- Oct.
1932] EDITORIAL: THE EFFECT OF SMOKING
adds one more link to the chain of endocrine
functions.
It is clear from the above that trust-
worthy observers are at variance in regard to
the value of the treatment of malignant
disease by seeking to control pituitary
activity. It may be remarked, however,
that the number of experiments is too small
as yet to warrant any final conclusions, and,
in the meantime, one or two favourable
results may be taken as justifying the con-
tinuance of research along these lines.
We may probably take it as correct that
in many cases of malignant disease a pituitary
hormone appears in the urine and that there
is histological evidence suggesting that the
activity of the anterior lobe of the pituitary
is increased (Zondek; Susman; Berblinger.),
but there are other plausible explanations
besides that advanced by Susman. Possibly,
the hormone may be manufactured by the
growth and not by the pituitary. So far, at
least, no hormone has been isolated from
new growths. Again, the growth may stimu-
late anterior pituitary activity (possibly
through the products of tissue necrosis)
rather than vice tersa. It may be argued
THE EFFECT OF SMOKING
VARIOUS attempts have been made from
time to time to incriminate the smoking
of tobacco as a harmful habit. A recent study
perhaps gives a clue to certain beneficial
effects that the smoker himself recognizes,
while at the same time indicating that there
are harmful potentialities. This interesting
study was published as a memoir in the Acta
Medica Scandinavica (1931, Supplement
xxxviii) by Erik Lundberg and Stina
Thyselius-Lundberg. They examined sys-
tematically the effect of smoking upon the
blood sugar, using finger-tip blood and a
technique of analysis which gave accurate
figures for glucose. Male and female smokers
and non-smokers were tested, and both
normal subjects and diabetic patients.
Cigarettes were chiefly employed as smoking
material. A few experiments with small
cigars gave comparable results. In every'
test immediately after smoking commenced
the blood sugar rose rapidly, and to a height
which sometimes was even 50 per cent above
ON THEF BLOOD SUGAR 421
too that the excretion of Prolan A may be
the result rather than the cause of tumour
formation, for it has been noted that in
cases of carcinoma uteri which gave positive
results the hormone disappeared within ten
days of hysterectomy, and Zondek found
that not only did it disappear from the
urine after the removal of the growth but
it reappeared in the case of recurrence. The
histological changes in the pituitary referred
to above may equally be interpreted as an
effect rather than a cause. And so the
matter rests for' the time-being. This line of
investigation is, however, undoubtedly well
worth pursuing. That even slight control of
cancerous growth has been obtained by
several observers affords ground for hope,
for it must be remembered that' the treat-
ment under review has only been carried
out in advanced and inoperable cases, where
any form of treatment is at great dis-
advantage. Probably more convincing re-
sults could be obtained by more extended
experimentation of this kind with rodents in
the early stages of artificially induced car-
cinomatosis, and also with the idea of
preventing "takes." A.G.N.
ON THE BLOOD SUGAR
the initial value. The maximum height was
usually reached towards the end of the
short smoking period of four or five minutes.
The blood sugar then slowly fell, so that
usually half an hour elapsed before 'the
normal level was reached. The effect was
even superimposed upon *a falling curve,
following injection of insulin. It was not
produced by smoking material previously
freed from nicotine. After the blood sugar
had regained its normal level, the smoking
of a second. cigarette led to the same series
of events and such a series of changes could
be induced several times. Whereas in a
normal individual the normal level of blood
sugar was always regained in about half an
hour, in diabetics this " basal" value steadily
rose, so that, for example, the consecutive
smoking of four cigarettes at 30 minute
intervals produced a change from 170 mg.
per 100 c.c. to 215 mg. half an hour after
the last smoking period. Such a result has,
obviously, an important bearing upon the
422
4 2 T H
THIF, CANADIAN MEDICAL AssoCIATION JOURNAL
CAAINMDCLAscAINJUNL[c.13
control of hyperglyc2emia and glycosuria in
the diabetic.
