1917 Journal of the American Medical Association  
We have followed the foregoing routine in over 200 cases, and I feel justified from the uniformity of our observations in stating that if the test shows the immune mechanism to be intact, operative treatment is indicated. Conversely, if the test shows the immune mechanism to be destroyed, operation is useless except for palliative reasons. Again, I believe that operation is best performed when the percentage of large mononuclear cells is high, as metastasis is less liable to occur from the
more » ... occur from the operative handling if the anticancer ferment is active when the operation is performed. One more word concerning the value of this test: It is a valuable prognostic aid. After complete destruction of the immune mechanism, which may occur occasionally when the initial tumor is small, the progress of the disease is always rapid, and operation in such cases is usually followed by rapid general metastasis, while many cases, apparently far advanced, will respond to stimulation of the immune mechanism. Such patients always live much longer than the phy¬ sician anticipates, unless he is particularly guarded in his prognosis. It is this class of case, with the alter¬ nating periods of retrogression and advancement of growth, that furnishes the fruitful field for the work of the charlatan, since the temporary benefit observed from Nature's efforts is usually attributed to whatever medication is being used at the time. ABSTRACT OF DISCUSSION Dr. Henry Schmitz, Chicago: I made the assertion some time ago, and again here in discussing Dr. Levin's paper, that in the study and treatment of carcinoma we should take into consideration the leukocytic and the differential white blood corpuscle count. By these the value or uselessness of dif¬ ferent therapeutic measures could be shown. If, for example, following the use of a certain therapeutic measure, there were a decrease in the red and the white blood count, we should wait until the blood returned to normal before making another attempt to treat the patient. If the decrease persists, further treatment would be useless. This is specially true in the radium and roentgen treatment of cancer. Persistence of leukopenia indicates the hopelessness of the treatment. Addi¬ tional exposures to the rays merely render the patient and the tumor worse. I therefore feel that the observations of Dr. Vaughan are of inestimable value, not only in the determina¬ tion of operability, and the prognosis of surgical treatment of carcinoma, but also of the palliative treatment. On my return home I shall immediately begin a study of my work from Vaughan's standpoint and see whether I can substantiate his deductions. Dr. Samuel W. Bandler, New York: I am delighted to hear the word immunity introduced in the study of carcinoma. I believe the preventive study will be along the line of immunity-determining why some of us have it and others do not. It would be interesting also in families to study whether the tendency to carcinoma is a characteristic of more than one member of the family or only of the person who has the disease. I have known histories in which the father has had carcinoma, in which three children have died in infancy ; one adult child of that father has tuberculosis; another adult daughter has carcinoma of the stomach at the age of 37 ; another adult daughter has carcinoma of the colon at the age of 34. Circumstances such as that point absolutely to a lack of resistance in that family, which takes the form of car¬ cinoma in the majority, of tuberculosis in one, and death in infancy or childhood in the others. It would be interesting to see in these cases whether there is a familial change in the blood and in the relation of the cells in other members of the family than the one with carcinoma. I would ask whether Dr. Vaughan has made studies of the same sort in benign tumors of various parts of the body, pointing to immunity in one individual and a lack of it in another. In women who have been pregnant we find in a certain proportion the devel¬ opment of hydatid mole, or an overgrowth of cells which are supposed to atrophy and disappear, showing a lack of protec¬ tion or resistance in that individual. Dr. J. Walter Vaughan, Detroit: The only studies we made with benign tumors were in making extracts from the tumors and testing out their power to increase the per¬ centage of large mononuclear cells. The more the tissue cells revert to embryologie type, the higher the increase-from 6 to 10 per cent. I am glad that the point has been brought out that the repeated differential blood count is of the utmost importance and gives us more aid clinically than any other examination.
doi:10.1001/jama.1917.02590500036009 fatcat:d3misusvkzgqpc2545wcn42qou