INTERNATIONAL MEDICAL CONGRESS. REPORT BY COLLECTIVE iESMi COIIITTEE. 111 NORWEGIAN MEDICAL ASSOCIATION * - % * ON THE ETIOLOGY OF RICKETS. ACUTE RHEUMATISM. CHOREA. CANCER. URINARY CALCULUS. (hristiania. Printed by Tie Steen. {BB7. INTERNATIONAL MEDICAL CONGRESS. REPORT BY COLLECTIVE iEMTiCDIHIITEE IF TIE NORWEGIAN MEDICtI Billi, n « ON THE ETIOLOGY OF RICKETS. ACUTE RHEUMATISM. CHOREA. CANCER. URINARY CALCULUS. (hristiania. Printed by Th. Steen. *BB7. question of collective investigation in Norway, similar to what already has been established in England and Germany, was first brought before the Norwegian Me- dical Association in Christiania at a meeting on the 12th September 1883 by Dr E. Bull. The question having been discussed at that and the following meeting on the 26th of the said month, it was determined to appoint a preparatory committee, to which on the 10th of October Drs C. Larsen, E. Bull, E. Winge, H. Heiberg and Lochmann were elected. The proposals of this committee were reported to the meeting held on the 27th February 1884 and gave rise to a further discussion, the result being, that it was determined to appoint a permanent committee consisting of 10 members, to be elected for 5 years, in order to promote collective investigation amongst Norwegian medical men. At a meeting held the 26th March a committee consisting of 10 members was elected, the following gentlemen being chosen; Drs Bidenlcap, C. BoecJc, E. Bull, 0. B. Bull, A. Keren, Lochmann, Nicolaysen, Schbnherg, Wulfsberg and E. Winge. At the International Medical Congress held in Copen- hagen August 1884 it was resolved, as is known, to endea- vour to establish international collective investigation, and 4 for this purpose an international preparatory committee was appointed, to which Dr E. Bull was elected as Norwegian representative. The 2nd October 1884 the Norwegian committee of ten members for collective investigation was constituted and elected Dr E. Bull as chairman. It was then determined to proceed with the investigations proposed by the inter- national committee concerning the etiology of Rickets, Acute Rheumatism, Chorea, Cancer, and Urinary Calculus. In a series of meetings the practical question of arranging the furtherance of the enquiries was discussed, and Dr Bidenkap and Prof. Schonberg were instructed to revise the replies received concerning Rickets, Drs C. Boeck and E. Bull to revise acute Rheumatism and Chorea, Prof. E. Winge Cancer, and Prof. Nicolaysen Urinary calculus. The preliminary expenses attending the investigations were undertaken by the Norwegian Medical Association. On a representation from the committee, the Storthing (Parli- ament) in 1886 voted a sum of 1000 kroner in order to complete the investigations and publish the obtained results. An additional light may be thrown on the results obtained by mentioning, that according to the official list of 1886 there were a total of 629 authorised practitioners in Norway. This number must however be reduced by at least 100, where the question arises of contributing to collective investigation, as some have gone abroad, others are old and have retired from practice, others have but lately become qualified and have not as yet commenced work on their own account, while others have appointments, which prevent them from practising. In reality however this number is too small, so that it may be assumed, that 5 there are about 500 practitioners, who are in a position to contribute to the investigations, of which we now treat. The number of those, who have in reality contributed to the following reported results, must therefore be judged from comparison with these figures. Report on the investigations about some points concerning the etiology of Rickets by Dr L Bidenkap and Prof. £ Schonberg. 1. Replies have been received from 75 practitioners, which include the following- number of cases: In 1882 112 - 1883 145 - 1884 116 - 1885 - 131 - 1886 111 Total 615. Of these cases there occured in towns in the years, 1882 54 1883 92 1884 62 1885 81 1886 70 Total 359. 7 In the country 1882 58 1883 53 1884 54 1885 50 1886 41 Total 256. In the three largest towns in the Kingdom the follow- ing numbers were observed: Christiania. Bergen. Throridhjem. 1882 18 2 6 1883 65 0 4 1884 42 2 3 1885 36 6 5 1886 44 0 10 Total 195. 10. 28. Further particulars of the number of cases mentioned as having occured in 1885, and 1886: Sex. Males 145. Females 97. Total 242. The stated ages of 236 patients. o—60—6 months, ...... 15 6 months and under 1 year, 45 1 year «• « IVa years, 73 IV2 years « « 2 « 47 2 « « « 2V2 « 31 2x/2 « « « 3 « 10 3 « « « 4 « 6 4 « « « 5 « 3 5 « « « 6 « 2 8 6 years and under 7 years, 2 8 « « « 9 « 1 13 « « « « « 1 2. Only in two cases was there clear proof of syphilis in the parents; in the one case both parents had suffered from syphilis but neither the time nor symptoms are men- tioned; in the other case three years previously the father had suffered from a syphilitic rash and affection of the throat. 3. In 7 other instances there were appearances, which indicated, that some of the parents had suffered from syphilis, in which the probable date of the syphilitic affection is reported in 3 cases, of which: The father had syphilis 18 years previously without any further account of symptoms 1 The mother syphilis 4or 5 years previously . . . . 1 The mother, whose children suffered from ulceration of the nose, infected by a syphilitic vagrant. . . 1 In the other instances the date of the suspicious symptoms is not given, and these only in two cases, namely; The father suffered from tertiary syphilis 1 The mother from a psoriasis like exanthem 1 4. The period of suckling of children is given in 183 instances, who left off taking the breast as follows: under 6 months 23 over 6 months and under 1 year . 50 « 1 year « « IV2 years 58 « 11/*I1/* years « « 2 « 29 « 2 « « « 2 x/ 2 « 20 « 2V2 « « « 3 « 3 26 children had not been suckled. 5. Information concerning the sufficiency of the food since weaning was obtained in 112 instances, of which in 100 cases it is described as sufficient, in 12 as insufficient. 6. Concerning the condition of the food since weaning a report is made of 131 cases, in which 74 are reported as good, 37 as unsatisfactory. The unsatisfactory condition of the food is most often said to have been from its containing too much amylacea, occasionally too much fat, and that it did not consist of sufficient milk. 7. An account of the age of the parents is given in 167 instances, which is reported further on page 11. 