The authors attribute the effects to the
stimulus of an adrenaline mechanism, evoked
by nicotine. Further detailed studies would
be valuable, such as the effects of prolonged
continuous smoking, differences between
smoking before. and after meals, the effects
of pipe-smoking, the relative effects of in-
Ebttortal Comments
A Collective Investigation on Cancer
of the Breast
The study of cancer is being conducted in an
intensive fashion in most of the progressive
countries of the world. The most spectacular
work is being done in the laboratories and some
striking and hopeful results have been obtained.
But it should not be concluded from this that
the chemistry, histology, pathology, and artificial
induction of neoplasia are, the whole story. Clini-
cal observation, surgical and radiological treat-
ment, and statistical information are, in their
way, not less important. So it is that the clini-
cian, and particularly the general practitioner,
may play a role not less helpful than that of
the laboratory worker. We are impelled to
make this observation through a reading of a
report entitled the "Collective Investigation
into the Incidence of Cancer of the Breast, and
its History after Treatment"' by Dr. Arthur
P. Luff, Director of Collective Scientific Re-
searches to the British Medical Association. This
investigation covers a period of one year, from
October, 1929, to September, 1930, and deals
with carcinoma of the breast, cervix, rectum
and tongue. The object of the enquiry was to
obtain precise information as to these forms of
cancer; as to the actual evolution of the disease
itself, and especially about the first symptom
that had called attention to it; as to the effect
of any treatment undertaken; and, as to the
duration of the disease when treated and un-
treated. The report under review is based upon
the study of 1,523 cases of cancer of the breast
(in women), information about which was ob-
tained from the general practitioner, be it noted.
Even a casual perusal of the report will bring
the conviction that the information obtained is
of great value, and, further, that the general
practitioner can help in a notable degree in the
elucidation of this most difficult subject. We
commend this report to the thoughtful con-
sideration of all who are interested in the sub-
ject of cancer, which means, or should mean,
*
Brit. M. J., 1932, 1: 897.
[0Oct. 1932
halation and non-inhalation, and so on. A
tendency to glycosuria has not been recog-
nized as common, even amongst the most
confirmed and ardent smokers, so that some
mechanism of adjustment probably exists.
Nevertheless, the results presented are too
consistent to be ignored, and an additional
problem in the care of diabetics has been
presented. A. T. CAMERON.
all medical mnen, without distinction. We should
like to refer in detail to certain of the matters
brought up in the report, but considerations of
space preclude this, and we must be content to
bring out the "high spots." Some of the facts
elicited merely confirm ideas previously accept-
ed generally, but at the same time serve to place
these ideas on a firmer basis, while others tend
to clarify some doubtful questions. Dr. Luff
summarizes certain of his findings .s follows.
1. The liability to cancer- df. the breast is not
increased by the production of a large number
of children, rather the reverse.
2. A relatively higher proportion of cancer
of the breast occurs in unmarried and non-
parous married women than in parous married
women.
3. Antecedent troubles in the breast (injury,
sore nipples, abscess, mastitis, and Paget's dis-
ease) do not appear to be important factors in
inducing cancer of the breast.
4. Hereditary disposition is not a dominant
factor in the etiology; only 23.1 per cent gave a
family history of cancer.
5. A painless lump was the&first symptom that
directed the patient's attention to the breast in
79.5 per cent of the cases; a painful lump in
8.7 per cent; and pain alone in 5.1 per cent.
6. Pain was completely absent in two-thirds
of the cases, and was not severe in a majority of
the remainder.
7. The longer the interval of time that has
elapsed between the first recognition of the dis-
ease and operation, the worse is the result, as
shown by the survival rate, the recurrence rate,
and the mortality rate.
8. As regards the after-results the complete
operation is markedly superior to the incom-
plete.
9. Prophylactic treatment with x-rays after
operation is apparently useless.
10. Prophylactic treatment with radium after
operation exercises a beneficial effect, as repre-
sented by the higher survival rate and the lower
recurrence rate, as compared with the post-
operative cases that either had no prophylactic