reported that incarcerations had occurred at other times, which had been reduced by manipulation; this, however, was the first time that the child had shown such a sick appearance. On account of the irreducible strangulation, an immediate operation was advised. The patient was admitted to St. Francis Hospital, and under ether anesthesia, a classical incision was made, exposing the constriction near the internal inguinal ring. The contents of the sac, however, could not be reduced. The sac was dissected free from the