8. Replies to the question concerning any definite cause, to which the illness might be attributed, have been received in 111 instances, which may be classed as follows: Consumption in both parents 1 « « the father 4 « « « mother 5 « and in the family 10 Both parents sickly 4 Mother of a weak constitution *... 11 « ill when pregnant 3 « elderly 1 Father « 1 Grandfather leprous 1 Mother suffering from rickets 1 Father « « « 1 « a drunkard 1 « a lunatic 1 Father suffering from chronic rheumatism 1 Mother repeated abortions 1 10 Consanguinity ot the parents . 1 Mother bleeding from the womb after parturition . . 1 Mother hydrorrhoea uteri during pregnancy .... 1 Twins 2 Prematurely born 3 Want of suckling and to early weaning 10 Over nursing . . 1 Dentition . 1 Unhealthy quarters 18 Too little exposure to fresh air 4 Unsatisfactory sanitary arrangements on the whole Indigestion 2 Chronic diarrhaea 7 Appearance of rickets after scarlet fever ..... . . . 1 Appearance of rickets after 2 « « « « whooping cough .... 3 « « « « itch 1 « « « '< acute gastritis 1 11 Years. Age of father. 25-80 30-35 35-40 40-45 45-50 30-35 35-40 50-55 40-45 65-70 60-65 55-60 70-75 55-60 35-40 50-55 50-55 Age of mother. 20-25 20-25 25-30 30-35 25-30 25-30 30-35 40-45 35-40 40-45 40-45 45-50 50-55 35-40 20-25 35-40 20-25 Total 9 8 11 12 2 23 19 4 2 1 2 2 1 1 ' 2 3 1 Years Age of father 35-40 30-35 40-45 45-50 20-25 25-30 Age of mother do. do. do. do. do. do. Total 13 13 5 2 1 11 Years. Age of father 20-25 26-30 30-35 35-40 35-40 25-30 40-45 30-35 20-25 Age of mother 30-35 30-35 35-40 40-45 45-50 35-40 45-50 40-50 25-30 Total 3 3 2 2 I 4 2 1 1 The father older than the mother 103. The father younger than the mother. 19. The parents of equal age. 45. 12 The reports of the mentioned cases of rickets were received from the following medical men; Augestad, (Tin & Gran). Berner, (Christiania). Binne- halle, (Sundal). F. Blich, (Arendal). P. Blich, (Do.) Blomberg, (Christiania). U. Bugge, (Eingsaker). E. Bull, (Christiania). P. Conradi, (Selbu). Dannevig, (Tonsberg). C. Dietrichson, (n. Fron). Drejer, (Aasnaes). Denim, (Elverum). Eger, (ostlofoten). Engh, (Indre Sogn). Gjestland, (Tysnaes). Glatved, (Drangedal). Graarud, (Holmestrand). F. Gren, (Christiania). Hartwig, (Kragere). Heimbeck, (Langesund). Henriksen, (Trygstad). Hoel, (Biri). 0. Holm, (Christiania). J. M. Holmboe, (Trorase). J. W. Holmboe, (Holden). F. Holst, (Tin). J. C. Holst, (Drammen). C. Holtermann, (Fredriksstad). Herbye, (Christiania). Johannessen, (Bae- rum). J. Johnsen, (Sarpsborg). Jensberg, (Henefos). E. Kaurin, (Molde). Kielland, (Trondhjem). Kinck, (Ytre Har- danger). Kjaer, (Lorn). Kittel, (Arendal). Kienig, (Chri- stiania). Knutssen, (Hof, Solor). Kolbjernsen, (S.Land). Kruger, (Midthordland). Hj. Lindboe, (Christiania). Lin- deman, (Eingsaker). F. Lund, (Trondenaes). J. Lossius, (Farsund). A. Martens, (Bergen). Meyer, (Midtre Sogn). J. F. Nielsen, (Karmeen). P. E. Nilsen, (Trondhjem). Ant. Olsen, (Jevnaker). Oxholm, (Mandal). E. Eanders, (Aale- sund). Eummelhoff, (Eiser). Scheel, (Christiania). Schou, (Indre Sendfjord). Schelderup, (Trondenaes). L. W. Selmer, (Surendal). H. F. Smith, (Molde). Sommerfelt, (Spydeberg). J. G. Stang, (Sandnaes). Steren, (Gran). Synnestvedt, (Eollag). Sedring, (Aalesund). H. J. Vetlesen, (Hamar). Wiesener, (Bergen). J. W. Wille, (Melhus). Besides these, a report from the out department of the Christiania Lying- in Hospital has been received. Reports from the following’ practitioners, who have not treated any case of rickets with bent bones during the years 1882—1886, have been received; Birch, (Holmestrand). Chr. Bull, (Evje). Frost, (Vos). J. M. Heidenreich, (Opdal). J. W. Holm, (Nses, Hedemarken). Bolter, (Eker). A. Selmer, Balsfjord. 14 Report on the investigations concerning some points in the etiology of Acute and sub-acute Rheumatism by Drs C. Boeck and E. Bull. The subsequently named 94 practitioners as well as the 2 medical departements of the National Hospital have in the years 1882—84 treated the following1 number of cases of acute and sub-acute rheumatism: In 1882 388 cases *) « 1883 469 « 1884 467 9 For comparison with these figures the number of eases of rheuma- tic fever throughout the whole of Norway is added, which according to the official medical reports were in 1882 2.801 cases « 1883 2.724 « 1884 3.005 15 The number of cases reported on in the named 96 forms of questions for the years 1885—86 amount to in 1885 523 cases « 1880 450 Total 973 cases. These 973 cases therefore form the basis for the collective investigation, undertaken in this country, concer- ning the etiology of rheumatic fever. will be seen from the following table: The appearance of the disease as regards the seasons January 113 cases February.... 97 March 112 April 107 May.... ... 112 June.. 76 July 72 August 55 September... 43 October 41 November... 69 December ... 76 Total 973 cases As will be seen, with the exception of February, the number of cases for the first 5 months of the year have 16 been about equal. From June the number decline some- what suddenly in the following months and gradually decrease until and including October. In November and December the numbers again increase. The maximum of cases occur in January, and the minimum in October. *) The sex is stated in 968 cases: Males 447. Females 516. The ages represented in these 963 cases will be seen from the following table. Years. ♦ 1 0-1 1-5 5-10 10-15 15-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 Total. Males 1 7 37 52 66 117 70 42 33 14 7 1 447 Females... 0 1 28 52 73 178 82 89 37 22 6 3 516 Total both sexes.. 1 8 60 104 139 295 152 81 70 36 13 4 963 This table appears to indicate in an interesting man- ner, how males under 10 years of age are much more subject to this complaint than females of the same age. Of the l) According to the official medical statistics the minimum number of cases of rheumatic fever generally occur partly in August and partly in September. 17 number of individuals attacked under 10 years of age the males number 65 per cent. In those cases, which occurred under 5 years of age, the comparison will be seen to be still more striking. Between the ages of 10 and 15 an equal number of both sexes have been attacked, whilst between the ages of 15 and 20 the number of females at- tacked has somewhat exceeded the males. Between the ages 20—40 a comparatively larger number of women have been attacked than men. The greatest difference in the number of cases, as will be seen, occurs between the age of 20—30. Between the ages 40—60 the cases again become more equal in both sexes, whilst in females over 60 years the numbers are again somewhat more. The colour of the hair and iris is given in 870 instances. The comparison will he seen from the fol- lowing table. Pair. Dark. Individuals- with dark hair & blue or grey iris. Individuals with light hair and brown iris. Males 226 78 92 1 Females 263 101 108 1 Total 489 179 200 2 18 The question; Has the patient’s father or mother ever had acute or sub-acute rheumatism? has been replied to concerning 682 cases. The father has been afflicted in 57 instances « mother « « « « 59 « In 4 of these instances both parents have been afflic- ted. Thus in 112 cases out of 682 one or other or both parents have suffered from rheumatic fever. 16.4 per cent. The question: Have any of the patient’s brothers or sisters suffered from the same illness? has been replied to concerning the same 682 cases, the result being, that in 95 instances one or more brothers or sisters have suffered from acute or sub-acute rheuma- tism about 14 per cent. It deserves maybe to be especially mentioned, that in 24 instances as well the parents as well as one or more of the brothers or sisters had suffered from rheumatic fever. The question; «Has the patient’s father or mother or any of his brothers or sisters ever had true gout? has been replied to concerning 720 cases; The father had suffered from gout in 6 instances. The mother « « « « « 2 19 It is also stated, that in 3 instances the patients them- selves have suffered from gout. It must he stated, that in Norway gout is a comparatively rare disease. The question: Have any of them ever had any nervous dis- ease, such as Chorea, Epilepsy, Migraine, Loco- motor ataxy, Insanity &°? is replied to concerning 655 cases, and of these in 512 cases in the negative. Nervous affections therefore prove to have appeared in the nearest relations in 143 cases out of 655 = 21.83 per cent. The most prevalent nervous affections in the parents and brothers and sisters appear to be migraine and insa- nity. To a less frequent extent neurasthenia, cephalalgia, epilepsy, hysteria and chorea. Cases of asthma, loco- motor ataxy, diabetes, morbus Basedowi and paralysis agitans occurred but occasionally in the nearest relatives. Migraine occurred in the father in 6 instances, in the mother in 19, in the brothers and sisters in 14. - In both pa- rents and brothers and sisters in 3 instances.x) In the relatives, without further particulars as to which of them, in 2 instances. Thus the cases of migraine in the nearest relatives amount to 41 = 6.25 per cent. In 7 cases the patients themselves are reported as suffering from migraine, and in 4 instances this illness has appeared both in the patient and his or her nearest relatives. 9 The 8 cases are also included amongst the previous 39 cases, and this also applies to the following complaints, where both parents and brothers and sisters have been attacked by the illness. They are there- fore not included in the totals. 20 Mental disease occurred in the father . . in 6 instances. « « « « mother « 6 « « « « « brothers & sisters « 22 « « « « « both parents and brothers and sisters « 2 « « « « « the relatives with- out special men- tion concerning which « 1 instance. « «was observed in the patient in 1 instance. Thus mental disease in the nearest relatives occurred in 35 cases = 5.34 per cent. Neurasthenia occurred in the father .... 5 instances. « « « « mother.... 8 « « « « « brothers & sis- ters 4 « « « « « both parents brothers & sis- ters 1 instance. « « « « the nearest re- latives without any special men- tion 1 « Therefore in the nearest relatives in 18 cases 2.75 per cent. Cephalalgia has been observed: « in the father in 1 instance. « « « mother « 8 instances. « « « brothers & sisters. . . « 3 » 21 Cephalalgia in the nearest relatives, but without further enligh- tenment as to who they were in 1 instance. Therefore in the nearest relatives in 13 cases = 1.98 per cent. Epilepsy occurred in the father in 3 instances « « « « mother « 3 « « « « « brothers & sisters« 7 « « « « « both parents and brothers and sisters in 2 « Therefore epilepsy in the nearest relatives in 13 cases -= 1.98 per cent. It is reported besides, that the patient suffered from epilepsy in 2 cases, and both patient and relatives in 1 case. Hysteria occurred in the mother in 7 instances. « « « « brothers & sisters in 1 instance. » « « « patient « 1 « Chorea occurred in the brothers and sisters in 6 instances. « « « « patient «.5 « « « « « both patient and relatives . . . « 1 instance. Convulsions have been reported in the brothers and sisters in 3 instances. « « « « « « patient 1 instance. Asthma has been reported in the father in 1 instance. « « « « « « mother « 1 « Locomotor ataxy has been reported once in a brother, diabetes once in a father, morbus Basedowi once in a mother, paralysis agitans once in a father. 22 Has the patient during the month proceeding the outbreak of rheumatism suffered from any disease, especially angina? The question; has been replied to concerning 950 cases. In 236 of these angina had in the course of the previous month proceeded the outbreak of rheumatic fever, thus in 24.84 per cent. One country practitioner, who of all those in the country, who have taken part in the collective investigation, has treated the greatest number, 45 cases, of rheumatic fever in the years 1885 and 86, points out, with respect to the relations between rheumatic fever and angina, that he, at the same time as the unusual outbreak of rheumatic fever, also had real epidemics of angina follicularis in his district. He points out besides, that angina not only appeared most fre- quently in the confined limits of his district, where the greatest number of cases of rheumatic fever also occurred, but that these two diseases likewise corresponded with each other as regards time, as the greatest number of cases in both in- stances occurred during the first months of 1885 and in the last months of 1886. In 28 of his 45 cases of rheumatic fever angina had preceeded the disease during the course of the month previous to its appearance. When the special form of the preceeding angina has been stated, the most frequent has been that of angina follicularis s. lacunaris, but phlegmonous angina and abscess in the tonsil has also been mentioned. Next to angina, the most frequent illness preceeding the rheumatic fever has been bronchitis, which is reported in 14 cases, after which comes erythema nodosum in 9 23 cases, scarlatina in 7, gonorrhoea in 4, diarrhoea in 3, urticaria, erysipelas, pituita, pneumonia, morbilli and abscess of the breast each in 2 cases, and varicellse, parotitis, herpes zoster, impetigo, panaritium, gum boil, cystitis, distorsio pedis, and hydartrus genu, each in 1 case. One practitioner in instances, proceeded by angina, observed the rheumatic fever complicated partly with erythema nodosum, partly with peliosis rheumatica and urticaria. The next question is: Can you in each case state approximately the height above the sea, lake, or valley? The height above the sea has been stated concerning 800 cases, and the result will be seen from the following table. Up to 25 Metres Metres above the sea. 25-50 50-100 100-150 150-200 200-800 372 49 74 62 58 70 Me tre s Total. 300-400 400-500 500-600 600-700 700-800 1000 37 21 28 19 9 1 800 From these figures it is impossible to arrive at any de- finite result concerning the influence, which a greater or less height above the sea exerts over the etiological features of this disease, as we are not in possession of any ac- curate information concerning the population at the various heights above the sea. So much however can be said, that 24 the disease in this country appears at every elevation, where people dwell. One practitioner states thus, that in one of the previous years he had treated 2 cases, which had occurred at a height of from 1100—1200 metres above the sea. As will be seen, the number of cases decrease somewhat suddenly at a height exceeding 300 metres above the sea, but at such a height the population certainly decreases considerably. Neither does the circumstance, that so many cases comparatively occur up to a height of 6—700 metres above the sea, indi- cate, that a considerable elevation above the sea in any de- gree decreases the liability to the disease. The great number of cases, which have occurred amongst those living at a less height than 25 metres above the sea, must be ac- counted for by the considerable coast population, and especi- ally the situation of all our large towns, which lie but a few metres above the surface of the ocean. As it was thought, that the height above the valleys, lakes and rivers might also possibly be of consequence as to the etiology, the question as regards the heights was put in the said form; and as regards this the following sta- tistics have been obtained. On the banks of From a few Metres lakes and rivers, and bottom of the valleys. metres to 25 metres above the sea. 25-50 50-100 100-150 Lakes 22 14 19 21 17 Rivers 22 35 8 5 3 Valleys .... 22 8 4 9 7 Total 66 57 26 35 27 25 Metres 150-200 200-300 300-400 400-500 Total. Lakes 5 6 3 2 109 Rivers - 1 - - 69 Valleys 8 8 1 2 64 Total 8 15 4 4 242 As will be seen from this table, the cases diminish somewhat suddenly at a height of 150 metres above a lake. but it must be pointed out, that the greater number of cases, in which the height above the lake has been mentioned, have occurred in the districts surrounding 2 of our largest lakes, Mjosen and Randsfjord, which both lie at a height of about 150 metres above the sea. Again at a height of 150 metres above the surface of these lakes, an elevation above the sea is attained, at which the population diminishes to a very considerable extent. The next question is: Can you in any case point out any spe- cial circumstances concerning the localities, where the disease has appeared? (Dampness of the soil, state of the dwelling, apartments in the cellar, the stories, and whether on the sunny or shady side). The question concerning the greater or less dampness of the soil has been replied to concerning 226 cases. 26 The soil is described as dry in 76 cases. « « « « « damp « 150 « The question concerning the state of the residence has been replied to concerning 295 cases, which have been described as: Good • . in 94 instances. Bad « 105 « Dry « 34 « Damp « 62 « Eleven of these residences have been besides specially pointed out as having no cellars, but resting entirely on the ground. Dampness thus appears to play a considerable part both concerning the nature of the soil and the residence. The materials, of which the house is built, is given in 23 instances; of these 18 occurred in wooden, and 5 in brick houses. In those cases, where the situation of the apartments towards the sunny or shady side is given, there were on the sunny side 112 cases. « « shady « 64 « thus quite contrary to what one would have expected. •The stories are stated concerning 152 instances in the cellar 2 cases « « ground floor .... 83 « « « first « .... 43 « « « second « .... 21 « « « third « .... 3 « In 34 instances «unhealty work places* is given as the most probable etiological feature, and damp- ness again, it appears, plays not a small part. 5 indi- viduals became affected on board ships, others have had 27 work to do with fish, floating of timber, lumbering work in peat mosses, in wet woods. Others again have laboured in damp cellars in dairies, in the basement story, in saw mills &%. Finally it may also be pointed out that in 1885—86 in no less than 15 houses 2 or more eases of rheumatic fever have broken out, as a rule within a short time of each other. In 1 house .... 5 cases occurred « 2 houses .... 3 « « in each « 12 « .... 2 « « « As regards 2 of the houses, in which during 1885—86 rheumatic fever occurred, it is shown, that the disease had also appeared there during the two previous years. It is also interesting to observe, how the disease occasionally can specially affect one individual group of closely situated houses. Thus one practitioner from one of the country districts relates, that a young man suffering from rheumatic fever was removed to his father’s residence in the country on the 6th Feb. 1885, and that his sister, who attended him, was attacked by the same disease on the 22nd of the same month. In the neighbouring house 2 indi- viduals were attacked by rheumatic fever on the 12th of March, and the 20th of the same month respectively. Furthermore in the neighbouring house to this latter one one individual was attacked by rheumatic fever on the 13th June 1885. On the 15th of March 1886 another case occurred in the centre house of the three, and in a house exactly opposite an individual was attacked on the 10th of August 1886. The same gentleman reports two other cases in which in two adjoining houses within the space of V/a months a case occurred in each of them. 28 The following practitioners have taken part in the collective investigation concerning the etiology of rheumatic fever: Augestad, (Grain). H. Berner, (Christiania). H. Birch, (Holmestrand). F. Blich, (Arendal). P. Blich, (Arendal). Blomberg, (Christiania). J. Boyson, (Skien). U. Bugge, (Eingsaker). Chr. Bull, (Evje). E. Bull, (Christiania). M. Beckman, (Throndhjem), T. Conradi, (Selbu). Danne- vig, (Tensberg). C. A. G. E. Dietrichson, (Nordre Eron). Drejer-Aasnses, (Soler). Derum, (Elverum). Chr. Eger, (Kabelvaag). C. A. Engh, (Indre Sogn). J. Frost, (Yosse- vangen). Gladtved, (Drangedal). G. M. K. Graarud, (Holmestrand). A. F. Gren, (Christiania). Klaus Hansen, (Bergen). Hartvig, (Kragere). J. M. Heidenreich, (Opdal). Heimbeck, (Langesund). Th. Henriksen, (Trygstad). Hoel, (Birid). J. Hoffmann, (Sandnses). J. W. K. Holm, (Naes, Hedemarken). O. Holm, (Christiania). J. Holmboe, (Tromse). J, AY. Holmboe, (Gvarv). M. Holmboe, (Eotvold). F. Holst, (Tinn). J. C. Holst, (Drammen). C. A. Hotter, (Hougsund). C. N. Holtermann, (Fredrikstad). C. L. E. Herbye, (Christiania). A. Johannesen, (Baerum). O. Johnsen, (Sarps- borg). • Jensberg, (Henefos). E. Kaurin, (Molde). Kinck, (Strandebarm). F. Kittel, (Arendal). C. Kienig, (Christiania). C. S. Kjelland, (Throndhjem). C. A. Kjaer, (Lorn). K. J. A. Knutssen, (Soler). Kolbjernsen, (Sendre Land). Kruger, (Sendre Midthordland). J. Langberg, (Aas). H. Lindboe, (Christiania), H. Lindemann, (Eingsaker). J. E. Lossius, (Farsund). J. C. Lund, (Hedemarken). Ivar Lund, (Tronde- naes). A. Martens, (Bergen). H. Meyer, (Sogn). E. Mohr, (Tromse). Chr. Munch, (Christiania). B. M. Muller, (Eeros). E. Nielsen, (Stegen). J. F. Nielsen, (Yigsnaes). K. E. 29 Nilssen, (Frosten). A. Olsen, (Ringsaker). Oxholm, (Mandal), E. Randers, (Aalesund), H. Rogge, (Fredrikshald). Th. Roll, (Christiania). Rnmmelhoff, (Riser). Chr. Romcke, (Halling- dal). A. Sclieel, (Christiania). C. A. Schjelderup, (Tronde- naes). Chr. Schmidt, (Sandvigen). Chr. Schou, (Forde). O. Schoyen, (Ytre Namdal). L. Selmer, (Surendal). H. F. Smith. (Molde). Sommerfeldt, (Spydeberg). Sontum, (Lyng- dal). Sodring, (Aalesund). J. H. G. Stang, (Sandnses). R. Steenstrnp, (Fredrikswsern). D. Synnestvedt, (Rollag). R. Torkildsen, (Bergen). H. J. Time, (Christiania). H. J. Yetlesen, (Hamar). Wiesener, (Bergen). Wildhagen, (Dram- men). W. Wille, (Melhus). P. Winge, (Christiania). Besides these the replies received from two practitioners were not signed. Finally reports have been received from the two medical departments of the National Hospital. 30 Report on the investigations concerning some points in the etiology of Chorea by Drs C. Boeck and £. Bull. The list of questions forwarded to the medical practitio- ners throughout the country, concerning some points in the origin and cause of chorea, has brought in 86 replies from practitioners besides reports from the medical departements of the National Hospital, and the Lying-in Hospitals Policli- nical Institution for diseases of children. Of the said 86 replies, 20 are of no real value as answers to the question, as they only illustrate, that chorea has not been observed by the gentlemen concerned, during the years 1882—86, and thus indicate, that chorea must be an excessively rare disease in their districts. The other 66 forms, as also those received from the National Hospital and the Policlinical Institution for diseases of children, contain replies to all or some of the questions, and from a comparison of these replies the following results have been derived. 31 According to the answers received choreahas been observed in 1832, 1883, 1884, 1885, 1886 in 25 cases, 27 cases, 30 cases, 76 cases, 62 cases. From these figures however, it must not be presumed that in the years 1885—86 chorea appeared to any greater extent than the previous years. The reason of the observations being so much more numerous in the last two years, will partly be found in the fact, that various colleagues, who have sent in replies, only began work on their own account during the last 2—3 years; and partly, because the request to take part in collective investigation, which was sent out about 2Va years ago, has caused a more careful record to be kept of all the cases, which appear, than previously. basis of the present report. The 138 cases during the years 1885—86 form the In 136 of these the month is stated, in which the doctor first observed them; it will thus be seen that these took place in: January in .... 11 instances February 16 « March 17 « April 13 « May 17 « June 9 « July 8 « August 10 « September 6 « October 5 « November .... 13 « December 11 « 136 instances. 32 The age and sex are given in all these cases. It appeared in: Age in years. 1 2 3 4 5 6 7 8 9 10 Males 2 8 3 6 5 7 Females 1 1 8 5 7 9 10 Total 1 2 1 6 8 13 14 17 Age in years. 11 12 13 14 15 15-20 20-25 25-30 Total. Males 3 5 9 2 3 3 2 - 53 Females 6 14 10 6 8 8 1 1 85 Total 9 19 19 8 6 11 3 1 138 From the received replies it appears, that it appeared in; Fair. Dark. Individuals with dark hair and blue or grey iris. Individuals with fair hair and brown iris. Males 30 11 3 1 Females 48 16 10 1 Total 78 27 13 2 33 Did the patient ever suffer from acute or sub-acute rheumatism? If so, how long before or after chorea? .Replies to this question have been received concerning 124 instances. From these it will be seen, that 95 pati- ents have not suffered from rheumatism previously x), whilst in 29 cases (2372 per cent) acute or sub-acute rheumatism has been observed for a longer or shorter time before the appearance of chorea. On closer inquiry into the individual cases it appears, that; in 6 cases chorea appeared immediately after rheumatism 2 « « « 8 days « « « 1 « 14 « « « « 1 « « « 1 month « « « 4 « « « IV2 months « « « 6 « « « 2 « « « « 2 « « « 3 ■ « « 1 « « 3V2 « « « « 1 « « « 4 « « « « 1 « « 6 « << « « 1 « « « 1 year « « « 1 « « « 472 years « « « 2 instances the time between is not stated. Total 29 cases. Concerning the first group, in which chorea appeared immediately after rheumatism, it can further be shown that one of the 6 cases was rheumatism after scarlet fever. *) In some of these 95 cases it is stated, that the patients have had, for instance, pain in a certain joint without fever, or that they have had slight rheumatic pains. 34 In two other af these cases it was a relapse of chorea, which occurred in 1885—86. The rheumatism, which had immediately preceeded the first appearance of chorea, in one patient had occurred 1 year, in the other 2 years before the relapse. In the other group, where rheumatism occurred 8 days previous to chorea, one of the two cases under observation was a relapse 7 years after the first attack of chorea. Finally, concerning the 6th group, where chorea appeared 2 months after rheumatism, amongst the 6 cases, one was a relapse 5 years after the first attack of chorea. In one other of these 6 cases the patient had suffered from rheumatism on 3 occasions, respectively 3 years, 2 years, and 2 months previously. Chorea only appeared after the last of these three attacks. The next question is: Was there any affection of the heart or peri- cardium before the attack of chorea: if so, what; and how long before? This has been answered concerning 121 instances. In 104 cases it is reported, that affection of the heart did not preceed chorea, whilst in 17 cases (14 per cent) various affections or symptoms of heart affection were present before the appearance of chorea. These 17 cases may be arranged according to the following table. Pericarditis 3 cases Mitral valvular affection 5 « Valvular affection (without further infor- mation) . . 1 « 35 Systolic murmur over the left ventricle 3 cases Diastolic 1 case Enlargement of the heart without murmur 2 cases Palpitations 2 « Total 17 cases. Of the cases of pericarditis one had occurred two years before chorea, the other two immediately preceeded the appearance of chorea. Concerning the affection of the mitral valves it is shown, that in one instance the valvular affection appeared 5—6 weeks before chorea; in one instance 2 months, in another 2, and in a third 3 years previously. Particulars are wanting in the sth5th case. This also applies to the other cases with the exception of one patient with enlargement of the heart without murmur, in whom the affection of the heart was observed some months before the appearance of chorea. Concerning the two cases of palpitation, it is reported, that one had occurred during acute rheumatism, in the other it is shown, that the action of the heart was easily affected. 36 The question; Has the patient been sufficiently nourished of late? has been replied to as regards 126 cases. In 64 cases the food has not been poor, but in 62 cases (49 per cent) it was found deficient. In 29 cases (5 males, 24 females) the patients are described as anaemic, in 83 cases (11 males and 22 females) as badly nourished. The question: AVas there any serious anxiety or worry just before the attack of chorea? Of what kind? has been replied to concerning 113 instances. In 83 cases no mental disturbance was found or other debilitating influences; while on the other hand in 30 cases, (2672 per cent), it appeared, that instances had occurred, which can be referred to such. Of all psychical influences fright is that, which is most commonly attributed as the cause of chorea. In 10 of the 30 cases fright from various causes is directly given as the cause affecting the mind, which has immediately proceeded chorea, and in several other instances this is undoubtedly connected with the more complicated mental impressions, which have affected the patients. Thus for instance in the case of 2 children, where the peace of home was disturbed by dissensions between the parents, which in one case led to personal assaults. Also in the case of an unfortunate natural child, who was illtreated by its foster parents; furthermore in the case of 37 a child, who got chorea two days after it had fallen into the sea. Amongst other things affecting the mind, which are reported, may he mentioned religious influence in one case. Disputes about heritage, with following sleep- lessness in another, pregnancy in an unmarried female, in a third. Hasty and quarrelsome had humour, teazing or annoyance, is reported in three cases. Debilitating influences of another kind are also men- tioned as immediately preceeding chorea, such as bodily over-exertion in the case of 4 patients; as a sth5th case that of a child, who suffered from having to go an exces- sively long way to school, may he taken into consideration. General slight suffering, partly on account of poor circumstances, is mentioned in leases. One patient got chorea after receiving a kick in the abdomen. Finally in a couple of instances the influence of the temperature is stated; in one the patient was in- sufficienty clad and suffered from cold in the winter time; in the other the patient had been exposed on board a steamer to great heat from both the sun and engines at the same time. The final question is: Was the chorea proceeded by any other illness or indisposition? Of what kind? Replies to this question have been received concerning 106 patients. In 90 of these cases no other illness had been observed before chorea. In 16 cases (15 per cent) the following illnesses are stated to have been previously present: Scarlet fever 3 cases1) Erythema nodosum 1 « 2) Catarrhus intestinalis chron; .... 2 « Icterus catarrhalis i « 3) Oxyuris 3 « Inflammation of the brain 1 « 4) Contusio capitis 2 « 5) Eclamptic attacks 1 « Rickets 2 « The contributions towards the above mentioned results were received by the committee from the following prac- tioners: Andvord, (Sondre Aurdal). H. Berner, (Christiania). P. Blich, (Arendal). Blomberg, (Christiania). E. Bull, (Christiania). U. Bugge, (Ringsaker). P. Conradi, (Selbu). A. Daae, (Kragero). Dannevig, (Tonsberg). C. Dietrichson (Nordre Fron). Engh, (Sogndal). Gjestland, (Tysnaes) Gladtved, (Drangedal). G. Graarud, (Holmestrand). A. F. Gron, (Christiania). Klaus Hansen, (Bergen). Hartwig, (Kragero). Th. Henriksen, (Trygstad). I. M. Heidenreich, (Opdal). Hoel, (Birid). Holm, (Christiania). M. Holmboe, *) In 2 cases 6 months previously, in 1 case shortly before chorea. a) 1 month previously. 3) Came on at the same time as, or immedia- tely before chorea. 4) 1 year previously. 5) In one case contusion of the head with wounds and symptoms of commotio cerebri 10 years previously, in one case a few days before the appearance of chorea. 39 (Rotvold). Frithj. Holst, (Tinn), I. C. Holst, (Drammen). Holter, (Hougsund). Chr. Holtermann, (Fredrikstad). A. Johannesen, (Bserum). O. Johnson, (Sarpsborg). Jonsherg, (Honefos). Edy. Kaurin, (Molde). Chr. Kielland, (Trond- hjem). Kittel, (Arendal). Kionig (Christiania). Knutsson, (Solor). F. C. Leegaard, (Laurvik). Hj. Lindhoe, (Chri- stiania). Lindemann, (Ringsaker). J. R. Lossius, (Farsund). Ivor Lund, (Trondenaes). H. Meyer, (Sogn). M. Mailer, (Roros). Chr. Munch, (Christiania). E. Nielsen, (Stegen). J. F. Nielsen, (Yigsnses). Anton Olsen, (Jevnaker). Oxholm, (Mandal). Einar Randers, (Aalesund). H. Rogge, (Fred- rikshald). Th. Roll, (Christiania). Romcke, (Hallingdal). Rummelhoff, (Riser). A. Scheel, (Christiania). C. A. Schmidt. (Sandvigen). 0. B. Scheien, (Nsere). H. F. Smith, (Molde). H. Sommerfelt, (Spydeherg)). J. G-. H. Stang, (Sandnaes). Steenstrup, (Fredriksvaern). Sedring, (Aalesund). Synnes- tvedt, (Rollag). H. J. Time, (Christiania). H. J. Yetlesen (Hamar). Wiesener, (Bergen). Wildhagen, (Drammen). W. Wille, (Melhus). O. Winge, (Christiania). Besides these, reports have been received from the medical departements of the National Hospital as well as from the Lying-in Hospital’s Policlinical Institution for diseases of children. The following practitioners have moreover returned the forms of questions stating, that chorea has not appeared in their districts in the years 1882—18861): Augestad, (Hadeland). F. Borchgrevinck, (Ibestad). Chr. Bull. (Evje). Drejer (Aasnses). Dorum, (Elverum). 9 Two of these practitioners have added, that during a still longer period they have not observed any case of chorea. 40 Eger, (Kabelvaag). Frost, (Yossevangen). W. Holm, (Nses, Hedemarken). J. Holmboe, (G-vary). Job. Holmboe, (Tromso). C. Horbye, (Christiania). C. A. Kjser, (Lom). Kriiger, (Sondre Midthordland). Alfred Martens, (Bergen). K. E. Mlsen, (Frosten). Schjelderup, (Trondenses). Torkildsen, (Bergen). Also from 3 practitioners, who have not signed their names. 41 Report on the investigatigation concerning some points in the etiology of Cancer. (Malignant disease including Sarcoma &c) by Prof. £ Winge. 1. Concerning the geographical distribution of this disease in Norway during the last 5 years, the replies, received from the medical practitioners in the land, to the series of questions issued throughout the kingdom furnish hut incomplete and unsatisfactory details. Only 94 replies have been received from the various practitioners throughout the country concerning 531 cases, which occurred during the years 1885, and 1886, whilst it is stated, that in the years 1882, 1883, 1884: 284, 300 and 310 cases were treated respectively. When these figures are compared with the Official Medical Report, which states the numbers up to the year 1884, it will be seen, that a far greater number of cases are mentioned (about 5 times as many) as occurring in the years 1882 to 1884, and the numbers given for 1885 and 1886 are even less than in the previous 3 years. It must not be supposed 42 however, that any diminution of the disease has taken place throughout the kingdom, notwithstanding that 2 of the practitioners really believe, that such is the case within their districts, as the difference is but slight, and it can also be seen, that somewhat many of the practitioners in these 5 years have resided at different places, so that it is difficult to compare these 3 years 1882—1884 with the last 2 years. In the official statistics the cases treated are in 1882; 1481, of which 892 died. « 1883: 1456, « « 959 « « 1884; 1489, « « 1006 « Now our medical statistics only contain a statement concerning about 50 per cent of the total deaths (Viz, 51 per cent in 1882, 50 per cent in 1883, 52 per cent 1884). If we therefore venture to make this percentage a basis for a calculation of the true number of deaths from cancer in Norway, the reported number of deaths must be doubled in order to make it right in other words, the mortality from cancer in 1882 should be about 1800, in 1883 about 1900, in 1884 about 2000, and the total number of cases of cancer treated each year have probably been about 2 960. As they in the replies to our series of questions for the years 1882—86 only amount to an average of about 285 for each year, it is probable, that only about VlO of the total number of cases of cancer are mentioned. That the reports received are likewise inadequate to throw a light on the comparative extension (frequency) in the various medical districts of the kingdom may be clearly seen, when the numbers reported in reply to our queries are compared with those detailed accounts from the county authorities in the official statistics for 1882—84. 43 The replies to the series of questions have been received from the following counties 1. Christiania (city of) from 12 private practitioners and the 2 medical divisions of the National Hospital con- cerning 70 cases. 2. Akershus Amt (county) from 4 practitioners con- cerning 33 cases 3. Smaalenenes « « « 4 « 30 « 4. Buskeruds « « « 6 « 41 « 5. Jarlsberg &Lanrviks« « « 4 « 32 « 6. Hedemarkens « « « 7 « 59 « 7. Christians « « « 7 « 32 « 8. Bratsbergs « « « 5 « 25 « 9. Nedenaes « « « 6 « 25 « 10. Lister & Mandals « « « 3 « 16 « 11. Stavanger « « « 2 « 2 « 12. Sondre Bergenhns « « « 4 « 25 « 13. Bergen (city of) ... « « 3 « 14 « 14. Nor dr e Bergenhns Amt « « 3 « 10 « 15. Romsdals « « « 6 «- 25 « 16. Sondre Trondhjems «\ (including the city of I « « 7 « 42 « Trondhjem) . . . J 17. Nordre Trondhjems Amt « « 1 « 5 « 18. Nordlands « « « 2 « 6 « 19. Tromso « « « 6 « 39 » 20. Finmarkens « « « 0 « 0 « Total 94 « 531. From the official medical statistics the following return of deaths from cancer in the counties has been obtained. 44 (Osteosarcoma has not been included amongst these). 1882. 1883. 1884. Total. 1. Christiania (city of) .... 86 90 102 278 2. Akershus Amt (county) 64 51 67 182 3. Smaalenenes « « 49 60 67 176 4. Buskernds « « 65 78 79 222 5. Jarlsberg & Laurviks « « 61 57 59 177 6. Hedemarkens « « 60 85 84 229 7. Christians « « 55 58 65 178 8. Bratsbergs « « 52 65 48 165 9. Nedenses « « 36 34 38 108 10. Lister & Mandals « « 27 25 33 85 11. Stavanger « « 29 31 26 86 12. Sondre Bergenhns « « 32 28 37 97 13. Bergen (city of) 33 35 35 103 14. JSTordre Bergenhns Amt « 31 41 33 105 15. Romsdals « « 33 41 42 116 16. Sondre Trondhjems « « 68 55 76 199 17. Nordre « « « 38 42 42 122 18. Nordlands « « 40 44 36 120 19. Tromso « « 17 15 18 50 20. Pinmarkens « « 7 9 4 20 In order that these figures may approximately be com- pared with the comparitive frequency of the disease in the counties, it is necessary to regard them according to the size of the population. If one reckons the percentage between the average numbers for the 3 years and 10 000 living (according to the census of 1875) the following result is obtained. 45 1. Bergen (city of) .' 9.0 per cent. 2. Buskernds Amt (county) 7.25 - « 3. Christiania (city of) 7.0 - « 4. Jarlsherg & Laurviks Amt.... 6.8 - « 5. Bratsbergs « .... 6.6 - « 6. Hedemarkens « .... 6.3 « 7. Akershus « .... 6.0 - « 8. Sondre Trondhjems « .... 5.7 - « 9. Smaalenenes « .... 5.4 - « 10. Christians « . . . . 5.01 - « 11. Nedenaes « .... 5.0 - « 12. Nordre Trondhjems « .... 4.8 - « 13. Nordre Bergenhus « . . . . 4.x - « 14. Nordlands « .... 3.8 - « 15. Lister & Mandals « .... 3.7 - « 16. Romsdals « .... 3.3 - « 17. Tromso « .... 3.1 - « 18. Finmarkens « .... 2.8 - « 19. Sondre Bergenhus « .... 2.7 - « 20. Stavanger « .... 2.6 - « Sex. In these 531 cases the sex of the patients was as follows. Males 278. Females 253. Age. The following is a statement of the ages of the patients. 46 1 1 2 B 4 5 6 Age Age Age Age Age Age Sex. 0—9 10—19 20—29 BO—89 40-49 50—59 Years. Years. Years. Years. Years. Years. Males 1 - 1 19 31 58 Females .... 1 1 6 15 27 66 Total 2 1 7 34 58 124 7 8 9 10 11 12 Sex. Age 60—69 Years. Age 70—79 Years. Age 80-89 Years. Age 90—100 Years. Age not stated. Total. Males 92 62 14 278 Females .... 70 51 7 2 7 253 Total 162 118 21 2 7 531 In the official statistics for 1882 to 1884 inclusive the following statement of deaths according to age and sex is given as follows; 1 2 3 4 6 6 Males 4 4 9 56 169 388 Females .... 3 2 22 84 200 437 Total 7 6 31 140 369 825 7 8 9 10 11 12 Males 474 217 41 - - 1862 Females .... 395 210 58 7 - 1413 Total 869 427 94 7 - 2775 47 These two tables, as one may see, almost completely agree, The age most numerously represented during all the 5 years is from 60 to 69; after which comes 50 to 59: then 70 to 79: then 40 to 49: 30 to 39 follows, then 80 to 89. Then follows with a comparatively even number of figures 20 to 29: and finally o—9,0—9, likewise 90 to 100, which in both tables have each the same numbers. They are least represented in both the classes; 10—19. The division of the sexes in the different classes of age is in both lists somewhat different: in the official tables for the years from 1882 to 1884 the female sex is the most numerously represented and is considerably in excess between the ages 50 to 59, whilst in our list most are found under the table of ages 60 to 69. The males are however more numerously represented in this class than females, who are almost as numerous as in the table of ages from 50 to 59. In both there are comparatively many women between the ages of 20 to 29 and above 90 only women. In our list, between the ages of 80 to 89, the males are compa- ratively more numerous, but in the official report the re- verse is the case. In the table of ages from 70 to 79 nearly the same proportion exists in both lists. As regards the seat of the cancer, the replies to the series of questions state it to be as follows: In the ventriculusit occurred in 141 men, 94 women, Total 235. « breasts « « « 34 « « 34. « lips (almost entirely in the lower lip). « « 26 6 < « 32. 48 Total. In the uterus it occurred in - men, 31 women, 31. « « hepar « « 17 « 15 « 32. « « ventriculus & hepar« « 14 « 9 « 23. « « oesophagus « « 11 « 4 « 15. « « abdomen (perito- naeum with or without the sto- mach or bowels). « « 9 « 9 « 18. « « skin and muscles (body & extre- mities). . « « 8 « 5 « 13. « « maxillae « « 6 « 8 « 14. « « other bones « « 8 « 3 « 11. « « bowels (exclusive of rectum). « « 6 « 4 « 10. « « face « « 3 « 6 « 9. « « rectum « « 2 « 4 « 6. « « tongue « « 2 « 4 « 6. « « mouth and gullet « « 2 « 4 « 6. « « penis .... « « 6 « - « 6. « « eyes .... « « 2 « 3 « 5. « « bladder . .' . « « 5 « 1 « 6. « « vulva .... « « - « 3 « 3. « « testes .... « « 2 « « 2. « « ovaries ... « « - « 3 « 3. « « kidneys ... « « 1 « 1 « 2. « « prostata ... « « 2 « « 2. « , « pancreas and duct, choledochus « « 1 « - « 1. « « gi. submaxillaris « « - « 1 « 1. 49 In the mediastinum it occurred in 1 man, - woman, 1. Total melanosarcoma| multiplex j .«««1 « - « 1. not mentioned « « « 2 men - « 2. Total M. 278 F. 253. T. 531. Table showing the chief seats of the disease at various ages. Years Yo age stated. 20-29 130-39 |40-49. 50-59 00-69 J70-79 jsO-89 90-100. ventriculus, males ... 0 9 15 40 46 28 3 0 - — females . I 3 7 29 36 14 3 0 1 the breasts, females .. 1 3 5 8 8 9 0 0 - the womb « 2 4 6 11 6 1 0 0 1 hepar, with and with- out ventri cuius males 0 2 4 1 15 8 1 0 - females 0 0 1 5 8 7 2 0 1 the bowels and rectum, males 0 1 1 0 1 4 1- 0 females 0 1 3 2 0 1 0 0 1 the lip, males 0 1 3 5 8 5 4 0 - females 0 1 0 2 1 I 0 1 - oesophagus, males .... 0 0 3 0 6 2 0 0 - females 0 0 0 2 0 2 0 0 - the maxillaries, males 0 1 0 3 0 2 0 0 - females 0 0 0 0 O 7 0 0 1 Tinder 10 years of age there were 2 patients, one with cancer in the mouth, the other with sarcoma of the eye. 50 Between the ages of 90 and 100, there were two women, one of whom suffered from cancer of the lip, the other from cancer in the face. Etiology- 2. Is the patient habitually a large eater, a moderate eater, or a small eater? I here form 2 classes; 1) cancer of the stomach, in which is included those cases, in which the ventriculus was also attacked., 2) Cancer in other parts. Large eaters. Small eaters. Moderate eaters. Un- known. Total. Cancer of stomach. 21 42 112 83 258 Cancer in other parts 11 51 119 92 273 Total 32 93 231 175 531 From this there will therefore he seen some excess of large- eaters amongst patients afflicted with cancer of the stomach when compared with those suffering from cancer in other parts; but the small eaters are however in the majority (about double as many with cancer of the stomach, 5 times as many with cancer in other parts, 3 times as many as all cases of cancer combined). The majority in both classes, and in the same proportion, are the moderate eaters. Amongst cancer patients on the whole the large eaters are hardly more numerous than in the rest of the population (about 6 per cent). 51 3. Is the patient habitually a large, a mo- derate, or a small eater of meat? Much meat. Little meat. Ordinary fare. Un- known. Cancer of stomach 12 *) 118 3) 75 58 Cancer in other parts.... 12 2) 115 81 65 Total 24 283 156 118 *) Of these in case not in the last 5 years. 2) Of these 10 were large eaters (but 2 hardly ever touched meat). *) Amongst these 2, who were otherwise moderate eaters. It thus appears, lsf that consumption of meat has not been more productive of cancer of the stomach than of cancer elsewhere. 2n„dly that the majority of both classes eat but little meat. 4. Has the patient habitually drunk beer, wine or spirits? Indicate the amount as for as you can! I here divide the disease into 3 classes. Ist,1st, cancer of the stomach, in which is likewise included cancer oesophagi, and those cases, in which the ventriculus is likewise alfected; 2ly cancer of the liver: 3ly cancer in other parts. 52 Intem- perate. Ab- stainers. Tem- perate *). Un- known. Total. Cancer of stomach. 29 2) 144 70 29 227 Cancer of liver ... 53) 18 7 1 31 Cancer in other parts 15*) 115 47 51 228 Total 49 277 124 81 581 *) With these are also included those < ases, which in question 4 come under the reply